Redefining Exercise in Pregnancy & Postpartum: New Research Insights — with MARGIE DAVENPORT, PhD

Told to slow down during pregnancy & postpartum? Not necessarily! 🏃‍♀️💪"

It's research update time again with @exerciseandpregnancy!

In this episode, Margie Davenport, Associate Professor at the @ualberta & former national team athlete, joins us again to give another update on research in pregnancy and postpartum exercise including: the 

🔹2025 Canadian guideline for physical activity, sedentary behaviour and sleep throughout the first year post partum (hot off the presses!)  
🔹@bjsm_bmj Special Issue on Postpartum Physical Activity
 
Dr. Davenport is leading the charge in making exercise guidelines more inclusive so women at ALL levels can move safely during pregnancy & beyond 

We get into:
🔹 Why movement matters during pregnancy (yes, even for elite athletes!)
🔹 The impact of mental health & anxiety on postpartum recovery
🔹 How sleep can make or break your return to sport
🔹 When to see a pelvic floor PT (hint: sooner than you think!)
🔹 The biggest myths about pregnancy & exercise that need to go 👋

Whether you're chasing a podium or just trying to stay active through pregnancy, this episode is a MUST-LISTEN. 🎧

What’s the worst pregnancy/postpartum fitness advice you’ve ever gotten? Drop it below! ⬇️😅

#PregnancyFitness #PostpartumAthlete #PelvicHealth #ReturnToRun #WomenInSport #MomRunner #PregnantAndStrong #PostpartumRecovery #PelvicFloorPT #StrongMoms #activemompodcast #paglianopodcast 

Time Stamps

1:00 Introduction

2:45 setting up the guidelines 

5:49 the importance of early movement

10:30 getting the new guidelines to OB/BYNs

13:03 get active questionnaire for pregnancy

19:55 gatekeeping of information

25:14 variability in practice patterns

27:08 the impact of sleep

34:00 impact of exercise

36:53 addressing diastasis recti

42:25 elite athletes in postpartum 

47:35 traveling to Nepal

CONNECT WITH CARRIE

IG: https://www.instagram.com/carriepagliano/

Website: https://carriepagliano.com

CONNECT WITH MARGIE

IG: https://www.instagram.com/exerciseandpregnancy/

Website: exerciseandpregnancy.ca

The Active Mom Podcast — a real mom's guide to pregnancy, postpartum, perimenopause & beyond, for active moms and the professionals who help them get there.

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Transcript

SPEAKER_00 0:00

You're listening to the Active Mom podcast with host Dr. Carrie Pegliano. I'm a mom physical therapist and your go-to guide for staying active with public health issues and pregnancy postpartum, Carrie Metapods, and beyond. Whether you're a fellow mom, physical therapist, or women's health professional, join me where I'll share expert insights, real life stories, and the latest research to help you approach running, CrossFit, yoga, Pilates pit, or whatever activity you love with confidence and evidence-informed guidance. Let's start the show. All right, this is the first. We have our first guest who's been on the show three times. Welcome back to the show, Margie Davenport.

SPEAKER_01 0:35

Thank you for having me. So nice to see you again.

SPEAKER_00 0:39

I know, you too. I was like, really? Is it this is the third time like yeah? It's been it was like 2022. And then um I think we must have recorded last spring, and then it went in um uh, but it the episode went in August because I typically don't record over the summer. And then um I was preparing for this episode and just scrolling through PubMed and pop your name in. And I just I had to finally stop because 2025. I don't even know if you've counted how many papers have come out with your name on it yet. Um there's a few. Um so tell us what you've been up to, and um, we can talk about some of those um really cool papers and big Canadian guidelines and all that good stuff. How about that?

SPEAKER_01 1:23

Yeah, no, it's uh it's been an exciting year since the last time we chatted, actually. Um so I think what you're seeing is actually everything sort of coming together. A lot of this work has been in progress for you know multiple years now, the guidelines especially. So um the 2025 Canadian Guideline for Physical Activity, Sedentary Behavior, and Sleep throughout the first year of postpartum will be um coming out very, very soon. I actually got the proofs this morning. So it's pretty exciting to see that actually come together. Um, and so a lot of the other papers are actually the underpinning evidence that will be supporting those new guidelines. Um, so it's been a massive team effort. Uh, I have a really phenomenal group of people that I worked with, especially on this guideline. Well, just in general, but on this guideline as well. Um, and so it's really a reflection of the work that they've been doing over the last year. And uh so it's pretty exciting to be able to start talking about it.

SPEAKER_00 2:22

Yeah, I know. You're like, I I think I asked you earlier in the year to come on. You're like, nope, wait, just wait. Okay, whatever she tells me to do, I'll do. So when you're pulling something together as big as guidance for a country for exercise and pregnancy and postpartum, like you talk about these underpinnings that have to occur, kind of this this foundational information. What's some of that that you had to do that now has kind of come out and and but things that needed to be sort of set up as that foundation?

SPEAKER_01 2:56

So there are lots of different ways that you can put together guidelines. Um, at the very sort of most basic level, you can get together sort of like general basic guidance, generally um expert opinion. Um, and those are, you know, they can be really great, they're quick and easy to do. Um, but what I would typically do is we call there's a really rigorous gold standard process called agree to um that we follow. It's designed to be rigorous, transparent, do a lot of consultation to try and make sure that the guidance and the guidelines that we're actually coming up with are based on the key priorities of the population that it's informing. Uh so in this case, it would be postpartum people. Uh and so uh we spent a good chunk of time first doing consultation to see what particular health outcomes were most important to them. And then based on that, we did uh seven systematic reviews and meta-analyses. Uh, if you're not that familiar with what they are, it's basically a synthesis of all available information about postpartum exercise, sedentary behavior, and then uh sleep in the postpartum period. And so that's what's been coming out over the last uh couple of months. Um, and then along with that, we also have our new Delphi study. That was uh so much fun to do. So if uh if you haven't seen it yet, um basically we have the uh 2025 guideline consensus panel um that uh was part of it. And then we I was able to um recruit uh sort of the leads on other major guidelines around the world with the goal of identifying uh sort of a global consensus of what are key contraindications or medical reasons why you should go and get advice from a healthcare provider before you know either beginning or returning to postpartum physical activity, um, but also identifying things that are not contraindications um but are typically barriers to physical activity as well in the postpartum period. So things like pelvic floor dysfunction, sleep, uh fatigue, um, and really trying to shine a light on the postpartum period. Um the goal of the guideline is to really encourage movement, especially early movement uh as much as possible, to be able to support the holistic health of uh a postpartum person, certainly the physical health, but essentially um mental health as well.

SPEAKER_00 5:31

I I loved kind of seeing some mental health and anxiety kind of um stuff come through because I do, I feel like they they run together. And of course you you throw sleep in there for sure. Um for you, why was it so important to um have this in writing that early movement is good? What are we trying to counter essentially?

SPEAKER_01 5:53

So for a very, very long time, uh we've had this idea that you really shouldn't do much of anything for the first six weeks after delivery. Um and then as soon as you get your six-week checkup, that your check cleared to go and you can go do whatever you want. And I think um, you know, with the um exposure and um, you know, especially with the advent of the 2019 return to running guidelines, you know, some very well-known physiotherapists put together uh and really changed the the way that the entire field started to think about things that, you know, you're not just like immediately cleared after six weeks post-partnum, but it's actually a rehabilitation process. And it should be early, you know, starting fairly early afterwards. We have data which actually suggests that um pretty soon after birth, if you start to have a higher number of step counts, I'm not saying go for a run like the day after delivery, but it's okay to get out of bed and you know, after a C-section, do a few extra steps, and that actually helps to facilitate um healing and um, you know, postpartum recovery, actually. Um so there's data that's emerging that's starting to show that. And so trying to counter this idea that, you know, physical activity in the first six weeks, postpartum especially, is harmful is something that needs to get out there to be able to support mental health. We know those first six weeks are actually really, really critical for um there's an increased risk of having postpartum depression, yeah, anxiety. And if you take away one sort of key tool to be able to improve overall mental health, we're doing a major disservice um to postpartum pupils. So that's just one of the key recommendations.

SPEAKER_00 7:34

Yeah. And and that one, I I think it's it's an interesting one for those of us that have been in sp this space for a long time. We're just so pumped that now we have a reflection of what we've been talking about, this change that's in in black and white, and we can use that. And on the other hand, even just as recently as the last two months, I had a new mom um told after a c-section that she couldn't walk the first it in and whether it was said to her or not, it does not matter. It's how she took it. And unfortunately, this mom had to go back to work um within one to two weeks after her c-section. And so I had to check myself because on one hand, I'm like, oh my God, this poor woman, you know, first kid, you know, have to go back to work. But on the other hand, she was also told not to do walking, but she had to for work. And so this actually worked out. So I'm not gonna like really I'm gonna let her know, hey, you're doing great. This is wonderful. I'm glad that she had to go back early in some ways because it countered the really, really wrong advice that she was given. Like, how is this still? I live in a major metropolitan area. This is a very educated woman. How is it that she was still told or it was interpreted that she shouldn't be walking? Like this is crazy.

SPEAKER_01 8:57

Yeah, it is. It's um it's really unfortunate, but that's why we need these um guidelines that are put together by major national and international organizations to provide clear, evidence-based information and guidance. Um, and certainly, you know, many other recommendations are things that are being done by well-informed practitioners like yourself and have done for a very long time. It's putting this into um, you know, black and white and having the evidence that supports it directly in those hard numbers. I think that you know, you cannot understand or understate it when we're trying to um action change, um, especially uh with clinicians who are going to be some of the first people that are seeing women after childbirth and to be able to say there are these new guidelines, this is evidence-based, early movement is great. Um you do have to have a graded individualized return to um moderate to vigorous intensity physical activity, but early movement is beneficial. And uh, you know, returning to that moderate to vigorous intensity physical activity as well within the first 12 weeks postpartum is actually really beneficial for mental health.

SPEAKER_00 10:14

Yeah, no, definitely, definitely. Um, I'm curious how you anticipate um this being used, not only as clinicians to kind of like us as physios, um to kind of almost hop that fence and get it into the hands of those people that are unfortunately still saying, Oh, you shouldn't be doing like basically our OBG WANs, I'll just be honest, our our birth professionals, that that's where sometimes the seed gets planted. And it takes a while for the information to get from us to them. Um, what are your thoughts as to how we as providers can, you know, disseminate that information or kind of almost like walk back up the chain and be like, hey, you guys, can you stop sending this down?

SPEAKER_01 11:06

Yeah, absolutely. Um, and I mean that's always the hardest thing. So, you know, I led the development of the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy, and we had a massive push to be able to um, you know, do what we call knowledge mobilization. So it's taking the evidence and getting it into the hands of the people that are going to use it. We'll do the exact same thing in the postpartum period, but it is a really um an uphill battle. It's a slow process, it's something that is so, so essential. Um, and so we do have a big push coming. Um, there's going to be a what I hope is going to be a pretty big media release. We're going to do a lot of work on social media, but um, you know, increasing awareness. So doing podcasts like this, this is why I'm here for the third time, is that, you know, um being able to explain what it is that we're doing and why and what the evidence actually is, I think is really, really important. Um, but then I think it also, you know, there are more of us that have a voice that are speaking the same message is actually really important as well. And having um the guidance at the same time uh in your hands to be able to say, this is what Canada says, this is the evidence. There's 594 in individual studies that support this particular recommendation, set of recommendations. Um, I think there's a lot of power in trying to get it out to a wide audience. Um, and it, but it certainly takes time.

SPEAKER_00 12:38

Yeah. There was, um, and and forgive me because I I I couldn't read it with small print, um, I've seen some of you in your social media have been holding up or up a kind of a screenshot of the, I think it's a screen. Like talk me through what what this is and and kind of how did you kind of come to pulling it all together?

SPEAKER_01 12:56

Okay. Uh, so I will absolutely send it to you. It's uh called the Get Active Questionnaire Postpartum. So if you are familiar with the pregnancy uh physical activity pre-screen, the get active questionnaire for pregnancy, it is basically the sister uh document to that. So what we did is an international group of you know, sort of leaders in physical activity in the postpartum period. Um we we met, we put together a Delphi study, and uh, because there's virtually no evidence about what would be a contraindication to physical activity postpartum. Um, and so we surveyed, well, I'd have to look at the numbers again, just off the top of my head, over a hundred um professionals that work with postpartum populations to get their opinion about what would be a key contraindication, sort of worked through a very uh rigorous process. And in the end, uh we actually have no absolute contraindications to postpartum physical activity. Uh, the reason for that is that we did not want to unnecessarily restrict people from being physically active postpartum. Um, and so there are a number of relative contraindications. So the difference between those two, an absolute contraindication would simply mean that you are not supposed to engage in sort of moderate to vigorous intensity physical activity, going for a gentle walk to the mailbox or things like that would still be recommended. Um, but with a relative contraindication, you would still go and speak to your healthcare provider and talk about, you know, is physical activity still, you know, beneficial for you, or do you have to make some modifications? Or in a very, very minority of cases, um, is physical activity not recommended in the moderate vigorous zone? And so, you know, when we're talking about what those key contraindications would be, um, they're they're pretty substantial. So um, for example, if you had a loss of consciousness um for any reason, if you um had high blood pressure that's not stable, you know, but then also very um sort of postpartum specific um uh conjure indications as well. So if you um had postpartum cardiomyopathy or C-section um pain that worsens with exercise, things like that as well, um, but really tailoring it to the postpartum population. Um and so we have this screen that uh is, you know, I'll I'll send it to you, but it's going to be publicly available by the time this actually gets out. And so it's been endorsed by a number of organizations and is in the process of being translated into um, I think we have the first three are set up to go, um, different languages. And uh the pregnancy questionnaire, we have it in 13 languages. So I expect it'll be very similar.

SPEAKER_00 15:50

That's nice that you have kind of almost this template with the the pregnancy guidelines that um you're just able to extrapolate for it. What uh kind of what lessons did you learn about putting that out that you really applied in and kind of getting these postpartum guidelines out?

SPEAKER_01 16:05

Um sorry, in terms of like the postpartum knowledge translation, that sort of thing. Uh that you have to do it.

SPEAKER_00 16:13

Yeah.

SPEAKER_01 16:16

It seems obvious, but yeah, it seems really obvious, but I I think also um, you know, really thinking outside of the box, like um traditional media is really important. So, you know, getting into in front of TV cameras, which I can't stand doing, I'm not very good at it. It's the worst, isn't it? Something that you have to do. Live TV, I get very stressed about. So um, if you see me on live TV and I start to be like, I don't know. Um, you know, but those are really, really important. Same thing, yeah, different media. But I think that there's a lot of power now that's quite different when, you know, back in 2018 when we released the pregnancy guidelines, 2025, social media spreads like wildfire. Um, and so you can actually reach a much broader population um in that way, but also having a really coordinated effort to be able to disseminate this information as much as possible in a variety of different ways is I think super important.

SPEAKER_00 17:16

But talking about I noticed that and I'll let you know how it goes. I noticed that yesterday. Um, a handful of you, I think it was like you and Rita, Christina, um, it was somebody else I saw very coordinated yesterday. Really nice job. That was a nice job. Um no, I I I mean, and and that's why I got super excited. I was like, wait, where do I get this? It just made me want to immediately go find that information and read more about it. And um, and you know, I would hope that you know, as you pass the torch down to the rest of us, we're able to continue to to pass it down to everyone behind us um and just kind of build that that standard. Um for you, so Delphi study, we've got this out. Um, did that somewhat inform the um the Canadian guidelines as well?

SPEAKER_01 18:08

So it's a piece of it. So um the the seven systematic reviews and meta-analyses, they really did drive um the uh the recommendations uh that we have with the postpartum guidelines. The Delphi study was informing what would be a contraindication. Um and then based on that information, that's when we develop this new tool. It's designed to be self-completed by postpartum people. Um they can fill it in themselves and identify whether or not they get need to um get additional medical guidance about physical activity postpartum. That would be a minority of people that would um be redirected to their healthcare provider. But for the vast majority, um, they will get this, you know, sort of check you are okay to restart or begin for the first time physical activity in the postpartum period. So taking away one of the really key barriers, which is getting this medical clearance at six weeks program, um it allows you to do it a little bit earlier for sure. Um, but it's uh really designed to empower people in the postpartum period to take um, you know, take sex towards uh you know re-engaging in physical activity.

SPEAKER_00 19:24

Yeah. No, I I I like having the ability to hand somebody something that it doesn't require, you know, anybody particular to, you know, administer the screen, just because those especially those first-time moms that are like, I want to do the right thing, right? And they don't want to wait till six weeks. And at least here in the US, it I think it was like back in 2018, we were supposed to like there was the the fourth trimester um paper that was put out by ACOG. Yes. Um, and they kindly wrote physio in one section, which we could have been in the whole thing, but um, that has not, at least not here in the States, has not held true. Like I have moms that are C-section moms that are getting their first visit, not at two weeks, at six weeks, um, because everybody is just overwhelmed. We've got tons of people leaving the medical profession. Um, and it really just does leave those moms high and dry. And especially those ones that are feeling good. And I think that's what we forget sometimes as physios. We're like, nope, you should see a physio first. I'm like, well, can we just do some basic clearance? If people are feeling good, can we let them start? Because I I've I've also learned that like sometimes I'm not gonna know how you're gonna do with stuff until you actually go do it.

SPEAKER_01 20:43

Absolutely.

SPEAKER_00 20:44

I'm not gonna know how walking feels to you until you actually go walk and you have to walk a little ways, and then then maybe something shows up. Um, but yeah, I think it really kind of tears down that gatekeeping of information, saying, Well, you can't do anything until I've given you my blessing, you know, that that whole thing. Um so in general, and and forgive me, I I'm not quite sure how the the the pregnancy guidelines or the pregnancy kind of screen went out. Um, is it expected that this would be just available in, you know, physicians' offices or just online and people find it themselves? Or like how how is it expected that people would find access to this information to be able to do a self-screen?

SPEAKER_01 21:27

So the self, the get active questionnaire postpartum is actually embedded within the Canadian guidelines. So we have two full dedicated pages of it. Lovely. Um and it's funny because you said that we were coordinated. Um, we actually the the Dowply paper actually came out slightly sooner than expected. So the website was not actually up yet. Um is totally fine. Um, it will be up before the guidelines come out. Um but it it's been a little hectic, and so there's been a little bit of changeover. So we won't actually as coordinated as we could have been, but we certainly tried.

SPEAKER_00 22:06

You know, I I think when when you're a mom, you just sort of run with it, you're like, whatever.

SPEAKER_01 22:11

It is like roll with the punches, everything works out. Yep. Um, but it it will be available on the CSAP website. Um for sure. It's going, it is um, we the C the Canadian Society for Exercise Physiology actually um supported the open access fees. So to these papers, open access is very, very um uh quite expensive. Yes. Um and this was actually a completely unfunded uh project. Um we we just made it work pretty much. Um, but it was so needed. It's like uh something that I just couldn't sit back and watch, you know, continue to drift the lack of guidance and information. Uh, we really needed that to start. Um and so it will be publicly available very soon. Um by the time this podcast is out, it will make sure of it.

SPEAKER_00 23:04

We'll hold this until it's time.

SPEAKER_01 23:07

But then we also go through the process of getting what we call endorsements. So the endorsement process, um, you know, when we do the different translations, so we go to Poland and um, you know, Anna, who is on the the Dowfi study, um, she will do the translation. It's a very rigorous process that makes it culturally relevant at the same time. Um, but then she sends it to the the Polish Society of Obstetricians, gynecologists, and sports medicine uh to get their endorsement. They put it up on their website.

SPEAKER_00 23:37

I see.

SPEAKER_01 23:38

And so we it's a longer process uh for sure, but um the endorsement uh makes it more widely available as well.

SPEAKER_00 23:46

Yeah, no, I think that's fantastic. Well, and and and I think, you know, in the meantime, those of us that that do know about it, obviously we're gonna use it as much as possible. Um I don't know what we're doing in the United States as far as research these days. We'll just let that sit the way that it is. But but we appreciate you letting us borrow it.

SPEAKER_01 24:07

Well, there were a couple of Americans, very well-known Americans, uh, that were involved in the Delphi and were really uh critical for uh its uh development.

SPEAKER_00 24:17

So there's certainly Rita's on it and then Shafali, I think, was on it. And then who's who was the other one?

SPEAKER_01 24:22

Uh those two.

SPEAKER_00 24:23

Okay. I was like, there's a third, really?

SPEAKER_01 24:25

Yeah, no, no, no, no. Sorry, did I say three?

SPEAKER_00 24:28

No, it's it's okay. I probably just like am trying to like create a third and be like, who is this? I need to know who they are.

SPEAKER_01 24:35

Yeah, but it was a lot of fun. Um, you know, we have representation from seven different countries.

SPEAKER_00 24:40

I know it looked like a really cool house party, is what it was.

SPEAKER_01 24:45

There was a it was it was so neat to, you know, it's great because we all have like our own slightly different perspective, whether it's based on the research that we do or culture or anything else, and just like some of the conversations um, you know, I've never had before. And so it was a very robust and exciting um series of conversations.

SPEAKER_00 25:07

So it was uh it was great. Can can you give me an example of like something where you're like, oh gosh, I've never heard that before? This is not typical Canadian culture. Anything that you can reference?

SPEAKER_01 25:18

Um I'll tell you offline.

SPEAKER_00 25:22

Okay. Now we're gonna have Active Mom Podcast After Dark. I gotcha. No, it's it's so interesting. Um, you know, as I I I get DMs from from people all the time all over the world. And um I think being in this space where I know so many of you that are amazing researchers, even in countries that you guys live in, um, where somebody will reach out to me and be like, hey, you know, this is this is the care that I've gotten here. What are my options? Because I'm seeing stuff online and I'm not seeing this in my country. Um, and it's it's hard because I'm like, I know there's good people, I know there's good resources. And again, things like this that do get disseminated, um, I think it it gives me hope to kind of be able to pull in everybody so we're all up on that same level. Because I I think, you know, one of the beauties of the internet has been we get to connect with so many people in so many different countries and see what standards of practice are. But there is, there's a lot of variability in practice patterns across the world. Um, like some countries I feel like, oh yeah, I I did that maybe like 15, 20 years ago. And it's frustrating for patients to see, well, this I went to my local physio and this is just not the care that I'm getting. Um, so I do think that that there's a huge role of these standards and and kind of being able to at least give to them, hey, this is a screen, this is where we can start to help kind of bring people along a little bit. So that's fantastic. All right, let's talk about. So we talked about Delphi. I have this whole list of papers. And I was like, I don't like how much time we got. What are we gonna talk about? Um, you did let's just kind of talk just high-level sorts of things. Um, there was a paper kind of looking at the impact of sleep. Um talk to me about sleep because that I'm glad to see that in writing.

unknown 27:17

Yeah.

SPEAKER_00 27:18

Considering my oldest did not sleep the first five years of his life.

SPEAKER_01 27:22

Yep, I know that one. Um yeah, so you know, it's interesting because you know, my experiences with postpartum, um, sleep was far and away the the hardest. Like my kids did not sleep. I felt absolutely tore terrible. I was able to, you know, be physically active postpartum, but yeah, I didn't sleep for years, and my kids are just over two years apart. So, you know, we're sleeping and then I know.

SPEAKER_00 27:51

How old are your kids now?

SPEAKER_01 27:52

Uh they are 10 and 12.

SPEAKER_00 27:54

Oh god, yeah. So you know, yeah.

SPEAKER_01 27:56

Yeah.

SPEAKER_00 27:57

That's right, you're sneaking right behind me.

SPEAKER_01 28:00

Yeah, exactly. Um, and so you know, when we were putting when I was like starting to be like, you know, we really, really have to start to put some guidance together about postpartum, like sleep is just such a critical part of it. Um, and I think, you know, I'm ex I'm actually expecting a lot of pushback on the sleep side of it, but I think it's also really important that we reflect on the fact that um, you know, certainly there's very little control over an infant who is like, you know, really hungry all the time, just wakes up all the time, um, light sleepers like mine were. But the evidence is actually quite strong that if you don't get sufficient sleep, um, that it increases your risk of depression, yeah. Um, it increases um, you know, cardiovascular disease, you're gonna be fatigued, you're gonna be irritable. That describes me to it. Yeah, right. Like I was grumpy all the time. Yeah. Um, and I think that to a certain extent, we've normalized that this is what happens in the postpartum period. And for to a certain extent, it absolutely is. Like, you know, no baby is gonna come right out of the womb and start sleeping for 12 hours a day.

SPEAKER_00 29:15

And if they do, don't tell anybody.

SPEAKER_01 29:16

Yeah, I would not appreciate that. No, but I think that there are strategies that can be implemented to help to improve sleep. And so that's why we were looking specifically at um sleep on health outcomes and then physical activity and exercise and sleep in the postpartum period. And what we did find is that, you know, contrary to what you expect, if you're physically active postpartum, you do have reductions in overall sensation of fatigue and you do have better sleep quality. You might not sleep more, it might still be fragmented, but when you're sleeping, your quality is better. On top of that, and this is where I find it might be um, we were getting pushback um in the consultation, like these this is not something that I can do. And it's totally fine. Everybody gets to the point where they're ready to do some sort of um intervention in terms of supporting infant sleep. Um, and what the data suggests is that if you implement a sleep intervention, so this can be just as simple as um education about sleep patterns and different strategies, um, that this actually reduces depressive symptoms very. And so we can't um underestimate the importance of sleep postpartum, but we also have to be really clear, we cannot leave people into the postpartum period to make all of these changes entirely on themselves. No, it is absolutely um uh the job of you know the partner, the family, society to help support postpartum women to be able to um make steps towards improved sleep, increased physical activity. Um, but normalizing poor sleep for five years, if I could go back and there was, you know, a strategy to, you know, my baby will actually go to sleep and stay asleep if we put them down, you know, 30 minutes earlier, or actually, my goodness, have a scheduled sleep schedule because I had no idea baby needs a sleep schedule. Um, and so I think just thinking about that and trying to start the conversation, um, you know, I was very anti um crying it out and the interventions um that were being implemented didn't involve crying it out. It's just education and using different strategies to help the baby to sleep a little bit better. Um yeah, anyways, it's an important one, but it's uh it's also one where we we can't normalize it and we have to really emphasize the importance of the social support to be able to achieve any of these recommendations.

SPEAKER_00 31:54

Yeah, no, and I I think that one, like to have data to go into a very polarizing conversation. Um, because especially those of us that had kids that did not sleep, you're blaming yourself. You try and read all the books, your kid didn't read the book. Um, and then things that work, you're told not to do, like don't sleep with your kid or you know, co-sleep or you know, this or that or whatever. I'm like, but I just want to sleep, you know? Um and and I I think you know that that probably was the hardest, one of the hardest things as a new mom. If there's one thing that I wish I had to do over with the brain that I have now, because I have so much empathy for that me is she was just exhausted trying to do the right thing with a kid that just like and you but yeah, I remember, you know, when I was finally able to get out and go for walks and things like that. Yeah, that definitely made me feel better. Um, and you made those things priorities. But it but again at the time, like if you're in a playgroup or a mom's group and everybody's talking about how wonderfully their baby sleeps, you just you're like, Well, I don't even want to be here because Yeah, yeah.

SPEAKER_01 33:06

No, absolutely. Those are the worst things to hear when you have a kid that does not sleep.

SPEAKER_00 33:11

And then project forward. Um, my son is now 14 and he's my height, which is insane. And on the weekends, he sleeps easily till 10 or 11 in the morning because he's a teenager. And I laugh at him because I'm like, great, I appreciate that you're giving this sleep back to me, but I could have used that a long time ago. Like you're a little late on the payback.

SPEAKER_01 33:34

My kids aren't quite there yet, but I look forward to it.

SPEAKER_00 33:36

Give it time. I promise you it's coming. It's coming. All right. So sleep. Um definitely we need to be talking about it. We need to be helping moms have strategies, have communities, have family help, that sort of thing. Um, another uh systematic review and meta-analysis you guys did. Um, impact of exercise on musculoskeletal pain and disability. I feel like that's a no-brainer that needed to be written. I I it sounds like you thought it was a no-brainer too that needed to be written. So, like talk about kind of why this needed to be kind of put in ink.

SPEAKER_01 34:21

Well, so it was actually listed as um some of the critical and important outcomes that were identified by postpartum women. And so that's why we had to do a systematic review on it. And I absolutely agree. A lot of these systematic reviews are confirming the um thoughts and even biases that we already had. Um, yes, of course, we know there's lots of data out there looking at the impact of physical activity on depression and depressive symptoms. That's well established in the general population. We don't have a lot of great evidence um in the postpartum period until now. It improves depressive symptoms, it improves anxiety. Um, same thing when we talk about um musculoskeletal pain. It's there's a lot of emerging evidence that suggests that being active and you know, movement actually does improve um sensation of pain. And um it, you know, at the end of the day, those are the health outcomes that are important to people who are postpartum. And so we answer their questions and provide that evidence.

SPEAKER_00 35:24

Yeah, no, and and and that's again, it on one hand, I look at this, I'm like, yeah, of course, of course, of course. But on the other hand, I'm like, it makes it so much easier, I think, to talk to a provider, especially some that you're somebody that you're trying to convince. Convince of something that like the sky is blue, and it's very obvious to you and me that the sky is blue. Um, having a systematic review and meta-analysis is a really nice way of saying somebody else did all the work, so I can hand this off to you. So I appreciate the amount of work that takes to go into that. And I mean, hopefully that's how it's going to be used for those of us that like there's not this one paper, there's a body of work that says how we want that that the sky is blue, right?

SPEAKER_01 36:10

So well, and I think the other piece too it is that um, you know, researchers and uh healthcare providers may be aware of this, but the general population isn't necessarily there's this idea that if you have pain, you are causing more pain or harm if you continue to exercise. And certainly if you have an injury, that might be the case, right? But if you're experiencing pain, um it may not necessarily be an injury, right?

SPEAKER_00 36:37

Right. And and Lord knows after you have a baby, you feel a lot of things. There's a lot of a lot of things. All right, the next one running down. Um, my personal favorite, um it just needs to be put to rest always, is uh postpartum exercise. Um, there's palve floor disorders and diastasis recti. Um are are we ready to put diastasis recti to bed? Can we stop demonizing it? Please.

SPEAKER_01 37:10

I'm not sure if I should answer that one. I think um, you know, I think we're definitely taking steps towards demonstrating a little bit more, but I'm not sure it's gonna go away anytime soon. There's a lot more work that really does need to be done on this, yeah, but it's very much a natural, normal, expected change that's going to happen. Yeah. Um, and there's a lot of people who are starting to demonstrate very conclusively right across the world that um it is not this terrible, harmful thing. Yeah. So I think there's more that needs to be done for sure.

SPEAKER_00 37:46

Yeah, no, I I've definitely been seeing a shift away from that. It's it's the attention has now shifted over to conning and doming. So maybe that's going to be your next paper you have to do. Like, why? People didn't even name it anything, even you know, like 10 years ago. Why is it, you know, why do we have to have a thing? Um, but yeah, no, I always used to think I still do that that diastasis recti is almost like a gateway drug to getting to physio because some people will come to physio for that and then mention their pelvic floor issue, um, which to me is a much greater priority. Um, I joke that I live in Virginia. I said I joke that you know, 99% of Northern Virginia thinks that they have a diastasis and they don't. So um it's okay, gateway, gate, gateway diagnosis. Yeah. I I love um, and maybe you can speak to this a little bit too. Um our our mutual friend Christina Previtz, she's been talking a little bit more about um straight abdominal exercises, um, like rectus training and pregnancy and postpartum. And um, I've been thinking a lot about that too. And our our kids are similar um age, that period of time that we were pregnant in postpartum, where you're you're unfortunately we kind of put ourselves in an atrophy situation, in a deconditioned situation by saying, don't do this, don't do that. Um with the the screening and the guidelines and these conversations moving forward, are there any other areas besides the abdominals that um we might have been inadvertently deconditioning pregnant and postpartum women all these years out of fear? I know that's a big question.

SPEAKER_01 39:33

Yeah, that's a loaded question.

SPEAKER_00 39:38

As a researcher, you're allowed to comment as a researcher, not as a mom. We'll do the mom thing later.

unknown 39:45

Yeah.

SPEAKER_01 39:46

So, you know, it it's it's tough, right? Because there are, you know, when we talk about pregnancy and postpartum, we come from a standpoint where we are actually trying to demonstrate safety and benefit as opposed to virtually every other population where we're coming from standpoint exercise, physical activity is good, and let's identify where it may or may not be.

SPEAKER_03 40:12

Right.

SPEAKER_01 40:13

And so we have these very long-standing um beliefs. Uh yep. Beliefs coming from expert opinion, theoretical risk. Um, but as soon as we get that into um into sort of like the social consciousness or fabric, it's really hard to be able to actually do the studies to counter that. So for example, um, you know, it's really difficult to get the ethics to be able to do high-intensity uh interval training, to do heavy weightlifting, that sort of thing. And those restrictions are based on expert opinion. And so I think um, you know, there's it's a really tough question to answer. Are we doing harm? We don't know because we can't do the research, or it's a it's a really tough thing to be able to do the research. Until we do that research, we simply don't know.

SPEAKER_00 41:08

Yeah, right. Yeah.

SPEAKER_01 41:10

And so it's really easy to um come out and say we're doing harm. Um, but until you do that work to demonstrate it is potentially harmful, right? Um, you know, I I think it's it's just a difficult conversation. But that's where research really comes in and why we have to advocate for more women's health research in general, right across the world. We have to test, we cannot guess. Because even saying that those activities are safe, we're still guessing.

SPEAKER_00 41:39

Right, right. No, and that's where I do think um even for people that aren't working with elite athletes, that's where I find the the research there really compelling. Um, and you've got you a couple papers that came out, and then also a pregnant female ultra runner, um, where these these athletes, this is their bread and butter, this is what they do. Um, and you know, if if we can can we extrapolate from what we're learning from them, which is like this, you know, potentially is the average recreational athlete. Can can we make some kind of basic understanding of like, hey, if this person can do this, generally we can this should be safe here. Like what what have you learned kind of diving into more of the elite athletes in the ultra-marathon world and that that sort of thing?

SPEAKER_01 42:30

So a lot of the work that I have been doing that's not out yet and that is in process um right now is actually trying to understand the extremes of activity. So at both ends. Um you know, certainly we have populations where you know that we have this broad recommendation you should not be physically active. They have an absolute or in some cases relative contraindication. And so, you know, congenital heart disease and twin pregnancies, um, you know, type 1 diabetes. We have ongoing studies looking at the impact of physical activity in those populations to try and provide an evidence base. Is it potentially harmful? And there are definitely studies out there demonstrating certain conditions where it is harmful, and in those cases, physical activity shouldn't be recommended. Opposite end of the spectrum, um, we have these athletes, and there's lots of them that are going through their pregnancies in their postpartum, and they're doing things that are well beyond outside of the scope of guidelines.

SPEAKER_03 43:28

Right.

SPEAKER_01 43:28

And that's that's great, that's their choice. They do it, you know, partly, you know, because that's their identity, it supports their mental health. We cannot understate the importance of supporting somebody's mental health by saying, Well, we have to ensure that you know you're not causing harm. We may actually cause harm to somebody's mental health, which has a demonstrated impact to the baby by implementing theoretical concerns. So, again, we have to test. This information. And so we are looking at long duration exercise. So training over 60 minutes, which there's a guideline out there which says do not ever go past 60 minutes in a population where they're training two to three hours at a time. Um looking at high intensity, heavy lifting, you know, you name it, let's test those limits. But those are really um technical studies to do. You have to make sure that they're done well.

SPEAKER_00 44:28

Yes, I would imagine.

SPEAKER_01 44:29

Um, and and so there's um a lot, it's actually a very difficult study to be able to run, but they're important ones. And I think that's what's going to start to change the guidelines.

SPEAKER_00 44:40

Yeah. Do you have more, do you feel like more athletes are open to participating because we've seen more athletes perform in pregnancy and postpartum? Do you feel like that there's kind of a shift to they want this information just as much as we do?

SPEAKER_01 44:56

Yeah, I mean, they're desperate for the information. So while they're doing it, um, what you don't often hear about, but what we hear in our interviews is that they experience quite a lot of stress and anxiety um while they're doing it because they don't know if it's safe. Um, oftentimes they will end up pulling back. Um, we have some upcoming data which suggests that reducing activity levels uh during pregnancy actually uh doubles your risk of injury in the postpartum period. So, you know, there we there's so much information that we need to know and understand. And um certainly, you know, athletes are becoming quite aware of the importance of sharing this information and data, it's still really difficult to get it. Um but for those that that do, they're the ones that are really opening the conversation and and changing the research. If we don't change the research um, you know, and get better high quality research, the guidelines will never change.

SPEAKER_00 45:52

Yeah, no, I think that's fair. I mean, it it's it's it's funny, you know, some people are like, well, why don't we have this information? And again, people forget the history. Like even five to ten years ago, you might have some women doing this, but they're doing it in very close circles. And the only people that they're, you know, feeling comfortable, you know, running or performing around are gonna be friends that support them. And that, you know, if they put things out on social media, they're gonna get, you know, slaughtered. Usually you're gonna hurt your baby, like that. And nobody wants to subject themselves to that. So the fact that we're from a society perspective, yeah, all that trash is still here. But the fact that we can do it and then we can actually help these people with you know, really getting into the nitty-gritty on the research, like we couldn't have done this. This is this is like the earliest I feel like we we could have even kind of had these conversations and asked these questions because we needed the the subjects, quite honestly.

SPEAKER_01 46:44

So no, exactly. And I mean, you know, if you think back before the 2019 guidelines came out, like that was the first full synthesis of available literature, conclusively demonstrating the safety of exercise. Before that, there were constant questions about you know, if you're training at a moderate to vigorous intensity level, is it actually safe? Is it potentially going to restrict the growth of the baby? And we very conclusively demonstrated it does not cause miscarriage, it does not cause an early delivery, and it doesn't cause a small baby within the scope of the guidelines. Now we need to extend that research to those more extremes. And so as you know, we we start to see that more and more, people are starting to share their data, and that data sharing, that information sharing is so, so critical.

SPEAKER_00 47:29

Yeah, no, absolutely, absolutely. All right. The last question I wanted to ask you about. You got to go to a very cool place in the last year. You got to go hang out in Nepal. Oh, yeah. What did you do in Nepal and what was that like?

SPEAKER_01 47:45

Oh my goodness. It was um, it was just the most incredible experience. So uh my husband is a high altitude researcher, so he looks at the uh effects of hypoxia, so low levels of oxygen on um the body's physiology. So that can be, you know, trucking to high altitude. It can also be um different medical conditions like um uh chronic obstructive pulmonary disease, that sort of thing. Um, and he he looks at all of them. Um so there's actually been three expeditions where um Craig and my uh our trainees have gone to uh Nepal to do some exercise testing uh with um uh women who are native to the region who are living uh at high altitude, because current guidelines, and this is right around the world, basically say that if you are above either 1800 or 2500 meters, that you shouldn't exercise. Well, if you're somebody who is born and raised at high altitude, you know, those guys are inappropriate. So back in, I think it was 2015 or 2016, um, one of Craig's colleagues was doing a high altitude expedition going up to base camp. And one of the guides showed up and she was six months pregnant, and he was like, Oh my gosh, what am I supposed to do? So I got the text in the middle of the night, and I'm like, accelerometer on her, um, measure oxygen saturation and like, you know, have her do fetal counts, um, you know, to make sure baby's moving and that sort of thing. They went and trekked all the way up to Eber Space Camp, came back down, delivered very healthy baby. Like this is part of her daily life. And um, so, anyways, uh that sort of started or sparked this um question about, you know, is this guidance about high altitude um exercise? Is it appropriate? Is it not? And so uh we've just wrapped up um that that particular series of studies. Um, it was all done in consultation with people who actually live and work in the region. Those are some of their questions that we're incorporating um for sure. And so uh yeah, anyways, it was great because my husband and I were there and because we were gone for a month, we dragged our two kids out of um school for a month. It was like grade four and six. It's okay, I guess. Um, and so they got to join us um mostly because I'm not leaving them for a month and uh nobody would come for a month either.

SPEAKER_03 50:24

Right.

SPEAKER_01 50:24

And so it was just a really phenomenal um experience to be able to get to know some really oh lovely people. Um, they were so excited. We had a clinical um scenographer with us, and so you know, they were able to see their baby, make sure that it was okay. We were working with clinicians there. Um, we did some health testing that they uh would not have had otherwise. And um, you know, it was it was just lovely. So, anyways, that's coming out looking at um exercise and high altitude um natives, and it is exactly what you would expect.

SPEAKER_00 50:59

Right. Oh my gosh. No, I am that's a part of the world I'm fascinated by and Everest and Basecamp and that whole thing. Is there I I I I feel like because I had a colleague that had gone there a number of years ago for some pelvic health sorts of things. Do is there a difference in incidence of of birth injuries that you recall off the top of your head or no?

SPEAKER_01 51:23

Um, off the top of my head, I don't know, but we did definitely ask about pelvic floor dysfunction.

SPEAKER_00 51:29

Yeah.

SPEAKER_01 51:29

Yeah. Um, when we were talking with the ladies, and it was great because um, you know, I was able to WhatsApp Emma Brockwell and be like, Emma, I need some resources um for these individuals who, you know, don't have any access to a pelvic floor specialist. You know, where where can I direct them? Like, is there a video of you talking? Um, and so uh she was able to support that. And so I was able to link them in a lot of them had never heard of it. Um, you know, public floor dysfunction and urinary incontinence, and yeah, um they were so um excited and maybe relieved um that there was actually something that they could do, but the leaking that they were experiencing. So that was that was pretty rewarding too.

SPEAKER_00 52:14

That's I think when you have these international conversations, and and I've I've been lucky enough to go to World Congress a couple of times and and talk to other uh pelvic providers, um, I think, you know, first of all, a lot of us don't realize that there's some countries just trying to get recognition for healthcare for women. And then there's countries like that where, you know, just they've never even heard of us or what we do, or that this stuff, you know, we can do anything about it. And um I I think that's the it kind of goes back to that elite kind of average person conversation is what can we take about all this from this amazing research that we're pulling together and simplify it and distill it down to something very basic to give to someone that is in a different environment than us, but still could benefit from some basic information. I I think at the end of the day, like we've got to figure out ways to to take all this amazing research and yes, be able to use it for a high-level athlete, but then also extrapolate it for you know, someone who lives at at such a high altitude and you know doesn't want to leak when they're you know carrying stuff around their village. Um, that's so cool. Oh yeah, it was what an amazing experience.

SPEAKER_01 53:24

Yeah, yeah, and it's sparked a collaboration that's ongoing. So we're gonna be supporting some clinician researchers there. That's super cool, which is which is great to help them to answer questions that are really important to their community. So um I I hope I can go back soon.

SPEAKER_00 53:40

Okay. Well, if you need if if you need a Sherpa, I will volunteer for that. I will carry anything. All right, I think we had a lot of topics. I want to be uh respectful of your time because we were on the clock today. Um, you know, I I I I can't thank you enough. One for for coming on and continually talking to us and sharing all this information, but um making it approachable and doing the work that um we need to have in print. Um and I I can't possibly imagine how much work it is to pull this stuff together, but um just know that that it's so cool to have been in this field so long and see so much change in recent memory. And it's really cool to see names up there where I'm like, yeah, I know they do good work and the stuff that's gonna come out is gonna be amazing and resources not just for for you and your community, but really keeping everybody on this earth in mind. And and that's just a really cool thing. So thank you for doing that. So thank you. All right, so this time next year, um we'll make it.

SPEAKER_01 54:47

It's got new big projects coming, so we'll have more to talk about.

SPEAKER_00 54:51

We expect it. We expect it. If you want to find more about uh Margie's work and her team, um you can find her on Instagram, exercise and pregnancy. Um thanks again, and we'll figure out when to uh to put this up so that we we we we're in line with everybody's release date. All right, thanks so much.

SPEAKER_01 55:10

Bye.

SPEAKER_00 55:11

If you're navigating pregnancy, postpartum or perimenopause, whether personally or professionally, check out all our free resources and upcoming courses at carypagliano.com. This podcast reflects the opinions of Dr. Cary Pagliano and her guests, and it is for entertainment purposes only and should not be considered medical advice. Always consult your healthcare provider with any medical questions. If you enjoyed the episode, please take a moment to leave us a five star review on your favorite podcast platform. And thanks for listening.