Guidelines for physical activity following pregnancy
The post-partum period may be a critical period for long-term weight gain and the development of obesity for women. Physiological changes due to childbirth, may contribute to weight retention and weight gain. Compared with weight gain during other life periods, excess weight retained after childbirth, appears to be particularly harmful, as evidence suggests that weight retained in the post-partum tends to be distributed centrally, and therefore, it may increase the risk of developing chronic diseases.
Benefits and barriers of post post-partum physical activity
Post-partum interventions that target exercise may help women reach a healthy weight after giving birth and improving their overall health status. The short-term benefits of post-partum physical activity include improvement in mood and cardiorespiratory fitness, promotion of weight loss, and reduction of post-partum depression and anxiety. Despite these benefits, the majority of women do not resume their pregnancy physical activity levels, after the birth of the baby, which is attributable to the presence of many barriers to physical activity. These barriers include: physical discomfort, parenting duties, being too tired, lack of time, not prioritizing health over other competing responsibilities, lack of partner support, social isolation, lack of childcare, family responsibilities and weather conditions. Furthermore, the guidelines for physical activity following pregnancy, recommend specific types of activities (i.e. aerobic, pelvic floor exercise, strengthening, stretching, walking and abdominal muscle exercise), clarifying key points related to the interaction of breastfeeding with physical activity and do not report adverse maternal events, however often lacking specificity. In fact, exercise prescription is generally considered in terms of, frequency, intensity, time, and type (FITT).
Nonetheless, the Canadian and USDHHA guidelines, give indications that are more precise on these domains, adding specificity to the prescribed physical activity. The Canadian guidelines recommend at least 15 minutes of aerobic exercise, three to five days/week and specify that “with the added fatigue of delivery and new-born care, some women may need to reduce the intensity or length of their exercise sessions”. The USDHHS recommends that healthy post-partum women, who were not highly active or engaging in vigorous intensity physical activity before giving birth, should do at least 150 minutes of moderate intensity aerobic activity spread throughout the week. On the other hand, women who were highly active may continue their physical activity into the post-partum period, if they are healthy, and should discuss this issue with their healthcare provider.
Despite the guidelines recommendation, scientific evidence concludes that only combined nutrition and exercise intervention can achieve post-partum weight loss. For this reason, interventions have to include firstly an increasing knowledge and awareness, and health care providers have a critical role at this point, encouraging women to be active at this particular time. Secondly, interventions have to include regular counselling and support, self-monitoring with diaries and pedometers, addressing barriers, referral to community resources for physical activity, and use of some strategies such as exercise group.