ACOG Guidelines

There are two leaders in the field of perinatal fitness training: the American Congress of Obstetricians and Gynecologists (ACOG), and Dr. James Clapp, author of Exercising Through Your Pregnancy. Both have been extremely influential in clarifying the ‘why’ and ‘how’ of training perinatal women and in establishing the guidelines that are most recognized and respected in the industry.

Here is what their research and guidelines say:

Dr. James Clapp, a pioneer in pregnancy exercise research, devised these simple guidelines for prenatal exercise:

• If a pregnant woman has been training prior to getting pregnant, she can continue to train at the levels she exercised at prior to pregnancy. She can proceed and improve as a normal non-pregnant client would.
• If a client has not exercised before pregnancy, she is encouraged to seek physician approval and then may begin an exercise program gradually (Clapp, 1998).

ACOG’s guidelines encourage pregnant women to exercise ”at least 150 minutes per week of moderate-intensity aerobic activity (ie, equivalent to brisk walking). This activity should be spread throughout the week and adjusted as medically indicated.” The guidelines also state that women who engage in high intensity exercise can “continue physical activity during pregnancy and the postpartum period, provided that they remain healthy and discuss with their health care provider how and when activity should be adjusted over time.”

Myths and Conservatism

Even today many myths surround prenatal fitness. I still hear people say “newly pregnant women should not exercise” and “exercise may harm the unborn baby”. Some women are told by their doctors to “take it easy” or not to do anything ”too strenuous”. Many women will not exercise for fear of miscarriage or premature delivery.

Many of these myths were bolstered by very conservative guidelines released by the American College of Obstetricians and Gynecologists (ACOG) in 1985. The guidelines recommended that active women strictly limit the type, duration, and intensity of exercise to minimize risk to themselves and their unborn babies. Women were told they could not exercise for more than 15 minutes in duration, they could not have their heart rate exceed 140 beats per minute, and their core temperature could not exceed 38 degrees Celsius.

In 1994, ACOG changed their guidelines and removed the somewhat arbitrary restrictions on exercise session duration and maternal heart rate. In December of 2015 they released a NEW set of guidelines that were even less conservative. Newer studies demonstrated that earlier cautions were unwarranted and that women tended to naturally adjust their exercise intensity as their pregnancy developed.

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-trimester women) might harm the baby’s development. This belief stemmed from the knowledge that problems such as spina bifida had been backtracked to excessive maternal core temperatures in some instances (such as when the mother was ill). However, more recent research has shown that women may exercise safely at higher intensities than previously thought, and that the “Talk Test” (having women able to talk comfortably throughout their workout) provides 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.

The new guidelines released in 2015 also change the recommendation about returning to exercise postpartum. Gone is the line about waiting six to eight weeks after birth of baby, instead, they advise that “exercise routines may be resumed gradually after pregnancy as soon as medically safe, depending on the mode of delivery, vaginal or cesarean, and the presence or absence of medical or surgical complications. Some women are capable of resuming physical activities within days of delivery.” They also recommend immediate return to pelvic floor exercises, something that I greatly believe in!

All Empower Fitness Programs are built on the following ACOG guidelines (ACOG, 2015):

General Guidelines:

• Always talk to a doctor before beginning an exercise program
• Most forms of exercise are safe, in particular: walking, swimming, cycling, and aerobics (especially low impact or water-based)
• After the first trimester, avoid exercises on the back
• Avoid brisk exercise in hot, humid weather
• Wear comfortable clothing
• Wear a supportive, well-fitting bra
• Drink plenty of water
• Consume adequate calories daily

Cautions:

• Avoid the following activities: contact sports, activities with a high risk of falling (skiing, surfing, etc), scuba diving, sky diving and Hot Yoga or Hot Pilates
• Changes in center of gravity can decrease stability, cause back pain, or increase the risk of falls, especially later in pregnancy
• Exercise should be at a level that still allows a client to talk normally

Warning Signs. Stop exercising and call your doctor if you have any of these symptoms: