Many women in the childbearing year wish to commence or continue with their exercise programs during and post pregnancy to maintain their health and quality of life. The traditional medical advice has been for exercising women to reduce their habitual levels of exertion in pregnancy and for non-exercising women to refrain from initiating strenuous exercise programs. This advice was primarily based on concerns that exercise could affect early and late pregnancy outcomes.1 However, recent investigations focusing on both aerobic and strength conditioning exercise regimens in healthy pregnant or postnatal women indicate that moderate exercise does not increase adverse pregnancy outcomes or quantity or composition of breast milk.

While an increasing demand for appropriate fitness services for pre and post-natal women provides an opportunity for many exercise professionals, it is imperative that pre and post-natal women are cared for individually, as there can be considerable variation between individuals and pregnancies.

Pre-Exercise Screening and Referral

All new participants should complete a suitable pre-exercise health screening questionnaire, such as the Adult Pre-Exercise Screening System (APSS) and follow recommended procedures in accordance with risk stratification. The Physical Activity Readiness Medical Examination for Pregnancy (PARmed-X for Pregnancy), developed by the Canadian Society for Exercise Physiology also provides a useful guide for screening and referral.

Importantly, if a new or continuing client has been identified with any medical or pregnancy related musculoskeletal condition that has exercise implications it is vital that appropriate ongoing consultation and collaboration takes place with the appropriate allied health or medical professional.

Exercise Programming

Exercise participation pre and post-partum has numerous health benefits which are well documented. However, Registered Exercise Professionals must recognise that throughout this period extra consideration and knowledge is required to design safe and appropriate exercise programs. During pregnancy both the client and developing baby are at a higher risk of exercise induced complications due to physiological and morphological changes. During the post-natal period extra care is required to ensure proper musculoskeletal recovery. Therefore as part of the ongoing service provided to pre and post-natal women it is important that the Registered Exercise Professional continues to closely monitor progress and refer to the appropriate pregnancy related health care professional if any concerns arise. This may include their doctor, mid-wife or women’s health physiotherapist depending upon the issue.

Post-Natal Guidelines

Activity choice

Many women can be in a hurry to return to exercise. The type of activity and when a new mum can return to exercise depends on pre-existing fitness, her pregnancy, labour and delivery and the post-natal health of both herself and her baby. Too much, too soon can cause long term problems and regrets. It is important that Registered Exercise Professionals encourage women to listen to their bodies, take their time and follow recommended guidelines when making a return to various activities. Registered Exercise Professionals should monitor the health of post-natal clients on a continuous basis, particularly for abdominal muscle separation, core stability and pelvic floor function.

Recommendations for Post-Natal clients

The following recommendations are specific phases for return to exercise. Factors such as altered sleep patterns, breastfeeding, hormonal changes and establishing new routines with a baby can result in fatigue, so programming for a post-natal woman needs to consider the individuals energy level.

Further modification may be required for women who have given birth by caesarean, have any existing pelvic joint or back pain, rectus diastasis or have additional risk factors such as assisted delivery, a long second stage (pushing over 1 hour) and birth weight over 4kg.

0-3 weeks post-natal

Should include walking, post-natal core/deep abdominal training and pelvic floor exercises.

3-8 weeks post-natal

It is recommended that clients wait until their 6 week postnatal check with their doctor or midwife before commencing a group exercise program, returning to the gym or to personal training. Recommended exercises at this stage include:

• Walking.
• Swimming (once bleeding stopped).
• Gym programs - maintain posture, light weights, no breath holding.
• Post-natal abdominal and pelvic floor exercises.
• Low impact aerobics or a post-natal class.
• Low intensity water aerobics classes (once bleeding stopped).

8-12 weeks post-natal

• As for 3-8 weeks, increasing intensity/weights.
• Progress post-natal core, abdominal and pelvic floor exercises.

12-16 weeks post-natal

• Abdominal and pelvic floor muscle testing prior to return to higher impact exercise / running / sport and commencing regular abdominal exercise programs.

After 16 weeks post-natal

• Return to previous activity levels providing that the client’s pelvic floor muscles and core control levels are back to normal. Additionally the client should be free of any ongoing pre or post-natal complications such as rectus diastasis and pelvic joint pain.
• The client should not experience any back pain, pelvic or vaginal heaviness or urine loss during or after exercise. If they do, they should be advised to slow down or reduce their intensity level.