Before you start training for that next half marathon or dedicate yourself to a new kettlebell routine, there's one thing you should do first, says Philip H. Cohen, MD, a primary care sports medicine physician, and that's to clearly define some health and fitness goals. Women who have recently given birth, are pregnant, or are planning to become pregnant can especially benefit from this proactive approach to health and fitness as a way to optimize their workouts and prevent injuries, says Dr. Cohen, who practices at UCLA Health Encino.
With that in mind, here are 7 steps that postpartum women can take to create a safe post-baby exercise routine.
Step 1: Define your goals
Do you want to shed leftover pregnancy weight, return to a more active lifestyle, start an exercise program for the first time, or return to athletic competition? All of these are appropriate goals if you’re postpartum, had an uncomplicated pregnancy, and have been cleared to resume physical activity by your obstetrician, Dr. Cohen says. "This is a great time to prioritize your health and well-being and make lasting changes to improve your health," he continues.
While every fitness plan should be personalized with this goal in mind, there are some general best practices to consider regardless of whether you want to take the occasional group fitness class or participate in a more structured or self-led exercise program.
Step 2: “Start low and go slow”
Once you’ve been cleared by your OB to return to exercise, Dr. Cohen says his biggest piece of advice is to, "start low and go slow."
"If you’re starting a new fitness routine and want to avoid burnout or injury," he explains, "you should introduce low-impact exercises first, such as walking or swimming, and prioritize consistency over the length of time you spend exercising."
Here’s how that looks in practice. Let’s say you want to work up to the recommendations from the American College of Sports Medicine, meaning 30 minutes of moderately vigorous, aerobic activity, 5 times per week; 30-45 minutes of strength and resistance training, 2-3 times per week; and stretching and flexibility training with every workout.
Aerobic activity: In the months after childbirth, skip high-impact exercises, such as jumping and running, or sports that combine these activities, like basketball, Dr. Cohen says. Instead, start with low-impact activities for 10 to 15 minutes, completed every other day. Gradually build up to 30 minutes of aerobic activity, completed for two to three days straight, followed by one day off—and repeat.
Strength and resistance: If the goal is to spend 30 to 45 minutes lifting weights or doing resistance training two or three times per week, start by focusing on your major muscle groups, and complete only one or two sets of each activity, Dr. Cohen recommends. As you get stronger, you can add additional sets and more weight or resistance.
Stretching: The same rules apply to stretching. Don’t overdo it, and slowly work up to a longer stretching routine with each workout.
In each of these activities, you should track your progress, and increase the intensity and length of your workouts when you’re ready.
Step 3: Make time for rest
"When you’re starting out—and especially when you’re a new mom—rest is incredibly important to build strength and avoid injury," Dr. Cohen says. He recommends that postpartum women rest between weight-lifting or cardio sets during workouts; rest between workout days; and rest by getting nourishing and restorative sleep at night (or naps during the day).
"Start with gentle workouts every other day, and build up to more intense workouts, five days a week," Dr. Cohen says. And remember: Be consistent with your workouts, and take it slowly, he adds.
Step 4: Fuel your body
"Adequate nutrition is vitally important, especially if you’re breastfeeding or have young children," says Dr. Cohen. "Be intentional about giving your body all of the fuel it needs to keep your energy up and to participate in the activities you enjoy."
If you skimp on sleep or nutrition, you risk burning the candle at both ends, he says, which makes you more susceptible to injury and muscle fatigue and breakdown.
Step 5: Learn the difference between muscle fatigue and injury
Most people who know their bodies fairly well can tell the difference between just being sore from a tough workout and experiencing pain caused by an injury, Dr. Cohen says. But if you’re not sure which sensation you’re experiencing, a good rule of thumb is that an injury will often cause sharp or severe pain and keep you from completing your regular day-to-day activities. It may also cause swelling or a bruise and potentially some functional problems, such as difficulty walking up a flight of stairs or an inability to lift something that wasn’t previously too heavy.
When in doubt, rest and don’t return to your exercise routine until you feel better, he says. If things don’t settle down in a reasonable amount of time, get checked out by a doctor who has a sports medicine background. One benefit of visiting UCLA Health’s Encino practice, Dr. Cohen says, is that they have an X-ray and ultrasound machine onsite and available to help physicians diagnose a musculoskeletal or joint injury, if necessary.
Step 6: Know when to quit, and when to get help
Several “red flag” symptoms should alert you to stop exercising right away, including chest pain, severe dizziness, trouble breathing or feeling as if you might pass out, Dr. Cohen says. "If you have one of these symptoms and it doesn’t resolve when you take a break, but stays persistent or gets progressively worse, call 911 and be checked out in the emergency room," he adds.
Now, there are a few caveats to this rule. If you just ran up a hill and are short of breath, you probably don’t need to call for an ambulance. Use common sense, and keep in mind the activity you’re doing and your fitness level to gauge whether you’re having a serious problem.
If you’re exercising during pregnancy, you also want to avoid getting over-heated or dehydrated—and to stop immediately if you’re feeling either of these symptoms. If it doesn’t resolve quickly with water and rest, you should get checked out by your OB or, depending on the severity of your symptoms, go to the emergency room.
Step 7: Don’t overlook postpartum changes in your body
"A lot of women expect to snap back into shape after pregnancy," Dr. Cohen says, "but there’s real value to being easy on yourself, and keeping in mind all of the changes your body just endured."
For instance, many women get hemorrhoids or varicose veins for the first time during pregnancy or after giving birth. Many women also have some pelvic floor dysfunction, or a lingering separation between their abdominal muscles. "Until these issues resolve, you should avoid doing a lot of heavy squats, or exercises in which you have to 'bear down' and increase the pressure in your abdomen and pelvis," he says. You should also avoid long-distance cycling, or any activity that feels needlessly uncomfortable.
If you had a cesarean birth, or complications during labor or delivery, even with their OK to exercise, you probably want to keep your OB or primary care physician involved as you start exercising again to ensure that you’re not negatively impacting your health or healing, he says.
"The good news about all of this," Dr. Cohen says, "is that while your progress may be slow, having a baby offers a great opportunity redefine your fitness goals, and make lasting changes to prioritize your health and well-being."
For more information on this topic, please see The American College of Obstetricians and Gynecologists’ guidelines for exercise during and after pregnancy. Also, remember that any questions you have about exercise during or after pregnancy should be discussed with your OB and other specialists, as warranted.
Dr. Philip H. Cohen is a primary care sports medicine physician who practices in Encino. He is board certified in internal medicine and sports medicine, and enjoys proactively working with patients to optimize their health and performance and prevent any injuries before they start. He offers same day appointments for new and existing patients.