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The Pregnant Question: How to Exercise?

Tuesday, May 3, 2005; Page HE03

Among the many benefits of serving as Crew Chief is the opportunity to investigate fitness matters I would never pursue for my own benefit -- for instance, the question of exercising during pregnancy, one of the queries we receive most frequently during our online chats. An Internet search on the topic yields pages of information, much of it (I learned) misleading, alarmist or wrong.

To clear things up, I consulted guidelines published by the American College of Obstetricians and Gynecologists (ACOG) in 2002. I also spoke with two experts, one a co-author of those guidelines, the other an independent clinician.

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The clear consensus on exercise during pregnancy: Yes.

"For too long we have told pregnant women in this country to eat for two and limit their activities," said guidelines co-author Raul Artal, professor and chairman of the Department of Obstetrics, Gynecology and Women's Health at the Saint Louis University School of Medicine. "This has contributed to obesity. [Pregnancy] is not a state of confinement."

Both experts noted that benefits of exercise include general good health, weight management and fewer aches and pains during pregnancy. Exercise has no impact -- positive or negative -- on a fetus, Artal said. But "the fetus will benefit in general from a healthy mother." ACOG suggests that pregnant women with no medical or obstetric complications follow the government's advice for most adults: Get at least 30 minutes of moderate exercise on most days of the week. There are, of course, important details and caveats.

Heart Rate Old advice said pregnant women should keep their heart rates below 140 beats per minute. "That was never based on sound science," said Hope Ricciotti, a clinician and associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School. "Just listen to your body," Ricciotti said. "Stop if you feel dizzy or very short of breath."

Body Heat If a woman is properly hydrated, Ricciotti said, the body heat generated by moderate exercise is no threat to the fetus. But Artal urges caution, since studies show that more extreme overheating (not directly linked to exercise) can cause neural tube defects. ACOG says pregnant women should not soak in hot tubs or sit in saunas.

Impact Avoid exercise that risks abdominal impact in the second and third trimesters, the guidelines say. Such activities include soccer, hockey and basketball, and sports with a fall risk.

Position During the second and third trimesters, do not exercise while lying on your back. That compresses the inferior vena cava blood vessel, limiting blood flow to the fetus. This applies to certain moves in weight training, yoga and Pilates. Ricciotti suggests using instructors certified in prenatal training.

Intensity Many pregnancy Web sites advise against strenuous exercise, but both Ricciotti and ACOG say there are no data clearly showing harm. Still, Artal suggests caution, noting that strenuous exercise is no better for one's health than moderate exercise. "And so the question is, 'Why would you do strenuous exercise unless you are competing?' " ACOG advises frequent OB-GYN visits for women who train hard.

Exceptions The ACOG guidelines list contraindications to exercise during pregnancy such as heart or lung disease; incompetent cervix/cerclage; persistent second- or third-trimester bleeding; and early labor. Among signs calling for immediate cease-and-desist and doctor consult: vaginal bleeding, dizziness, headache, chest pain, calf pain or swelling or amniotic fluid leakage.

Join us Thursday at 11 a.m. for the Moving Crew chat: www.washingtonpost.com. Or send comments to move@washpost.com.

-- John Briley

© 2005 The Washington Post Company


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