Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period.

of Obstetricians and Gynecologists (ACOG) published new recommendations and guidelines for exercise during pregnancy and the postpartum period. 1 Regular exercise is promoted for its overall health benefits. Pregnancy is recog-nised as a unique time for behaviour modification and is no longer considered a condition for confinement. It is currently recognised that habits adopted during pregnancy could affect a woman's health for the rest of her life. For the first time the recommendation suggests a possible role for exercise in the prevention and management of gestational diabetes. The recommendations also promote exercise for sedentary women and those with medical or obstetric complications, but only after medical evaluation and clearance. Box 1 lists the absolute contraindica-tions to aerobic exercise during pregnancy , and box 2 the relative contraindi-cations. As with any form of exercise prescription, these recommendations also include the warning signs to terminate exercise while pregnant (box 3). The recommendations also offer guidelines for sports and recreational activities. It cautions against participation in contact sports and recommends avoidance of scuba diving. As for postpartum resumption of activities, the recommendations note that rapid resumption has no adverse effects, but gradual return to former activities is advised. This review includes background and comments to the above recommendations. The health benefits of physical activity are well recognised, and conversely sedentary habits and low levels of cardiores-piratory fitness are leading risk factors for subsequent development of cardio-vascular disease. Sports Medicine (CDC-ACSM) have recommended the accumulation of 30 minutes or more of moderate intensity physical activity on most, and preferably all, days of the week. 4 Moderate intensity physical activity is defined as activity with an energy requirement of 3–5 metabolic equivalents (METS). For most healthy adults, this is equivalent to brisk walking at 3–4 mph. The CDC-ACSM statement also recognises that more intense exercise performed in 20–60 minute sessions on three to five days a week will result in higher levels of physical fitness. Despite the fact that pregnancy is associated with profound anatomical and physiological changes, there are few instances that should preclude otherwise healthy, pregnant women from following the same recommendations. MUSCULOSKELETAL ADAPTATIONS Anatomical and physiological changes during pregnancy have the potential to affect the musculoskeletal system at rest and during exercise. The most obvious of these is weight gain. The increased weight in pregnancy may significantly increase the forces across joints such as the hips and knees by as much as …