New mother doing exercise

Returning to Exercise Postpartum

Share this post:

Becoming a mother is a life-changing experience, and for those mothers who want to return to running and other endurance activities, returning to training and/or competition after giving birth can be a challenging journey. It is important for women returning to exercise postpartum to prioritise their health and well-being during this time, considering the physical changes that occur throughout the body. In this blog post, we will explore the head-to-toe considerations for postpartum endurance athletes, focusing on key areas that require attention and care.

As a starting point, have a look at this fantastic infographic from the British Journal of Sports Medicine below.

Source : Afifi T, Barrack MT, Casey E, et al. Br J Sports Med 2024;0:1–3. doi:10.1136/bjsports-2023-107624

Mental health

Becoming a mother can significantly impact your mental health. Postpartum depression (PPD) is common, affecting 20% of women within a year after childbirth (1). PPD can also increase the risk of future depression episodes and is associated with urge urinary incontinence (1). PPD, anxiety, psychosis and other mental health conditions can also be of concern, but how common they are remains unknown in post-partum athletes (2).

Eating disorders have been associated with pregnancy complications, and have been shown to increase the risk for developing PPD and contribute to relative energy deficiency in sport. This is a common pre-cursor for bone stress injuries – especially in endurance athletes. Don’t hesitate to seek professional help for any mental health concerns and make sure you are prioritising your mental health alongside your physical health!

Bone Health

Breastfeeding can sometimes temporarily decrease bone density, which is presumed to be from calcium being drawn from the mother and supplied into the milk. However, Bone Mineral Density (BMD) often recovers on the resumption of the menstrual cycle or weaning from breastfeeding. Because it often recovers over time, bone density tests are not always necessary for most women (3). It is definitely a factor worth considering on the resumption of activity though, as there is an increased risk of bone stress injuries. Athletes should focus on weight-bearing exercises and proper nutrition to build and maintain bone strength, and use progressive overload to restore BMD over time.

If weight loss is a goal during the postpartum period, moderate energy restriction (ie less calories in) combined with resistance training promoted weight loss in postpartum lactating women without any adverse effects on BMD (4). The key here is moderate energy restriction – your body still needs energy to function well. Consider seeking nutritional advise and support and exercise programming to ensure that you are using safe weight loss strategies that are relevant to you and your activity goals.

Cardiovascular Factors

During pregnancy, a mother undergoes several cardiovascular changes including increased resting cardiac output, often related to increased heart rate and stroke volume and lower systemic vascular
resistance (5). This increased cardiac output often seen in postpartum athletes can even persist for up to
1 year (5). While the performance-enhancing potential for these persistent physiological changes in the postpartum period is debated, it is notable that changes are similar to results of endurance exercise
training. What this means is that resuming cardiovascular training post-partum stands to possibly maintain some of these positive physiological changes that occur during pregnancy. This may result in athletes able to return to or even exceed previous performance levels in the years after pregnancy!

The abdominal wall and pelvic floor

Pregnancy and delivery can cause stretching, pain or damage to the abdominal wall and pelvic floor. Common symptoms of pelvic floor muscle dysfunction during exercise include heaviness in the pelvic area, pelvic pain, as well as faecal and urinary incontinence (3). Returning to regular training and doing too much too fast can may also increase risk (3). Women with pelvic floor dysfunction should complete rehabilitation to address any underlying impairments and make sure that clearance is obtained from a qualified Pelvic Health Physiotherapist. A Pelvic Health Physiotherapist examination can check for prolapse and pelvic floor function, and provide exercises, devices and other support to improve abdominal and pelvic floor function.

Abdominal wall changes during pregnancy may result in diastasis recti (DR) or abdominal muscle separation. This common issue results in a gap or ‘doming’ in the middle of the abdominal wall around the belly button, which can compromise the function of the abdominal wall resulting in weakness or instability, and associated distension after eating and drinking. A Pelvic Health Physiotherapist can also help with a thorough assessment and rehabilitation.

Haematological Factors

Iron deficiency is common after childbirth due to blood loss during delivery. Athletes are at an increased risk for anemia, which can significantly impact performance and recovery. If you are concerned, you should review with your doctor, and regular blood tests and iron supplementation (oral supplements or intravenous injection) can help address this concern. Perinatal anaemia is the most common perinatal complication identified in athletes returning to competition (7).

Nutritional Factors

Postpartum athletes, especially those breastfeeding, have higher nutritional needs to meet energy requirements. Its important to focus on a balanced diet rich in protein, complex carbohydrates, healthy fats, and essential vitamins and minerals. As an example, some studies show that during the first 6 months post-partum, breast feeding increases energy expenditure at 500–600 kcal, protein requirements by 25g and fluid needs by 900 mL/day (8).

Key takeaways

  • Prioritise your mental and physical health.
  • Seek professional help for any mental health concerns.
  • Focus on rebuilding strength and stability in your core.
  • Fuel your body with a balanced and nutritious diet.
  • Make sure you are hitting you energy needs
  • Address any iron deficiencies with your doctor.
  • Listen to your body and gradually increase training intensity.

By considering these key factors, you can create a safe and effective plan to return to your athletic pursuits after childbirth. Remember, motherhood is a journey, and taking care of yourself is the first step to achieving your fitness goals. If you need help or support our team can support you with Exercise Physiology for guidance with training, Dietitian support and Psychological support.


(1) Hullfish KL, Fenner DE, Sorser SA, et al. Postpartum depression, urge urinary Incontinence, and overactive bladder syndrome: is there an association. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:1121–6.

(2) Wowdzia JB, McHugh T-L, Thornton J, et al. Elite athletes and pregnancy outcomes: a systematic
review and meta-analysis. Med Sci Sports Exerc 2021;53:534–42.

(3) Bø K, Artal R, Barakat R, et al. Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC expert group meeting, Lausanne. part 3—exercise in the postpartum period. Br J Sports Med 2017;51:1516–25.

(4) Colleran HL, Wideman L, Lovelady CA. Effects of energy restriction and exercise on bone mineral
density during Lactation. Med Sci Sports Exerc 2012;44:1570–9.

(5) Afari HA, Davis EF, Sarma AA. Echocardiography for the pregnant heart. Curr Treat Options Cardio Med 2021;23.

(6) Schulz JM, Marmura H, Hewitt CM, et al. “Navigating the “new normal”: what guidelines exist for postpartum return to physical activity and sport? A Scoping review”. Br J Sports Med 2023;57:1573–8.

(7) Nose-Ogura S, Yoshino O, Nakamura-Kamoto H, et al. Medical issues for female athletes returning
to competition after childbirth. Phys Sportsmed 2023:1–7.

(8) Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements.
Washington, DC: National Academies Press, 2006: 1344.

Share this post:

Related Posts