Exercise as it relates to Disease/What are the most effective exercise recommendations for promoting physical activity among postpartum mothers?

What is the background to this research?

In 2013, Emily L Mailey and Wei-Wen Hsu conducted research into exercise in postpartum mothers. The research compared how effective a postpartum mother's behaviour to exercise changes if it was conducted through structured exercise recommendations or through a generalised physical activity recommendation. Due to previous research examining mainly exercise as a general concept during the first 12 months postpartum, this research contributes to the specific exercise reschemes that can be put in place (1) in comparison to general physical activity. This study also conducts a 6-month follow-up post intervention to determine and compare if the effects were maintained (1). During the first 12 months of the transition into motherhood, evidence shows that physical activity remarkably declines (2). Other studies have backed this up showing that a high percentage of mothers who were physically active and meeting the national physical activity recommendations no longer hit this targets after giving birth (3) By understanding how we can improve the effect of behaviour towards physical activity in postpartum mothers and encouraging their engagement in physical activity provides an array of benefits including (4):

-       improved cardiovascular health,

-       improved energy levels,

-       restore muscle strength,

-       weight loss,

-       improved psychological well-being.

Due to these declines in physical activity in this population, it is critical to explore ways we can effectively promote and encourage these physical activities.

Where is the research from?

There were 79 postpartum females, who were between the 6 weeks and 12 months phase, who were assessed for eligibility of the research. These participants had to gain approval from a physician for safety reasons post childbirth. 62 of these participants were recruited from multiple sources, although mainly from a university email list. The participants were split into 2 groups; 1 group (25 participants) was the specific exercise recommendations, and 1 group (24 participants) was the general physical activity recommendations.

The authors of this research have conducted previous as well as more recent studies regarding physical activity in similar sedentary populations who aren’t meeting current national physical activity recommendations. This is their first research published relating to postpartum mothers and physical activity.

The authors of this research paper received funding from Kansas State University Small Research Grant and declared no conflicts of interest between the findings, the research, and the publication (1). This research was published in 2019 on the Journal of Health Psychology (1).

What kind of research was this?

This study implements a randomised control test, comparing the 2 groups in the effectiveness of specific exercise recommendations to general physical activity recommendations. There was no significant demographic difference between these 2 groups.

Participants indicated availability (e.g., weekends vs weekdays), and based on availability, was randomly assigned with other mothers with a similar timetable. These grouping were then randomly assigned by a random number generator into the 2 intervention groups.

What did the research involve?

All participants went through baseline measurements, which the information was gathered by an accelerometer that was worn for a week by each participant. The participants then proceeded to participate in 3 group workshops that lasted 1.5-hours across 2 months. After these 2 months, participants were given an accelerometer to wear for a week and complete questionnaires online. Once 6-months post research workshops, participants were asked to wear the accelerometer for a week and complete questionnaires online again. Both comparative groups received the same questionnaire.

I believe this methodology wasn’t the most effective approach to monitor the participants behaviour to physical activity both during the research and for the future. Due to the workshops being group ones, they had to schedule based on the maximum number of participants that could attend. It could have been more effective if a smaller group or individual methods were used, tracked by an accelerometer or smart watch, so that more session could have been conducted throughout the research period.

Limitations in this methodology is the quality of information gathered throughout the accelerometer in the weeks post workshop period as they could conduct more than their normal physical activity to give dishonourable data. This trustworthiness is also a factor to consider in the online questionnaires.

What were the basic results?

The participants showed a significant increase in short-term physical activity post research workshop sessions. The generalised physical activity group showed an increase in their physical activity maintenance in their accelerometer information both in the first week post workshops and 6 months later.

The authors interpreted this result was due to the participants in the generalised group having more enjoyment in the activities as they were given the opportunity to participant in their preferred physical activities.

The authors mainly emphasis on how this research paper is just a baseline for further research into this topic. Due to this paper being one of the first to get into specifics of exercising in postpartum mothers, results and discussion mainly reflect on how they can improve and reduce limitation and decrease potential errors in data.

What conclusions can we take from this research?

Based on these findings, we can conclude that allowing participants to engage in physical activity that they genuinely enjoy and want to participant is a great way to encourage physical activity in postpartum mothers (5). Postpartum mothers have many barriers in their life both physically and psychologically, therefore regaining the confidence and motivation to participate in physical activity that they enjoy will be the best step to a positive long-term outcome (6, 7).

The specific exercise recommendation group should be an effective way to introduce physical activity as a beginning phase, as the gradual return to activity can be programmed and factored in. Sedentary populations have found success in this progressive programming for increasing physical activity (8), so if it could be used as a starter program to then integrate into general physical activity may be a beneficial approach.

Practical advice

Although general physical activity was successful in promoting exercise compared to a more specific approach, the research paper didn’t disclose any specific exercises or how to conduct them. Due to no specifics of return to physical activity post childbirth, consulting a doctor before exercising is highly recommended for clearance and guidance. Consulting an exercise physiologist is another great way to return safely to physical activity.

Further information/resources

For further information regarding postpartum exercise, see resources below:

- https://www.pregnancybirthbaby.org.au/safe-return-to-exercise-after-pregnancy

- https://www.acog.org/womens-health/faqs/exercise-after-pregnancy

For further information regarding health professionals and guidance, see resources below:

- https://epexercisephysiology.com.au/postnatal-strong/

- https://www.pregnancybirthbaby.org.au/your-body-after-having-a-baby

References

1. Mailey E, Hsu W. Is a general or specific exercise recommendation more effective for promoting physical activity among postpartum mothers?. Journal of Health Psychology. 2017;24(7):964-978.

2. Bellows-Riecken K, Rhodes R. A birth of inactivity? A review of physical activity and parenthood. Preventive Medicine. 2008;46(2):99-110.

3. Albright C, Maddock J, Nigg C. Increasing physical activity in postpartum multiethnic women in Hawaii: results from a pilot study. BMC Women's Health. 2009;9(1).

4. Larson-Meyer D. Effect of Postpartum Exercise on Mothers and their Offspring: A Review of the Literature. Obesity Research. 2002;10(8):841-853.

5. Segar M, Richardson C. Prescribing Pleasure and Meaning. American Journal of Preventive Medicine. 2014;47(6):838-841.

6. Ingledew D, Markland D. The role of motives in exercise participation†. Psychology & Health. 2008;23(7):807-828.

7. Kwan B, Bryan A. Affective response to exercise as a component of exercise motivation: Attitudes, norms, self-efficacy, and temporal stability of intentions. Psychology of Sport and Exercise. 2010;11(1):71-79.

8. Ashe M, Winters M, Hoppmann C, Dawes M, Gardiner P, Giangregorio L et al. “Not just another walking program”: Everyday Activity Supports You (EASY) model—a randomized pilot study for a parallel randomized controlled trial. Pilot and Feasibility Studies. 2015;1(1).