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Most physicians believe that pregnancy is not the time to start a strenuous ex- ercise program. If you're already on one, then it's per- missible to continue, within the realm of comfort, of course. But it's important to avoid dehydration and overheating. The guidelines of the American College of Obste- tricians and Gynecologists, of- fer suggestions for exercising during pregnancy. Keep the heart rate to 140 beats per minute. There's a significant increase of blood volume that circulates when you're preg- nant. If you raise the heart beat too much, you're asking the heart to pump a greater load at a faster rate, making the risk of heart failure possible. In addition, there's the add- ed risk of shunting blood away from the nourishing placenta toward the areas of the body that are requiring it at the time, such as the arms and legs. to tend Physicians discourage "bouncy jerky" ex- ercise later in pregnancy. Hormones make your ligaments more elastic, so there can be a greater risk of injury. That risk doesn't end the moment you give birth either. It should be at least six to eight weeks before you resume any high-impact exercise. The objective of exercising when pregnant is to make a woman fit, not to make her an athlete. For that reason, most doc- tors recommend exercise pro- grams that are specifically geared to pregnant women. At the Jewish Community Center of Metropolitan Detroit, Candice Bousquet, director of physical education and health, also offers a pre- and post-natal exercise pro- gram, both on the floor and in the pool. Like most other pre- natal exercise programs, Ms. Bousquet requires all preg- nant women to have their doc- tor's permission and allows them to begin the program only after the first trimester. "We follow the ACOG guidelines," says Ms. Bouse- quet, "including keeping the heart rate to 140, and not do- ing any exercise lying flat on the back." The "rules" of pregnancy have changed in other areas besides exercise. Nutrition, and specifically weight gain, have been rethought. Years ago, pregnant women were told not to gain "too much" weight. Today, most doctors suggest an average weight gain of 25 to 30 pounds to en- sure a healthy baby. However, optimal weight gain depends on pre-pregnancy weight. Physicians discourage drinking, too much caffeine and cigarettes. That is echoed by Donald Blitz. "The average range is 25-30 pounds," he admits, "but if you're 5'3" and 190 pounds to start with, a 30-pound weight gain is not so good. On the other hand, if you're 5'7" and 90 pounds, 40 pounds would be better. "People have a tendency to hang on numbers," he adds. "What we say is eat normal- ly and don't pay as much at- tention to how much you're gaining. Use common sense. Eat green vegetables, lean protein (just two extra ounces a day should do it), limit star- ches and fat." Perhaps the one issue that has the most women the most Doctors allow women to continue to exercise during pregnancy, while following common sense guidelines. confused is the age limit. Or, as most doctors today would say, "What age limit?" Twenty years ago, women over the age of 30 were older mothers. Today, that is not true. For women over the age of 35, there is a slightly higher risk for chromosomal abnor- mality, specifically — but not limited to — Down's Syn- drome, and for that reason physicians recommend genetic counseling for the older woman. Dr. Bitz remarks that the bottom line is physical condi- tion, not age. "If you're 40 and in good shape, you may have even more reason to have a good pregnancy than a 25-year-old who's not in good condition. I have pa- tients in their 40s who are pregnant. "Physically, there shouldn't be a problem," he adds. "Men- tally, of course, that's a whole different ball game. That's even more significant to me. Having a baby entails tremendous lifestyle changes that older couples may not be as prepared for. When you're younger and you're not as established, it may be easier to be more flexible. "But today," he adds, "We are seeing a lot more older pregnancies. "It's almost to the point that if we see a 25-year-old who is pregnant, we're surprised. That's almost like a teen-age pregnancy these days." ❑