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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
  1. Kari Bø1,
  2. Raul Artal2,
  3. Ruben Barakat3,
  4. Wendy J Brown4,
  5. Gregory A L Davies5,
  6. Michael Dooley6,7,
  7. Kelly R Evenson8,
  8. Lene A H Haakstad1,
  9. Bengt Kayser9,
  10. Tarja I Kinnunen10,
  11. Karin Larsén11,
  12. Michelle F Mottola12,
  13. Ingrid Nygaard13,
  14. Mireille van Poppel14,
  15. Britt Stuge15,
  16. Karim M Khan16,
  17. IOC Medical Commission17
  1. 1Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  2. 2Department of Obstetrics, Gynecology and Women's Health, Saint Louis University, St Louis, Missouri, USA
  3. 3Facultad de Ciencias de la Actividad Física y del Deporte – INEF, Universidad Politécnica de Madrid, Madrid, Spain
  4. 4Centre for Research on Exercise Physical Activity and Health, School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
  5. 5Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Queen's University, Kingston, Canada
  6. 6Department of Sport Gynaecology, Poundbury Clinic, Dorchester, UK
  7. 7Poundbury Clinic, King Edward VII Hospital, London, UK
  8. 8Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  9. 9Faculty of Biology and Medicine, Institute of Sport Science, University of Lausanne, Lausanne, Switzerland
  10. 10School of Health Sciences, University of Tampere, Tampere, Finland
  11. 11The Swedish School of Sport and Health Sciences, Stockholm, Sweden
  12. 12R Samuel McLaughlin Foundation-Exercise and Pregnancy Lab, The University of Western Ontario, London, Canada
  13. 13Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
  14. 14Institute of Sport Science, University of Graz, Graz, Austria
  15. 15Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
  16. 16Department of Family Practice and School of Kinesiology, Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
  17. 17IOC, Medical, Commission
  1. Correspondence to Professor Kari Bø, Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo 0806, Norway; kari.bo{at}nih.no

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Background

This is Part 3 in the series of reviews from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related complaints experienced by athletes1; Part 2 addressed maternal and fetal perinatal outcomes.2 In this part, we review the implications of pregnancy and childbirth on return to exercise and on common illnesses and complaints in the postpartum period.

The postpartum period can be divided into hospital-based (during hospital stay), immediate postpartum (hospital discharge to 6 weeks postpartum) and later postpartum (6 weeks to 1 year, corresponding sometimes to cessation of breast feeding).3  In the literature, the postpartum period is usually defined as the first 6 weeks after pregnancy, during which time women have not typically been encouraged to exercise, except for strength training of the pelvic floor muscles. However, 6 weeks is an arbitrary time point and, anecdotally, many elite athletes report starting exercise inside that period. For the purpose of the present review, we consider the postpartum period to be up to 12 months following birth.

Aims

The aims of this paper are to present (1) the findings from a systematic review of the scientific literature on factors related to returning to exercise after childbirth in recreational and elite athletes, and (2) the prevalence, risk factors and evidence for prevention and treatment of common postpartum conditions that may affect sport performance and overall quality of life.

Methods

For each section of the document, a search strategy was performed using search terms such as ‘pregnancy’ OR ‘pregnant’ OR ‘postpartum’ AND ‘exercise’ OR ‘physical activity’ OR ‘leisure activity’ OR ‘leisure’ OR ‘recreation’ OR ‘recreational activity’ OR ‘physical fitness’ OR occupational activity’ AND terms related to the condition under study (eg, ‘pelvic …

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