For physiotherapists working in women’s health and orthopedic rehabilitation, the postpartum period represents a distinct physiological window characterized by significant musculoskeletal and behavioral changes. A common clinical assumption is that establishing robust physical activity (PA) habits during pregnancy will naturally translate into sustained activity levels postpartum. However, new data from the FitMum randomized controlled trial challenges this assumption, highlighting the complexity of maternal activity patterns and the necessity for longitudinal clinical support.
The FitMum Protocol: Assessing Interventions
Published in Scientific Reports, the FitMum trial sought to map physical activity, sedentary time, and sleep trajectories from early pregnancy through one year postpartum. The study involved 220 healthy, previously inactive pregnant women. Participants were randomized into three groups: standard care (CON), supervised exercise (EXE), and motivational PA counseling (MOT). By utilizing wrist-worn activity trackers continuously from inclusion to one year postpartum, the researchers provided granular data often missed by self-report measures.
Divergent Postpartum Activity Patterns
The study yielded nuanced results regarding the “volume vs. intensity” debate in rehabilitation. Postpartum daily steps increased by approximately 2,000 steps compared to late pregnancy levels. While this appears positive initially, clinicians should note that Moderate-to-Vigorous Physical Activity (MVPA) significantly declined over the same period. This suggests that while new mothers are moving more frequently—likely due to the demands of infant care—they are engaging in less intensity-based conditioning. For orthopedic rehabilitation, this reduction in MVPA is significant, as low-intensity ambulation may not be sufficient to restore pre-pregnancy core stability and lumbopelvic strength.
Sleep Dynamics and Sedentary Behavior
Sleep architecture is a primary concern for postpartum recovery and tissue healing. The trial found that while sleep duration dropped significantly in the first three months postpartum, subjective sleep quality surprisingly improved. This paradox may be attributed to increased sleep pressure resulting in deeper, albeit shorter, sleep cycles. Sedentary time remained relatively stable, suggesting that the increase in daily steps did not necessarily displace sedentary behavior but rather fragmented it.
Clinical Implications for Physiotherapy
Perhaps the most critical finding for the clinician is the limited carry-over effect of prenatal interventions. Neither supervised exercise nor motivational counseling during pregnancy resulted in significant differences in postpartum PA or sedentary time compared to standard care. However, the EXE group did report marginally better sleep outcomes than the MOT group at the one-year mark.
These findings suggest that prenatal education and exercise, while vital for gestational health and labor preparation, are insufficient on their own to guarantee active postpartum behaviors. Physiotherapists should view the postpartum phase not as a continuation of prenatal habits but as a distinct rehabilitation phase requiring specific, timed interventions to reintroduce MVPA safely and effectively.
References
Jessen, A. D., Alomairah, S. A., Jensen, I. K. B., de Place Knudsen, S., Roland, C. B., Bendix, J. M., Molsted, S., Løkkegaard, E., & Stallknecht, B. (2025). Mapping postpartum physical activity, sedentary time, and sleep: assessing the impact of prenatal physical activity interventions in the FitMum randomized controlled trial. Scientific Reports. https://pubmed.ncbi.nlm.nih.gov/41044147/
