Article Text

Original research
Postnatal exercise interventions: a systematic review of adherence and effect
  1. Edward Mullins1,2,3,
  2. Shalini Sharma4,
  3. Alison H McGregor5
  1. 1Department of Metabolism, Surgery and Cancer, Imperial College London Faculty of Medicine, London, UK
  2. 2Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK
  3. 3The George Institute for global health, London, UK
  4. 4Leicester Royal Infirmary, Leicester, UK
  5. 5Surgery, Imperial College London Faculty of Medicine, London, UK
  1. Correspondence to Edward Mullins; edward.mullins{at}


Objective To evaluate adherence to and effect of postnatal physical activity (PA) interventions.

Design Systematic review of PA intervention randomised controlled trials in postnatal women. The initial search was carried out in September 2018, and updated in January 2021.

Data sources Embase, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases, hand-searching references of included studies. The 25 identified studies included 1466 postnatal women in community and secondary care settings.

Eligibility criteria Studies were included if the PA interventions were commenced and assessed in the postnatal year.

Data extraction and synthesis Data were extracted using a prespecified extraction template and assessed independently by two reviewers using Cochrane ROB 1 tool.

Results 1413 records were screened for potential study inclusion, full-text review was performed on 146 articles, 25 studies were included. The primary outcome was adherence to PA intervention. The secondary outcomes were the effect of the PA interventions on the studies’ specified primary outcome. We compared effect on primary outcome for supervised and unsupervised exercise interventions. Studies were small, median n=66 (20–130). PA interventions were highly variable, targets for PA per week ranged from 60 to 275 min per week. Loss to follow-up (LTFU) was higher (14.5% vs 10%) and adherence to intervention was lower (73.6% vs 86%) for unsupervised versus supervised studies.

Conclusions Studies of PA interventions inconsistently reported adherence and LTFU. Where multiple studies evaluated PA as an outcome, they had inconsistent effects, with generally low study quality and high risk of bias. Agreement for effect between studies was evident for PA improving physical fitness and reducing fatigue. Three studies showed no adverse effect of PA on breast feeding. High-quality research reporting adherence and LTFU is needed into how and when to deliver postnatal PA interventions to benefit postnatal physical and mental health.

PROSPERO registration number CRD42019114836.

  • obstetrics
  • sports medicine
  • public health

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Supplementary materials


  • Contributors EM, SS and AHM were involved in study design and conduct, data analysis, report drafting and editing. EM and SS conducted the literature review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.