At a British 10K charity run last year, a blonde with sunglasses and a slew of world records jogged easily among the 11,000 other runners who'd shown up that day. Olympic marathoner Paula Radcliffe crossed the finish line with a huge smile on her face, despite being a whopping 15 minutes off her best time for the distance.
The ultra-competitive Radcliffe, who at the time was seven months' pregnant with her second daughter, told reporters after the race that she "wasn't concerned about running a time, it was about enjoying the day."
But the day was also about staying in shape; though Radcliffe toned down her training during pregnancy, her ultimate goal was to make the 2012 British Olympic team. (She qualified at the Berlin Marathon in September.)
Back in the 1950s and 1960s — before the jogging and aerobics boom hit the U.S. and thousands of health clubs dotted the land — exercise during pregnancy was rarely discussed. These days, pregnant women are packing prenatal yoga and low-impact aerobics classes. They're swimming, biking and running — and, yes, they're occasionally lining up at a race near you.
"The benefits of exercise during pregnancy are tremendous," says Dr. Raul Artal, author of the exercise and pregnancy guidelines for the American College of Obstetricians and Gynecologists, or ACOG, and chairman of the Department of Obstetrics, Gynecology and Women's Health at St. Louis University.
"Pregnancy shouldn't be a state of confinement. I consider it an ideal time to start engaging in physical activity," Artal says. For a healthy pregnant woman, ACOG recommends at least 150 minutes a week of exercise, preferably in 30-minute bouts — although shorter bouts of 15 minutes are OK, says Artal.
Healthy nonexercisers with a normal pregnancy should start slowly (like any new exerciser). ACOG recommends starting with five minutes a day and adding five minutes a week to reach the 30-minute-a-day mark. Walking, swimming or aquacise classes and low-impact/gentle aerobics are great options for beginners.
A previously active woman who's healthy and has a normal pregnancy can usually continue what she's doing, but at a less-intense level. (She shouldn't be short of breath at any point during exercise.)
What do the 30-minute bouts of exercise bring? According to ACOG, they can help reduce backaches, constipation, bloating and swelling; may help prevent gestational diabetes; increase energy, improve mood and posture; promote muscle tone, strength and endurance; and help you sleep better.
Women who should not exercise, says Artal, are those with significant heart disease, those with risk factors for preterm labor or risk of bleeding and women with poorly controlled Type 1 diabetes. Other women — such as those with severe anemia, severe obesity or high blood pressure — should talk to their doctor before starting an exercise program and do it under a doctor's supervision.
The talk test
Neal Pire, a fitness educator and fellow of the American College of Sports Medicine, has noticed a huge change in attitude from both pregnant clients and the medical profession over the past few decades. Pire, based in Bergen County, N.J., cites the old ACOG restriction that pregnant women never let their heart rates go above 140. That number's no longer valid, he says.
Now women are being advised to follow the "talk test." Basically, if you're exercising and you get to the point where you're short of breath and finding it difficult to hold a conversation, back off, explains Dr. James Pivarnik, Director of the Center for Physical Activity and Health, Michigan State University. "If the shortness of breath continues, stop the exercise," he says.
"Usually the moms who are active before pregnancy can continue their exercise routine up until birth," Pire says. "If they're starting a program they should start as any basic exerciser should — slow and gradual."
"If you're a moderate exerciser before pregnancy — doing walking, low-impact aerobics and moderate weights, for example — you should not start doing a spin class and upping your heart rate to 200 and adding plyometrics and heavy lifting. That's a whole different animal," Pire says. "Don't start anything new that's dramatically more intense than what you've been doing."
Exercise physiologist and trainer Karen Merrill, who trained for a marathon while pregnant, has pregnant clients who use kettlebells, TRX (suspension training bands) and other challenging fitness tools, but only if they've used them before pregnancy.
"My clients don't want to give those things up when they're pregnant, but they need to have a good sense of balance and a strong core," says Merrill, a mother of two and spokeswoman for the American Council on Exercise. "As a trainer, you look at each pregnant woman individually, assess what her strengths are, and design a program based on that. Even then, there are going to be changes as the pregnancy progresses."
As for concerns about running, Pivarnik says, "There is no evidence to suggest that running does any harm to the growing fetus. The uterine environment is amazingly efficient at cushioning any blows that might occur, so jostling is not an issue.
"In general, I would not recommend that a woman who has never run start a running program during pregnancy. If she wants to pick up her activity, then walk, walk and walk some more."
Adjustments and things to avoid
Breasts and stomach might get in the way of certain exercises, "so sometimes we have to shift those positions," Merrill says. "Or maybe she didn't sleep well last night so we might do a different cardio workout then planned."
She also reminds her super-athletic clients that pregnancy is a temporary state. "This is a nice time that goes by pretty quickly when you look back on it."
She also tells them to follow the rules. "I did a few 22-mile runs while I was pregnant, but I made sure my breathing was correct and that I could pass the talk test," Merrill says. "There's more of a load on the heart when you're pregnant, so you want to take that into consideration."
Both novice and experienced exercisers should keep in mind that carrying a baby can affect balance and posture and stress joints and muscles. Pregnancy hormones can make joints and tendons looser and less supportive, so ACOG recommends avoiding "jerky, bouncy or high-impact motions that can increase your risk of injury." Other sports with quick movements, like racket sports, could increase your risk of falling.
Experts say that sports with a high risk of falling or contact, such as downhill skiing, horseback riding, ice hockey, soccer and basketball should be avoided to prevent injury to you or your baby. Scuba diving is also off-limits because of the risk of decompression sickness.
"Where research has taken us recently is that there are a lot fewer negatives to women training and maintaining a higher level of fitness during their pregnancy than earlier believed," Merrill says. "But it's really important for trainers to work with ACOG guidelines as well as each individual's physician instructions."
Advice for safe exercise
After your first trimester, avoid any exercises while lying on your back.
Avoid brisk exercise in hot, humid weather or when you have a fever.
Wear clothing that helps you keep cool.
Wear a well-fitting bra that offers support.
Drink plenty of water to keep you from overheating and dehydrating.
Consume the daily extra calories you need during pregnancy.
Do not exercise to the point of exhaustion.
For more information, visit: acog.org/publications/faq/faq119.cfm