Impact of postpartum physical activity on cardiometabolic health, breastfeeding, injury and infant growth and development: a systematic review and meta-analysis

Objective To examine the relationship between postpartum physical activity and maternal postnatal cardiometabolic health, breastfeeding, injury, and infant growth and development. Design Systematic review with random-effects meta-analysis and meta-regression. Data sources Eight online databases were searched up until 12 January 2024. Eligibility criteria Studies of all designs in all languages were eligible (except case studies and reviews) if they contained information on the population (postpartum people), intervention (frequency, intensity, duration, volume, or type of exercise, alone (‘exercise-only’) or in combination with other intervention components (eg, dietary; ‘exercise+co-intervention’), comparator (no or low volumes of physical activity), and outcomes: hypertension, diabetes, cardiometabolic risk factors (systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, high density lipoproteins, low density lipoproteins, and triglycerides, glycated hemoglobin (HbA1C), glucose and insulin concentration), breastfeeding (breast milk quality and volume), infant growth (length and weight) and development, or postpartum injury. Results 46 unique studies (n=8766 participants) from 20 countries were included. Moderate certainty of evidence showed exercise+co-interventions reduced the odds of developing diabetes by 28% (7 randomised controlled trials (RCTs), n=2496; OR 0.72 95% CI 0.54, 0.98, I 2 12%), reduced SBP (10 RCTs, n=2753; mean difference (MD) −2.15 95% CI −3.89 to –0.40, I 2 73%) and DBP (9 RCTs, n=2575; MD −1.38 95% CI −2.60 to –0.15, I 2 66%) compared with controls. Infant growth and development, breast milk quality and quantity, and risk of injury were not different between exercise and control groups. Conclusions Physical activity improves cardiometabolic health without adversely impacting breast milk supply or quality, infant growth or maternal injury.