The rules regarding fitness during pregnancy have changed. Medical studies indicate that exercise during pregnancy has all the benefits (muscle tone, increased strength, flexibility, improved mood, weight loss) of pre-pregnancy fitness. In addition, exercise can decrease the risk for diseases such as gestational diabetes and preeclampsia. In fact, pregnant Island women are placing such a high value on exercise that there are fitness instructors and personal trainers who specialize in prenatal fitness.

Being fit can alleviate some of the discomfort of pregnancy. The nagging back ache, water retention, swelling of hands and ankles and drooping shoulders can be helped. Even labor pains are lessened when a woman is fit, say physicians and fitness enthusiasts.

It's critical, of course, to talk to a physician before beginning any exercise program.

"The American College of Ob/Gyns recommends exercise throughout the pregnancy — if not every day, at least three days a week, for 45 minutes to an hour," said obstetrician/gynecologist Cheryl Leialoha of Kapi'olani Medical Center. "I tell my patients it doesn't have to be vigorous, just as long as you're moving."

She recommends any exercise regimen — walking, swimming, Pilates, yoga — as long as it isn't high-impact or a contact sport.

"Those with an established fitness regimen can continue it unless the doctor recommends against it," Leialoha said. "I have a patient who was a runner, and she ran throughout her pregnancy, right up to the end, and she did great."

YOGA BENEFITS

The doctor herself found yoga to be beneficial during her own pregnancies with Zachary, who is now 4, and Noah, 2.

"I highly recommend yoga. I tell all my patients that," Leialoha said. "I recommend it not just for the exercise benefits but for increasing flexibility and strengthening the pelvic floor, which can really help during delivery and post partum. I used to have a lot of back pain but because of yoga, I did not have one ounce of trouble throughout my pregnancies."

Yoga's mind-body connection, as well as the deep breathing, are also beneficial, Leialoha said, to both the baby and the mother. "In yoga we take really deep breaths, which we don't do in a normal day. You get more oxygen to your body and to the fetus."

Eden Monteilh, healthy lifestyles director at the Nu'uanu YMCA, who is eight months pregnant with her third child, advises women: "If you are not exercising already, start exercising as soon as you know you want to get pregnant," rather than waiting until you are already pregnant.

Monteilh has attended programs put on by national fitness organizations such as the Aerobics and Fitness Association of America that specifically address fitness during pregnancy.

"The rule of thumb is you can continue what you were doing prior to conception, and intensity really doesn't have to decrease," she said.

She added, "Pregnancy really does need to be viewed as planning/training to run a marathon. It's very taxing on our bodies and we need some type of conditioning to help us during labor and to help our recovery. It curbs gestational diabetes, keeps our weight gain under control, helps with our water retention, our mood and overall general well-being."

Monteilh is the mother of two children, Xavier, 14, and Kaili, 5. During her first pregnancy, at age 23, she said, "I did no exercise. I just ate and slept with him," and gained 50 pounds.

"With Kaili, though, I was already moderately physically active and carried that over into and through the pregnancy."

As a Pilates instructor at the Y, she only recently suspended teaching her classes (because she couldn't demonstrate the moves properly, not because she doesn't have the stamina or athletic ability) and she still does her own exercise regimen of three to six days a week of cardio and weight training.

"If I exercise later in the day, it helps with stamina," Monteilh said. "On days when I don't exercise I'm more tired. It also helps with self-esteem; it lets you know there's a body you can get back to."

Pilates has been especially helpful during this pregnancy, with its focus on core stabilization and posture awareness. "I'm so much more in tune with my body this time," she said.

COMMITMENT

Cecile Sebastian, a dentist, is more fit during her fourth pregnancy (at age 44) than she was through her first three pregnancies, when she was in her 30s.

With daughters Chloe, 13, Claire, 11 and Calais, 9, Sebastian was not as committed to fitness as she is now. In fact, she ran her first marathon in 2006 and trained throughout 2007 for last year's marathon.

In early December she began to have what she thought were symptoms of menopause: "All my friends were going through menopause, and I thought I was too."

The day before the marathon she went to see her doctor. Menopausal? Nope. She was pregnant.

"I didn't believe it at first," she said with a chuckle. She decided that running a marathon during her first trimester was not the best thing for her body, or her baby.

She did keep running, however, until her seventh month. Her obstetrician, Dr. Allison Shigezawa, encouraged her to run as long as she felt good. Now in her eighth month, she finds some discomfort while running so she walks instead.

Sebastian also joined the Kokokahi YWCA, where she attends body sculpting, Jazzercise and step aerobics classes. She has a note from her doctor for each activity.

"It's important to keep the ligaments stretched," she said.

In addition to staying active, Sebastian watches her diet carefully. "I really eat as if I'm training for a marathon," she explained. "I started drinking milk; I never drank milk before."

She has also curbed her cravings for sweets. "It's somehow easier knowing there's a baby inside me who doesn't need sweets. In pregnancy I can resist them better. It's really the best motivator of all. In the end, I want to have a healthy baby so I eat healthy foods: more grains, fruits and fiber. If my body gets used to healthy foods, hopefully my baby will have a liking for healthy foods, too."

YOGA + PREGNANCY = FIT

Jennifer Reuter teaches a prenatal yoga class at Open Space Yoga in Chinatown. She is in her eighth month of pregnancy and still keeps to her regular teaching schedule.

"This is a therapeutic yoga, not a vigorous Ashtangi style," she explained.

Even if you have never done yoga before, Reuter believes it's OK to start with a basic beginner's yoga class when pregnant.

"If you've never done yoga, it's a great time to start," she said. "Even if your schedule doesn't allow for a targeted prenatal yoga class, come to a yoga basics class, and the instructors should be educated on how to handle a prenatal woman and should know what poses not to put them in."

It's important, Reuter said, that you respect your body.

A growing number of pregnant women are attracted to yoga during pregnancy, noted Jennifer Wolfe, a San Francisco yoga instructor who is also a childbirth doula: "The increased strength, flexibility and stamina that grow out of a regular yoga practice can decrease common side effects of pregnancy such as back pain and sciatica, increase energy levels and even reduce the likelihood of unwanted medical interventions during labor."

A TRAINER'S TAKE

Personal trainer Angela Yamashita of Gold's Gym has trained dozens of pregnant women over the years. She is also the mother of Ian, age 4, and she maintained a high level of fitness throughout her pregnancy.

Regardless of their level of fitness, Yamashita requires a note from an obstetrician for every pregnant client. She recommends that pregnant women keep moving, "at least 30 minutes of moderate cardio at least three days a week, but preferably every day. It doesn't have to be in the gym. It can be just walking in the park or swimming."

Yamashita said she has seen pregnant women making some scary mistakes in the gym. Among them are lifting heavy dumbbells while going up and down a step; another is walking lunges with barbells.

"You're so susceptible to falling during your second and third trimesters. You may think you can do it but you can lose your balance and fall unless there's someone there to catch you."

A third no-no cited is a leg press with too much weight, which can cause unnecessary strain on the abdomen.

While being fit throughout pregnancy may not mean looking like Angelina Jolie, it can certainly help a woman look — and, more importantly, feel — her best during this critical time.