New screening tool and first ever guidelines for postpartum exercise, sleep

In a global first, there are now guidelines addressing exercise, sedentary behaviour and sleep during the first postpartum year.Published in the British Journal of Sports Medicine (BJSM), the guideline was developed by a Canadian cross-multidisciplinary group including researchers in obstetrics-gynecology, kinesthesiology, family medicine, exercise science and more. Its consensus panel also included several international experts.There has hitherto been a lack of clear guidance for postpartum women and their healthcare providers on how to appropriately engage in postpartum physical activity.“The previous guidance for the postpartum period in Canada was from 2003 and embedded within recommendations for pregnancy,” said lead author, Margie Davenport, professor of kinesiology, sport and recreation at the University of Alberta. “There were two recommendations at that time: performing pelvic floor exercises postpartum was encouraged to reduce the risk of urinary incontinence, and that exercise and breastfeeding could be safely combined.”She added that there were no recommendations on postpartum sleep. Historically, women were advised to avoid physical activity for the first six weeks postpartum after which medical clearance was needed to resume physical activity. The intent was to ensure adequate healing and recovery after giving birth. But, some women can be physically active well before six weeks, while others need to delay for a longer time.“This new Guideline emphasizes that one size does not fit all,” she told the Canadian Healthcare Network. It addresses the one-year transition period between the recommendations for pregnancy and the recommendations for adults. It takes into consideration transitioning from pregnancy to not being pregnant is more complex than previously thought.To create the guidelines, the team reviewed about 19,000 different articles which were then used in seven different systematic reviews. Those reviews, also published in the BSJM. examined the relationship between physical activity, secondary behaviour and sleep on various health outcomes. “We found that engaging in at least 120 minutes of moderate vigourous intensity physical activities spread over three or more days of the week was associated with a 45% reduction in the odds of developing depression 37% reduction in the odds of developing urinary incontinence and a 28% reduction in the odds of developing type two diabetes,” said Dr. Davenport.Encouragingly, the benefits weren’t associated with any greater risk of injury or affecting breastmilk supply, infant growth or development. Normal activities such as pushing strollers around or walking to the corner store should be taken into account. It’s more about accumulating 120 minutes of moderate-to-vigorous intensity physical activity over the course of the week. “As long as the activity you are doing is equivalent to a brisk walk . . . you do not have to go to a gym and ‘sweat it out’ to meet these targets,” she said.People who can’t meet the suggested targets still get benefits in terms of cardiometabolic health even if they make only small reductions in sedentary behaviour. The 12-page guideline includes a physical activity pre-participation screening tool—the Get Active Questionnaire for Postpartum, to help determine who can resume exercise and when.Unlike many other guidelines, issues relating to sleep are included. Over half of postpartum women experience poor sleep quality. And lack of sleep is associated with an increased risk of depression and weight gain. Needless to say, getting enough sleep is difficult with a hungry, light sleeping infant, but the evidence suggests good sleep hygiene helps. Plus, “education about infant sleep patterns and strategies, were associated with a reduction in severity of depressive symptoms, and physical activity interventions were associated with improvements in sleep quality and a reduction in daytime fatigue,” she said. While moms won’t necessarily sleep longer, they can get better quality sleep. Dr. Davenport noted that people postpartum can’t always do this on their own. Social, emotional and physical support by others is essential to optimize the health and wellbeing of both mother and infantWhile meeting all of the recommendations at different points may not be possible for everyone, the guideline stated that “even small steps towards achieving them will promote physical and mental health benefits.”The guideline was endorsed by several national and international associations such as the Canadian Association of Midwives, the Canadian Physiotherapy Association, the Chartered Association of Sport and Exercise Sciences, the Exercise and Sports Science Australia, and ParticipACTION.Summaries of the key recommendations of the guideline consensus:All postpartum women and people without contraindications be physically active to obtain clinically meaningful benefits such as prevention and reduction of depressive symptoms.People with potential contraindications to physical activity obtain medical guidance about beginning or continuing moderate-intensity to vigorous-intensity physical activity (MVPA) following childbirth. Modifications may be needed.Accumulate at least 120 minutes of MVPA, such as brisk walking or cycling, spread over four or more days per week. Incorporates a variety of aerobic and resistance training activities. Perform pelvic floor muscle training (PFMT) daily to reduce the risk of urinary incontinence (UI) and rehabilitate pelvic floor muscles impacted by pregnancy, labour and/or delivery.Begin or return to MVPA in the first 12 weeks postpartum to support mental health.Suggest initiating early mobilization with light-intensity physical activity such as gentle walking and progressing to MVPA once surgical incisions or perineal tears have sufficiently healed and vaginal bleeding (lochia) does not increase with MVPA.Follow an individualized, gradual and symptom-based progression towards at least 120 minutes per week of MVPA.Adopt a healthy sleep hygiene routine such as avoiding screen time and maintain a dark, cool, quiet environment before bed to support maternal mental health.Limit sedentary time to eight hours or less, including no more than 3 hours of recreational screen time, and breaking up long periods of sitting.

New screening tool and first ever guidelines for postpartum exercise, sleep

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