Exercise in Pregnancy.

As a marathon runner, I am convinced of both the physical and psychological benefits of exercise. Many physicians may not share my enthusiasm, however, and when faced with a pregnant woman who is eager to maintain a challenging exercise program, their natural reaction may be to say no.

The current recommendations of the American College of Obstetricians and Gynecologists are definitely quite conservative when it comes to exercise in pregnancy However, there's very little underlying evidence to support most of them.

The ACOG Technical Bulletin on this subject (#189, 1994) advises that pregnant women can continue mild to moderate-exercise up to three times per week with modifications according to their symptoms and the addition of at least 300 calories per day But it also advises against exercise in the supine position after the first trimester; prolonged, motionless standing; and all exercise in which loss of balance is detrimental, which narrows one's options.

An increasing number of women who are coming to pregnancy with well-established fitness routines simply don't want to hear about these restrictions on their physical activity Many of them are hooked on exercise and will actually search out a more accommodating physician rather than stop.

I end up seeing many of these patients, and I tell them that, while we still lack a lot of high-level data to set thresholds and safe parameters, there is at least some evidence to show that exercising at levels that exceed ACOG recommendations does not affect pregnancy outcomes.

In one retrospective study researchers who surveyed 173 women at a national fitness meeting found that, although 83% were familiar with the ACOG guidelines, only 53% adhered to them during ...