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1. Introduction
Regular aerobic exercise is an important component for the maintenance of overall health. Exercise is especially important in pregnancy, as women of childbearing age are at increased risk of gestational diabetes mellitus (GDM), which has been strongly linked with obesity.[1,2] As more women tend to gain an excessive amount of weight during pregnancy, they also tend to retain the weight after delivery.[3,4] Gaining an excessive amount of weight during pregnancy can result in obesity-associated co-morbidities, which are a major health concern in the US.[5]
In 2002, the American College of Obstetricians and Gynecologists (ACOG) published exercise guidelines for pregnancy.[6] These suggested that in the absence of medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women. These guidelines were based on the 1995 joint recommendations by the Centers of Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM).[7] However, these were general public health recommendations, with no clarity on the definition of 'moderate intensity' exercise or the recommended amount of weekly physical activity energy expenditure.
It has been 15 years since those initial CDC and ACSM recommendations were established, and 9 years since their adoption by ACOG. Since then, new science has emerged that has enhanced our understanding of the amount of physical activity expenditure per week required and the intensity of exercise needed to improve health outcome and quality of life. In 2007, updated physical activity recommendations were published by the ACSM and the American Heart Association (AHA).[8,9] These included definitions of 'moderate' and 'vigorous' exercise, and provided recommendations for muscle strengthening activities (table I).
Table I. The American College of Sports Medicine (ACSM) and American Heart Association (AHA)'s physical activity recommendations for men and non-pregnant women[superscript] a[/superscript] [Table omitted.]
As such, we believe these updated 2007 recommendations should be used to establish new ACOG guidelines for pregnancy in the absence of medical or obstetric complications. Pregnancy is not a state of confinement, yet pregnant women spend less time performing vigorous exercise with less duration and frequency than non-pregnant women.[12] Indeed, women who maintain their exercise regimen during pregnancy continue to exercise at a higher intensity than those who stop.[13] Over...