The world’s first stand-alone guideline on exercise and sleep for new mothers has been released in Canada, providing evidence-based recommendations that support women’s health in their first year after giving birth.
“It is only fairly recently that we have started to recognize that the postpartum period is far more complex than simply transitioning from pregnancy to not being pregnant,” says Margie Davenport, a professor in the Faculty of Kinesiology, Sport, and Recreation who led the development of the new guideline. “There are unique considerations, whether it’s recovery from a caesarean section, mental health or barriers such as lack of sleep.”
Postpartum women who follow the recommendations will likely experience a reduction in fatigue as well as improvements in mental well-being, pelvic floor health, musculoskeletal health and cardiometabolic health, according to the guideline. The guide also highlights that early mobilization — light-intensity activity soon after giving birth — has been shown to help with healing.
The guideline recommends that women engage in at least 120 minutes per week of moderate to vigorous intensity physical activity to gain the most health benefits, including better quality sleep and improved mental health. Those who engage in this kind of physical activity in the initial 12 weeks after giving birth also have a 45 per cent reduction in the risk of depression, notes Davenport.
The experts who compiled the guideline also developed the Get Active Questionnaire for Postpartum, a screening tool women can use to find out whether they have any medical conditions that may warrant additional guidance from their health-care provider before they begin or continue with physical activity postpartum.
“It’s really designed as an evidence-based tool to empower women to feel comfortable engaging in physical activity,” says Davenport, who also holds the Christenson Professorship in Active Healthy Living and serves as director of the Program for Pregnancy and Postpartum Health.
In addition to physical activity, the guideline also covers sleep and its role in maternal health. “We know poor-quality sleep is associated with an increased risk of depression, cardiovascular disease and Type 2 diabetes, so it’s really important that we see if there are any potential supports to help improve sleep quality.”
A newborn’s sleep schedule means that getting uninterrupted stretches of sleep is nearly impossible for new moms. However, the guideline identifies a few areas that could help. For example, it recommends adopting a healthy sleep hygiene routine, such as avoiding screen time before bed, and familiarizing yourself with infant sleep strategies like establishing a bedtime routine and maintaining a consistent bedtime.
Experts also found that engaging in physical activity led to reduced levels of fatigue as well as higher-quality sleep. “You may not sleep longer, you may still have fragmented sleep, but when you do sleep, you sleep better,” says Davenport.
The guideline also recommends that women do daily pelvic floor muscle training to reduce the risk of urinary incontinence, and clarifies that engaging in physical activity does not have any adverse effects on breast milk quality or supply.
As Davenport explains, the previous recommendations for physical activity postpartum were embedded in the pregnancy guideline crafted in 2003 and hadn’t been updated since, making this new guideline a much-needed resource. The development of the guideline was supported by the Canadian Society for Exercise Physiology.
Researchers followed the “gold standard methodology” to create the postpartum guideline, and in addition to drawing on their expertise in the field, they consulted with postpartum women and their health-care providers during the development process.
“That’s one of the key differences with this type of guideline,” says Davenport. “It’s not just coming from expert opinion. It is evidence-based but it was driven by what postpartum women actually wanted to know.”
And though the recommendations themselves didn’t change because of the consultations, the language used in the guideline did, emphasizing the integral role physical, mental and emotional support plays in the postpartum period.
“We adapted the recommendations to make the guideline accessible to people who are reading it and to reflect the reality of postpartum, which is that if you don’t have support, none of this is really possible.”
The around-the-clock nature of feeding and caring for a new baby can make adhering to the recommendations challenging, so it’s also important not to take an all-or-nothing approach, says Davenport, something that is expressed throughout the guideline.
“Every minute counts and every small change will help.”
The guideline was published in a special issue of the British Journal of Sports Medicine alongside seven systematic reviews and meta-analysis of research on exercise in the postpartum period, compiled by Faculty of Kinesiology, Sport, and Recreation students. Davenport is a member of the Women and Children’s Health Research Institute.