Have You Been Cleared for Exercise?

If you’re currently pregnant and have been consistent with exercise, you’re probably already planning your return to exercise postpartum, especially if exercise has always been a part of your life. I know most of my clients who have continued to stay active during pregnancy have goals to return to fitness as soon as their doctor gives the OK postpartum.

If you’ve recently had a baby, you may be awaiting your postpartum appointment to find out if you are “cleared for exercise”. Getting cleared for exercise can feel liberating if you’ve been missing that sense of control over your body. However, it’s important to understand what being cleared means as well as how to return to physical activity after pregnancy.

What Does "Cleared for Exercise" Mean?

Being cleared for exercise is your doctor’s medical opinion that you are physically ready to start increasing physical activity, or that it’s generally safe for you to exercise. This typically happens at your 6-week postpartum check-up, but if you’ve had complications like tearing or are recovering from a c-section, that may happen a bit later. 

In other words, your doctor will either tell you it’s safe, or that it’s not. Which, don’t get me wrong is important information. You shouldn’t begin to increase physical activity or exercise if you have contraindications. However, the trouble with the yay or nay approach is that it’s one size fits all. Postpartum exercise clearance usually comes with the advice that you should ease back into it and listen to your body. This is not inherently bad advice, but it’s pretty subjective and doesn’t educate you on what a proper progression looks like, or why easing back into it is essential. Fortunately for you, if you’re reading this, you probably already have an understanding that there are important considerations when returning to exercise after having a baby. In the rest of this article, I’ll provide you with tips and strategies to guide you in your return to fitness.

What do the postpartum exercise guidelines say?

At the time of this article (12/2023), postpartum exercise guidelines have not been published. BUT, there is encouraging news that they’re finally in the works and should be released soon. I’ll link to them when they come out, but in the meantime, I’m going to provide you with some tips inferred from the research that exists, my background in exercise science, as well as the practical experience I have working with pregnant and postpartum moms.

Do you need to see a pelvic floor physical therapist or postpartum exercise specialist?

The ideal answer is yes, it would be great if everyone was able to receive personal guidance from a professional after having a baby. The more realistic answer for most people is that it depends. If you have any concerning symptoms like incontinence, pelvic or back pain, abdominal separation, or others then I strongly encourage you to see a pelvic floor physical therapist as a starting point. If you live in a major city there are probably those that accept insurance, as well as cash-based, but you should be able to see someone. Additionally, if you are concerned about excessive fatigue, anxiety, or depression, I’d also recommend seeing a professional before beginning a structured exercise program beyond general physical activity. If you were not active during pregnancy or you’re new to strength training or core exercises, a postpartum exercise specialist can save you a lot of time and energy in the long run by helping you determine which exercises are best for you.

Time for the Tips

Aerobic

The general physical activity guidelines for adults recommend 150 minutes per week of moderate or moderate-vigorous physical activity, with activity occurring on most days. The postpartum guidelines may skew a bit, but will not be drastically different. In any case, that duration and intensity is what you’re working up to and not where you’re starting. For most moms that I’ve worked with, getting out and pushing the baby in the stroller for 10-20 minutes every day is a great starting point. Walking is great because you can still spend time with your baby, being outside may boost your mental health, it’s a low-impact activity ensuring you’re not stressing your healing pelvic floor too soon, and it’s a trackable activity that you can strategically progress to longer durations, distances, and intensities. 

Strength

Here’s where I plug the method I developed called the Core, Function & Fitness approach. The idea is that the core is the foundation of fitness and where you should prioritize your efforts. During the postpartum period, this most often means addressing any pelvic floor concerns and coordinating breath with your deep ab muscle activation. Initially, this could be through pelvic tilts or heel slides but can progress to exercises like the deadbug. After you’ve made some progress in core strength and function, you can add in functional strength training. So this might mean you’re spending 5-10 minutes on isolated core exercises and then doing a full body circuit focusing on muscles you need to move through your day pain-free, as well as the major movement patterns. For example, lengthening chest muscles and strengthening upper back muscles is usually a necessary focus for moms due to the feeding posture. 

After you’ve laid a solid foundation of core training and strength training you can continue to increase the duration, frequency, and intensity of your workouts, while also setting more specific goals like running.

Don’t Forget About Lifestyle Factors

To benefit from exercise, there are more factors than the workout or activity. Things like sleep, nutrition, hormones, childcare, the ability to be consistent, and the ability to recover all determine whether you’ll get the benefits you’re expecting from exercise. For this reason, not jumping back into structured workouts until you are more healed, getting a bit more sleep, and have found ways to stay hydrated and eat a balanced meal is a reasonable decision and it’s smart. Now this doesn’t mean you should do anything. You should begin to increase physical activity and address core strength at a minimum, but it means that rather than aiming for pre-pregnancy 60-minute workouts at the gym, your starting point might be daily walks and two minutes of isolated core work when the baby is doing tummy time.

On the flip side, if you have childcare help, you’re feeling healed and sleep deprivation isn’t an issue, you may be feeling like you’re ready to get back to your old routine. To that I’ll say, remember that your abdominal and pelvic floor muscles and tissues are still healing and your hormones are still fluctuating, so even if you’re feeling good, I’d suggest the same gradual core, function then fitness framework. You may move through the progression quicker than someone else but don’t skip the gradual transition.

The Takeaway

This article is just one piece of the postpartum exercise puzzle, but I hope it gave you some perspective on getting cleared for exercise. To summarize:

• Prioritize healing

• Remember that lifestyle factors should support the type of workouts you’re doing

• Core, then add functional strength then set fitness goals

Being an active mom is a lifestyle and will look different as you move through different stages of motherhood. The fourth trimester is not even the first chapter, we’ll call it the introduction.

Ready for more tips? Download 5 Tips for a Stronger Core After Pregnancy.

Feeling Overwhelmed When You Think About Returning to Fitness?

As we all know exercise has many physical and mental health benefits. We all are also probably somewhat familiar with exercise guidelines and recommendations. So why does beginning an exercise program after having a baby feel so difficult? The answer is that there are many real challenges for new moms. Being a military mom adds another layer of barriers and stressors. Sleep deprivation, lack of time, changed priorities, minimal support from family, fear, birth complications, pain, lack of postpartum exercise and healthcare resources, and pressure to lose weight and perform, are all very real barriers (not excuses!). Although every mom’s journey back to exercise will be different, these three general strategies can make your return to exercise a little less overwhelming.

1) Understanding Changes to Your Body: Having information and knowledge about the anatomical and physiological changes during and after pregnancy will validate why you feel weaker despite exercising during pregnancy, or why you can’t seem to lose the last five pounds, or why you’re experiencing soreness like you never have before. Understanding how the changes to your body impacts fitness is essential, yet most postpartum care doesn’t include such information. Having this understanding will help you make sense of why workouts feel so difficult, why you’re not seeing progress at the rate you’re used to, and hopefully allow yourself some grace during those first few months after having your baby. 

There could be an entire book about this, but hormones play a huge role in muscle development and exercise recovery. Hormones don’t stabilize immediately after giving birth, and even when they begin to “balance out”, other hormones due to lack of sleep and stress can keep your hormones at levels that will impact your ability to lose weight, workout at higher intensities, and recover after a workout. Additionally, hormones can have an impact on your mood, affecting your motivation to exercise and desire to hit the gym like you used to. If you’re breastfeeding, you’ll have an even longer delay of hormones getting back to pre-pregnancy levels, so having the understanding that breastfeeding doesn’t automatically make it easier to change your body composition due to so many other factors, is also really important.

In addition to hormones, you need to have an understanding of tissue healing. You may be feeling stronger and ready for more physical activity, but whether you’ve had a vaginal delivery or c-section, your abdominal wall and pelvic floor tissues can take 9-12 months to fully heal and regain strength. Having this understanding is important so that you’re not choosing exercises that will do more harm than good, hence stunting your progress and inhibiting fitness results. Exercise is important in healing, but not over stressing the tissues is crucial in progressively increasing strength and function. This means if running feels overwhelming, that’s OK. Recent guidelines suggest that running and other high impact activity shouldn’t even happen until at least 12 weeks postpartum, and after proper strength training.

Hormones, tissue healing, and other factors don’t mean that you can’t exercise, in fact you absolutely should. Those factors also don’t mean that you won’t see results. What those changes to your body do mean is that you shouldn’t expect to exercise at your same pre-pregnancy level right away, and that initially, your program will probably need to look different. Having this understanding about the changes to your body means you’ll be able to gradually progress in fitness. As long as you’re moving forward with no setbacks, you’ll get there.

2) Prioritize: Being able to prioritize will help ease some of the pressure and stress around exercising. You’re probably used to thinking of fitness as aerobic, strength, and flexibility. And you’re correct, these are all major components of fitness. However, as a new mom it’s important that you make the most of your time and energy. To set yourself up for success, you should prioritize the type of workouts and exercises you’re choosing. Your first priority should be on healing. This includes any tears, incisions, scarring and any emotional trauma, depression, or anxiety. So if you once prioritized high intensity cardio and heavy weights, you’ll need a mental shift to feel good about the workouts your body needs. Next you should prioritize core strength and function, specifically addressing any concerns for abdominal separation, back pain, or pelvic floor dysfunction (pain or incontinence). Next make sure you’re functional. Functional strength training is somewhat of a trendy term, but for moms it means that you can perform all of your daily movements and demands of caring for a baby without pain. As it relates to exercise, it means you have mastered all of the major movement patterns (squat, lunge, hinge, push, pull, rotate/anti rotation) with good technique, and ability to recover. Your last priority is progressing to more vigorous physical activity and your traditional fitness goals. After you have the foundation of core strength and functional movements, you should be able to advance comfortably and with reduced injury risk. This is a simplified progression, but I like to think of Core, Function and Fitness as a pie chart with different percentages. You’ll always be working on all parts, but the percentage of each will change based on your priorities and needs.

3) Mental Shift: This has been touched on a bit already, but the first step in returning to exercise is mental. The fitness requirements of the military are relevant, but this comes secondary to how you view postpartum physical activity, especially now that you have a year to meet your military fitness and body composition goals. Your body has changed so your workouts will and should as well. The goals you once set were for a different body. Exercise should be a tool and if you begin to look at it that way, you will choose and plan your workouts differently, and with less stress. During the first few months, what type of exercise will help you heal? What type of exercise can you do without childcare? What workouts are realistic with the time you have? If you’re not sleeping, when is the best time of day to exercise and the appropriate intensity? Shifting your perspective about fitness and exercise is not a sign of weakness, but rather a helpful and smart tactic.

Now that you have those three general strategies to help you overcome the numerous barriers you face as a mom returning to exercise, I want to make it very clear that being a mom does not have to negatively impact your fitness. Moms actually have an advantage when it comes to fitness. By training in a very specific way and a way that you’ve never trained before, you have the ability to have a stronger core, be more functional, and feel stronger than you’ve ever been. Why? Because now your training will probably include pelvic floor muscles and breathing techniques, making your core function optimally. By caring for a baby, you’ll probably need to address posture, aches, and pains caused by muscle weaknesses/tightness, that you just ignored before. Your workouts as a mom will now have more meaning and serve many more purposes. If you can understand what your body needs, prioritize the proper exercise progression, and change your mindset, you will feel strong and confident in your body again.

Looking for a little more guidance? Take this Free Self-Assessment.

3 Ways Your Baby Benefits From Prenatal Exercise

It can be hard to stay motivated to exercise during pregnancy. Most moms that I work with are driven by wanting to maintain a healthy weight, avoid aches and pains, and prepare for labor and postpartum recovery. However, some of the most overlooked, but really amazing benefits are about the baby. Here are three ways your baby benefits from you being an active mama-to-be:

1. A head start in brain development

   If you exercise even just 20 minutes, three times per week, your baby might get a head start in brain development. Research shows more cerebral activation after birth in babies born to moms that exercised during compared to sedentary moms.

2. Healthy birth weight

   Long term studies show that if you exercise regularly during pregnancy, you’re more likely to have a baby born at a healthy birth weight. Why is this important? A healthy birth weight has been tied to risk reduction later in life for diseases like cardiovascular disease, diabetes and obesity. 

3. Better heart health

   Research shows that babies born to moms that exercise during pregnancy developed stronger hearts. This is indicated by a slower heart rate and heart rate variability. The assumption is that your baby’s heart synchronizes with your during exercises, giving your little one the same cardiovascular benefits as you. 

Personally, I exercised my entire pregnancy but did not end up with the benefit of an easy delivery. After I recovered from my C-section, I was comforted knowing that all of my prenatal workouts still paid off by most importantly enhancing the health of my daughter. So whether you’re trying to get the motivation to go to your prenatal strength group, or processing an unexpected birth, know that your baby benefits from your physical activity. It can be scary exercising during pregnancy, with fear of doing something harmful to the baby. Don’t let lack of guidance be your barrier.

Need a simple starting point? Download 5 Tips for a Stronger Core During Pregnancy.

Do Prenatal Exercise Guidelines Provide Enough Guidance?

Exercise during pregnancy benefits both you and your baby. It’s one of the first decisions you can make for the health of your child. Unfortunately less than 25% of moms-to-be are meeting the physical activity recommendations. The reason? Lack of guidance. Your doctor has probably encouraged you to exercise, and may have even reviewed the prenatal exercise guidelines with you. So why do so many people feel like they don’t have enough guidance to exercise? My assumption is that most moms don’t have the experience to translate the recommendations into practice. At a time when you may be worried about safety, and feel scared that you’re going to do something to harm you or the baby, a little more specificity and support implementing the guidelines can go along way. It’s not necessarily that guidelines don’t provide guidance, but rather more moms need access to professionals that can help them understand how to put them into practice. Let’s take a look and translate the American College of Sports Medicine Prenatal Exercise Guidelines a bit further so that you don’t end up in the 75+% of moms that don’t get enough activity during pregnancy.

Recommendation One: “Accumulate 150 minutes of moderate physical activity each week. Physical Activity is encouraged everyday, but should occur over a minimum of 3 days per week.”

The Breakdown: Moderate refers to intensity. There is no longer a heart rate max. limit during pregnancy. The best way to monitor intensity is to use the Borg Scale, which measures perceived exertion. A moderate intensity generally falls between 12-14 (breathing harder, but can still talk). If you were active before pregnancy, higher intensities may be appropriate, however maximum intensities for most people should be avoided. Suggesting you accumulate 150 minutes means the amount of activity can fluctuate each day, but you’re aiming to total 150.

My Take: Structured Exercise is important, but just as important is not being sedentary. Move more to make your pregnant body feel good. I’ve seen such success with strength training that I’d recommend two days of full body 30-minute strength workouts (more if you enjoy it and have energy), and walking on most other days (around 20-30 min. each day). If you like to do different forms of cardio you can supplement the walking.

Recommendation Two: “A variety of physical activities should be incorporated, both aerobic and resistance in nature, along with yoga and gentle stretching.”

The Breakdown: Aerobic is another word for cardio workouts and refers to workouts that challenge the cardio-respiratory system (walking, dancing, possibly jogging/biking). “Resistance in nature” refers to workouts that use resistance to target muscle strength (bodyweight, free weights, machines, bands, etc.). The guidelines state yoga or gentle stretching because you can usually find prenatal options, but the purpose here is to emphasize lengthening muscles that tend to get tight during pregnancy.

My Take: In terms of resistance training, rather than focusing on training specific muscle groups, emphasize training movement patterns like squats, lunges, hip hinges, push, pull and (anti) rotational movements. This will ensure you’re able to continue to move well as your body changes. The guidelines may give you the impression by using the term “gentle”, that you need to be worried about the type of mobility work you do, but even with the relaxin hormone there isn’t a ton of evidence saying that it will contribute to injury. Yoga is a great option, but for the non-yogis, a dynamic warm up before a strength session, or some targeted stretching at the end of a walk can serve the same purpose. The goal is really to keep your joints moving as they should, despite some muscles being shortened due to the changes in your body while pregnant….hips are usually an area that feels tight for pregnant moms.

Recommendation Three: “Pelvic Floor related exercises (e.g., Kegels) should be performed daily”

The Breakdown:Your pelvic floor muscles are impacted both by hormones, change in function of abdominal muscles, changed breathing, and weight of the baby. Unfortunately most people don’t know much about the pelvic floor until pregnancy, and usually when they experience incontinence. Your pelvic floor muscles can be considered the basement of your core, so to have a functional and strong core during pregnancy, training these muscles can’t be ignored.

My Take: Aiming to daily kegels is a bit unrealistic and not super helpful for most people. However this recommendation is new to the guidelines and a very important addition. More effective than stationary and isolated exercises like kegels, is being able to incorporate both contraction and relaxation of the pelvic floor muscles during movement. I’d prefer people do this during strength training and major movement patterns because that’s when you need to be the most functional. Use kegels to teach yourself what activation of these muscles feels like, and then learn to coordinate activation with breath and movement.

Recommendation Four: “Warm-up and cool-down periods should be included in any Physical Activity regimen”

The Breakdown: Think of a warm-up and cool-down as transition periods. The warm-up should prepare your body for the type of exercise you’re going to do, and the cool-down should help you return to a resting state after working out.

My Take: Your body’s cardiovascular system changes quite a bit during pregnancy. The higher blood volume can mean a higher heart rate. A warm-up and cool-down can help you gradually increase and decrease your heart and respiratory rates, so for those of you that didn’t make much time for that before, you may find it more beneficial during pregnancy. However, you don’t necessarily need a specific routine. If you’re going for a brisk walk, your warm-up might mean starting slow and gradually increasing your pace. If you’re working out first thing in the morning, it might mean a longer period of mobilizing areas that tend to get tight during pregnancy, like back and hips. Your warm-up should mimic your workout and your cool-down should be to bring your body closer to a relaxed, resting state.

Recommendation Five: “Physical Activity programs should be individualized for each woman based on situation, experience, and current health status”

The Breakdown: Avoid any one-size-fits-all fitness advice. Factors like exercise history, pregnancy complications, access to equipment, energy level, and ability to perform strength exercises with good form…it all should be considered in workout selection or program design.

My Take: In reality, fitness should always be individualized, but it’s unrealistic to think everyone can have access to a fitness professional that can customize your program. However, if there is anytime to be thoughtful about exercise, it’s during pregnancy. Exercise can be your most powerful tool in combatting the aches and pains of pregnancy, and feeling strong and confident. Take some time to self-assess your needs and abilities. Don’t get caught up in the internet rabbit hole of Do’s and Don’ts, or best exercises for each trimester. Don’t overcomplicate things. If you aren’t able to seek the support of a prenatal exercise specialist, keep it simple: Walk often, hit the major movement patterns twice per week incorporating pelvic floor work, and stay mobile.

Hopefully, this breakdown has eased some anxiety and motivate you to exercise during pregnancy. Continue to follow this blog for tips or @activemomfitness on Instagram.