BEYOND ACOG
DEFINITIVE WORKOUT GUIDELINES FOR PREGNANCY
By Birgitta Gallo Lauren

Regardless of whether you are a beginner or a seasoned athlete, pregnancy is not an opportunity for an all-out challenge. Nor is it a time to put your feet up. Pregnancy being a challenge in it self, making you fitter in the process, is a time to maintain fitness and strength for you and your baby's sake. How to do so safely can be tricky. Our 1994 ACOG guidelines to prenatal exercise are a godsend, although still a tad limited and general. As such they don't lend themselves to specific exercise prescription and can leave o lot of pregnant women and their doctors confused over how to best design a fitness program. To make this task a little less confusing, the guidelines below are a combination of ACOG's, the American College Of Sports Medicine (ACSM) safety recommendations, the latest research from studies and obstetric professors and nine years of personal experience working with pregnant women.

Before you start:

• Make sure to get a physical and written permission from you OB before joining any exercise class or starting your own program. Have your individual program evaluated and modified periodically with your physician and/or prenatal trainer. Certain unforeseen risk factors may modify your exercise severely. A prenatal instructor needs to be certified and experienced.
  
• Be aware that not every place is a good place to exercise. Due to the lack of oxygen, don't exercise at altitudes higher than 8,000 feet. Wait 3-4 days before exercising above 6,500 feet. Avoid 10,000 feet and above altogether and do not exercise in hot, humid weather. Exercise indoors with air-conditioning, or outdoors early in the morning or in the evenings.
  
• Eat a light snack of fruit, juice or toast, 30 -60 minutes prior to your workout to prevent low blood sugar levels.
  
• Check your exercise equipment to make sure it's in proper working condition and that the floor or ground conditions are even to avoid injuries.
  
• Drink plenty of water before, during and after exercise.
  
• Wear appropriate clothing for the weather and the activity. A well supporting jog-bra is a must. To avoid overheating, do not wear support hose for varicose veins unless they're too painful. If it's cold, wear several layers to be removed as needed. If it's warm wear loose cotton or breathable fabrics like Supplex® and Coolmax® to stay cool.
  
• Always check your abdominal midline for a possible separation (diastasis), before every workout.
• Flex your abdominals tight and feel for a muscle separation with your fingers above and below the belly button.
• If you're a beginner, start slowly and increase gradually. If you're an intermediate exerciser or a well-trained athlete, depending on the sport you may continue your exercise routine with modifications as your pregnancy progresses.
  
• Always warm up slowly to increase the heart rate, loosen up muscles, and prevent injury.
  
• Steady, low-impact exercise is better than interval training during pregnancy. Do cross train to prevent boredom, but choose similar intensity activities.
  
• Prevent accidents by practicing proper posture, alignment, and muscle control and avoid quick changes in movement or direction such as difficult choreography and plyometrics.
  
• Rise slowly from the floor or seated positions to avoid dizziness.
  
• Use Borg's scale: "Rate of Perceived Exertion" to measure your exercise intensity, which should be between 5-8.

RPE - scale
1. Sleeping 6. Moderately intense exercise
2. Awake 7. Intense exercise
3. Light exertion: typing 8. Very intense exercise: speed walking/jogging
4. Strolling 9. Too hard
5. Moderate exercise 10. Adrenalin-driven action (your house is on fire)

• Walk around between exercises to avoid blood pooling; do not sit or lie still for extended periods.
  
• Never exercise to exhaustion or lift very heavy weights.
  
• Avoid athletic competition.
  
• Do not use hand, wrist or ankle weights for walking or aerobics classes as they can cause joint injury or hit your belly.
  
• Do exercise all muscles, but concentrate on Kegel's, abdominals, hip mobility, legs and back muscles (strengthen upper and stretch the lower back).
  
• Avoid all flyes, chest presses and lateral shoulder raises with dumbbells, as the pregnancy induced hormone relaxin seems to leave you with no control over these movements. Push-ups and machines are safer.
  
• After 12 weeks avoid crunches, leg raises, sit-ups and most twisting exercises as your distended abdominals are changing your hip mobility. Cat stretches are better.
  
• After 30 weeks of pregnancy when the baby's head has settled down in the birth canal, avoid any inverted (upside down) positions such as shoulder-, head - and handstands, or certain bent over yoga poses, as they may cause a breach position baby. Do the yoga "down-dog" with your hands on a chair.
  
• If you feel dizzy, sick, too hot, your chest is pounding - stop, sit down, drink some water and keep your head higher than your heart. For any pain, pubic pressure, bleeding, strong contractions, injuries or if your water breaks seek medical attention.
  After every workout:
  
• Cool down and stretch every muscle to prevent stiffness, soreness and injury.
  
• Replenish your body with more water and a light snack.

More than anything listen to your body and modify your exercise program as you see fit. If something doesn't feel right - it isn't. Slow down on "tired" days and take advantage of those ''feeling terrific" days. Stay active, have a great workout and a fabulous pregnancy.

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