Postpartum return-to-exercise criteria

Immediately after childbirth, your body is dealing with several changes at once. The effects of relaxin, a hormone that increases during pregnancy, linger for a while, and the abdominal wall and pelvic floor have been bearing increased loads for a long time. Breastfeeding, insufficient sleep, and repeatedly holding and carrying your baby on your front or back add to this. That makes it difficult to decide how much exercise you can do based only on how many weeks have passed since childbirth. Major guidelines also take an approach that considers both elapsed time and your individual physical condition.

The most widely cited guidance in this area is the postpartum return-to-running guidelines by Goom, Donnelly, and Brockwell (2019). Their main points are as follows.

• Timing — Regardless of the mode of delivery, the guidelines advise not starting high-impact activities such as running until at least 12 weeks postpartum. Running involves repeated impact of several times your body weight with every step, so the aim is to allow tissues enough time to recover.
• Progression — Begin with walking, then move on to light strength training and pelvic floor exercises, progressing in sequence from low-impact movements to movements involving impact.
• Readiness checks — These include checking whether you can walk for 30 minutes, hold a single-leg stance, perform single-leg squats, and do light forward hops without pain or discomfort.
• Pelvic floor assessment — The guidelines also include having a professional assess your pelvic floor before returning to high-impact exercise, regardless of the mode of delivery.

These criteria are a consensus drawn up by experts from relevant research and clinical experience. “12 weeks” is not a threshold meaning “you are ready from this point onward,” but more of a minimum meaning “do not rush before this point.” If the readiness-check movements are still uncomfortable after 12 weeks, it is fine to progress more slowly.

Many factors affect the pace of recovery. These include the mode of delivery and course of recovery, activity levels before pregnancy, the degree of diastasis recti (separation between the muscles along the middle of the abdomen), whether symptoms of pelvic floor dysfunction are present, sleep and opportunities for recovery, a twin pregnancy, and the number of times you have given birth. Two people can be at the same 8-week point and be in very different physical condition.

Also, setting your sights on your “pre-pregnancy performance” can easily leave you feeling rushed. Resuming exercise is less about going back to how things were and more about rebuilding your capacity for load under your body's changed conditions. This is in line with the principle explained in progressive overload.

• Start with walking. Begin with short walks with your baby, and gradually add time if your body feels comfortable. Walking places relatively little demand on the body at any stage.
• Start by reactivating your breathing and pelvic floor. Practicing gently engaging your pelvic floor and lower abdomen as you breathe out lays the groundwork for larger movements. See also transversus abdominis and core exercises.
• Increase one thing at a time. Increase only one of duration, intensity, or impact at a time, and check how your body responds the next day before moving to the next stage.
• Keep track of symptoms. If you leak urine, feel a heavy downward pressure in your lower abdomen, notice bulging along the middle of your abdomen, or have lower back or pelvic pain during or after exercise, try stepping back a level for now.
• Rest is part of exercise, too. When sleep is in short supply, lowering the intensity and prioritizing recovery can get you further in the long run.
• Pay attention to how you carry your baby, too. For the strain of holding and carrying your baby on your front or back, see Postpartum posture and infant-carrying strain. For your neck and shoulders while breastfeeding, see Neck and shoulder strain during breastfeeding.

A noticeable increase in bleeding or the return of red lochia after exercise, pain or a feeling of opening at the cesarean incision (Cesarean scar), ongoing leakage of urine or stool, or a feeling of something descending in the pelvis or vagina are signs that differ from the usual recovery process. If these occur, lower your exercise intensity and have your condition assessed by an obstetrician-gynecologist or through specialist pelvic floor physical therapy (Pelvic floor physical therapy). Routine postpartum checkups look at overall recovery, so it is helpful to discuss returning to vigorous exercise separately, based on your physical condition.