36 | Akwa | December 2022 / January 2023 / February 2023 After the birth of a child begins the period called postpartum or puerperium, which can be one of the happiest and most exhausting moments in a woman's life. On the one hand, is the feeling of joy for the experience of motherhood. On the other hand, challenges arise from sleep deprivation, recov- ery from childbirth, disruption of routines, and hormonal changes. In the first six weeks after delivery, women are generally not encouraged to exercise except for pelvic floor muscle strengthening and some postural work. However, this timing is flexible; many elite athletes report starting exercise during this period (1). In the case of a Cesarean section, six weeks is generally recommended. Each new mother should consult with her medical care provider about the appropriate timing for returning to exercise. A thorough anamnesis (medical history) should consider multiple factors: type of childbirth, medical discharge, evalu- ation of abdominal diastasis, evaluation of pelvic floor func- tion, breastfeeding, emotional state, quantity and quality of sleep, associated diseases/conditions, postural changes, and social environment and involvement. These are factors that will influence exercise capacity and predisposition. Postpartum is physically, emotionally, and mentally exhaust- ing. Therefore, when a woman returns to her exercise rou- tine, it is important that she return to the initial/basic level with a reduction in the initial intensity and duration of the exercise routine. A general recommendation would be low to moderate intensity for 15-30 minutes or according to the individual's exercise tolerance. This recommendation may make sense for a woman without a regular physical exercise routine, but it can be challeng- ing for someone with an intermediate and advanced training level. Most are anxious to move and return to exercise and the feeling of "(re)owning" their bodies (2). It is, therefore, extremely important to remember that recovery is essential and that the body needs to be "re-trained" before it can be trained. During the postpartum period, some experience changes for several months (especially if the woman is still breastfeed- ing); this is the case because of the production of the hor- mone relaxin. Some changes cease soon after the child is born, such as the positioning of the organs. Other changes cause parallel consequences, such as postural changes. And some are considered retroactive; changes during pregnancy having consequences in the postpartum, as is the case of urinary incontinence. Due to the numerous anatomical and functional changes during pregnancy that can cause constraints in the post- partum period, it is recommended to perform stability and mobility training in all sessions. The goals are to reinforce body awareness and to correct alignment and posture. Pay special attention to the pelvic girdle, shoulder girdle, and feet because they have undergone many changes caused by the compensation of volume and weight and the alteration of the center of gravity (3-6). It is recommended that exercises for strengthening the pel- vic floor be started immediately after delivery (minimum of three times a week) to restore adequate pelvic muscle func- tion, rehabilitate the diastasis of the rectus abdominis, and reduce the risk of incontinence. With abdominal strength- ening, the focus should be on using the bracing technique associated with awareness and activation of the transversus abdominis and pelvic floor. Strength training should be performed on at least two Post-Partum Exercise: When And What? By Renata Tarevnic, PhD, & Cristina (Tinoca) Senra, MS
