Postpartum Physical Activity and Sleep: Guidelines From the Canadian Society for Exercise Physiology

Women in the postpartum period have increased risk for depression, weight retention, sleep disorders, diabetes, and cardiovascular disease; however, this can be mitigated with physical activity and improved sleep. The postpartum period can be a critical window for implementing early interventions to prevent chronic disease. The Canadian Society for Exercise Physiology published guidelines regarding physical activity and sleep in the postpartum period.

In the postpartum period, all women without contraindications should engage in physical activity, which reduces symptoms of postpartum depression, anxiety, urinary incontinence, and back pain. Physical activity reduces the symptoms of postpartum depression with a number needed to treat of 8 (95% CI, 5–83) and urinary incontinence with a number needed to treat of 11 (95% CI, 7–18).

Patients should begin or return to activity within 12 weeks postpartum to improve mental health, lumbopelvic pain, and weight loss. At least 120 minutes of moderate to vigorous physical activity, such as brisk walking or cycling, should be performed over 4 or more days per week and incorporate a variety of aerobic and resistance training activities.

The Get Active Questionnaire for Postpartum​ is a self-administered screening tool that can identify patients who should seek medical guidance before performing physical activity in the first year after childbirth.

When providing postpartum activity counseling, clinicians should screen for barriers including mental health symptoms, pelvic floor and abdominal wall dysfunction, musculoskeletal pain, anemia, relative energy deficiencies, poor sleep, fear of movement, eating disorders, and issues affecting wound healing, lactation status, and social and emotional support.

Contraindications to these recommendations include severe abdominal pain, significant vaginal bleeding, postpartum cardiomyopathy, caesarean delivery with symptoms that worsen with physical activity, unstable hypertension, eating disorders, malnutrition, and excessive fatigue suggestive of anemia or low energy availability. Additional contraindications include serious medical conditions that worsen with exertion or make exercise unsafe.

Early mobilization should begin with light physical activity including gentle walking and pelvic floor therapy. Once surgical incisions or perineal tears are sufficiently healed and if vaginal bleeding (lochia) does not increase with activity, exercise should progress to moderate to vigorous intensity.