This document summarizes international guidelines for physical activity following pregnancy from 6 sources: Australia, Canada, Norway, United Kingdom, and two from the United States. All guidelines embedded physical activity recommendations within pregnancy guidelines. They identified benefits like improved mood and fitness. Guidelines agreed that moderate physical activity does not negatively impact breastfeeding. They provided general timing for resuming activity and mentioned aerobic exercise, pelvic floor exercises, and walking. However, guidelines lacked specificity around exercise prescriptions and did not discuss sedentary behavior.
Pushing it up the Agenda: Promoting the Importance of Physical Activity amongst Pregnant Women by Smith R Examines in Physical Medicine and Rehabilitation
Dr Anna Campbell's keynote speech 'The Importance of Staying Active after a Cancer Diagnosis' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.
Knowledge, Attitude and Practices of Expectant Mothers on Physical Activity A...ijtsrd
Pregnancy is often considered a crucial and complete metamorphic stage in a woman life. Undoubtedly as you continue your pregnancy, you will have numerous questions about various aspects of having a healthy and safe pregnancy. Being physically active during pregnancy contributes significantly towards the health and wellbeing of the mother as well as the child. The aim of the current study is understand the knowledge, attitude and practices of expectant mothers towards physical activity in pregnancy. A total of 100 expectant mothers in the third trimester, 50 of government hospital and 50 of private hospitals, were selected from different maternity hospitals across the city, Hyderabad, through random sampling. The data was collected through self administered questionnaires. Data compilation was done using Microsoft excel version 2010 and statistically analysed using chi square test. The results revealed that while majority of the expectant mothers from both the hospital settings agreed that physical activity is important during pregnancy, they reported decrease in physical activity following pregnancy which may be attributed to various reasons like the lack of advice from health care providers regarding physical activity majorly among the government hospital women and reported barriers like fatigue and pregnancy discomfort, lack of time and fear regarding the safety of physical activity during pregnancy. It was observed that greater number of expectant mothers of the government hospital performed adequate physical activity when compared to their counterparts. Thus, the study concludes that although there was no statistically significant difference in knowledge regarding the guidelines for physical activity in pregnancy yet the expectant mothers of government hospitals were more physically active than that of expectant mothers of the private hospital. Anam Fatima | Dr. P. Ashlesha ""Knowledge, Attitude and Practices of Expectant Mothers on Physical Activity - A Comparative Study"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-4 , June 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23745.pdf
Paper URL: https://www.ijtsrd.com/medicine/gynecology/23745/knowledge-attitude-and-practices-of-expectant-mothers-on-physical-activity---a-comparative-study/anam-fatima
Effect of Maternal Physical Activity on Pregnancy and Birthing OutcomesKimberly Rooker
A meta-analysis of assessed maternal and fetal responses to exercise in regards to pregnancy and birthing outcomes; possible risks and benefits of exercise during pregnancy; and current recommendations for exercise during pregnancy.
Healthise health information shares yogaand braininjurie gmbeditv1AmitaShourie
Healthise.com shares about a study of yoga and brain injury. This pilot study was designed to identify the potential benefits of breath-focused yoga on respiratory, physical and psychological functioning for adults with severe traumatic brain injury (TBI). Participants: Ten individuals with severe TBI, who self-selected to attend weekly yoga classes, and 4 no treatment controls were evaluated. Methods: Participants were assessed at pre-treatment baseline and at 3-month intervals for a total of 4 time points. Outcomes of interest included observed exhale strength, ability to hold a breath or a tone, breathing rate, counted breaths (inhale and exhale), and heart rate, as well as self-reported physical and psychological well-being.
Strength training is not just for bodybuilding anymore. There is so much more to it than pure appearance aspect. Anyone who is serious about getting more life out of their years should seriously consider engaging in the safe strength training routine.
Most strength training methods, as practiced in the 'box gyms', are not very safe, are time consuming and not necessarily health improving. This presentation talks about a 30,000 foot view of some of the key quality of life, health, fitness and appearance benefits safe strength training has to offer. In addition, it highlights some key aspects of how it could be practiced safely and suitably.
Hospital Acquired Deconditioning in Older AdultsChris Hattersley
Evidence based information on hospital acquired deconditioning in older adults, links to any studies referenced are included in the notes section of the presentation slides.
Pushing it up the Agenda: Promoting the Importance of Physical Activity amongst Pregnant Women by Smith R Examines in Physical Medicine and Rehabilitation
Dr Anna Campbell's keynote speech 'The Importance of Staying Active after a Cancer Diagnosis' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.
Knowledge, Attitude and Practices of Expectant Mothers on Physical Activity A...ijtsrd
Pregnancy is often considered a crucial and complete metamorphic stage in a woman life. Undoubtedly as you continue your pregnancy, you will have numerous questions about various aspects of having a healthy and safe pregnancy. Being physically active during pregnancy contributes significantly towards the health and wellbeing of the mother as well as the child. The aim of the current study is understand the knowledge, attitude and practices of expectant mothers towards physical activity in pregnancy. A total of 100 expectant mothers in the third trimester, 50 of government hospital and 50 of private hospitals, were selected from different maternity hospitals across the city, Hyderabad, through random sampling. The data was collected through self administered questionnaires. Data compilation was done using Microsoft excel version 2010 and statistically analysed using chi square test. The results revealed that while majority of the expectant mothers from both the hospital settings agreed that physical activity is important during pregnancy, they reported decrease in physical activity following pregnancy which may be attributed to various reasons like the lack of advice from health care providers regarding physical activity majorly among the government hospital women and reported barriers like fatigue and pregnancy discomfort, lack of time and fear regarding the safety of physical activity during pregnancy. It was observed that greater number of expectant mothers of the government hospital performed adequate physical activity when compared to their counterparts. Thus, the study concludes that although there was no statistically significant difference in knowledge regarding the guidelines for physical activity in pregnancy yet the expectant mothers of government hospitals were more physically active than that of expectant mothers of the private hospital. Anam Fatima | Dr. P. Ashlesha ""Knowledge, Attitude and Practices of Expectant Mothers on Physical Activity - A Comparative Study"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-4 , June 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23745.pdf
Paper URL: https://www.ijtsrd.com/medicine/gynecology/23745/knowledge-attitude-and-practices-of-expectant-mothers-on-physical-activity---a-comparative-study/anam-fatima
Effect of Maternal Physical Activity on Pregnancy and Birthing OutcomesKimberly Rooker
A meta-analysis of assessed maternal and fetal responses to exercise in regards to pregnancy and birthing outcomes; possible risks and benefits of exercise during pregnancy; and current recommendations for exercise during pregnancy.
Healthise health information shares yogaand braininjurie gmbeditv1AmitaShourie
Healthise.com shares about a study of yoga and brain injury. This pilot study was designed to identify the potential benefits of breath-focused yoga on respiratory, physical and psychological functioning for adults with severe traumatic brain injury (TBI). Participants: Ten individuals with severe TBI, who self-selected to attend weekly yoga classes, and 4 no treatment controls were evaluated. Methods: Participants were assessed at pre-treatment baseline and at 3-month intervals for a total of 4 time points. Outcomes of interest included observed exhale strength, ability to hold a breath or a tone, breathing rate, counted breaths (inhale and exhale), and heart rate, as well as self-reported physical and psychological well-being.
Strength training is not just for bodybuilding anymore. There is so much more to it than pure appearance aspect. Anyone who is serious about getting more life out of their years should seriously consider engaging in the safe strength training routine.
Most strength training methods, as practiced in the 'box gyms', are not very safe, are time consuming and not necessarily health improving. This presentation talks about a 30,000 foot view of some of the key quality of life, health, fitness and appearance benefits safe strength training has to offer. In addition, it highlights some key aspects of how it could be practiced safely and suitably.
Hospital Acquired Deconditioning in Older AdultsChris Hattersley
Evidence based information on hospital acquired deconditioning in older adults, links to any studies referenced are included in the notes section of the presentation slides.
Since then there has been a dramatic change in how doctors and scientists perceive exercise during pregnancy.
Exercise is now thought to be great for the mother and the unborn child.
Physical Activity during Pregnancy and the Effect on Mothers and Fet.docxmattjtoni51554
Physical Activity during Pregnancy and the Effect on Mothers and Fetal Health
Abstract
1.2 Introduction:
Physical activity is an essential role that all people should engaged, aerobic and muscle strength exercises are an easy to do where the benefits of it are great, prevention, treatment of disease and keeping fit in all stage of life even in pregnancy period and this exercises can be modify to suit physical condition of the pregnant womens
Pregnancy is a blessing from Allah that every woman wishes. Pregnancy it’s condition that many changes it happened on women bodies from the day of fertilization to the day after delivery of the baby and the popular effect in women bodies it’s the increment of body weight, as it's known that many women they didn’t control them weight and they become overweight or obese, in this condition the pregnant woman she will be in danger, many diseases start with increase of the body weight and it may lead to a serious health problems. Without controlling the body weight increment, woman with a normal weight it may become an overweight or even obese.
In general overweight and obesity one of prevalence public issue that affect many countries in the world where it’s observe in all ages, adults, adolescents, and children it maybe became a global epidemic , the impact of this issue has a strong relationship with mortality and morbidity also this relationship have been known for more than 2000 between health professionals[1-2]. body mass index (BMI) is the way that give a right measurement for the total body fat compare with body weight, the method for calculation by determining the body weight in kilogram and divide it by height in meter squared, this way determine the degree of overweight easy with a reliable number.
There are interventions that can control the body weight before pregnancy period, during pregnancy period and after it, but the most important intervention that we will cover it’s the physical activity or exercise and the advantages for this intervention on the mother health and the outcome also the disadvantages that it can happen if available.
Physical activity and exercise has a great impact on health status, where there are many study done to prove this relation. where health outcome in people with physical inactivity is a major problem in the world and specially in developed countries. In worldwide physical inactivity appear in a huge number where one out of every five adults is physically inactive and the long period of sitting independent show that is a risk factor for mortality[3]
The healthy body weight in pregnancy it depends on the body mass index (BMI) so the WHO classify the BMI into four categories underweight: <18.5 kg/m2, normal weight: 18.5-24.99 kg/m2, overweight: 25-29.9 kg/m2, and obese ≥30 kg/m2 [4-5]. With this category, recognizing every case will be easy and right grouping will be more accurate.
all pregnant women are included in all age and different country.
The roles of Physical Activity, including exercise, in improvement of fitness and health, and prevention and treatment of many health conditions have been well recognized. Physical inactivity has been identified by the World Health Organization as one of the major risks of mortality [1]. Based on the evidence from research and professional practice, governments and professional bodies have published guidelines for adequate levels of physical activity in daily life [2-4]. American College of Sports Medicine (ACSM) and American Medical Association (AMA) jointly introduced the concept of “Exercise is Medicine” in 2007, encouraging primary care physicians and other health care providers to include physical activity as a standard part of medical treatment and patient care [5]. The concept and practice of “Exercise is Medicine” have been adopted in more than 30 countries globally.
Research process | Meta-analysis research | Systematic review and meta-analysisPubrica
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4th year medical students initiate a quality improvement project for health care providers. Be sure to visit http://wp.me/p4V1Uc-sb for the pre and post test and more information.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ocular injury ppt Upendra pal optometrist upums saifai etawah
physical activity and pregnancy
1. Summary of International Guidelines for Physical Activity
Following Pregnancy
Kelly R. Evenson, PhD, MS, FACSM,
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina
– Chapel Hill, 137 East Franklin Street Suite 306, Chapel Hill, North Carolina 27514, United
States Phone: 919-966-4187 kelly_evenson@unc.edu
Michelle F. Mottola, PhD, FACSM,
R. Samuel McLaughlin Foundation-Exercise & Pregnancy Laboratory, School of Kinesiology,
Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of
Medicine, Children’s Health Research Institute, University of Western Ontario, London, Canada
N6A 3K7 Phone: 519-661-2111, extension 85480 mmottola@uwo.ca
Katrine M. Owe, PhD,
Norwegian Resource Centre for Women’s Health, Oslo University hospital, Rikshospitalet and
Department of Psychosomatics and Health Behaviour, National Institute of Public Health, Oslo,
Norway Phone: +47 916 83 023 owekam@outlook.com
Emily K. Rousham, PhD, and
School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United
Kingdom Phone: 44 (0) 1509 228812 E.K.Rousham@lboro.ac.uk
Wendy J. Brown, PhD, MSc
School of Human Movement Studies, University of Queensland, Blair Drive, St Lucia, QLD 4072,
Australia Phone: +61 (0)7 3365 6446 wbrown@hms.uq.edu.au
Abstract
Postpartum physical activity can improve mood, maintain cardiorespiratory fitness, improve
weight control, promote weight loss, and reduce depression and anxiety. This review summarizes
current guidelines for postpartum physical activity worldwide. PubMed (MedLINE) was searched
for country-specific government and clinical guidelines on physical activity following pregnancy
through the year 2013. Only the most recent guideline was included in the review. An abstraction
form facilitated extraction of key details and helped to summarize results. Six guidelines were
identified from five countries (Australia, Canada, Norway, United Kingdom, United States). All
guidelines were embedded within pregnancy-related physical activity recommendations. All
provided physical activity advice related to breastfeeding and three remarked about physical
activity following Caesarean delivery. Recommended physical activities mentioned in the
guidelines included aerobic (3/6), pelvic floor exercise (3/6), strengthening (2/6), stretching (2/6),
and walking (2/6). None of the guidelines discussed sedentary behavior. The guidelines that were
Address for Correspondence: Kelly R. Evenson, 137 East Franklin Street, Suite 306, University of NC, Gillings School of Global
Public Health, Department of Epidemiology, Chapel Hill, NC 27514, kelly_evenson@unc.edu; fax: 919-966-9800 .
Conflicts of Interest: The authors have no conflicts of interest to disclose.
NIH Public Access
Author Manuscript
Obstet Gynecol Surv. Author manuscript; available in PMC 2015 July 01.
Published in final edited form as:
Obstet Gynecol Surv. 2014 July ; 69(7): 407–414. doi:10.1097/OGX.0000000000000077.
NIH-PAAuthorManuscriptNIH-PAAuthorManuscriptNIH-PAAuthorManuscript
2. identified lacked specificity for physical activity. Greater clarity in guidelines would be more
useful to both practitioners and the women they serve. Postpartum physical activity guidelines
have the potential to assist women to initiate or resume physical activity following childbirth, so
that they can transition to meeting recommended levels of physical activity. Health care providers
have a critical role in encouraging women to be active at this time, and the availability of more
explicit guidelines may assist them to routinely include physical activity advice in their
postpartum care.
Keywords
exercise; leisure activities; postpartum; recommendations; review; strengthening
Introduction
The postpartum period is defined as the time immediately following birth and is often
without a definitive end point. However, many of the physiological and morphological
changes of pregnancy persist for four to six weeks postpartum (1). The time periods can be
divided into hospital-based (during hospital stay), immediate postpartum (hospital discharge
to six weeks postpartum), and later postpartum (six weeks to one year, corresponding to
cessation of breastfeeding). The postpartum period provides an opportunity for women to
begin or reengage in physical activity. The short-term benefits of postpartum physical
activity include improvement in mood and cardiorespiratory fitness, promotion of weight
loss, and a reduction in postpartum depression and anxiety (2, 3). Despite these benefits, the
majority of women do not resume their pre-pregnancy physical activity levels after the birth
of a baby (4).
As the early postpartum period focuses on recovering from delivery and caring for the
infant, the importance of resuming physical activity during this time is often not made clear
to women, many of whom need guidance to begin or resume physical activity (5). For
example, in a study of women at around seven weeks postpartum, almost half reported the
desire for more information about exercise, whether or not postnatal education was provided
(6). In another study among pregnant women who planned to exercise after their child’s
birth, only 15% reported that their physician discussed with them the appropriate time to
begin exercising after delivery (7). This period is therefore often a missed life course
opportunity for beginning or resuming physical activity. Previously active women who do
not resume their pre-pregnancy physical activity levels may remain inactive for many years.
For example, data from the Australian Longitudinal Study on Women’s Health show a sharp
decline in physical activity levels in the three years following the birth of a baby (8).
The World Health Organization’s guideline on physical activity recommends that adults age
18 to 64 years engage in at least 150 minutes of moderate intensity aerobic activity
throughout the week in bouts of at least 10 minutes, or at least 75 minutes of vigorous
intensity aerobic activity, or an equivalent combination of the two (9). Muscle strengthening
should be done two or more days per week. The guideline states that postpartum women
may need extra precaution and should seek medical advice before striving to achieve these
Evenson et al. Page 2
Obstet Gynecol Surv. Author manuscript; available in PMC 2015 July 01.
NIH-PAAuthorManuscriptNIH-PAAuthorManuscriptNIH-PAAuthorManuscript
3. recommendations. Country-specific postpartum physical activity guidelines inform both
health care providers and women about safe levels of physical activity during this unique
time period. The aim of this review was to identify and summarize guidelines for postpartum
physical activity from around the world.
Methods
PubMed (MedLINE) was searched for published guidelines on physical activity during the
postpartum period. The search was narrowed to peer-reviewed studies published between
1990 and 2013. In each country with guidelines, an authority was identified and served as
the expert for that guideline in this review. To narrow the scope of the review, only the most
recent country-specific public health or clinical guidelines from obstetrics, gynecology, or
sports medicine were included. Layman-oriented guidelines were excluded. A single author
reduced all extraction forms into tables that coauthors subsequently checked.
Results
Background
In total, six guidelines from five countries were identified: Australia (10, 11), Canada (12,
13), Norway (14), United Kingdom (UK) (15), and the United States (US) (1, 16) (Table 1).
The two US guidelines were coded separately and included: American College (now
Congress) of Obstetricians and Gynecologists (ACOG) (1) and the US Department of Health
and Human Services (USDHHS) (16). The guidelines were endorsed by organizations
representing obstetrics and gynecology (Australia, Canada, UK, US ACOG), public health
(Canada, Norway, USDHHS), sports medicine (Australia), and exercise physiology
(Canada).
Four guidelines were original and two represented updates from prior versions (Table 1). All
guidelines were embedded within recommendations for physical activity during pregnancy.
Most resulted from a comprehensive literature review, but only the Canadian guideline
included a comprehensive rating of scientific evidence and a quality assessment of the
evidence to support each specific recommendation. Two of the six postpartum guidelines
referred to existing physical activity guidelines for adults: Norway (published in the same
document) and the US ACOG (referred to the 2000 American College of Sports Medicine
recommendations (17)).
Benefits
All the guidelines identified the health benefits of postpartum physical activity, such as
improvements in mental health or mood (Australia, UK, USDHHS), emotional well-being
(Australia), weight loss and/or maintenance (UK, USDHHS), and cardiorespiratory fitness,
particularly if exercise was also performed during pregnancy (Australia, UK, USDHHS)
(Table 2). Three guidelines stated that postpartum physical activity also may reduce
postpartum depression (Australia, UK, US ACOG) and one stated it may reduce anxiety
(UK).
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4. Breastfeeding
All guidelines remarked on the impact of physical activity or exercise on breastfeeding
(Table 2). They suggested that sporting activities (Australia), moderate exercise (Canada,
UK), moderate physical activity (USDHHS), and moderate to vigorous physical activity
(Norway) will not negatively affect breast milk volume, as long as there is appropriate food
and fluid intake (Australia), and that these activities also do not affect composition of breast
milk or infant growth. The Canadian guideline stated that if babies do not feed well
immediately after maternal exercise then mothers should feed their baby before exercise,
postpone feeding to one hour after exercise, or express milk prior to exercising that may be
used after the activity.
Resumption of Physical Activity and Exercise
All but the USDHHS guideline recommended, at least in general terms, when physical
activity or exercise could resume during postpartum. The Canadian guideline stated that
“depending on the mode of delivery, most types of exercise can be continued or resumed in
the postpartum period” (page 520)(13), while the US ACOG guideline stated that “pre-
pregnancy routines may be resumed gradually as soon as it is physically and medically safe”
(page 173)(1). Similarly, the Australian guideline suggested that, after a normal vaginal
delivery, non-ballistic exercise could be commenced “as soon as is comfortable” (page 16).
The UK guideline recommended that if pregnancy and delivery are uncomplicated, a mild
exercise program may begin immediately; otherwise a medical caregiver should be
consulted before resuming pre-pregnancy physical activity (15). Norway’s guideline was
stricter, indicating that generally women may start exercising after the six week postpartum
clinic visit, and that self-perception was an important indicator for what kind of exercise to
engage in (14).
The Australian, Canadian, and UK guidelines considered type of delivery, and suggested
that women who experienced a cesarean should consult with their healthcare professional
about resumption of physical activity. The Australian and UK guideline implied this would
occur usually after the first postpartum visit with a healthcare provider, while the Canadian
guideline indicated that women “may slowly increase their aerobic and strength training,
depending on the level of discomfort and other complicating factors such as anemia and
wound infection” (page 520) (13). None of the guidelines specified different
recommendations for women who had a vaginal delivery but required stitches.
Exercise Prescription
Generally, exercise prescription is considered in terms of duration, frequency, intensity, and
type, but only the Canadian and USDHHS guidelines remarked with some specificity on
these domains (Table 3). The Canadian guideline recommended at least 15 minutes of
aerobic exercise three to five days/week and specified that “with the added fatigue of
delivery and newborn care, some women may need to reduce the intensity or length of their
exercise sessions” (page 520)(13). The USDHHS recommended that healthy postpartum
women who were not highly active or engaging in vigorous intensity physical activity
should obtain at least 150 minutes of moderate intensity aerobic activity spread throughout
the week. Those who were highly active could continue their physical activity into the
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5. postpartum period, provided that they remained healthy, and should discuss this issue with
their healthcare provider. The USDHHS also mentioned that during postpartum, women
should discuss with their healthcare provider how to adjust physical activity volume or
amounts. The UK guideline remarked on intensity more generally, stating that “women need
to return to pre-pregnancy exercise levels gradually, not resuming high impact too soon”
(page 6)(15).
Recommended types of activities mentioned in the guidelines included aerobic (3/6
guidelines remarked on this), pelvic floor exercise (3/6), strengthening (2/6), stretching
(2/6), and walking (2/6). The Australian guideline cautioned against activities that cause
high gravitational load on the pelvic floor (i.e., running, aerobics). Both Canada and the UK
recommended pelvic floor exercise in the immediate postpartum period in order to reduce
future urinary incontinence and the Norwegian guideline specified the importance of pelvic
floor training for women who have given birth. None of the guidelines discussed sedentary
behavior.
Discussion
In this review, we identified, summarized, and contrasted six clinical or public health
guidelines for postpartum physical activity from around the world. In general, we found that
the specific content of the guidelines varied somewhat depending on the date of publication
and target audience. However, all guidelines were brief when discussing postpartum
physical activity, particularly since each guideline primarily focused on pregnancy-related
recommendations. This lack of clarity around the issue of postpartum physical activity may
lead to inconsistent or no advice being offered by health practitioners. All the guidelines
mentioned the interaction of physical activity with breastfeeding, and supported women
doing both. Since there are separate policy statements regarding breastfeeding (example:
(18)), those guidelines could cross-reference physical activity recommendations, and clarify
key points related to the interaction of breastfeeding with physical activity.
Despite the six physical activity recommendations, many postpartum women do not meet
these guidelines (for example (19-27)). Qualitative studies indicate a number of barriers to
physical activity postpartum including physical discomfort, parenting duties, being too tired,
lack of time, not prioritizing health over other competing responsibilities, lack of spousal/
partner support, social isolation, lack of childcare, family responsibilities, financial,
neighborhood safety, and weather (28-37). Compared to the pregnancy period, postpartum
barriers to physical activity seem to focus less on health-related barriers, such as shortness of
breath and musculoskeletal issues, or on physical limitations and restrictions (35, 38). In
postpartum, time limitations become a more common barrier, perhaps particularly for first-
time mothers (35, 38, 39). With barriers to physical activity changing over time, women
may benefit from specific guidance to address the changing challenges they face during this
life stage.
Qualitative studies also indicate a number of enablers to postpartum physical activity. These
include knowing the benefits of physical activity, weight loss, social support, and returning
to work (corresponding with child care) (28, 30, 34, 35, 39). Quantitative studies confirm
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6. these findings, particularly the need for social support to facilitate postpartum physical
activity (for example (24, 29, 38-41)). Although less studied, the neighborhoods where
women live, work, or travel may also impact on physical activity behavior. The barriers and
enablers to postpartum physical activity may differ across countries, particularly for women
returning to work, since policies in this regard vary across countries.
In the literature, prospective observational studies using accelerometry have indicated that
overall and moderate intensity physical activity increase during the extended postpartum
period, however the absolute changes are quite small and time spent in sedentary behaviors
is quite large (42, 43). More intensive interventions were recommended to help postpartum
women integrate physical activity and reduce sedentary behavior. Intervention studies
starting in pregnancy and extending into postpartum, as well as those that begin during
postpartum, indicate it is possible to increase physical activity, including components of
endurance and strength, during this time period (44-57). Promising strategies include
increasing knowledge, regular counseling and support, self-monitoring with diaries and
pedometers, increasing self-efficacy, addressing barriers, referral to community resources
for physical activity, and use of walking groups. These interventions were either atheoretical
or based on the Social Cognitive Theory or the Transtheoretical Model.
Postpartum guidelines for physical activity should help women quickly achieve levels of
physical activity that are commensurate with guidelines for all adults. It would be
opportunistic for the postpartum statements to reference these adult recommendations. Of
the guidelines reviewed, only the US ACOG referenced the 2000 American College of
Sports Medicine recommendations (17) and the USDHHS guideline, which was
comprehensive for multiple groups, including postpartum women and apparently healthy
adults. To facilitate the implementation of physical activity guidelines in practice, one study
recommended that health professionals include a continued assessment of women in all
health care encounters, including well baby visits (58). Another idea is to consider the
Physical Activity Readiness Medical Examination (PARmed-X) for Pregnancy tool (59)
which provides a pre-exercise checklist for the woman to complete and a prescription for
health care providers to complete, as part of an evaluation of pregnant women who want to
start a prenatal fitness program. Use of this tool may increase adherence to the guidelines by
both providers and their patients (60, 61). A similar tool could be created for the postpartum
period; this could be introduced at hospital discharge or at the first postpartum visit with a
healthcare provider. Across the countries that have guidelines that we reviewed, it is
standard practice to conduct a postpartum visit at approximately six weeks postpartum. In
our view, this period is too long to wait for most postpartum women before resuming or
beginning a low intensity physical activity program, including walking, pelvic floor, and
abdominal muscle exercises.
Limitations
This review has several limitations. It was narrow in scope and other guidelines that met our
review criteria may not have been captured with our search efforts, particularly those not
found in PubMed. For example, the review did not include guidelines from lower income
nations, indicating either the recommendations were not captured by our search procedures
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7. or do not exist. While we abstracted information from published guidelines, some countries
created supplemental documents geared towards laypersons; these were not reviewed.
Future reviews can expand upon this work as guidelines are developed, updated, and better
accessed. Lastly, a number of terms were used in the guidelines including “physical
activity”, “exercise”, “aerobic exercise”, “aerobic activity”, and further variations with
intensity modifiers (“moderate” or “vigorous”). These inconsistencies made comparisons
across guidelines challenging. Definitions of these key terms should be provided and used
consistently. While the focus in this review was on physical activity, another important
concept to consider in the guidance documents is sedentary behavior, defined as periods of
little or no movement while awake (62, 63). It is important to note that it is possible to meet
physical activity recommendations and to also accumulate large amounts of sedentary time,
with the latter being potentially detrimental to health and well-being. This could also be
addressed in postpartum guidelines.
Conclusions
Despite these limitations, to our knowledge this review is the first to summarize and
compare guidelines for postpartum physical activity from six countries. The guidelines were
generally brief and often lacked specificity. Greater clarity in guidelines would be more
useful to both practitioners and the women they serve. The lack of specificity may also
indicate areas in need of research. To facilitate this, a critical review and synthesis of the
literature is needed to guide the development of improved postpartum physical activity
guidelines, and to identify areas where quality evidence is lacking. The review should cover
a range of physical activities, including aerobic and strengthening exercise, as well as
sedentary behavior. This evidence-based summary could stimulate more national bodies to
develop guidelines where they do not exist and promote the sharing of best practices across
countries. Postpartum physical activity guidelines have the potential to assist women to
initiate or resume physical activity following childbirth, so that they can transition to
meeting recommended levels of physical activity. Health care providers have a critical role
in encouraging women to be active at this time, and the availability of more explicit
guidelines may assist them to routinely include physical activity advice in their postpartum
care.
Acknowledgments
Funding: Kelly Evenson acknowledges support from the National Center for Research Resources and the National
Center for Advancing Translational Sciences, National Institutes of Health (NIH, #UL1TR000083), and the
University Research Council at the University of North Carolina – Chapel Hill. Michelle Mottola acknowledges
funding from the Canadian Institutes of Health Research, and endorsement from Health Canada and the Canadian
Society of Exercise Physiologists. The content is solely the responsibility of the authors and does not necessarily
represent the official views of the funding agencies.
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