Navigating the ‘new normal’: what guidelines exist for postpartum return to physical activity and sport? A scoping review

Abstract

ObjectiveWomen are often advised to return to activity (RTA) as early as 6 weeks postpartum, despite undergoing significant physical, physiological and psychological changes. Our objective was to examine existing evidence and clinical practice guidelines to navigate a safe and successful RTA or return to sport (RTS) postpartum.MethodsWe searched CINAHL, Embase, Medline, PsycINFO and SPORTDiscus and included any secondary studies with recommendations or guidelines for RTA or RTS postpartum. Grey literature and primary sources were excluded. Four reviewers independently screened titles and abstracts, followed by full-text review for eligibility, with conflicts resolved by a third-party reviewer. One reviewer extracted data, which was cross-referenced by another reviewer.Results5851 studies were screened, and 33 were included in this scoping review. Most studies stated that RTS postpartum can begin once ‘medically safe’, around 6 weeks postpartum, but this term was generally left undefined. In addition, most studies recommended engaging in 150 min of moderate-vigorous physical activity per week after 6 weeks postpartum, but the type of exercise recommended was often non-specific.ConclusionA lack of consistent, evidence-based guidelines exist for RTA or RTS postpartum. Multiple evidence gaps require additional research to inform patient and activity specific guidelines for a safe and successful RTA or RTS postpartum.

What should be included in an Olympic Sports International Federations’ pregnancy and postpartum policy and guidance?

“…While research is emerging, evidence-based guidance for female athletes during pregnancy and the postpartum period is limited 11–13. As a starting point to fill this evidence gap, we present an outline of what an International Federation pregnancy and postpartum policy and/or guideline might contain for elite athletes and their support staff (table 1).…”

“…Policies should highlight the importance of psychological readiness to exercise, and it is critical that pregnant and postpartum mental health is considered more broadly, such as antenatal and postnatal depression. Exercise guidance during the postpartum period should be underpinned by current frameworks to facilitate a medically safe return-to-sport post partum 11–13. While general timeframes for return-to-sport may be provided for guidance, such timeframes must respect individual variation and the time needed for tissue healing to mitigate postpartum-specific health risks and sport-specific injury risk.…”

Increasing Health Equity for Postpartum Women Through Physical Activity

“…However, to date, a lack of research and clinical practice guidelines make it difficult for both postpartum women and healthcare providers to navigate a safe and effective return to PA postpartum. 11 These guidelines may include preparatory and prevention methods, including access to pelvic physiotherapists and exercise physiologists, who are essential to women's health both before and after childbirth to facilitate guidance and support self-efficacy for PA. [11][12][13] In addition, community and municipal organizations must embrace partnerships with recreational organizations and allied healthcare providers (eg, maternity providers, general practitioners, pelvic physiotherapists) to ensure PA programming is catered toward mothers' needs, such as offering mother and child fitness activities, childcare, and reducing membership fees when finances may be strained.…”