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Postpartum Exercise

Roy, Brad A. Ph.D., FACSM, FACHE

doi: 10.1249/FIT.0000000000000071
DEPARTMENTS: Fitness Focus
Free

This copy-and-share column discusses postpartum exercise.

Brad A. Roy, Ph.D., FACSM, FACHE, is an administrator/executive director at Kalispell Regional Medical Center. He is responsible for The Summit Medical Fitness Center, a 114,800 sq ft medical fitness center located in Kalispell, Montana, and a number of other hospital departments.

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During the past 25 years, numerous research studies have demonstrated significant benefits associated with physical activity during and after pregnancy for both mother and baby. Pregnancy triggers numerous physical changes in a woman’s body, including water retention and weight gain. After delivery, many women have difficulty returning to their prepregnancy weight, with an average weight retention of 0.5 to 3.8 kg (1.1 to 8.4 lbs) noted per pregnancy. Nearly 20% of women are more than 5 kg (11 lbs) heavier 6 to 18 months after delivery. Postpartum weight retention is related to inadequate physical activity, poor nutrition, and, in some cases, excessive weight gain during pregnancy. Across time, weight retention, physical inactivity, and poor nutritional choices can lead to a myriad of chronic health conditions, including obesity.

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POSTPARTUM EXERCISE CHALLENGES

Whereas the postpartum period is a critical transition time, return to a physically active lifestyle, balanced diet, and a gradual shedding of extra weight can be challenging. For some women, the challenges of motherhood manifest themselves in physical and mental symptoms. Fatigue, frequently compounded by sleep disturbance, is common and present in nearly two thirds of women 12 months after delivery. The lack of vigor associated with fatigue, newborn sleep and feeding schedules, and the strain of balancing other family duties and work schedules can be overwhelming and can negatively affect mom’s ability/desire to exercise consistently. In some women, these factors lead to significant levels of depression.

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BENEFITS OF POSTPARTUM EXERCISE

Although conventional wisdom might suggest that exercise will accentuate fatigue, the opposite is generally true. Prolonged rest/physical inactivity actually contributes to fatigue, promotes increased body weight and decreased vigor and mental acuity, and increases the risk of developing future chronic health conditions. An emerging body of evidence indicates that exercise in the postpartum period:

  • ○ Reduces fatigue and increases vigor
  • ○ Improves mood states and mental acuity
  • ○ Improves fitness
  • ○ Promotes return to prepregnancy weight
  • ○ Decreases the risk for developing future chronic health conditions
  • ○ Provides important mom time and social interactions
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RETURNING TO PHYSICAL ACTIVITY

After delivery, women are encouraged to increase their physical activity gradually. Because the delivery course varies and many of the physiological changes of pregnancy persist for 4 to 6 weeks, the process should be individualized. Generally, moms experiencing an uncomplicated delivery will receive a green light to exercise at 4 to 6 weeks after delivery, whereas those healing from a cesarean delivery may need additional time. Women who consistently exercised before pregnancy and remained physically active throughout pregnancy often can return to their prepregnancy routines fairly quickly once given medical clearance. Those who were inactive previously and those who adopted a sedentary lifestyle during pregnancy will need to start and progress more gradually. Following are some tips to consider when restarting your exercise routine:

  • ○ Obtain medical clearance from your provider before beginning.
  • ○ Begin with low-intensity activity and gradually increase to moderate efforts.
  • ○ Women who are competitive athletes and those doing higher-intensity training before pregnancy usually can return to those levels fairly quickly.
  • ○ Consider using an accelerometer or pedometer, with an initial focus on gradually increasing daily steps rather than focusing on weekly time accumulation (150 minutes or more of moderate-intensity exercise each week generally is recommended). Start where you are and add 500 to 1,000 steps each week, with a goal of building to 10,000 steps per day.
  • ○ Light to moderate exercise does not seem to affect breast milk, whereas high-intensity exercise can increase lactate levels in milk. Consider breast feeding or pumping just before exercising to both feel more comfortable when you are exercising and avoid the increase in lactate associated with high-intensity workouts.
  • ○ Gradually introduce various resistance training and/or functional training activities. A personal trainer can provide guidance on appropriate activities, form, and intensity.

There are numerous benefits to being physically active after pregnancy, including a reduction in fat mass, increased lean mass, improved lipid profiles, and enhanced mental outlook and acuity. All women are encouraged to begin exercising as soon as medically appropriate and to remain physically active throughout their lifetimes.

© 2014 American College of Sports Medicine.