Introduction

Two definitions to keep in mind throughout this article are:

• Anxiety – anxiety is defined as a continuous fear or worry of a situation that can’t be controlled
• Post-partum – post-partum is defined as an early motherhood period up to one year after delivery

During the post-partum period, symptoms can range from physical problems to mental health issues. For example, anxiety disorders are common and problematic.¹ People assigned female at birth (AFAB) are vulnerable to developing anxiety disorders during the postpartum period due to their perception of their postpartum weight gain. 

Some research evidence also suggests mood disturbances are due to sudden hormonal changes which in turn show alterations in immune responses during pregnancy or postnatal period. These psychiatric disorders not only affect social behaviour but also affect the child’s development and the functioning of the family. 

85% of new mothers experience mood disturbances throughout their postpartum period. The research authors reported that first-time mothers are at higher risk for anxiety, which in the worst cases may lead to hospitalisations.² 

Despite many psychological and pharmacological treatments, exercise interventions are the best therapeutic option for anxiety and have many positive effects on the brain, muscles, bones and heart with no side effects. Exercise can be defined as planned, structured, and repetitive movements to improve physical fitness.³

Definition of postpartum anxiety

Anxiety describes feelings of excessive stress or dread concerning an event or situation. This feeling may be difficult to control and may take some time to overcome. Post-partum anxiety, to be specific, may occur at any time after delivery and has been attributed to d a decrease in hormone levels after the birth of the child. 

Some studies also suggest that there may be an increased risk of being diagnosed with postpartum anxiety as a result of self-perceptions towards gestational weight gain.⁴

Doctors should emphasise the importance of social support to new mothers, fathers or families as a preventive measure for postpartum anxiety. Anxiety differs from depression and necessitates assessments to identify whether the individual’s symptoms point towards anxiety, depression or both. This distinction is important not only for accurate diagnosis but also for preventing comorbidities.⁵

Importance of addressing postpartum anxiety

The postnatal period is critical in the relationship building of mother and child. If anxiety is not managed appropriately, it may lead to an escalation of issues and tragedies. One example is suicide. 20% of postnatal deaths are by suicide.⁶

Postpartum anxiety not only affects mothers but also affects the long-term development of the newborn into adulthood. Therefore it is crucial to identify vulnerable AFAB individuals who are at risk of anxiety.

Exercise an anti-anxiety therapy for postpartum mothers

Exercise energises your body. However, postpartum mothers who are suffering from anxiety disorders possess lower self-esteem and may find exercising a challenging task to initiate.    Therefore, motivation and support will need to be provided by healthcare professionals and mental health professionals to ensure they engage in exercise regularly.  

Studies have shown that physical activity and exercise are attributed to the release of neurotransmitters which play an important role in preventing stress and reducing anxiety. Exercise interventions such as aerobic and resistance exercises are useful in reducing anxiety and show improvement in quality of life.³

Symptoms of anxiety

Anxiety causes mild to moderate levels of worryness. In the post-partum period, it is common to see symptoms ranging from excessive distress to panic attacks. This is mainly due to the dysregulation of hormones after delivery. Some examples of symptoms include:

• Restlessness
• Worry
• Fears and phobias
• Irritability
• Sleep disturbances
• Panic attacks

Risk factors and contributing factors

Anxiety has many risk factors. This can present as physical or emotional entities. A mother may be at risk of anxiety as a result of the factors below:^2,5  

Physical factors

• Preterm birth
• Unplanned caesarean section
• Pre-eclampsia 
• Premature rupture of membranes
• In-vitro fertilisation
• Twin pregnancy
• Familial history 

Emotional factors 

• First-time mothers
• Anxiety during pregnancy 
• Stressful life events 
• Poor marital relationships
• Lack of social support
• Low socio-economic status
• Unwanted pregnancy
• History of anxiety disorders

Diagnosis of postnatal anxiety

Postpartum anxiety has no specific diagnostic criteria and is detected using questionnaires and interviews. Doctors should be attentive to their patient’s behaviours during antenatal follow-ups or postnatal consultations. Early screening and effective management of anxiety are critical to promote the well-being of mother and child.

Benefits of exercise for postpartum women

Physical activity and positive effects on mother and child health are directly linked. 20 to 30 mins a day, 3 to 5 times per week, for 4 weeks to 6 months of moderate level of exercises (eg. walking, swimming, cycling, aerobic exercises, pilates, stretching) are recommended to increase muscular fitness and prevent postpartum anxiety. Evidence shows that practising yoga also has an impact on decreasing anxiety.⁷

Strong evidence shows that practising exercises as recommended, not only decreases postpartum anxiety but also aids in managing weight, improving cardiovascular health, preventing type 2 diabetes, and feeling light.⁶

Considerations for exercising postpartum

Don’t be in a rush to start the exercises soon after delivery. Due to the placental disruption during the delivery, there may be vaginal bleeding. Before starting active exercises, the vaginal bleeding has to stop. Low-intensity movements like stretching, pelvic floor muscle exercises, breathing exercises, and walking with your newborn are encouraged. Maintaining good nutrition and proper hydration is the utmost priority.

To start a moderate level of physical activity, the mother should wait until the first postnatal check-up and get medical approval from the doctor.

Those who are breastfeeding, and about to start their exercises should begin with 5-10 mins of warm-up, followed by 10 mins of moderate-intensity exercise and 5-10 mins of cooldown. This is recommended to avoid fatigue. 

A great strategy for incorporating exercise into postpartum life is by personally selecting exercises that can be easily engaged with and enjoyed to ensure consistency and reduce anxiety.⁸

FAQ’s

Are there any changes in breast milk seen while exercising during the postpartum period? 

Researchers did not find any changes in breast milk when they followed  the below-recommended  guidelines: ⁸

• Adequate hydration maintained all-day
• Adequate nutrition intake for both exercise and lactation
• Feeding the baby before the exercise
• Wearing a support bra while exercising 
• Avoid vigorous exercises

How much weight (in kgs) one should lose during the postpartum period?

As the postpartum period is also a lactating period, losing more than 1.5 kg per week is not recommended. Losing 0.5 kg alongside appropriate nutrition and exercise is safe in overweight lactating mothers.

Which exercises should be avoided during the postpartum period?

Avoid strenuous exercises like sit-ups, crunches, and abdominal curls. These exercises may produce more pressure, leading to lower back pain.⁸

Summary

Postpartum care takes up to a year after delivery and is a critical period for building a healthy relationship between mother and child. 

Exercise poses positive health benefits such as reducing the risk of obesity during postpartum, elevated mood, and social well-being. Physical activity is considered the best mode of treatment to cure anxiety because it has no other side effects. Mild to moderate levels of exercise proper hydration, and nutrition are recommended during the postnatal period.