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Should You Train While Breastfeeding?

20.07.2022
lactation_8bf4e2d73a

Though there has been limited research on the recommendations for exercising during the postpartum period, particularly while breastfeeding, there are several findings that suggest returning to exercise provides no substantial risk to either mother or baby. Rather, findings advocate for the use of moderate to intense exercise to promote mental wellbeing, limit bone-density loss, and improvement of body composition.

The drastic fluctuations in hormones and the overwhelming life changes that accompany giving birth can occasionally lead to cases of postpartum depression (PPD) (1). Though diagnosed in only 20% of new mothers, upwards of 50% of individuals experience depressive symptoms that may affect their quality of life (2). Typical treatments for PPD are often more traditional, including antidepressants and cognitive behavioral therapy (CBT); however, some studies indicate that exercise may help reduce depressive symptoms. For example, a 2019 review by Teychenne and York noted that 60-minutes of postpartum physical activity may ease depressive symptoms (3). Further, the study suggested that intentional physical activity (i.e., outside of work) provides depressive-limiting benefits (3). Research regarding PPD and exercise is limited, but studies suggest that simply walking may lead to lower depressive symptoms.

To create and house new life, as the female body so brilliantly does, expecting mothers need to gain between 11-16 kg (~25-35 lbs) throughout their pregnancy (4). During the first year postpartum, many mothers retain upwards of 4 kg (8.8 lbs) of body weight. Participating in exercise early on does not increase the weight loss of new mothers; however, it does appear to improve overall body composition. Several studies that investigated those that participate in exercise programs saw an increase in lean body mass and a decrease in body fat as compared to their sedentary counterparts (5). It has been proposed that this finding owes thanks to the increase in prolactin, the hormone responsible for milk production, which encourages reliance on fat during high-intensity exercise (5).

Exercise may also help limit bone loss that often accompanies lactation. Because maternal free calcium often does not meet the nutritional requirements of the developing baby and mother simultaneously, bone is often broken down to accommodate the limited supply (2) . To ensure that the infant is supplied with ample calcium for proper development, the process can occur well into the postpartum period. In one study, the rate at which bone is broken down was determined to be close to 10-times that of postmenopausal women (5). Given these drastic losses in bone mineral density, it is important that mothers participate in axial loading exercises that have shown to preserve bone density (5).

lactation.png Image taken from Miyamoto et al. 2019 (8).

Aside from the benefits that return to exercise may have for mothers, there has been limited evidence to suggest that exercising may affect the quality or quantity of the milk produced for their babies. In fact, a 1990 investigation found that mothers that participated in vigorous exercise produced a greater amount of milk, with more caloric density (6). It is important to note, however, that lactate concentrations may be elevated following an intense bout of exercise (7). Such elevated levels are likely to introduce a sour taste to milk that may lead to infant rejection (7). Coupled with the discomfort that can come from filled breasts, it is recommended that mothers feed their infants prior to engaging in exercise (2).

Though the research may point to the benefits associated with return to exercise in the postpartum and breastfeeding period, it is important that new mothers gradually ease back into their pre-pregnancy fitness programs. Many mothers experience performance decrements postpartum that result from reduced physical activities during pregnancy. While performance metrics such as 1-RM and VO2 Max are likely to return 12 to 52-weeks postpartum, it takes time to retrain the body (2). Additionally, pain associated with cesarean sections, the pelvic floor, or other post-partum complications should be discussed with a physician and taken into consideration when programming. Lastly, the benefits of postpartum exercise, particularly while breastfeeding, are constrained to individuals that are providing their bodies with adequate nutrition. Australian, Canadian, Norwegian, and American guidelines advocate for exercising in the lactating period, provided mothers are sufficiently hydrating and feeding themselves (2).

Research involving exercise in breastfeeding mothers, particularly with athletes, is severely lacking. Though the findings provided in this article are promising, current research is insufficient to provide definitive recommendations. Additionally, though this overview provides insights into exercise in the breastfeeding period, it should not be taken as expert advice. The best practice when returning to activity is to consult with your primary care physician. The female body is a beautifully complex beast that is capable of overcoming so much, but it's recovery after giving birth should be taken seriously.

References

[1] “Postpartum Depression - Symptoms and Causes.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617. Accessed 7 June 2022.

[2] Bø, Kari, et al. “Exercise and Pregnancy in Recreational and Elite Athletes: 2016/17 Evidence Summary from the IOC Expert Group Meeting, Lausanne. Part 3—Exercise in the Postpartum Period.” British Journal of Sports Medicine, vol. 51, no. 21, 2017, pp. 1516–25, https://doi.org/10.1136/bjsports-2017-097964.

[3] Teychenne, Megan, and Rebecca York. “Physical Activity, Sedentary Behavior, and Postnatal Depressive Symptoms.” American Journal of Preventive Medicine, vol. 45, no. 2, 2013, pp. 217–27, https://doi.org/10.1016/j.amepre.2013.04.004.

[4]Weight Gain During Pregnancy | Pregnancy | Maternal and Infant Health | CDC. 26 May 2021, https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm.

[5] Meyers, Katya, and Mee Young Hong. The Physical Effects of Exercise in Lactating Women: A Review. 2021, https://doi.org/10.14198/jhse.2021.164.01.

[6] Lovelady, C. A., et al. “Lactation Performance of Exercising Women.” The American Journal of Clinical Nutrition, vol. 52, no. 1, July 1990, pp. 103–09, https://doi.org/10.1093/ajcn/52.1.103.

[7] Wallace, Janet P., et al. “Lactate Concentrations in Breast Milk Following Maximal Exercise and a Typical Workout.” Journal of Women’s Health, vol. 3, no. 2, 1994, pp. 91–96, https://doi.org/10.1089/jwh.1994.3.91.

[8] Miyamoto, T., Miyakoshi, K., Sato, Y. et al. Changes in bone metabolic profile associated with pregnancy or lactation. Sci Rep 9, 6787 (2019). https://doi.org/10.1038/s41598-019-43049-1

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lactation_8bf4e2d73a

Though there has been limited research on the recommendations for exercising during the postpartum period, particularly while breastfeeding, there are several findings that suggest returning to exercise provides no substantial risk to either mother or baby. Rather, findings advocate for the use of moderate to intense exercise to promote mental wellbeing, limit bone-density loss, and improvement of body composition.

The drastic fluctuations in hormones and the overwhelming life changes that accompany giving birth can occasionally lead to cases of postpartum depression (PPD) (1). Though diagnosed in only 20% of new mothers, upwards of 50% of individuals experience depressive symptoms that may affect their quality of life (2). Typical treatments for PPD are often more traditional, including antidepressants and cognitive behavioral therapy (CBT); however, some studies indicate that exercise may help reduce depressive symptoms. For example, a 2019 review by Teychenne and York noted that 60-minutes of postpartum physical activity may ease depressive symptoms (3). Further, the study suggested that intentional physical activity (i.e., outside of work) provides depressive-limiting benefits (3). Research regarding PPD and exercise is limited, but studies suggest that simply walking may lead to lower depressive symptoms.

To create and house new life, as the female body so brilliantly does, expecting mothers need to gain between 11-16 kg (~25-35 lbs) throughout their pregnancy (4). During the first year postpartum, many mothers retain upwards of 4 kg (8.8 lbs) of body weight. Participating in exercise early on does not increase the weight loss of new mothers; however, it does appear to improve overall body composition. Several studies that investigated those that participate in exercise programs saw an increase in lean body mass and a decrease in body fat as compared to their sedentary counterparts (5). It has been proposed that this finding owes thanks to the increase in prolactin, the hormone responsible for milk production, which encourages reliance on fat during high-intensity exercise (5).

Exercise may also help limit bone loss that often accompanies lactation. Because maternal free calcium often does not meet the nutritional requirements of the developing baby and mother simultaneously, bone is often broken down to accommodate the limited supply (2) . To ensure that the infant is supplied with ample calcium for proper development, the process can occur well into the postpartum period. In one study, the rate at which bone is broken down was determined to be close to 10-times that of postmenopausal women (5). Given these drastic losses in bone mineral density, it is important that mothers participate in axial loading exercises that have shown to preserve bone density (5).

lactation.png Image taken from Miyamoto et al. 2019 (8).

Aside from the benefits that return to exercise may have for mothers, there has been limited evidence to suggest that exercising may affect the quality or quantity of the milk produced for their babies. In fact, a 1990 investigation found that mothers that participated in vigorous exercise produced a greater amount of milk, with more caloric density (6). It is important to note, however, that lactate concentrations may be elevated following an intense bout of exercise (7). Such elevated levels are likely to introduce a sour taste to milk that may lead to infant rejection (7). Coupled with the discomfort that can come from filled breasts, it is recommended that mothers feed their infants prior to engaging in exercise (2).

Though the research may point to the benefits associated with return to exercise in the postpartum and breastfeeding period, it is important that new mothers gradually ease back into their pre-pregnancy fitness programs. Many mothers experience performance decrements postpartum that result from reduced physical activities during pregnancy. While performance metrics such as 1-RM and VO2 Max are likely to return 12 to 52-weeks postpartum, it takes time to retrain the body (2). Additionally, pain associated with cesarean sections, the pelvic floor, or other post-partum complications should be discussed with a physician and taken into consideration when programming. Lastly, the benefits of postpartum exercise, particularly while breastfeeding, are constrained to individuals that are providing their bodies with adequate nutrition. Australian, Canadian, Norwegian, and American guidelines advocate for exercising in the lactating period, provided mothers are sufficiently hydrating and feeding themselves (2).

Research involving exercise in breastfeeding mothers, particularly with athletes, is severely lacking. Though the findings provided in this article are promising, current research is insufficient to provide definitive recommendations. Additionally, though this overview provides insights into exercise in the breastfeeding period, it should not be taken as expert advice. The best practice when returning to activity is to consult with your primary care physician. The female body is a beautifully complex beast that is capable of overcoming so much, but it's recovery after giving birth should be taken seriously.

References

[1] “Postpartum Depression - Symptoms and Causes.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617. Accessed 7 June 2022.

[2] Bø, Kari, et al. “Exercise and Pregnancy in Recreational and Elite Athletes: 2016/17 Evidence Summary from the IOC Expert Group Meeting, Lausanne. Part 3—Exercise in the Postpartum Period.” British Journal of Sports Medicine, vol. 51, no. 21, 2017, pp. 1516–25, https://doi.org/10.1136/bjsports-2017-097964.

[3] Teychenne, Megan, and Rebecca York. “Physical Activity, Sedentary Behavior, and Postnatal Depressive Symptoms.” American Journal of Preventive Medicine, vol. 45, no. 2, 2013, pp. 217–27, https://doi.org/10.1016/j.amepre.2013.04.004.

[4]Weight Gain During Pregnancy | Pregnancy | Maternal and Infant Health | CDC. 26 May 2021, https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm.

[5] Meyers, Katya, and Mee Young Hong. The Physical Effects of Exercise in Lactating Women: A Review. 2021, https://doi.org/10.14198/jhse.2021.164.01.

[6] Lovelady, C. A., et al. “Lactation Performance of Exercising Women.” The American Journal of Clinical Nutrition, vol. 52, no. 1, July 1990, pp. 103–09, https://doi.org/10.1093/ajcn/52.1.103.

[7] Wallace, Janet P., et al. “Lactate Concentrations in Breast Milk Following Maximal Exercise and a Typical Workout.” Journal of Women’s Health, vol. 3, no. 2, 1994, pp. 91–96, https://doi.org/10.1089/jwh.1994.3.91.

[8] Miyamoto, T., Miyakoshi, K., Sato, Y. et al. Changes in bone metabolic profile associated with pregnancy or lactation. Sci Rep 9, 6787 (2019). https://doi.org/10.1038/s41598-019-43049-1

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