Returning to Exercise Postpartum

In a world of immense knowledge and research it’s sometimes surprising that when it comes to pre and postpartum care there is little to be seen. Not much research has been done on when and how to return to training or exercise once you’ve gone through your pregnancy and birth. This can leave moms nervous about resuming their pregnancy habits or creating new ones to improve their health.

The good news is that there are some guidelines that can be helpful for your journey. First though we must consider a few things that can occur with any birth. This includes potential abdominal wall issues such as a diastasis rectus abdominis or DRA, pelvic floor and breathing dysfunctions, wound healing and scars at the perineal and cesarean sites. Your body has gone through nine months of transformation to care for your baby, it will take several months for you to start feeling like yourself again. Physiologically it can take anywhere from 6-8 weeks for your reproductive organs to return to normal and 6-12 weeks for your cardiac output to return to baseline, as well as 8-12 weeks for the perineal and cesarean wounds to heal. Your doctor though may clear you for exercise by 4-6 weeks after a vaginal birth and 6-8 weeks after a cesarean.

That leaves the question then of where to start and how. We do know that individualized advice is best when possible, so seek out a qualified postpartum trainer, physical therapist and or pelvic floor specialist prior to resuming exercise. In general your return to exercise should be gradual and progressive. Women should be encouraged to listen to their bodies and watch for signs and symptoms to know when to cease exercise. This can include persistent health concerns from pregnancy such as preeclampsia, increase in vaginal bleeding, new pain or discomfort, development of fever, malaise, extreme weight loss, extreme fatigue, and re-opening of previously healed perineal or cesarean sites.

Whether you had a Vaginal or Cesarean Birth American College of Obstetricians and Gynecologists (ACOG) in 2020 determined that gradual return to exercise routine is okay for most women, for cesarean births, you must consider complete wound site recovery. At about 6 weeks ACOG and American College of Sports Medicine (ACSM) recommend, 150min of moderate intensity aerobic activity/week. Each session should be long enough to work up a sweat, and increase heart rate, but can also be as brief as 10 min. Strength and weight lifting should be performed at least 2x a week, including body weight or resistance training to target large muscle groups.

In general this is what you can start with day one postpartum, pelvic floor exercises, lower abdominal drawing in and breathing exercises. By week 2-4 you can start with low impact body weight movements such as air squats or restorative yoga. By 4-6 weeks you are progressing your body weight exercises to adding light weights based on tolerance and recovery and adding walking. At 6-8 weeks you may be able to include power walking as well as moderate weights, progressively building on the weeks prior. At 8 weeks you can potentially resume swimming and increase your lifting capacity based on your wound healing. Around 12 weeks is when you can resume running.

Now, when it comes to resuming high impact activities such as running, CrossFit, or heavy lifting you should get cleared of any abdominal wall issues such as a DRA, as well as any pelvic floor or breathing dysfunctions. You may also want to consider how much rest you are able to get, in order to optimize your recovery, e.g. it’s okay to take a nap! As well as having proper nutrition and hydration. If you had a cesarean birth, this many times can silently impact breathing, intra-abdominal pressure control, deep core and general abdominal engagements, as well as trunk and hip flexibility. A good screen you can perform to know if you’re ready to start running can include performing at least 20 reps of: single leg calf raise, single leg bridge, single leg sit to stand, and side-lying abduction.

Just know you are not alone, if you are unsure of where to and how to start get help from a qualified pelvic floor specialist and or physical therapist. Start slow and progressively work up, listening to your body and watching for any signs and symptoms of when to stop exercise.