Exercise During Pregnancy: A Practical Approach Theodore S. Paisley, MD*, Elizabeth A. Joy, MD, and Richard J. Price, Jr., MD Address *Department of Family and Preventive Medicine, University of Utah, Madsen Family Health Clinic, 555 Foothill Drive, Suite 301, Salt Lake City, UT 84112, USA. E-mail: tsp@alum.dartmouth.org Current Sports Medicine Reports 2003, 2:325–330 Current Science Inc. ISSN 1537-890x Copyright © 2003 by Current Science Inc. Introduction Practitioner recommendations and guidance concerning exercise during pregnancy have evolved throughout the years. This evolution reflects the growing acceptance of exercise without new evidence of danger to the mother or fetus. Early standards of care allowed pregnant women to walk 1 mile a day [1,2]. In 1985, the American College of Obstetrics and Gynecology (ACOG) approved aerobic exercise routines for pregnant women, but restricted dura- tion to 15 minutes and heart rate to 140 beats/min [3]. The next expansion occurred in 1994 when ACOG stated, “dur- ing pregnancy, women can continue to exercise and derive the health benefits even from mild to moderate exercise routines. Regular exercise (three times per week) is prefera- ble to intermittent activity” [4]. Although the 1994 proclamation was seen as a cau- tious approval to engage in exercise, the first formal recom- mendation to include exercise during pregnancy came in a 2002 ACOG position statement. It states, “in the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not at all, days of the week is recommended for pregnant women” [5•]. The 2002 ACOG statement takes into account much of the information found in the August 1996 issue of Semi- nars in Perinatology. The entire issue is devoted to exercise during pregnancy and discusses all aspects of exercise dur- ing pregnancy from study methods of animal and human models to exercise at altitude and scuba diving. The works presented clarified the scientific basis of exercise during pregnancy, and dispelled many myths about risk of pre- term delivery and negative effects of exercise on the fetus. A few high-risk activities were identified, but no adverse out- comes for mother or fetus were seen secondary to regular exercise [6–14]. Gestational diabetes was also introduced in the 2002 ACOG committee opinion in support of exercise during pregnancy. More recent reports indicate that gestational diabetes is a diabetogenic state, both hormonally and physically, and that exercise can prevent the onset of non– insulin-dependent diabetes mellitus [8,17]. Gestational diabetes is an increasing cause of morbidity and mortality to pregnant women and their offspring, causing increased rates of infection, pre-eclampsia, hydramnios, and postpar- tum hemorrhage. Gestational diabetes complicates between 1.4% and 12.3% of pregnancies [8,15–17]. Exer- cise, however, is helpful in improving glycemic control in patients with gestational diabetes, and may play a role for primary prevention of developing gestational diabetes in morbidly obese patients (body mass index > 33) [8,15– 17]. Although the impact of exercise on gestational diabe- tes is important, the impetus for the 2002 statement seems to have primarily been to allow women “to derive the same associated health benefits during their pregnancies as they did prior to pregnancy” [5•]. Although not cited in the ACOG report, the general acceptance of exercise in pregnancy has grown in the past decade, and exercise studies continued to support the notion that exercise during pregnancy was safe to the mother and the fetus [18–21]. A 1998 study by Krandel and Kase [20] is noteworthy because the subjects were very physically fit and performed at high intensities. Three of the subjects in the study were among the five best women athletes in the world in their respective events (biathlon, bicycling, and marathon). The athletes participated in high- or medium-intensity exercise programs throughout their pregnancies. The conditioning programs consisted of muscle strength training, interval training, and endurance training. The medium-intensity group exercised an average Attitudes toward exercise during pregnancy have changed dramatically over the past 20 years. Recent studies show that, in most cases, exercise is safe for both the mother and fetus during pregnancy, and support the recommenda- tion to initiate or continue exercise in most pregnancies. This report discusses the rationale behind the changes, and offers educational tools that may be employed to ini- tiate behavioral change. We also propose exercise pre- scriptions for pregnant women who are sedentary, physically active, and competitive athletes. Armed with this information, the practitioner will be better equipped to counsel patients and incorporate a discussion on physi- cal activity into prenatal visits.