Welcoming a newborn to your family is a time of excitement, filled with first-time adventures and experiences that run the gamut from the surreal to existential joy. For the recreational or elite athlete, a return to pre-pregnancy fitness and performance levels is an added challenge to navigate.
Whether you’re a lifelong exerciser or you haven’t even considered stepping foot inside a gym until now, the benefits associated with working out during the postpartum period are numerous. Decreased incidence of postpartum depression, anxiety and fatigue are all noted in the research literature; however, the exercise must be stress-relieving and not stress-inducing to be effective. Reduction in pregnancy-related urinary stress incontinence, pelvic girdle pain, and low back pain can be achieved, especially when pelvic floor and deep abdominal muscle work is included in the program.
Pregnancy and delivery is a process comparable to healing an injury and returning to exercise—ease into a workout routine rather than jump back in at full speed. If a woman’s mode of delivery is vaginal—without or of low complication—low intensity exercise can be initiated one to two weeks postpartum. If delivery is complicated or via Cesarean section, waiting six to eight weeks for a follow-up visit with the obstetrician is highly recommended.
Postpartum athletes face an uphill battle against poor body image, postpartum fatigue and/or depression, low back pain (LBP), pelvic girdle pain (PGP), pelvic floor pain, and a variety of overuse injuries (i.e. tendonitis or tendinopathy). Initial goals should be to establish—or reestablish—a strong core, good foundational strength and an adequate cardiovascular base.
Although there is no evidence suggesting that mild- to moderate-intensity exercise increases normal bleeding after delivery or contributes to the risk of postpartum hemorrhage, it is advised to avoid heavy resistance training and swimming activities until any bleeding has subsided.
As exercise and lactation are energy-demanding physiological processes, nursing mothers should take care to balance fluid and consider any nutritional losses related to training outputs to ensure adequate milk production. Moderate physical activity levels have no negative effect on infant breast milk acceptance or the child’s growth. Feeding prior to exercise can decrease discomfort related to engorged breasts. It also decreases acidity in the milk secondary to buildup of lactic acid.
Overall, listen to your body! Muscle soreness is expected and welcomed. However, if you experience joint pain or swelling that persists into the day after exercise, or if this pain interferes with daily activities, reduce training volume or intensity until symptoms resolve. If pain persists, seek advice from a health care professional.
Postpartum athletes may benefit from focusing on endurance during the first three to six weeks of return to exercise.
For strength training, adhere to the American College of Sports Medicine (ACSM) recommendation of less than 70 percent of your one-rep max, performing two to four sets of 10 to 25 repetitions with a 30 to 60 second rest period.
For cardiovascular exercise, ACSM recommends starting at 15 to 20 minutes a day, three times a week, and progressing to at least 30 minutes a day, five time a week. Use of anti-gravity treadmills or pool running can facilitate this process.
Tony Lauretta is the Cedar Park Clinic Director at Texas Physical Therapy Specialists.