Although exercise for both fitness and recreation has become a routine activity for many women, the effects of physical exertion on pregnancy outcome are not known, since there has not been a prospective, randomized trial studying this issue. Decreased rate of weight gain and subcutaneous fat deposition in the third trimester has been demonstrated in one (nonrandomized) study, although overall weight gain remained within the normal range. 25 In general, uncomplicated pregnancy should not limit the ability to engage in moderate physical exercise. The American College of Obstetricians and Gynecologists recommends some modifications in exercise routines in view of the physiologic and morphologic changes of gestation. 5 Non-weight-bearing activity and activities that minimize the chance of even mild abdominal trauma are preferable. Exercise in the supine position should be avoided completely after the first trimester due to potential for decreased cardiac output. Although there does not appear to be a need to alter goal intensity as judged by heart rate, exercise should be stopped at the onset of fatigue rather than continuing to exhaustion. Extra attention should be given to augmentation of heat dissipation, hydration, and appropriate clothing during activities. Adequate dietary intake should be ensured. As for all individuals, regular activity is preferable to sporadic exertion. Subjective benefits of exercise both preconception and during early pregnancy have been reported.26 Specific recommendations for exercise during pregnancy need to be individualized and made with the knowledge that there is no conclusive evidence on which to base recommendations.
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