When Can I Start to Exercise After Having a Baby?

“When can I exercise again after having the baby?”, OR “Do I have to wait until my 6-week postpartum appointment to get back to physical activity?” The answers to these questions are going to vary based on your individual situation and needs. In general, it is safe for most moms to begin connecting with their deep abs and pelvic floor muscles using breath. Low-intensity walking and mobility exercises may be beneficial for you as well. Let comfort and energy level be your guide. Remember movement is good, but you don’t want to interfere with healing, especially if you had tearing or a c-section. You should not return to anything more vigorous before a doctor can tell you that there are no medical contraindications. If bleeding increases following even light activity, that may indicate that you are doing too much and you should contact your physician.

If you are “cleared” for exercise at your postpartum visit, this means that your doctor from a medical perspective thinks you can begin to be more physically active. You should still approach exercise with a gradual and progressive approach. This is not a green light to jump into your old routine. Abdominal and pelvic floor tissues can take up to 9-12 months to heal.

If your doctor approves and you’re ready to exercise, the progression below might help you prioritize your first steps back to fitness.

1. Heal: Whether you’ve had a c-section or vaginal delivery you have tissues that need to heal. Your initial focus should be on promoting healing by getting enough water, and nutrients and resting when you can. You should not begin to exercise until you know that any tears or incisions have healed properly. You’ll also want to address any scar tissue. Part of healing may also mean addressing concerns like incontinence, the feeling of pressure or bulging in your vagina, or abdominal separation. These are all common conditions, but not normal. It may not necessarily mean that you can’t begin an exercise program simultaneously, but you should consult with a pelvic floor therapist and prioritize exercises that will help you improve those symptoms or conditions.

2. Core: Most muscles of your core are impacted by pregnancy and delivery. All moms should strengthen these muscles and ensure that they function optimally by working synergistically. This often means beginning with breath, transverse abdominis, and pelvic floor muscles.

3. Function: Being a mom is physically demanding. Part of your return to fitness should be mastering repetitive movements like hip hinges or getting up off of the floor (think deadlifts and lunges), strengthening muscles that impact posture (think back and glutes, and focusing on mobility (think upper back, ankles, hamstrings and hip flexors).

4. Strength: After you have foundational core strength and have mastered movement patterns, you can begin to think about gradually progressing your program. This could include adding more resistance, moving to moderate to high-impact activity, and performing more demanding abdominal exercises like rotations or exercises in positions against gravity.

Other considerations of when it’s best for you to begin to exercise include sleep (ability to recover), support from family/friends, and mental state. Hopefully, this doesn’t sound overwhelming because there are many positives to postpartum exercise like establishing a healthy lifestyle for your family, and training in a way that you can become stronger than you were before pregnancy. And remember, exercise as a mom is not a luxury, it is essential in meeting the physical and emotional demands of motherhood.

Is Some Exercise Really Better Than No Exercise?

Unfortunately for busy moms, when life gets chaotic we tend to prioritize things other than exercise. This may result in sporadic workouts and an inconsistent routine, or possibly skipping structured workouts altogether. This leads to the question, is something better than nothing??

Well, the short answer is yes…when it comes to the health benefits of exercise, then some physical activity is absolutely better than no activity. In fact, so much so that "make exercise a lifestyle" really needs to be a priority.

In a study of 35 healthy men and women, researchers found that many of the benefits they gained during a 13-week exercise program were lost over the course of one month of cessation of the program. This included strength gains, body fat percentage, and measures of heart health. However, the most important to note is that it only took one week for participants to lose the improvements in their blood pressure and cholesterol! This indicates that to keep your cardiovascular risk factors low, you need to maintain physical activity and make it a lifestyle. So returning to the answer to the question, yes some exercise is better than being sedentary when it comes to exercise and health. Upper and lower body strength gains also decreased progressively the month after completing the program. The good news is that the study did show us that 20-30 minute resistance training workouts just 2-3 times per week was enough to see fitness improve!

If staying consistent with exercise sounds easier said than done, here are some tips on how to make fitness work for you.

1. Be realistic with your time and identify ways that physical activity can naturally fit into your life. If you’re up several times per night, then setting a goal to do even a 10-minute HIIT workout before the baby wakes up in the morning is probably unrealistic and completely un-motivating. However, saying that you’re going to beat the afternoon energy slump by doing a 10-minute stroller walk with the baby, is probably more manageable and something you might look forward to.

2. Start with the minimum. If you can get benefits from just two days per week of strength training, start there. If you don’t have a gym membership, start with at-home bodyweight exercises. If you feel weak and experience pain with exercise, start with just a few core exercises.

3. Hire a professional. We invest in professionals for all sorts of things…cleaners to save time with housework, going to a nail salon instead of home pedicures, and therapists to improve our mental health. But for some reason when it comes to fitness, hiring a professional can be seen as a luxury. There is nothing wrong with seeking someone to hold you accountable. There is value in having an expert design a 30-minute program that will improve your strength.

I hope this post encourages you to adopt an active lifestyle!

Running After Having a Baby: Guidelines for Postpartum Running

You’re six weeks postpartum and you’ve just been cleared for exercise. You may be wondering if you are ready to get back into running. Or maybe you’ve gone for your first run after having a baby and you’re wondering why it feels so hard. Either way, the purpose of this article is to tell you NOT to run as soon as you’re cleared for exercise, and to encourage you to take the proper steps so your first return runs feel good.

Unfortunately you can’t search the internet for standardized postpartum running guidelines. You may find blogs with suggestions and advice, but research-backed guidelines are hard to come by. The best ones I’ve found were created by Gráinne Donnelly, Emma Brockwell, and Tom Goom in 2019, which I will summarize in this post. The following information is to help you 1) determine if you’re ready to run 2) make you aware of concerns, and the suggested progression of exercise leading up to running.

Running is a high-impact activity requiring core strength and function. To manage the intra-abdominal pressure that stabilizes your body during running, your abdominal and pelvic floor muscles need to be strong and functional. These muscles are weakened during pregnancy and can be further impacted during labor and delivery (cesarean and vaginal). Therefore, incontinence and prolapse can be a concern in postpartum running. You have to allow yourself enough time to heal and strengthen. How will you know if you have pelvic floor or abdominal wall issues? The following is a list of symptoms that could indicate dysfunction and should be addressed with a pelvic floor physical therapist before running.

• Urinary and/or fecal incontinence

• Urinary and/or fecal urgency

• Heaviness/pressure/bulging in the pelvic area

• Pain with intercourse

• Separated abdominal muscles and/or decreased abdominal strength and function

• Low back/pelvic pain

Based on evidence, these experts state that return to running is not advised prior to 3-6 months postpartum or beyond if any symptoms of pelvic floor dysfunction are experienced before running or after attempting to run. Furthermore, even if you don’t have symptoms, 3-6 months is still a minimum guideline to allow your tissue and muscles time to heal and strengthen. For example, it’s been found that after a c-section, your abdominal wall has only regained 51% of its tensile strength by 6 weeks postpartum, and reaches 73-93% only at 6-7 months postpartum.

After (or while) addressing any pelvic floor and/or abdominal concerns, it’s time for you to focus on building overall strength, with a focus on the core and lower body (I recommend glutes for all moms!). Stronger muscles will allow you to better manage the load/demand running puts on your body. If you’re able to work with a qualified postpartum exercise professional they can lead you through the proper training progression. When I work with people I start with making sure all of the muscles that attach to the pelvis are strong, functional, and know how to work together. I then move on to bigger movement patterns like squats, hinges, and lunges. The guidelines referred to in this article use the following exercises to assess readiness to run:

• Walking 30 minutes

• Single leg balance 10 seconds

• Single leg squat 10 repetitions each side

• Jog on the spot 1 minute

• Forward bounds 10 repetitions

• Hop in place 10 repetitions each leg

• Single leg ‘running man’10 repetitions each side

• Single leg calf raise 20x

• Single leg bridge 20x

• Single leg sit to stand 20x

• Side lying abduction 20x

Keep in mind that this is not a prescriptive list, but it gives you an idea of what you should be working toward. You want to be able to do these exercises (or exercises that require similar load and strength) without pain or incontinence before returning to running.

So mama, before you break out the running shoes (which by the way, make sure they support your new postpartum feet), take the time to heal, strengthen, and get assessed by a pelvic floor PT if you have access to one. You have your entire life to be active (with your children!) and you don’t want to have any setbacks…so remember progression is essential.

And PS. This article doesn’t account for other factors like sleep, scar tissue, weight, breathing, breast size/breastfeeding, jogging strollers, or emotional readiness, which all will factor into your readiness and ability to run.

Postpartum Back Pain: 3 Changes to Make Now

Low back pain is common for moms but doesn’t have to be accepted. It’s estimated that 68% of women that have pregnancy back pain, continue to suffer postpartum, impacting daily life and even the ability to work. Hormonal shifts, joint laxity, weak core, heavier breasts, frequent lifting/bending, forward-leaning posture, and changes in your feet can all contribute to low back pain so it should go without saying there isn’t one easy fix.

Exercise, specifically core stability and strength training have been proven to improve low back pain., but exercise is only one piece of the puzzle. Here are 3 changes you can make now:

1. Update the gear. Heavier breasts mean a more supportive bra. If you’re breastfeeding you’re probably wanting to avoid compression, but a wide strap, supportive bra is key. If you’ve noticed flatter feet, wider feet, or longer feet…it’s time to update your shoes. Support starts from the ground up, so consider a new pair of shoes, or if you’re walking around barefoot a lot, you may need some supportive house shoes/slippers.

2. Better your body mechanics. We’ve all probably heard lift with your legs to prevent back pain, but the truth is that it isn’t always that simple when you’re performing the same movements day in and day out. Identify the most common movements you do throughout the day and then self-assess if you’re providing your back support with your leg muscles. If not, it’s time to make some changes. If you’re lifting the baby out of the crib, focus on support from your abs, glutes, and hamstrings similar to a deadlift. If you’re holding the baby as you get off the floor, practice standing from a kneeling lunge position. Forward leaning while feeding the baby? Get in the habit of stretching your chest muscles right after.

3. Nourish to Heal. In our superwoman society sometimes we forget that the postpartum period is more than just caring for the baby and beating the sleep deprivation. Your body has been through major changes and your tissues need to heal and hormones need to regulate. It’s important to nourish your body with enough water, sufficient nutrients, and good gut health. If this isn’t a focus, do your back a favor and begin to make simple changes.

I know it may seem overwhelming to care for your children and yourself, but healing and core function will impact your quality of life for years to come. Your child is only going to get heavier, and the physical demands of being a mom aren’t going anywhere. Let’s tackle this low back pain now. If you have access to a pelvic floor physical therapist or a postnatal fitness trainer, their support will be invaluable. You deserve to feel good, mama! If you need more guidance, try the FREE 5-Day Program to Reduce Your Risk of Back Pain.

Summer is Coming: Tips for Moms to Meet Their Fitness Goals

I’ll start with a disclaimer that I don’t love the idea of people putting pressure on themselves to up their exercise routine in preparation for summer. I firmly believe fitness is a lifestyle and the best way to sustain results is to be consistent year round. However, with that said, I also see nothing wrong with having aesthetic or other goals that make you feel confident this summer. So if you’re someone that is working toward your summer fitness goals, keep reading for a few tips.

Pregnancy Tips:

Summer can be an uncomfortable time to be pregnant. In order to stay active and continuing to make progress in your fitness consider the following 3 tips.

• Exercise first thing in the morning: hot summer days can make it harder for you to regulate your body temperature, and quite honestly can just feel draining. Use the month of May to start a morning workout routine. Working out at the coolest point of the day can be safer, more comfortable and help you stay consistent.

• Hydrate: not having enough water can raise your body temperature, and dehydration can even lead to uterine contractions. Make sure to replenish fluids after a workout. Use the month of May to get in the habit of increasing your fluids and maybe even treat yourself to a new water bottle.

• Invest in workout gear or embrace the belly and sports bra look: If you no longer have moisture wicking clothing that fits, take some time during May to order a few new tops. You’ll want to be able to dissipate the summer heat. If you exercise regularly your sweat point will be lower in order to help with temperature regulation so you’ll want to stay comfortable and have clothing that drys quickly.

Postpartum Tips

If you’re still recovering from birth or building your fitness foundation, then your goals shouldn’t change too much with the season. However, there are a few tips that will help you plan for increased physical activity outside with your little one this summer.

• Invest in a new carrier or switch to a stroller: During the cold months it’s possible you were only wearing the baby around the house or for short walks. With the nice summer days, your walks will get longer (as baby gets heavier) and that can cause neck and back pain without a supportive carrier. Take the month of May to make sure you have the right gear. Look for something with thick shoulder straps and a waist belt. Consider using a stroller for long walks until your core is strong and functional again.

• Implement a walking progression: Before jumping in to longer walks and more physical activity, use the month of May to do it gradually. Aim to increase your walks 5-10 minutes each time or by gradual distance increments each week. Use interval style training to prepare your body for longer durations.

• A little extra attention to specific muscles: During the month of May set aside 10 minutes/day, at least 3 days per week to focus on strengthening your abs, low back and glutes. Also include mobility exercises for your hip flexors and thoracic spine.

Beyond Postpartum Tips

You’ve been exercising consistently, have a strong fitness foundation and just want a little push toward your goal of more defined arms or feeling comfortable in a two piece at the beach. There is nothing wrong with aesthetics being part of your goals and here are some tips to get you that much closer.

Choose a muscle to focus on: Keep with your regular routine, but choose one muscle group to emphasize during the month of May. Include an additional 10 minutes working that muscle each workout, aiming for 3 days per week of targeted training.

Increase your cardio: If you know me, you know I believe strength training is key. However, if your goal is to see the muscles you’ve been working hard for, a little extra cardio during the month of May can give your body what you need to drop your overall body fat percentage if needed (remember, you can’t target train fat away!). Try adding some intervals to a strength workout or moderate intensity cardio on your strength recovery days.

Increase protein and water: If your plan is to add some cardio for more calorie/fat burning as suggested above, make sure you don’t lose the muscle mass you’ve worked so hard for. Aim to get at least 1g protein/kg of body weight to help you sustain muscle. Don’t forget your body needs enough water to function properly so make sure to hydrate!

So whether you’re pregnant, postpartum or further along in your motherhood journey, May through June is a great time to put these tips into action.

Stages of Being an Active Mom

You care about being an active role model for your family. You see exercise as a tool for both physical and mental health. You recognize that a mom's body needs to be trained differently, and that strength and core training is important. You also understand the need to be flexible, stay committed, and get creative when it comes to finding time for fitness and family. Your goal to be an Active Mom might not waiver, but how you attain this vision looks different at various stages of motherhood.

Based on my personal experience, as well as many of yours, here's what I've come up with as a quick guide for all stages.

Pre-conception/Get Healthy Stage: You’re assessing whether your physical health will support fertility and pregnancy. You might be considering your weight and stress levels. You have a desire to “be in shape” for pregnancy.

What exercise could look like: Start by meeting the physical activity guidelines. Use exercise as a tool to decrease mental stress. Using resistance training and aerobic exercise to achieve a healthy weight. Make sure your calorie intake supports your activity so as to not impact your menstrual cycle.

Prenatal/Pregnant Stage: Your doctor is recommending exercise. Your energy levels fluctuate. You’re adjusting to the changes in your body. You may experience aches and pains.

What exercise could look like: Aim to meet the physical activity guidelines for pregnant people. Enlist the help of a prenatal exercise specialist. Prioritize muscle groups impacted by pregnancy such as the pelvic floor, core, glutes, and upper back. Consider whether a shift to low-impact aerobic activity is right for you. Include mobility work in your routine. Adjust exercise intensity according to your energy level. Ensure you eat a snack before activity to maintain energy and blood sugar levels.

Newborn/Fourth Trimester: Your newborn baby is your priority. Your schedule is completely unpredictable. You feel disconnected from your body (even if you were active during pregnancy). Your tissue is healing. You are sleep-deprived.

What exercise could look like: Recovery is your priority. If you’ve had a c-section or any vaginal delivery complications, healing before increasing activity is key. When you’re ready, begin with stretching and activation of your deeper core muscles through breath. Try to reconnect with pelvic floor muscles (see a pelvic floor PT). Take short walks with the baby in the stroller. Walking is a great form of exercise early on in addition to your short 5-10 minute bouts of core strengthening. Gradually increase the duration of your walks and add bodyweight strength exercises. Focus on posture and stretching.

Baby’s first year/Postpartum: You’re still tired, but you’re feeling motivated to start to feel like yourself again. You have very little time for yourself and your schedule is dictated by baby/work/family. You may be feeling the overuse aches in your feet, wrists, and back from taking care of the baby. Hormones may still be shifting. You may have weight loss goals. Your abs are different and the pelvic floor may be giving you trouble.

What exercise could look like: Enlist the help of a postnatal exercise specialist. Walking is still one of the best modes of exercise because it can be conveniently worked into your day, outdoors can boost your mood/energy, and your baby can join you. Gradually progress in your core exercises, but still prioritize deep abdominal muscles and pelvic floor through breathing. You can begin to incorporate more strength training, with a focus on movement patterns (squats, deadlifts, lunges), core, and muscles to help with aches like upper back and glutes. You’ll have the most success with short 10-15 minute bouts of exercise each day.

Toddler years/Pre-Conception: You still may be juggling an inconsistent schedule with naps and nighttime sleep habits, but you’re less sleep-deprived. Your energy is challenged by keeping up with a toddler. You’re starting to feel like yourself again, but may not be completely pleased with your inconsistent exercise routine. You might be motivated by the fact you’re going to try for another baby, or the idea that your body won’t endure another pregnancy…either way, you want to ramp up your fitness routine. You appreciate the role of physical activity in your mental health, but also the fact you now have to role model healthy behaviors for your family.

What exercise could look like: Assuming you’ve rebuilt your core strength and have a fitness foundation, you have many options for exercise. Strength training should still play a major role in helping you meet the demands of motherhood, and continue to build the body you aesthetically want (aim for a minimum of two times per week, more if you’re really aiming for muscle definition or weight loss). Aerobic activity can vary according to your likes. Consider home workouts not just for convenience, but to begin to model exercise to your children as a habit and priority. Your child will most likely try to interrupt. Try to remain patient, but also firm in letting them know it’s important to you. Ask them to join. Thirty-minute workouts are probably the most feasible, sneaking in longer ones when you can/if you want. Outside of structured workouts, walks, hiking, and playground activity are great ways to be active with the family, and encourage your child to love activity too.

School-age years/perimenopause: Just when you think you’ll get some time back, your child starts to have their own activity calendar. Your energy and time balancing fitness and family is manageable but has to be intentional. You’ve learned that mornings might be your most reliable time for exercise. You might be back to some of your old activities or taken up new ones. Your postpartum hormones are stable, but you might be experiencing minor symptoms of menopause, finding that your body fat distribution is changing/feeling like your metabolism isn’t functioning like it used to. You might be experiencing more anxiety or depression.

What exercise could look like: Exercise is a great tool during this stage to manage stress, promote mental well-being, spend time with your older child, prepare your body for the changes associated with age/menopause, and as a social activity with your friends. Strength training should still be a major component. This will be the key to protecting your bones as you get older and maintaining the physique you’ve grown to love. This stage is an opportunity to start exploring new activities with your child like hiking, ice skating, tennis, or biking. Aiming to exercise at least 30 minutes most days of the week is your goal. Strength training at least 2-3 times per week is ideal and will help maintain lean body mass. It’s basically the stage you’ve been working so hard for….you get to be a healthy and active mom, enjoying physical activity by yourself and with your family!

Returning to Exercise After Covid

Are there dangers on returning to exercise post Covid? That is still something being studied, but we do know there are long term effects from Covid and because of possible complications there should be guidelines on how to return to physical activity. There is increasing evidence that “long Covid” symptoms can include cough, elevated resting heart rate, and extreme fatigue. Cardiac damage is also a concern, especially in athletes returning to sport post virus. The American College of Sports Medicine is one of the first organizations to provide guidelines based on your level of risk.

Low Risk: If you are under the age of 50 with asymptomatic or mild respiratory symptoms that resolved within seven days.

• When to return to activity: Rest for at least ten days after being diagnosed. Once asymptomatic for seven days then follow a gradual return to exercise without evaluation.

• How to return to activity: You should first return to normal daily routine and sleep patterns. You should be able to perform daily activities and be able to walk 500 m (.31 miles) on a flat surface without fatigue or shortness of breath. Your first workout should be light intensity for a duration of 15 minutes. If you feel your energy is as it was post covid, you can increase the duration during your next workout. It’s recommended you begin with bodyweight exercises and then progress to heavier resistance and sports. *Athletes should engage in at least two weeks of minimal exertion activity before resuming sport.

Intermediate risk: If you had symptoms or fatigue lasting for more than one week, or prolonged shortness of breath/chest pain that did not require hospitalization.

• When to return to activity: it is suggested that you be evaluated with an EKG and troponin test if you have an abnormal EKG. A personalized exercise prescription is recommended.

• How to return to exercise: a specialist team should create a personalized exercise prescription

High risk: if you were hospitalized or experienced shortness of breath or chest pain at rest or with basic daily activities.

• When to return to activity: it is suggested that you be evaluated with an EKG and troponin test if you have an abnormal EKG.

• How to return to exercise: a specialist team should create a personalized exercise prescription

A gradual return to exercise will help mitigate risk. Working with an exercise physiologist and care team is to your benefit as we continue to learn more about Covid-19 and exercise.

Below is an example of a low risk return to exercise progression. You should make sure you recover from each workout and that no new/returning symptoms occur. Contact your doctor if you experience any chest pain, irregular heartbeat or shortness of breath. This progression may take place over a 1-2 month period.

1. Stage 1: Mobility/Flexibility and light walking

2. Stage 2: Continue to build up walking intensity and duration

3. Stage 3: Moderate intensity aerobic exercise and bodyweight resistance training (one day of exercise interspersed with one day of recovery)

4. Stage 4: Moderate intensity aerobic activity and resistance training (moving up to two days of exercise and one day of recovery)

5. Stage 5: Attempting your baseline level of activity, ramping up intensity to moderate/vigorous.

This post is an interpretation of an article titled Safe Return to Physical Activity After Covid-19.

3 Holiday Fit Tips

As if your to-do list wasn’t long enough already, now add maintaining the holiday gathering calendar, planning/prepping more meals, and making sure your kids experience family traditions...phew, it’s no wonder our perspective on fitness changes a bit this time of year. Here are a few reminders as we approach the holiday season.

1. January is not your start date: From November through December life gets busy and fitness might be a lower priority, but do yourself a favor and don’t see these last two months of the year as pointless when it comes to workouts. Sure it’s easier to ramp up fitness in January, but you don’t want to enter 2022 feeling like you’re starting over or that you’re “getting back on track”. If you know the end of 2021 will mean less consistency with exercise, instead look at it as your off-season; a chance to maintain what you’ve built, try different types of exercise, enjoy shorter movement sessions, and prepare your body for a surge in a couple of months.

2. Embrace the dark (and cold): whether you work out early in the morning or in the evening, chances are it’s going to be dark and cold. Acknowledge the challenge, but don’t let it become an excuse. Brighten up your home workout area, enlist an accountability partner, lay out your clothes the night before...whatever it takes to embrace the change of season and not let it sabotage your goal to stay active.

3. Exercise is not an exchange for indulging: During the holidays meals tend to be heavier and alcohol might be more frequent. Indulging a bit more is often part of tradition and good times with friends and family. If you’re choosing to indulge, it’s important to be OK with it and not fill yourself with guilt and stress. Don’t fall into the thinking that exercise is there to make up for eating more than usual. Continue to fuel your workouts with good nutrition and if you’re making the choice to have that extra dessert or glass of wine, accept it and enjoy it, knowing that your healthy habits over long periods of time will help you maintain your baseline.

As you can see, for your fitness routine to survive the holidays, it takes a little bit of a mental shift and recognizing that this is a temporary time period and adjustments should be made. So enjoy the family traditions, acknowledge the challenges, and change your perspective on what fitness means to you during this time. If you’d like some guidance with your holiday fitness plans or want to set yourself up for success in the New Year, schedule your personal exercise consult.