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.

Taking Care of Your Pelvic Floor During Exercise

You may not have known anything about pelvic floor muscles until pregnancy or after having a baby. Most likely, you’ve heard two things 1) you should do kegels to strengthen them, and 2) problems with these muscles can cause incontinence. 

Those two things are a good start, but I’d love to provide you with a bit more education so that you feel empowered to care for these muscles and/or continue to exercise if you’re dealing with pelvic floor muscle dysfunction. In this post, we’ll talk about where the pelvic floor muscles are located and their function, common problems that can occur, and four ways to engage and protect them during your workout routine.

What are pelvic floor muscles?

Your pelvic floor muscles form a hammock-like layer across the base of your pelvis. They stretch from your pubic bone in the front to your tailbone in the back. I’ve also heard them referred to as a trampoline, which should be taught and durable. Here are a few things to know about their function:

• When these muscles contract, they lift up and support your pelvic organs. 

• When you bear down, like when sneezing or lifting something heavy, the pelvic floor stretches and lengthens to accommodate the pressure created in your abdomen.

• Additionally, your pelvic floor muscles play a role in sexual function. When these muscles are too tight you might experience painful intercourse. Strong functioning pelvic floor muscles can help you achieve greater sensation during orgasms.  

• Pelvic floor muscles play a role in continence, allowing you to have control over elimination, including passing gas. 

• Lastly, they play a role in spinal and pelvic stability as a member of the core muscle-stabilizing team. 

Common Pelvic Floor Issues in Moms

Factors like pregnancy, childbirth, and aging can impact the function of these muscles. They may weaken due to the weight of the uterus, or they may become too tight due to the birthing process. Either way, if they’re not functioning as they should, it can lead to incontinence, prolapse, and impact your core strength. 

Most of you are probably aware of the connection between pelvic floor muscle function and incontinence. Did you know that there are two types of incontinence? 

• Stress incontinence causes leaking of urine when you cough, laugh, sneeze, or during exercises that involve impact, breath holding, or bearing down.  

• Urge incontinence is when you have the sudden urge to urinate and may not be able to hold it. An example often given is that you know you have to use the bathroom and right before you get to the toilet the urge gets stronger and you can’t prevent urinating.

The majority of incontinence for moms is stress urinary incontinence, however, some moms will also struggle with fecal incontinence which is the inability to control bowels. This can happen due to trauma during the delivery process.

Another condition that involves the pelvic floor muscles is pelvic organ prolapse. Because the pelvic floor muscles support your organs, if there is a dysfunction this can cause organs like your uterus or bladder to drop into the vaginal wall. Picture a hammock or trampoline that can’t support the weight of the person on it…it begins to sag toward the ground. In some cases, the organs can extend outside of the vagina.

The good news is that pelvic floor physical therapy is more widely available and we’re learning more about lifestyle changes and exercise that can treat, improve, or help you cope with these conditions. Additionally, qualified exercise professionals should be able to prescribe exercises that support your efforts to improve pelvic floor function.

Four Ways to Engage, Strengthen, and Protect Your Pelvic Floor During Exercise

As I mentioned, either while you’re in pelvic floor physical therapy, or after you’ve been discharged, a qualified exercise professional can help you engage, strengthen, and protect your pelvic floor during strength workouts. Here are a few strategies you can implement during your workouts:

1. Coordinate your breath: Your pelvic floor muscles are the basement of your core, where the diaphragm is the ceiling. The cylinder which is your core will function optimally when both of those muscles work in synergy. When you exhale your pelvic floor muscles are lifted and when you let the breath out your pelvic floor relaxes. The diaphragm should move in the same direction, descending on your inhale and rising on your exhale. Coordination of these two muscles isn’t always easy, especially when movement is involved. However, it’s important enough to master so that you’re not putting excessive pressure on the pelvic floor muscles. 

2. “Close the holes” or "Blow before you go”: I can’t take credit for these terms as I’ve heard them from several pelvic floor physical therapists. The strategy is to engage the pelvic floor muscles right before you’re about to lift something heavy. Imagine closing your anus as if you’re trying to not pass gas. This will activate your pelvic floor right before there is increased abdominal pressure. You can also try “blow before you go”, which means that right before you’re going to lift, you begin the exhale. Again this can help manage pressure pushing down on the pelvic floor muscles.

3. Avoid impact exercises postpartum until you’ve dedicated time to resistance training: The postpartum running guidelines suggest a minimum of 12 weeks of progressive exercise, including resistance training. However, if you’re having symptoms of pelvic floor muscle dysfunction, this may take longer. When you’re ready to add higher impact activities, start with fewer reps and shorter duration. Take your time to progress and build up. You wouldn’t go from lifting a 5-pound dumbbell straight to 50 pounds, would you? It’s worth mentioning that there aren’t prenatal running guidelines and plenty of moms do run during pregnancy, but if you’re noticing symptoms, that may mean your pelvic floor muscles can’t handle the impact and it’s probably best to move to low impact options. 

4. Remember that pelvic floor muscles are muscles: We all understand the concept of challenging a muscle in order to make it stronger and stretching muscles to relax and lengthen. The same goes for pelvic floor muscles. If you have a weak pelvic floor, you don’t want to avoid core training altogether because it’s going to need the challenge of the exercise to get stronger. If you’re not having symptoms, it’s also important to learn how to contract and relax those muscles. The easiest way to do this is by focusing on breath and core stabilization during strength training. If your core muscles are working together, your pelvic floor muscles will maintain/gain strength. If you prefer isolated exercises, you can throw in kegels of different durations (long contractions and quick contractions). 

Education should be empowering. As you learn more about your body, don’t let it cause fear. Research around core stability exercises benefiting the pelvic floor muscles is increasing, which is an incredibly positive thing. So whether you’re experiencing any of the named conditions, or if you’re concerned about atrophy as you age, or if you just want a well-rounded core program, take the time to become familiar with your pelvic floor muscles. 

If you’re ready to put core training to reduce your risk of incontinence and back pain into practice, consider my free 5-day core course.

Happy training!