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Post natal – Obesity and Post natal PA

Obesity and post natal physical activity  

Evidence summary  

There is moderate quality evidence to suggest that a combination of physical activity and diet intervention in the post natal period is the optimal combination to promote postpartum weight loss (1)(2)(3)(4)(5)(6).  

An Evidence Review of systematic reviews and meta-analysis found postpartum combined diet and physical activity reduced postpartum weight retention in women of any BMI (−2.57 to−2.3 kg) or with overweight/obesity (−3.6 to−1.22kg)(5).  

Programmes including supervision (7), individualised support (8) or those that have objectively defined goals, such as the use of heart rate monitors or pedometer are more likely to be successful in promoting healthy post-partum weight (2).   

Short term interventions (10 – 16 weeks in duration) have more favourable results compared to long term interventions (24, 36 and 52weeks duration) (2)(9).  

There is inconclusive evidence regarding the positive effects of post-partum physical activity when used alone (8,10–12).  

There is weak evidence that the type of exercise may be influential; postpartum women who gained lean soft tissue reported engaging in moderate to vigorous physical activities at 3 and 9months post-partum (not significant) (13).  

Multi-component approaches including a balanced diet with low glycaemic load and light to moderate intensity physical activity, 30–60 min per day 3–5 days per week, should be recommended during the postpartum period (5).  

Quality of evidence  

Grade B – There is evidence from RCTs that Physical activity in conjunction with dietary interventions can positively affect post-partum weight loss. However, there are some inconsistencies amongst findings and concerns regarding quality of studies.   

Strength of recommendation  

Grade 2 – Limited number of studies looking at subset populations.   

Conclusion  

Interventions that include diet and physical activity along with individualised support, self-monitoring and supervision are more likely to be successful in promoting postpartum weight loss. RCT’s of exercise-only interventions are currently limited and therefore it is difficult to draw meaningful conclusions about the best ways to engage postpartum women in physical activity. Further robust RCT’s are needed in this field.    

References   

  1. Van derPligt, P., et al. “Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth.” Obesity reviews 14.10 (2013): 792-805.  
  2. Nascimento, S. L., et al. “The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis.” International Journal of Obesity38.5 (2014): 626. 
  3. Lim, S., et al. “Effective strategies for weight loss in post‐partum women: a systematic review and meta‐analysis.” Obesity reviews 16.11 (2015): 972-987. 
  4. Adegboye, Amanda R. Amorim, and Yvonne M. Linne. “Diet or exercise, or both, for weight reduction in women after childbirth.” Cochrane Database of Systematic Reviews 7 (2013).  
  5. Farpour-Lambert, Nathalie Jacqueline, et al. “Obesity and Weight Gain in Pregnancy and Postpartum:an Evidence Review of Lifestyle Interventions to Inform Maternal and Child Health Policies.” Frontiers in endocrinology 9 (2018): 546.   
  6. Dodd, J. M.,Deussen, A. R.,O’brien, C. M., Schoenaker, D. A., Poprzeczny, A., Gordon, A., & Phelan, S. (2018). Targeting the postpartum period to promote weight loss: a systematic review and meta-analysis. Nutrition reviews, 76(8), 639-654.   
  7. The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and meta-analysis of randomized controlled trials. Preventive medicine, 56(6), 351-364. A systematic review and meta-analysis of randomized controlled trials. 
  8. McKinley, M. C., Allen-Walker, V.,McGirr, C., Rooney, C., & Woodside, J. V. (2018). Weight loss after pregnancy: challenges and opportunities. Nutrition research reviews, 31(2), 225-238.  
  9. Lifestyle Interventions in Overweight and Obese Pregnant or Postpartum Women for Postpartum Weight Management: A Systematic Review of the Literature. 
  10. Tripette, Julien, et al. “Home-based active video games to promote weight loss during the postpartum period.” Medicine & Science in Sports & Exercise 46.3 (2014): 472-478.  
  11. Lee, A. S., McInnes, R. J., Hughes, A. R., Guthrie, W., & Jepson, R. (2016). The effect of the more active mums instirlingtrial on body composition and psychological well-being among postnatal women. Journal of pregnancy, 2016.   
  12. Systematic review of the effect of individual and combined nutrition and exercise interventions on weight, adiposity and metabolic outcomes after delivery: evidence for developingbehaviouralguidelines for post-partum weight control.   
  13. Elliott, S. A., Pereira, L. C.,McCargar, L. J., Prado, C. M., Bell, R. C., & ENRICH Study Team. (2018). Trajectory and determinants of change in lean soft tissue over the postpartum period. British Journal of Nutrition, 1-9.