Seeing a pregnant woman run on the treadmill may feel as shocking as watching a pregnant woman sip a martini. but medical experts allow athletic and fit women to maintain their exercise programs throughout pregnancy.

"We have patients who run long distances during most of their pregnancy," said Alan Peaceman, chief of maternal fetal medicine at Prentice Women's Hospital at Northwestern Memorial Hospital in Chicago.

Running on a treadmill or trail is permitted as long as the woman carefully monitors her body temperature and hydration. other exercises are off-limits as a pregnancy progresses.

Scuba diving, for example, is not recommended during any stage of pregnancy. other than this limitation, women in their first trimester can continue to bike, weight lift, run, ski or swim.

"Some people can do in the first trimester what they were doing before; there are not a lot of physical changes that occur in the first trimester," said Michelle Pretorius, personal trainer at Fitness Formula Club Gold Coast in Chicago.

While the first trimester allows women to continue outdoor activities and exercise, Pretorius said a physician should first approve the program.

"The most important thing is to check in with your doctor. What they say goes," Pretorius said.

Women can expect their doctors to make adjustments to their exercise routine during the second semester. Significant changes occur within the second trimester as the joints become looser to prepare the body for labor. this increases the risk of injury, Pretorius said.

The center of gravity also begins to shift and activities such as road bicycling and skiing are off-limits in the second trimester. "In terms of running or using the treadmill, the elliptical - those are fine and I do not suggest people need to decrease their activity," said Peaceman.

Maintaining balance is important for preventing jury and women should also avoid lunges. Squats, however, can be performed throughout the pregnancy. "If you are doing any type of weight training, compensate for the center of gravity," Pretorius said.

In the past, doctors advised women to keep their heart rate below 140 beats per minute. Peaceman does not feel this restriction is reasonable and said women who were fit before their pregnancy can continue with cardiovascular activities.

While high-intensity cardiovascular activities are still permitted, women are advised to monitor their body heat carefully. Body temperature increases during the second trimester and women must ensure they do not overheat during exercise.

Wearing lightweight clothing and being conscious of overheating symptoms such as light headedness is advised. Pretorius also suggests working out in the early morning or evening when body temperature tends to be lower.

Another option is to switch to swimming which has the benefit of aerobic activity without the risk of overheating. "It's almost impossible to get overheated because the heat dissipates into the water," Peaceman said.

The water also supports the weight during pregnancy which helps avoid stressing joints. For women concerned about chemicals in the water, Peaceman said there are currently no studies suggesting the chemicals are problematic for pregnancy.

Women can also incorporate strength training during the second trimester but Pretorius strongly cautions women to not lie flat on their backs during exercise. "It obstructs the vena cava, blood flow to the feet. Exercises on back must be on a 45 degree angle," she said.

Women in both the second and third trimesters are also advised to be conscious of dehydration and Pretorius recommends monitoring water intake to ensure enough fluids are consumed.

The big belly limits high impact activities and Peaceman advises women refrain from exercises or sports that involve jumping. "It's not because it will injury the pregnancy but because the joints are more vulnerable during the pregnancy," said Pretorius.

Women can continue with weight lifting and aerobic activities that don't compromise balance. And as long as women feel comfortable, exercise and activity can be continued until the end of the pregnancy.

After birth, most doctors recommend waiting six weeks before returning to strenuous exercise. Women who underwent caesarians will need to plan on a longer recovery time.

Returning to exercise may be a shorter wait for women who experienced easy births. Peaceman said women with two or three prior birth experiences are more likely to recover quickly and return to the gym at a faster pace.

Women who need to wait for return to strenuous activity can still be mobile. Softer impact activities are always an option while the body heals. "It's reasonable for most women to start walking," Peaceman said.

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