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Active in Brisbane’s guide to post-pregnancy exercise and fitness

Becoming a new mum is one of the significant experiences a woman will ever undergo. A new little person will affect every part of her life, often in unforeseen ways.

We’ve all seen the magazine covers and #insta feeds showing celebrities returning to their pre-baby bodies, seemingly within weeks of giving birth, and it can be hard not to feel that this is something all mums ‘should’ do. There is a lot of societal pressure for new mums to ‘bounce back.

In an attempt to sift fact from fiction, Active in Brisbane asked six south-east Queensland health and fitness professionals for their advice and expertise in response to the important questions for new mums considering how best to approach exercise post-pregnancy.

What do new mums need to consider before making the decision to exercise post-pregnancy?

Many mums are keen to get back into exercise as soon as possible after birth, which is fantastic physically, socially and mentally. However, it’s not simply a matter of returning to pre-pregnancy exercise routines. For one thing, getting used to looking after a newborn can be demanding and exhausting, leaving mums with little energy for anything else. But all our experts agree that the key question to ask yourself is, “Am I ready?”

Consideration of your body’s condition is essential, particularly, as personal trainer Kate Beeley (aka MissFit) says, if you’ve had a caesarean or an episiotomy, or experience lower back and pelvic pain from carrying your baby for nine months. Senior physiotherapist Alex Forde concurs, saying that “it is important for a new mum to consider all of the changes that her body went through during pregnancy and birth, before she jumps back into old exercise routines. As a physiotherapist, I focus on the physical requirements exercise puts on our body and how the changes associated with pregnancy and birth might change what a woman’s body may be able to do.”

Exercise physiologist and Pilates instructor Kelly Prosser recommends asking yourself a number of questions, including, “Am I well informed? What does my body want versus what my brain wants? Is my body up for it yet? What are the risks of doing too much too soon? Who will be a part of my team of professionals to assist me during this phase? I have been for my 6-week check-up and been given the all clear – but does that mean I am completely safe to return to my normal exercises?” Brent Cunningham, exercise physiologist and myotherapist, also recommends consulting with your obstetrician or GP to ensure there’s no risk to exercising, and then consider seeing an expert such as a physiotherapist or exercise physiologist to discuss evidence-based guidance on commencing exercise following medical clearance.

Once you have the medical all-clear, choosing the right exercise is the next step. As Brent says, “I believe it is important to then chose a form of activity that you enjoy, in an environment or setting you enjoy, for example in a social group, with your newborn, indoors, etc.” Tessa Marsh, a musculoskeletal therapist, agrees: “When you feel you are ready you may want to make decisions regarding the type of exercise you wish to do. We are spoilt with options for exercising. Find what works for you and your new baby. Running may be what you need as an emotional release, or you may prefer a slower exercise like yoga. None are wrong, it is just what suits you and your new body.”

How long after birth is it safe for new mums to recommence exercise and begin a fitness program?

Alex Forde says that “Low levels of exercise can be very beneficial following delivery. In fact, some hospitals offer exercise programs instructed by physiotherapists during the days immediately following child birth to assist mums to have a healthy recovery. However, these programs are carefully monitored and all exercise should be approved by a health professional. Some women may be able to participate in gentle exercise such as walking earlier than this, however for some woman it may take longer for their bodies to be ready to exercise.”

Kelly Prosser agrees with introducing gentle exercise shortly after birth, if you are ready: “Returning to function can start to happen soon after the birth depending on how you are feeling. This means doing gentle restorative type exercises such as deep breathing, pelvic floor exercises, a gentle range of motion exercises and stretching, some gentle stability exercises, such as Pilates, or gentle walking. These movements help to lay the foundation of functional movement for later on down the track. Focusing on these during the initial phases will help reduce some of the aches and pains associated with being a new mum.”

While you may be able to do some gentle exercise straight after birth, our experts agree that it’s best to wait until after the 6-8 week postnatal check-up with your obstetrician before embarking on higher-intensity exercise. Your doctor can identify any post-partum issues and discuss your exercise goals with you at this point. Pregnancy and paediatric chiropractor Claudia Cadona also recommends having your pelvic alignment and function checked and corrected post-birth before starting any exercise. “Weight gain and our change in stance put added strain on the joints of the pelvis and can cause discomfort or pain. The birth, whether natural, assisted or caesarean, can also strain the pelvic joints, ligaments and muscles; it’s no easy feat! If the joints and muscles aren’t working well and in sync it can lead to pain, discomfort and injury.”

A pelvic floor screening carried out by a women’s health physiotherapist will be able to assess how likely new mums are to experience prolapses or other issues. Alex Forde explains that “By identifying the risk of developing complications from exercise early, your physiotherapist is able to provide guidance and monitor your exercise program to reduce the chance of long-term complications.”

Furthermore, one thing that every parent will know intimately is the effect a new baby has on sleep, and the impact that this in turn has on your body. Musculoskeletal therapist Tessa Marsh says, “Childbirth and then of course a new born is highly fatiguing mentally and physically for the body. Be sure you feel you have the energy for the type of exercise you have chosen and your body feels ready. Each mum is going to be different and I urge them to listen to their bodies.”

SLEEP!!

Kelly Prosser stresses the vital role that sleep has in your ability to exercise. “While you are not sleeping well, your body can’t recover well and working too intensely can lead to injury, or you might notice that you need a longer recovery period between bouts of work. When you start getting a full (or decent) night’s sleep, or when you stop breastfeeding, you will notice that your body will be capable of increasing your exercise capacity naturally.”

What type of exercise would you recommend for mums post-pregnancy?

The common advice from our experts? Start with gentler activities, such as walking, hydrotherapy or cycling, before building up to more intense exercise. Kate Beeley recommends “very low impact exercises like pelvic floor exercises and walking. Then mums can move onto light weight and body weight exercises as time goes on. At MissFit, we have mums starting their exercise programs with us from 8-12 week mark, and we work with them and modify exercises to suit their fitness level.”

Kelly Prosser says that it’s not what you do so much as how you do it: “Gradually build up exercises as your body is able to and try to avoid comparing yourself and your fitness to others. If you have worked on your foundations of breathing, pelvic floor strength and greater joint stability, you can begin to working on some strength training – start with light weights or body weighted exercises and gradually increase with good control.”

While there is no one type of exercise best for mums, our experts all agree on one thing: rehabilitation of your pelvic floor is key! Brent Cunningham states, “I would always suggest that a new mum receives education and/or exercise supervision surrounding pelvic floor strengthening and diaphragmatic breathing.” Physiotherapist Alex Forde recommends joining a class specifically focussing on post-pregnancy and pelvic floor rehabilitation: “These types of classes should be run by health professionals with extensive training in woman’s health. These exercise classes might include exercises such as yoga, Pilates, body resistance classes, balance classes, or low impact cardio classes. It is important if you are joining a class that the instructor has specific knowledge about the impact exercise can have on the pelvic floor especially post pregnancy and cater accordingly. If you’re unsure just ask the instructor about their qualifications in this area.”

Musculoskeletal therapist Tessa Marsh agrees, saying “If you are looking for things to focus on to help your body post pregnancy you can’t go past core and pelvic floor. Specifically designed programs can advance you through core and pelvic floor rehabilitation, while Pilates is also a great option.”

Are there any exercises that should be avoided?

It’s all about allowing the pelvic floor time to recover from nine months of pregnancy and birth. Our experts are in agreement that high impact and intense exercises should be avoided in the first post-birth period, to avoid putting pressure on your pelvic floor and to give you a chance to assess how your body is recovering. These exercises include long distance running, heavy lifting, direct abdominal exercises, skipping or riding. But Alex Forde warns that even some exercises that seem gentle, such as certain yoga and pilates exercises, can be just as hard on the pelvic floor as running. Brent Cunningham, specifically recommends avoiding exercises such as wide-stance lower-limb and single leg exercises, or those that involve holding the breath and bearing down, as these put pressure on the pelvic floor and the pelvis.

The essential tip to remember? Listen to your body! “The golden rule is to always listen to your body and never push past pain,” warns Miss Fit. Tessa Marsh agrees, stating that “any exercise that is painful should be avoided.” As well as sensations of pain, take note of other physical reactions: “Anything that causes symptoms, such as breath holding or bladder leakage, needs to be modified accordingly,” Kelly Prosser says. “A sensible approach to gradually progressing your exercise will ensure that you remain a versatile exerciser.” Brent agrees, saying that “if you are doing an activity and find that you’re holding your breath and not rhythmically breathing, the activity may be too progressed or too heavy at the current time.”

All our experts recommend a gradual return to exercise that puts strain on the pelvic floor, but some women may find that these types of exercise continue to cause issues for years after childbirth. However, Alex Forde assures that professional assistance, such as specific rehabilitation or assistance devices, including vaginal pessaries, can often help women return to their exercise of choice.

What is a healthy and realistic timeframe for new mums to get back to 100% fitness following pregnancy?

It’s important to remember that every woman is different. Physiotherapist Alex Forde says that “A slow gradual increase in exercise and fitness over time is the healthiest way to return to 100% fitness, but rather than focusing on comparing themselves to where they once were, women should focus on moving their body in an effort to keep healthy and feel better. We shouldn’t be giving women timeframes, but rather emphasising that returning to pre-baby fitness and exercise is as individual and personal as the entire birth journey.” This is a point that myotherapist Brent Cunningham agrees with: “100% fitness would be different for every new mum. I would suggest taking it slowly and setting a nine-month goal. Pregnancy is a nine-month process, so give yourself the same time in return to focus on you.”

Your body has carried a child for nine months and given birth, and, in many cases, breastfed the new baby, and therefore a little kindness to yourself is vital. As Tessa Marsh says, “Yes, we are designed to do this and our bodies are magnificent at coping, but cut yourself some slack and appreciate what you have been through. Realistically, the body can take twelve months or more to return to full health. However, hormones during breast feeding, labour journey, pre-pregnancy and the type of exercise can all alter the body’s abilities and health as well. Everyone is different and I don’t believe we should put a time frame on returning to 100% fitness.”

What are the risks of exercising post-pregnancy? Are there any warning signs for new mums to look out for that may suggest they are doing too much?

Tessa Marsh, musculoskeletal therapists, explains that “there are always risks to exercising,and the same apply to post pregnancy. You need to feel physically ready to return to exercise and gradually ease into work. If pain is present the exercise is not appropriate and should cease immediately. Women who exercised pre-pregnancy will be able to return to exercise much quicker than those who have not.”

Kate Beeley agrees: “Post pregnancy mums will experience loose ligaments which mean they will have a greater chance of injury if they go too hard too soon. Ease into your new routine and remember every training session is a building block to improve strength and fitness levels.”

Some risks include musculoskeletal injuries because of ligament laxity that occurs due to the pregnancy hormone relaxin, and deconditioning of the musculoskeletal and cardiorespiratory system if activity wasn’t maintained during pregnancy, explains Brent Cunningham.

Alex Forde lists other complications that could arise from returning to exercise too quickly, including: prolapses; bowel and bladder incontinence; pelvic, hip and lower back pain; joint pain caused by pregnancy hormones; abdominal muscle separation; and hernias. Awareness of these possible risks is essential because, as Alex explains, “complications that arise from retuning to exercise too early post-birth are much better prevented than treated, especially as some of the complications can be irreversible.”

Again, pain, incontinence, breath-holding or difficulty recovering from an exercise session are signs that you may be doing too much too fast. Paediatric chiropractor Claudia Cadona agrees: “If you are experiencing and lower back pain, sciatica, catching or clicking in the pelvic joints, pelvic floor weakness or sharp pubic symphysis pain, it is best to avoid exercise until you have been assessed. These are common symptoms post pregnancy and can often be easily corrected with the right treatment and exercise advise.”

Do you have any other advice, tips or comments for new mums who want to get back into exercise post pregnancy?

Finally, a last word from some of our experts:

Alex Forde, senior physiotherapist: “Most people don’t know that some physiotherapists undergo further training in the area of women’s health and continence physiotherapy. These physiotherapists can provide specialist care to women during their birth journey and help new mums return to exercise in a safe way.

Brent Cunningham, exercise physiologist and myotherapist: “Make the exercise fun and about you. It’s important that you enjoy the process as you’re more likely to subscribe to it. To make exercise a habit and a part of your life, we need to establish the behaviours to assist you toward that goal. I suggest focusing on daily consistency, 20-30 mins or even split that across the day, rather than the intensity or duration. Moving daily is what we are designed to do and this will accumulate across weeks, months, years providing steady progress, making exercise more achievable and delivering you the benefits and results.”

Kelly Prosser, accredited exercise physiologist and Pilates instructor: “Seek professional help! Firstly, see a pelvic floor physiotherapist to ensure you are on the right track! Second, seek help from an accredited exercise physiologist to help guide your return to exercise – no matter what type of exercise it is. And third, always listen to your body and ensure you are educated about the risks of doing too much too soon. Don’t be afraid either! It’s all about finding a healthy balance.”

Personal trainer Kate Beeley: “Find a supportive community that promotes being “healthy fit” and one that understands the day to day life of being a mum. At MissFit, we really focus on mums getting back into an exercise routine with our Baby Boot Camps three times per week where we have dedicated staff looking after their babies.”

Tessa Marsh, musculoskeletal therapist, has five key pieces of advice for your return to fitness: “1: Take it easy. 2: Don’t rush back it you’re not ready. 3: Listen to your body. 4: Do it for you. 5: Be kind to your body. It’s been on one heck of a journey!”

A final thought: new mums need nurturing – from both themselves, and greater society. Be realistic and remember, this is all about you. It’s your fitness journey and your body, find what works for you and don’t compare yourself to others – they have their own journeys to figure out.

Active in Brisbane would like to thank all of our experts for their contributions. More info about are fantastic experts is included below.

Alex Forde is a senior physiotherapist at FORDEPHYSIO in Paddington. She is passionate about pain management, and uses her background in physio, pharmacy and clinical pilates to provide a unique approach to healthcare.

Brent Cunningham is an Accredited Exercise Physiologist and Myotherapist in Brisbane and specialises in musculoskeletal rehabilitation and movement education. Brent is in private clinical practice with his business, Better Kinetics, and is also a lecturer in the Bachelor of Health Science – Myotherapy faculty at Endeavour College of Natural Health. I use both exercise and manual therapy interventions and enjoy assisting people from all walks of life.

Claudia Cadona is a highly qualified pregnancy and paediatric chiropractor and owns Scope Chiropractic, with two clinics located in East Brisbane and Ipswich. She has completed her post graduate diploma of paediatric chiropractic and been focusing in pregnancy care and paediatric chiropractic for a number of years. Her passion lies in helping women feel good and keep active throughout their pregnancy.

Kate Beeley aka MissFit is one of Brisbane’s leading fitness trainers, and has created MissFit Personal Training and Sportswear to support women with their health and fitness goals. Kate motivates and leads her MissFit team by example and holds the current Guinness World Record for most Burpees in one hour by a female 1,321 total.

Kelly Prosser is an accredited Exercise Physiologist, Pilates instructor and owner of Fluid Exercise Physiology. Kelly is passionate about creating positive changes in people’s lives. She has been working with pre- and post-natal mums for over 10 years, and enjoys changing clients’ lives by tweaking exercise to help reduce pain, recover from injury, and return to work and life.

Tessa Marsh is the Principal Musculoskeletal Therapist and Director of Utile Functional Health Team. Tessa believes in hands-on treatment and educating clients about their injuries in order to rehabilitate and prevent further injuries.

This blog was written for Active in Brisbane by Dr Catherine McTavish.

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