Exercise and Activity Guidelines

For a woman with a normal pregnancy there are no known contraindications to exercise during the pregnancy. Recent reviews have documented the benefits of exercise during pregnancy (Agnostini, 1994; Artal, 1996; Clapp, 2000). The incidence of infertility, spontaneous abortion, congenital malformation and placental abnormalities is not increased in women who continue a strenuous weight-bearing type of exercise (running, aerobics, crosscountry skiing, stair stepping, and so forth) throughout early pregnancy. The concern that continuing a strenuous exercise program or beginning to exercise in mid to late pregnancy might lead to preterm labor or premature rupture of the membranes is not supported by current data. Previous concern about exercise during pregnancy has been related to the hypothetical risks of strenuous maternal exercise, including resulting in fetal stress, competing for blood flow and depriving the fetus of oxygen, fetal hypoxia and thermal stress resulting in neural tube abnormalities (Backer, 1997). Thus pregnant women should be warned to avoid hypoglycemia, hyper-thermia and dehydration while exercising.

Studies to date have confirmed the benefits of aerobic exercise. The effects of anaerobic training is not known. Thus the data available indicate that healthy fit women with normal pregnancies can begin or continue a regular program of exercise during pregnancy. In fact, improved outcomes for mother and fetus are associated with regular weight-bearing exercise. Regular exercise appears to enhance placental growth.

The ACOG Guidelines (ACOG, 1994) may be too restrictive for some women who exercise on a regular basis. Most researchers support a more flexible approach to exercise, for both the regular and the elite athlete, during a normal pregnancy.

Temperature control in important. A pregnant woman should avoid extreme exercise in a hot and humid climate because of the possible effect of raising the maternal and fetal temperature. The concern is of an increase in neural tube defects. Hot tubs and saunas should be avoided for the same reason.

A woman's previous level of exercise and endurance should be considered when planning an adventure. Common sense should be used. For example, a pregnant traveler who wants to go on a ski vacation should consider the fact that changes in her body's center of gravity and increased joint laxity may put her at risk of an accident due to a change in balance. Even an expert skier could fall under these circumstances, resulting in trauma to the fetus and the mother. It is probably best not to ski or trek at high altitudes due to the lack of access to care if an emergency should occur.

Limitations and/or contraindications to an exercise program during pregnancy would include any of the following problems: a history of spontaneous abortion or miscarriage, premature labor, multiple gestation, incompetent cervix, unusual bleeding, placenta previa or severe cardiac or pulmonary disease.

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