references: <199512291714.MAA26061@postbox.acs.ohio-state.edu> <4c2cff$44p@panix2.panix.com>
organization: A killfile near you...
newsgroups: misc.fitness.aerobic

[Bobbie's advice to pregnant women - updates from the American College of
 Gynecologists' 1994 review of their own guidelines, via the American
 College of Sports Medicine.]

Bobbie provides some excellent guidelines, but there have been some *very*
recent updates to them.  Below is the revised set of guidelines of
the American College of Gynecologists as of 1994, from the ACSM's Guidelines
for Exercise Testing and Prescription, 5th Edition (1995):

	1.  During pregnancy, women can continue to exercise and derive
	health benefits even from mild to moderate exercise routines.
	Regular exercise (at least 3 times per week) is preferable to
	intermittent activity.

	2.  Women should avoid exercise in the supine position after the
	first trimester.  Such a position is associated with decreased
	cardiac output in most pregnant women.  Because the remaining
	cardiac output will be preferentially distributed away from 
	splanchic beds (including the uterus) during vigorous exercise,
	such regimens are best avoided during pregnancy.  Prolonged
	periods of motionless standing should also be avoided.

	3.  Women should be made aware of the decreased oxygen available for
	aerobic exercise during pregnancy.  They should be encouraged
	to modify the intensity of their exercise according to maternal
	symptoms.  Pregnant women should stop exercising when 
	fatigued and not exercise to exhaustion.  Weightbearing
	exercises may under some circumstances be continued at
	intensities similar to those prior to pregnancy throughout
	pregnancy.  Non-weightbearing exercises, such as cycling or 
	swimming, will minimize the risk of injury and facilitate the 
	continuation of exercise during pregnancy.

	4.  Morphologic changes in pregnancy should serve as a relative
	contraindication to types of exercise in which loss of balance
	could be detrimental to maternal or fetal well-being, especially in
	the third trimester.  Further, any type of exercise involving the
	potential for even mild abdominal trauma should be avoided.

	5.  Pregnancy requires an additional 300 kca/lday in order to
	maintain metabolic homeostasis.  Thus, women who exercise 
	during pregnancy should be particularly careful to ensure an
	adequate diet.

	6.  Pregnant women who exercise in the first trimester should
	augment heat dissipation by ensuring adequate hydration,
	appropriate clothing, and optimal environmental surroundings
	during exercise.

	7.  Many of the physiological and morphological changes of
	pregnancy persist four to six weeks postpartum.  Thus,
	prepregnancy exercise routines should be resumed gradually
	based upon a woman's physical capability.

The changes in the 1994 guidelines largely are the removal of somewhat
arbitrary restrictions on exercise session duration and maternal heart rate,
as studies have demonstrated that earlier cautions were unwarranted,
and that women tended to naturally adjust their exercise intensity with
respect to the developing pregnancy.

The concerns about the 140 BPM maternal heart rate, exercise duration,
and body core temperature were due to concerns that excessive maternal
core temperature during exercise (especially in first-trimeseter women)
might impair fetal development, as problems such as spinal bifida had
been backtraced to excessive maternal core temperatures in some instances
(such as when the mother was ill).

However, more recent reserach has demonstrated that women may exercise
safely at higher intensities than previously thought, and that perceived
exertion ("mild to moderate exercise") proves an effective safeguard
when properly applied.  Moreover, given the variation in ages of
pregnant women, plus the wide variation of maximum heart rate in the
general population, an arbitrary maximum heart rate specified by a single
number was virtually meaningless.

ACSM also lists several reasons to discontinue exercise and seek medical
advice during pregnancy:

	1.  Any signs of bloody discharge from the vagina.
	2.  Any "gush" of fluid from the vagina (premature rupture of
		membranes).
	3.  Sudden swelling of the ankles, face, or hands.
	4.  Persistent, severe headaches and/or visual disturbance;
		unexplained spell of faintness or dizziness.
	5.  Swelling, pain, and redness in the calf of one leg (phlebitis).
	6.  Elevation of pulse rate or blood pressure that persists 
		after exercise.
	7.  Excessive fatigue, palpitations, chest pain
	8.  Persistent contractions (>6 to 8/our) that may suggest onset of
		premature labor.
	9.  Unexplained abdominal pain.
	10. Insufficient weight gain (<1.0 kg/month) during the last two
		trimesters.

ACOG also lists several contraindications for exercising during
pregnancy:

	1.  Pregnancy induced hypertension.
	2.  Pre-term rupture of membrane
	3.  Pre-term labor during the prior or current pregnancy
	4.  Incompetent cervix
	5.  Persistent scond to third trimester bleeding
	6.  Intrauterine growth retardation

ACOG also differentiates between women who are established exercisers before
pregnancy vs. new exercisers.  Women who exercised regularly before
pregnancy can continue their exercise programs (making appropriate adjustments)
during pregnancy.  New exercisers are encouraged to seek physician approval,
and to participate in low-impact activities, like swimming or cycling.

					larry...



	
-- 
--------"It's my personal opinion that people need to be more clear about what 
	 is fact and what is in fact their personal opinion." -- me