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When Can I Exercise Postpartum?

Hi friends! This week we are going to discuss the hot topic of, “When can I start exercising after pregnancy?” You may be wanting to exercise for a variety of reasons, and that’s great! We know that exercise has so many benefits for our bodies, but keep in mind the postpartum body just did some amazing things to grow a baby and it needs time to heal. The quick answer to the question: it depends. It depends on how your delivery was and if there were any complications, it depends on what kind of exercise you want to return to, and so much more.


As always, remember that here at myPFM we are pelvic health physical therapists, but we are not your physical therapist. This information does not replace evaluation by a licensed healthcare provider.



In the United States, it is recommended you wait until cleared by your birth provider to return to exercise. This typically happens at your 6-week checkup.


In those first 6 weeks postpartum, you are likely caring for and tending to the needs of your newborn before your own needs. If this happens, you may find yourself cleared to return to exercise at six weeks only to return to exercise and find that it’s not the same. You may have pain in places that you haven’t had pain before, your scar(s) may hurt, or you may find that you are leaking pee or poop. This can leave you wondering, “Why didn’t anyone warn me about this?”


You may feel defeated when you go to exercise and you don’t feel like your body is ready or you don’t feel like your body is the same. Recovering from pregnancy and childbirth often presents its own challenges. Your body is going through physical changes, including changes in your hormones. Common postpartum complications include back pain, bowel and bladder (pee and poop) problems, and scar tissues/adhesions (Stone, 2020). Individuals who delivered via cesarean section are 2 to 5 times more likely to have low back and pelvic girdle pain compared with those who had a vaginal delivery (Stone, 2020).


The six week recommendation to return to exercise is often based on the principle that tissue (like a scar) takes about 6 weeks to heal. However, “exercise” is such a broad term and means different things to each person. One individual might think of exercise as a stroll around the block while another thinks of exercise as training for a marathon. Not all exercises are equal which means some may be more appropriate in the first six weeks than others.


With that said, we know that exercise is good. It has been shown to reduce postpartum fatigue (Lui, 2020) and improve mom’s cardiovascular fitness (ACOG, 2020).


So, what kind of exercise is “safe” in the first six weeks postpartum? Here are a few things you might start immediately postpartum.


Pelvic floor muscle exercises—when these are done in the immediate postpartum period it may reduce your risk of developing urinary incontinence (Davies, 2018; ACOG, 2020)


Breathing—practice diaphragmatic breathing to gently stretch the pelvic floor and engage the abdominals.


Gentle abdominal muscle engagement/core bracing—think about bringing your belly button to your spine, not crunches. In studies, postpartum individuals have been shown to have core stabilizing muscles that get tired more quickly than their counterparts who have never been pregnant (Deering, 2018). The immediate postpartum period is a great time to start re-training these muscles to avoid problems later on. Additionally, abdominal strengthening exercises can help with diastasis recti abdominus (ACOG, 2020).


Walking—going for a walk outside is good for so many things. Listen to your body, it will tell you how far you can go.


The number one rule is to listen to your body! Watch for these warning signs that something may not be right when exercising postpartum:

  • Bleeding from the vagina

  • Feeling dizzy or faint

  • Shortness of breath before starting exercise

  • Chest pain

  • Calf pain or swelling

  • Muscle weakness

  • Headache

  • Doming in the middle of your abdomen

  • Leaking pee or poop

If you experience any of these, talk with your provider.


A physical therapist who specializes in the pelvic floor or pregnancy and postpartum is a great resource to help you get back to exercising safely while addressing any complications you might have.


You may be worried about returning to exercise if you are breastfeeding. Studies have shown that moderate exercise while breastfeeding does not affect the quantity or composition of breast milk or impact infant growth (Davies, 2018). It is recommended that you breastfeed or express milk (e.g. pump) before exercise to avoid pain due to engorged breasts (ACOG, 2020). It is also extremely important to make sure you are hydrating while breastfeeding—whether you are breastfeeding or not (ACOG, 2020).


There are so many other important factors that go into postpartum healing including sleep, what you eat, drinking water, and more. Be sure to talk with your providers about any concerns or issues you may be experiencing.


Here are some great resources to help you recover postpartum:

  • Ask your healthcare provider for a referral to a pelvic therapist to help you exercise safely and to prevent any pelvic floor symptoms.

  • Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.

  • Watch our YouTube playlist on Postpartum and Your Pelvic Floor

  • Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics

  • Visit our Amazon store for our favorite postpartum products.

  • Sign up for our email newsletter!

For providers, check our online courses to help your postpartum clients. Consider joining our Ambassador Program and most of our courses are included with your membership!

Written by Emily Reul, PT, DPT


References

1. Davies GAL, Wolfe LA, Mottola MF, MacKinnon C. No. 129-Exercise in pregnancy and the postpartum period. J Obstet Gynaecol Can. 2018;40(2):e58-e65.

2. Liu N, Wang J, Dan-Dan C, Wei-Jia S, Ping L, Zhang W. Effects of exercise on pregnancy and postpartum fatigue: a systematic review and meta-anaylsis. Eur J Obstet Gynecol Reprod Biol. 2020;253:285-295.

3. ACOG Committee Opinion No. 804: Physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2020;135(4):e178-e188.

4. Edie R et al. Barriers to exercise in postpartum women: a mixed-methods systematic review. J Womens Phys Therap. 2021;45(2):83-92.

5. Deering RE et al. Fatiguability of the lumbopelvic stabilizing muscles in women 8 and 26 weeks postpartum. J Womens Phys Therap. 2018;42(3):128-138.

6. Stone J, Skibiski K, Hwang S, Barnes C. Physical therapist in addition to standard of care improves patient satisfaction and recovery post-cesarean section. J Womens Phys Therap. 2020;45(1):10-19.

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