By Annette M. Boyle
FAIRFIELD, CA —Many women return to their units after pregnancy with one overriding concern: “Can I pass the fitness test?”
The vast majority of those women do end up passing the six-month postpartum test, but their anxiety could be ameliorated and their performance improved with a few simple interventions, military experts suggested.
More than 214,000 women serve on active duty, and 90% of them are under age 40, with an estimated 10% are pregnant in any year. Therefore, providing support and understanding of the needs of these women so that they can return to expected levels of fitness has a significant impact on the servicemembers themselves as well as their units and overall military readiness. Failure to pass the fitness assessment may lead to a range of negative consequences, including unsatisfactory job evaluations, prohibition from certain duty assignments and potential discharge.
Strong post-pregnancy results start before delivery, according to Lt. Col. Nicole H. Armitage, chief of clinical research at Travis Air Force Base, who noted that talking with women during pregnancy can make passing the first post-baby fitness test easier.
“Studies in civilian populations show that women who maintain some level of training during pregnancy will return to higher levels of fitness after having a baby than those that don’t,” Armitage pointed out. “We can intervene with active duty women to help them understand what they can and can’t do during pregnancy that will help them get back into condition.”
In those prenatal conversations, healthcare providers should also provide “anticipatory guidance,” Armitage told U.S. Medicine. “Women don’t know how to prepare for the fitness test after having a baby. Chances are they will lose some conditioning and be at risk of injury as their joints come back into place.”
To minimize injury and maximize results, women should gradually ramp up their conditioning. Many active duty women are advised not to do any training for the first six to eight weeks postpartum, which will diminish fitness even in women who continued to exercise throughout their pregnancies. When they return to training, some women try to pick up where they left off and panic when they find their speed and endurance significantly below their previous levels, Armitage said.
“They should not immediately try to do a three-mile run at eight weeks,” Armitage explained. “They need to gradually increase to pass the test and recognize that at six months they probably won’t score as high as they did pre-pregnancy, but most will be able to train for and pass the fitness test.”
In late 2010, Armitage’s research with Air Force women found that 26% failed the six-month postpartum fitness test, but her most recent research found a failure rate of just 6%. She noted that the failure rate across the Air Force was high in 2010, about 17%, following mid-year changes to the test.
Previously, an airman could pass the assessment even if she failed one of the four components—abdominal circumference, timed sit-up repetitions, times push up repetitions and a timed 1.5 mile run— as long as she performed well enough on the others. After the change, failure of any part (or minimum scores on all) resulted in a failed assessment. In the more than three years since establishment of the new requirements, men and women have had time to adjust and overall pass rates have risen. 1,2
To reduce anxiety and help women pass the postpartum test, nurses and other healthcare providers should also reach out to active duty women after birth, Armitage noted. “These women are not necessarily going to ask for help, even if they have complications which would warrant an extension” for the test, she said. And, even those with straightforward recoveries likely need postpartum follow-up.
“A lot of women get scared after the first practice tests, then they train hard, but don’t realize how they need to train. We can refer them to physical therapy, talk to them about training safely, get them nutritional counseling and provide reassurance,” Armitage added.
For the woman and her baby, nutritional counseling also can have long-term benefits. “Some take drastic measures to lose weight, not realizing that if they restrict calories too quickly, they will impair their milk supply,” she noted. “Breastfeeding turned out be a relatively big physical factor” for women returning to training, both because of the challenges of retaining and building milk supply and because of the impact on time available.
The women interviewed who received referrals to physical therapy reported that the therapists gave them specific exercises to strengthen their core, particularly after cesarean sections. Many women noted a dramatic loss in core strength following both vaginal and cesarean births, but those with C-sections felt particularly anxious about the fitness test as they often had an extended time during which they were advised to not exercise, yet still needed to be fit in six months.
Aside from assisting women with understanding the proper nutrition and exercise plan to regain conditioning, healthcare providers can also help them find and receive support they need to train and to adjust to being a new mother or having an additional child. “We can help the unit and supervisor understand that they may need a little extra training time and address misunderstandings and unknowns,” said Armitage. “We all—healthcare providers, servicemembers, supervisors—want them to pass. It’s about giving them the tools and support.”
- Armitage NH, Smart DA. Changes in Air Force fitness measurements pre- and post-childbirth. Military Medicine. 2012;177(12):1519-1523.
Armitage NH. Experience of postpartum active duty women training for the U.S. Air Force fitness assessment. Washington State University. 2013. http://hdl.handle.net/2376/4762