Exercise in the Postpartum Period: The Practical Applications

woman exercising with an exercise ball
October 27th, 2018 0 Comments

Hunter Bennett

The aftermath of giving birth can vary in difficulty from person to person. There are some constant issues and side effects. They can be fixed by starting an appropriate exercise regime!

Unfortunately, most people are unaware of the potential benefits associated with postpartum exercise.  Many women are hesitant to return to exercise after giving birth.

Which truly is a shame, because post-pregnancy exercise is one of the best things you can do to get your body back on track!

What is Considered the Postpartum Period?

The postpartum period is broken down into three sections after delivery has occurred:

  1. Hospital-based care, which typically describes the first 48 hours after a vaginal birth, or the first 72 hours after a Caesarean birth
  2. The immediate postpartum period, which describes 2 days to 2 weeks after delivery
  3. Late stage postpartum, which describes up to 6 weeks after delivery, and beyond

While the most sensitive time from an injury risk perspective is the first two weeks after birth, there is a growing body of evidence to suggest that even after 6 weeks postpartum, women continue to face a number of mental and physical health issues.

The physical health issues can include a loss of strength and function, and inability to perform tasks of daily living. Mentally includes an increased risk of depression and anxiety, and rapid mood swings. This can also come with metabolic and cardiovascular health issues!

However, research has shown that you can enhance health after childbirth by emphasizing key lifestyle changes – namely revolving around exercise.

Related Article: The Effect of Exercise on Postpartum Depression 

What are the Benefits of Exercise After Pregnancy?

There are several key benefits associated with exercise after childbirth. They are categorized into physical benefits, mental benefits, and benefits for the child.

What are the Physical Benefits of Exercise After Pregnancy

Both during, and after, the entire pregnancy period, weight gain is somewhat unavoidable. However, with the associated declines in physical activity experienced during this demanding time (and often the change in diet that comes with it), it typically becomes excessive.

Fortunately, exercise has been shown to attenuate the weight regain that most women experience after giving birth. This increase in weight management can also assist in losing the unwanted weight gained during throughout the entire pregnancy period (Dewey, 1994).

This can have positive implications for cardiovascular and metabolic health, while also assisting in the treatment of gestational diseases such as gestational diabetes and hypertension (Lovelady, 1995).

Additionally, after childbirth, you also see a huge change in your abdominal musculature. Your capacity to stiffen the trunk, keep your torso erect, and stabilize the spine becomes severely inhibited.

But by commencing an appropriate postnatal exercise regime, you can return function to those muscles while also making them stronger and more resilient (Mordved, 1996).

And the result? Less likelihood of low back pain and an improved ability to function daily.

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What is the Mental Benefits of Exercise After Pregnancy?

Postpartum depression (also commonly known as ‘post-natal depression’) is a mental illness that affects women after giving birth.

Postpartum depression results in extremely strong feelings of sadness, loneliness, and anxiety after pregnancy. This often comes with associated sensations of restlessness and fatigue, and even a loss of self-worth. These feelings can last well beyond the postpartum period

In short, it’s not good.

However, partaking in exercise after childbirth causes large improvements in mood, energy levels, and depressive symptoms (Poyatos‐León, 2017), while simultaneously increasing feelings of value and self-worth (NCCMH, 2007).

While this has been hypothesized to be the result of exercise both acting as a distraction to negative thoughts and feelings, there is a reason they believe that it may also elicit positive physiological changes in the brain and hormonal system (Knapen, 2015), thus causing lasting improvement in mental health.

It is txhe perfect option to improve mental health throughout the entire postpartum period.

How Does Postnatal Exercise Impact the Child?

In conjunction with the above, there is also reason to believe that if a mother undertakes postpartum exercise, it can also have a positive impact on the child.

You see, a mother’s participation in regular exercise after childbirth has been shown to encourage regular physical activity habits in her own children well beyond the postpartum period (Fogelholm, 1999).

Although this may not sound like a big deal, promoting regular physical activity habits in children has been shown to reduce their long‐term risk for chronic disease, weight gain, heart disease, type II diabetes, and osteoporosis.

It essentially sets them up for a life of health and happiness.

Related Article: Mothering – The Good, The Bad, & The Ugly

How Does Postpartum Exercise Effect Lactation?

There has previously been reason to suggest that exercise can have a negative impact on the quality and quantity of their breast milk. Recent research has shown that these worries are for the most part unfounded.

Exercise has been shown to have absolutely zero impact on the volume of milk produced, or the macronutrient profile of the milk produced – even if it also happens to be performed in conjunction with dietary restriction (McCrory, 1999).

Similarly, it has also been shown to have no impact on the mineral composition of breast milk (Fly, 1998), which ultimately means that it is still going to be full to the brim with all the required essential vitamins and minerals no matter how often you exercise.

Finally, there are concerns that moderate to vigorous intensity physical activity during the postpartum period will result in the accumulation of lactic acid within the breastmilk itself – which was hypothesized to have a negative impact on the health of the infant.

Interestingly, there is evidence to demonstrate that this, in fact, true, with the lactic acid content of breastmilk being elevated for up to an hour after vigorous exercise (Wallace, 1994).

With this in mind it is important to note that the lactic acid itself will not exhibit any negative health effects to the infant, however, it does have the capacity to cause the milk to become ‘sour’ in taste, which could result in the infant rejecting it.

This means that it may be best to use stored breastmilk after exercise, or trying to avoid breastfeeding your child for the first hour after your exercise session.

Postpartum Exercise Recommendations Following a Normal Delivery

So, we know that postpartum exercise is good for both the mother and the child. There are few recommendations we need to adhere to before we get straight into it.

Regarding a natural birth with no complications, you will be fine to start an exercise regime consisting of light intensity walking, pelvic floor exercises, and whole body stretching, by the second stage of postpartum (Mottola, 2002).

Over the subsequent weeks, you can slowly integrate more demanding aerobic exercises of a moderate intensity into your weekly exercise routine. This can be completed on most days of the week without any significant risk of injury.

During this time, you can get back into the gym and start focusing on building up the strength of your muscle tissue. A great place to start here is with the introduction of whole-body strength exercises (such as squats, lunges, and deadlifts) and isometric core exercises (such as side planks, planks, and pallof presses).

For the first six weeks postpartum it may be best to sticking with lighter loads and using 2-3 sets of 10-15 repetitions, without exercising to muscular failure (Schoenfeld, 20100). After the six-week postpartum period, you can slowly increase the exercise intensity as you see fit.

Postpartum Exercise Recommendations Following a Caesarean Delivery

Exercise recommendations for cesarean delivery are extremely similar to those made for a natural birth, however, the time frames are going to be markedly different.

Abdominal skin, muscles, and connective tissue of the abdominal cavity are completely severed during a cesarean. There is a much lengthier time period of recovery – often lasting between 6 and 8 weeks.

With this in mind, it is often recommended that you completely avoid any formal physical activity for at least 6 weeks after the delivery. This is to allow enough time for your muscle tissue to heal and repair. Additionally, when you do return to exercise, you want to place a premium on restoring muscle strength to your abdominals (Artal, 2003).

Isometric core exercises are going make up the bulk of your training for the first couple of weeks after delivery.  Planks, bird dogs, and side planks are good core exercises. They are safe and provide the perfect method of retraining your abdominals to stabilize the spine and aid in movement (Mordved, 1996).

During this time, you can participate in a low-intensity aerobic activity and lower load strength training. I strongly recommend that you stick to using low loads during this time.

Once you feel confident in your capabilities and have restored strength and function to your abdominals, you can start to progress in intensity.

This means can add harder forms of aerobic exercise into your routine. It’s also a great time to introduce whole-body strength exercises (such as squats, lunges, and deadlifts) into your gym training sessions.

The key here is to take your time and progress slowly – remember it isn’t a race!

Take Home Message

Postpartum exercise is one of the most potent ways of recovering physical capacity after childbirth. It has positive implications for cardiovascular, metabolic, and even mental health.

It is important that you get back into it slowly and slowly add more demanding exercises into your routine gradually. Take your time and progress slowly because the primary goal is to keep you fit and healthy!

References

Dewey, Kathryn G., et al. “A randomized study of the effects of aerobic exercise by lactating women on breast-milk volume and composition.”.  New England Journal of Medicine 330.7 (1994): 449-453.

Lovelady, Cheryl A., et al. “Effects of exercise on plasma lipids and metabolism of lactating women.”. Medicine and science in sports and exercise 27.1 (1995): 22-28.

Poyatos‐León, Raquel, et al. “Effects of exercise‐based interventions on postpartum depression: A meta‐analysis of randomized controlled trials.” Birth 44.3 (2017): 200-208.

Knapen, Jan, et al. “Exercise therapy improves both mental and physical health in patients with major depression.” Disability and Rehabilitation 37.16 (2015): 1490-1495.

Fogelholm, Mikael, et al. “Parent-child relationship of physical activity patterns and obesity.” International journal of obesity 23.12 (1999): 1262.

National Collaborating Centre for Mental Health. “Antenatal and postnatal mental health: clinical management and service guidance. NICE Clinical Guideline CG45.” (2007).

McCrory, Megan A., et al. “Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance–.”.  The American journal of clinical nutrition 69.5 (1999): 959-967.

Fly, Alyce D., Katherine L. Uhlin, and Janet P. Wallace. “Major mineral concentrations in human milk do not change after maximal exercise testing.”.  The American journal of clinical nutrition 68.2 (1998): 345-349.

Mottola, Michelle F. “Exercise in the postpartum period: practical applications.” Current sports medicine reports 1.6 (2002): 362-368.

Schoenfeld, Brad. “Resistance Training during pregnancy: safe and effective program design.” Strength & Conditioning Journal 33.5 (2011): 67-75.

Artal, Raul, M. O’Toole, and American College of Obstetricians and Gynecologists. “Exercise during pregnancy and the postpartum period.” Clin Obstet Gynecol 46.2 (2003): 496-499.

Mordved, Siv, and Kari Bo. “The effect of post‐natal exercises to strengthen the pelvic floor muscles.” Acta obstetricia et gynecologica Scandinavica 75.4 (1996): 382-385.

https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2002.114

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