new guideline for postpartum moms validates challenges and benefits of exercise
6 minute read
postpartum women need evidence-backed guidance for starting physical actively safely. the new guideline helps individuals, healthcare providers and exercise professionals develop custom programs.
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this article was produced by the healthing editorial team with the support of a grant from canadian society for exercise physiology. while the csep made the production of this article possible, they did not have any editorial influence or control over the content, including review prior to publication.
there’s so much excitement leading up to the birth of a baby, but what happens to moms afterward hasn’t been a focus of research or support. but it should be. the reality is that the postpartum period is a vulnerable time of life. routines fly out the window as the demands of childcare outweigh the critical self-care mothers need when they are sleep-deprived, sedentary and often lonely, struggling to keep it together.
a statistics canada survey found that 23 per cent of mothers in 2018 who recently gave birth reported feelings consistent with postpartum depression or an anxiety disorder. of note, postpartum depression is different from the “baby blues” because symptoms are more intense and last longer. a 2020 study in the canadian journal of public health estimated that postpartum depression affected 17.9 per cent of new moms, while 13.8 per cent experienced postpartum anxiety. factors such as younger age, indigenous or immigrant status, low income and a lack of social support were linked to higher rates.
postpartum almost a ‘forgotten period’
“when we talk about women’s health research, it’s extremely understudied. when we talk about pregnancy and postpartum, we know that’s understudied. but postpartum, especially, is almost this forgotten period up until recently,” says dr. margie davenport, a university of alberta professor and researcher who leads the program for pregnancy and postpartum health. the postpartum period is the full year after the baby comes.
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“we have started to recognize that it’s a unique transitional point in a woman’s life and that it’s extremely important for not only the mother’s health, but also the baby’s health and family’s health as well.”
why? new moms can face an onslaught of issues—depression, relentless fatigue, lack of sleep, pelvic floor trauma and often little support. the physical and mental strain leads to prolonged inactivity, preventable health issues and poorer quality of life.
with all the benefits of exercise well-documented, starting to be physically active in the postpartum period, at your own pace, can help improve health and well-being. but here’s the hurdle: healthcare providers may be unsure about recommending exercise without knowing what’s appropriate. and postpartum women can be uncertain about what is safe or where to start.
there’s a gap in care that leaves something as foundational as movement underutilized.
how and when to exercise after childbirth
“women are going to have a different point in their postpartum recovery where they are ready to be active. that might be very early on postpartum, and for others, that might be quite late postpartum. individualization is really key. what we’ve had previously is that most women were told that they needed to get medical clearance at six weeks postpartum. it works for some people, not for others.”
davenport’s research program examines the benefits of exercise prior to, during and following pregnancy for both mother and child. she’s worked in the field for 20 years and led the development of a new landmark resource in partnership with the canadian society for exercise physiology: the 2025 canadian guideline for physical activity, sedentary behaviour and sleep throughout the first year postpartum.
the guideline, designed for postpartum women, healthcare providers and exercise professionals, validates the postpartum experience, providing practical, individualized recommendations and ensuring safety through the introduction of a physical activity prescreening questionnaire for this population that is self-administered. the get active questionnaire is designed to be completed when the woman is ready to engage in postpartum physical activity, empowering women to make decisions about their health.
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“for a very long time, we only had basic guidance that physical activity could be combined with breastfeeding and encouraging that engaging in pelvic floor muscle training would help prevent or treat urinary incontinence. so that doesn’t give a lot of information in terms of supporting postpartum physical activity. we know that there’s a lot of questions, concerns about how and when to be able to be physically active. it was well past time to provide women with the guidance that they’ve been asking for for so long.”
the postpartum women themselves were at the forefront of the development of the guideline, where research began with consulting several hundred postpartum women, as well as healthcare providers, to hear the feedback about what was most important to postpartum women. beyond safe physical activity, they wanted to know about the impact on mental health and information on supports for sleep. based on their feedback and opinion from an expert panel, researchers surveyed more than 19,000 research abstracts and titles and synthesized all the information into seven systematic reviews and meta-analyses.
“we were synthesizing all available literature to be able to answer the questions that the women actually had,” she explains, noting the growing research on movement behaviours that also include sitting time and sleep.
physical activity reduces risk of depression, type 2 diabetes and urinary incontinence
the results of the systematic reviews demonstrated that being physically active postpartum was associated with a 45 per cent reduction in the odds of depression, 28 per cent reduction in the risk of developing type 2 diabetes and 37 per cent reduction in the risk of urinary incontinence. they also noted reduced symptom severity of anxiety, depression and lower back and pelvic pain.
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“importantly, we also found reduction in fatigue and improved sleep overall. we also did not identify adverse effects, so we didn’t see that there was an increased risk of injury, that there was an impact on breast milk volume or quality or composition. so these are all really important findings demonstrating that physical activity is quite safe. it’s extremely beneficial in the postpartum period.”
some women are ready to be active early on after delivery, while others need a lot more time. the guideline strongly emphasizes the importance of individualization, reflecting that everyone’s postpartum experience is going to be quite different. the emphasis is on building foundations for early movement, davenport says. “so that’s not getting up and going for a run the day after delivery. that is not being afraid to get up out of bed and just go and move your body in a way that feels okay to you, whether that’s sort of shuffling to the kitchen or if it’s getting outside to the sunshine.”
she also stresses that the new guideline offers more than just exercise advice but addresses the need for robust social support to be able to engage in physical activity. for example, women may need help to take care of the baby in the middle of the night so that they can sleep a little bit longer, or someone to join them to go for a walk so that they feel supported and have that social interaction.
“they want the recognition that this can be a challenging, vulnerable period in their life where they do need extra support.”
stepping into a new phase of life
davenport says that the need for postpartum care isn’t about women “bouncing back” to the body and capabilities they had before childbirth. “rather, it’s stepping forward into a new phase of your life,” she explains. “also, from a societal perspective, we want to move away from this idea that postpartum is some sort of vacation where women are expected to do it all.”
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as well, moms take parental leave and pause career plans during this period, going on to typically become the primary caregivers in the household. the shift in family dynamics can aggravate postpartum symptoms.
davenport is excited to see the guidelines released and also published in the prestigious british journal of sports medicine. she calls the guideline the most comprehensive scientific document of its kind that brings an international consensus—a first—on safety for physical activity postpartum. (most postpartum guidelines around the world are embedded in pregnancy guidelines.) international experts in guideline development were consulted for this dedicated postpartum guideline for canadians.
now the focus is on getting the guideline out to the public so it will be used to empower postpartum women, healthcare providers and qualified exercise professionals to understand evidence-based recommendations for physical activity postpartum.
“i’m proud that we were able to begin to provide the guidance that women wanted and incorporate their voices in it as well,” davenport adds. “it allows them to understand what is recommended and what is not recommended postpartum, so that they can make decisions about their health.”
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