Physical Activity Throughout the First Year Postpartum

Physical Activity Throughout the First Year Postpartum

Moderate – vigorous intensity physical activity

•    Encourage starting or coming back to heavy activity in the first 12 weeks after childbirth to support mental health.
•    Suggest early mobilization with light-intensity activity, progressing to moderate  once surgical incisions or perineal tears have healed and vaginal bleeding does not increase with activity.
•    Ensure adequate nutrition and hydration to help prevent low energy availability.
•    Suggest breastfeeding or expressing milk before exercise sessions to reduce breast weight and improve comfort during physical activity.
•    Recommend adopting a healthy sleep hygiene routine to support maternal mental health.
•    Suggest limiting sedentary time to ≤8 hours daily, including no more than 3 hours of recreational screen time, and breaking up long periods of sitting when possible.
•    Recommend daily pelvic floor muscle exercise to reduce the risk of urinary incontinence and rehabilitate pelvic floor muscles.

Assess the following factors, as they are key barriers to vigorous activity:
o    mental health status (including eating disorders)
o    musculoskeletal pain
o    lactation status
o    perineal tears and surgical incisions
o    relative energy deficiency in sport
o    sleep quality
o    fear of movement or injury (kinesiophobia)
o    pelvic floor and abdominal wall function
o    availability of social/emotional support.

Contraindications to heavy exercise:
•    For postpartum people with potential contraindications to physical activity, advise them to obtain medical guidance about beginning or continuing exercise following childbirth.
•    Vigorous activity may proceed in most cases, but modifications may be required until the medical condition or symptom has resolved.
•    Be aware of the following relative contraindications in the first year after childbirth, which may require further medical consultation:
o    dizziness or light-headedness during exercise
o    severe abdominal pain
o    Caesarean section with symptoms that worsen (for example, surgical incision pain)
o    unstable high blood pressure (>140/90 mmHg)
o    kidney disease
o    eating disorders or malnutrition
o    postpartum cardiomyopathy
o    fractures or other significant musculoskeletal injuries
o    vaginal bleeding not associated with menses
o    haemodynamic instability
o    acute systemic infection accompanied by fever, body aches, or swollen lymph glands
o    calf pain or swelling indicative of DVT
o    breathing difficulties at rest that are not resolved with medications
o    excessive fatigue suggesting anaemia or low energy availability .
o    new onset of chest pain, discomfort, and other angina-like symptoms with exertion.
o    loss of consciousness for any reason.
o    neurological symptoms (for example, ataxia or muscle weakness that affects balance).
o    other medical or physical conditions that may affect the ability to be physically active.

•    Avoid a rapid return to vigorous activity, especially if the patient is experiencing symptomatic musculoskeletal pain, incisional pain, heavy vaginal bleeding, pelvic floor dysfunction, or mental health concerns.

Lifestyle Changes
Exercise
•    Recommend all postpartum people without contraindications be physically active to obtain clinically meaningful benefits, such as preventing and reducing depressive symptoms.
•    Recommend that the person follows an individualized and gradual progression to the point when she is doing a minimum of 120 minutes of moderate to vigorous pgysical activity (which could include brisk walking or cycling, and should also incorporate a variety of aerobic exercises and resistance training activities)spread over ≥4 days of the week.
•    Suggest initiating early mobilisation with light-intensity physical activity, such as gentle walking, and progressing to heavy exercise once surgical incisions or perineal tears have sufficiently healed and vaginal bleeding does not increase with the activity.
•    Ensure adequate caloric intake and hydration (understanding that needs will be greater during lactation) to prevent low energy availability, which can lead to poor recovery, decreased bone health, amenorrhoea, sleep disturbances, and fatigue.
•    Advise patients that breasts will rapidly change size during lactation, and a bra with good support is required to minimise mobility during exercise. A tight-fitting or binding bra should be avoided to ensure that breastmilk supply is not compromised.
Advice :[2]
•    regular activity can relax you, keep you fit, and help you to feel more energetic
•    it can also help your body to recover after childbirth and may help to prevent postnatal depression
•    if you had a straightforward birth, you can start gentle exercise as soon as you feel up to it; this could include walking, gentle stretches, and pelvic floor and tummy exercises.
•    it's usually a good idea to wait until after your 6-week postnatal check before you start any high-impact exercise, such as aerobics or running.
•    your lower back and core abdominal muscles may be weaker than they used to be, and your ligaments and joints are also more flexible for a few months after birth, so there's an increased risk of injury.
•    listen to your body; pace yourself and make sure that you get plenty of rest too.

Sleep
•    Encourage the postpartum woman to prioritize quality sleep, to support mental health, physical and cognitive recovery, and to reduce the risk of injury.
•    Advise the person to adopt a healthy sleep hygiene routine to support maternal mental health, which could include avoiding screen time and maintaining a dark, cool, quiet environment before bed.

Dr Najeeb Layyous  F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist