Postpartum is a challenging time for mothers. Not only have they just gone through perhaps the most physically demanding challenge ever with child birth, but they must care for a baby who does not have regular sleep schedule. For fitness clients who are in the postpartum phase of motherhood, it is a challenge to maintain their fitness program. Paying attention to getting as much sleep as possible, including naps, is important. To a certain extent, re-inventing their fitness program to use lower intensity training such a yoga, and shorter work-outs such as medium intensity interval training, may be required.
- Understand how important the postpartum time is for a mother as it relates to regaining fitness.
- Describe the adverse effects of fragmented sleep for mothers.
- Explain the benefits of low intensity training for mothers who are sleep deprived.
Postpartum involves attempting to get proper rest, nutrition, and finding an exercise program our postpartum clients can tolerate (www.healthline.com). It lasts six to eight weeks. Postpartum begins when the baby is born and is a time when the Mother is recovering from childbirth and regaining her pre-pregnancy fitness (www.webmd.com).
Impact of Lack of Sleep
Newborns sleep for three to four hours at a time. Babies have fragmented sleep because they do not have their circadian rhythm yet. Circadian rhythms are physical, mental, and behavioral changes that follow a 24-hour cycle, responding primarily to light and darkness. A baby’s segmented sleep means the mother does not get continuous sleep either (www.postpartumprogress.com). New mothers lose two hours of sleep or more per night until the baby is around five months old (www.consumer.healthday.com).
Sleep deprivation is one of the most common postpartum side effects as well as one of the most disruptive to the health of the mother (www.postpartumprogress.com). Postpartum women experience physical and mental health issues because of lack of sleep. To illustrate the impact of lack of sleep, Roehrs, et al. (2003) forced 8-hour sleepers to only get 6 hours of sleep. They found that 6 hours of sleep slowed reaction time, decreased memory recall, and decreased self-rated quality of performance, same as drinking 2 - 3 beers, a level that equates to about .05% breath alcohol. Getting 4 hours of sleep impaired performance same as drinking 5 – 6 beers - a level that equates to about 0.10% breath alcohol.
Other symptoms of poor sleep, or lack of sleep include: impaired cognitive functions, difficulty performing some of the simplest tasks, and difficulty remembering things. Other common symptoms of chronic poor sleep include: irritability, high blood pressure, headaches, and muscle aches, all of which make it hard for the postpartum client to get in their regular workout.
For the postpartum mother, it is recommended to sleep when the baby sleeps. It is strongly recommended to make sleep a priority. This is to say, rather then trying to get “things done,” it is better to focus on sleep.
Benefits of Napping
Napping is a way to reduce the sleep debt caused by fragmented sleep. A planned nap is a powerful alertness strategy that can significantly increase performance and alertness. A nap of 20-minutes to 2-hours can be effective at improving physical and mental health.
Waterhouse, et al. (2007) found a nap improved performance, alertness, and accuracy on a reaction time test. After getting 4-hours of sleep at night, subjects sat quietly or took a 30-minute nap. The nappers improved mental alertness, short-term memory, accuracy in an 8-choice reaction time test, and grip strength. And they decreased sleepiness, resting heart rate, 2-meter sprint time by 0.041 seconds, and 20-meter sprint time by 0.093 seconds.
Maintaining Fitness during Postpartum
Even though high intensity interval training (HIIT) is short and effective, postpartum mothers may not tolerate the high intensity training when they are not getting enough sleep. As such, medium intensity interval training (MIIT) may be better. Tremblay, Simoneau, and Bouchard (1994) investigated the impact of exercise intensity on skinfolds and muscle metabolism by comparing moderate-intensity aerobic exercise (MIAE) and MIIT. There were two groups: 1) performed 20-weeks of MIAE by cycling 4 or 5 x/week, 30 to 45 minutes at 60% - 85% of heart rate reserve and 2) a 15-week MIIT group who performed 10 – 15/15 – 30 sec intervals then 4 - 5/60 - 90 second intervals at 60% - 70% of their maximum with a recovery heart rate being down to 120-130 beats per minute. It would be recommended to have a definite recovery time rather than heart rate. It is suggested to use 45 – 90 seconds of rest for both protocols.
The results show the MIIT group decreased sum of 6 skinfolds nine times less than MIAE program. There was also significant increase in enzymes promoting fat being used as energy for muscle contraction in the MIIT group. A MIIT program similar to Tremblay, Simoneau, and Bouchard (1994) may be well-tolerated by postpartum mothers.
Yoga and Pilates might be better tolerated by sleep deprived postpartum clients. Ko, et al. (2013) studied the effectiveness of a yoga and Pilates program for postpartum women to lose weight and reduce fatigue and depression. The women performed Yoga/Pilates once a week for three months, 60 minutes per session. No difference was found for fatigue, but women in the high-score group showed a significant decrease in depression. There were also significant reductions in the subjects’ body weight, body fat percentage, and fat mass.
Considering how poorly the body functions with chronic lack of sleep, it is important to work with postpartum clients to find the exercise that is best tolerated and will not leave them exhausted. Consideration must be given to the fact that stress and lack of sleep increases the production of cortisol, which can increase the risk for muscle and tendon injuries (Van Cauter, et al., www.medscape.org).
Ko, Y. L., et al., (2013) Community-based postpartum exercise program. Journal of Clinical Nursing, 22(15-16):2122-2131
Roehrs, T. et al., (2003) Ethanol and sleep loss: a “dose” comparison of impairing effects, Sleep, 26(8), 981-985
Tremblay, A., Simoneau, J.A., and Bouchard, C. (1994) Impact of Exercise Intensity on Body Fatness and Skeletal Muscle Metabolism. Metabolism 43(7): 814–818.
Van Cauter, E. et al., The Impact of Sleep Deprivation on Hormones and Metabolism https://www.medscape.org/viewarticle/502825), Retrieved August 1, 2018.
Waterhouse, et al., (2007) The role of a short post-lunch nap in improving cognitive, motor, and sprint performance in participants with partial sleep deprivation. Journal of Sports Sciences. 25(14):1557-66.
https://www.webmd.com/parenting/baby/features/postpartum-problems, Retrieved July 21, 2018.
http://www.postpartumprogress.com/dealing-postpartum-sleep-deprivation), Retrieved July 29, 2018
http://www.postpartumprogress.com/dealing-postpartum-sleep-deprivation, Retrieved July, 24, 2018.
https://consumer.healthday.com/encyclopedia/parenting-31/parenting-health-news-525/sleep-deprivation-and-new-parents-643886.html, Retrieved, July 23, 2018.