Cardiovascular Activity After Cesarean

WALKING - CAN START IMMEDIATELY POST-OP

Although rest is absolutely necessary in these early weeks, getting moving is also important. This doesn’t mean strenuous exercise. Getting outside for some light walks after you get home from the hospital is encouraged.

Use the 5-minute rule for guidance. The first week, start with 5 minute walks on flat surfaces. Each subsequent week, increase time by 5 minute increments based on how you feel (2nd week = 10 minutes, 3rd week = 15 minutes, etc.). Monitor for any increased pink/red bleeding after your walk. This can be an indication of too much activity.

BIKE/PELOTON - CAN START >6 WEEKS

Spin/cycle is typically well-tolerated after being cleared for exercise because it is low impact. Generally, around the 6-week mark it is okay to start with some short, easier, low impact rides (think 15-20 minute). Based on how you feel the following day is how you can gauge progress each week. Aim to progress one parameter at a time - i.e. if you increase the time on your ride, don’t add more hills, time out of saddle, etc.  Over the course of weeks to months, increase the difficulty of your rides.

SWIMMING - CAN START >6 WEEKS (IF BLEEDING IS STOPPED AND SCAR FULLY HEALED)

Again, well-tolerated to start because of the buoyancy water provides making it low impact. Start with an easy pace, around 15-20 minutes. Assess how you feel and progress distance and speed over the course of weeks to months as tolerated.

ROWER - CAN START >6 WEEKS

You may need to adjust how far you lean back initially and monitor for any painful pulling in the abdomen. Put an emphasis on the leg drive - push your body away, instead of pulling through the abs. Start with a lower resistance and distance and gradually build over the course of weeks to months as tolerated.

SKI ERG - CAN START >6 WEEKS

Generally well-tolerated after 6 weeks. Think about exhaling and drawing the abdominals in as you pull down. Adjust range of your pull as needed. Start with a lower resistance and time and gradually build over the course of weeks to months as tolerated.

JUMPING - CAN START ~12 WEEKS

We want to train jumping prior to running since running is essentially a series of single leg jumps. If all strength exercises are feeling coordinated, strong and pain-free, you can start considering some plyometric movements. Start with double leg jumps: jump rope, squat jumps, box jumps, etc. and progress toward single leg movements: speed skaters, single leg hops, etc. Work on landing light with good control.

RUNNING - CAN START ~12 WEEKS

Based on the 2019 guidelines that reviewed all current research, it is recommended to wait to start running until at least 12 weeks postpartum. This 12-week period simply allows for more time: additional time for healing, but also (just as important), time for strength training and improving coordination to prepare for the high-impact sport. Pregnancy is a major source of deconditioning despite training throughout. There are postural, strength and balance changes. We know that postpartum runners are often limited by low back, pelvic, and hip pain (amongst other musculoskeletal issues). I have my clients focus solely on building strength and coordination (just like this program), eventually adding in plyometric training for at least 6 weeks before returning to run.

Around 12 weeks, we do an assessment to look at tolerance for load/impact as well as single leg control.

Can you:

  • Balance on one leg >30 seconds?

  • Perform 10 single leg squats on each leg with good control?

  • Perform 10 single leg RDLs on each side with good control?

  • Double leg hop for 30 seconds without pain/issues?

  • Single leg hop for 15 seconds each side without pain/issues?

  • Run in place for 1 minute without pain/issues?

If these tests feel easy, I’ll prescribe a progressive return to run program. Here is a link to the PDF I provide my patients. This allows for graded exposure over the course of several weeks. It can look a lot like a “couch to 5K” program. Running should be symptom-free: no pain, leaking, pelvic pain, or heaviness.

Since this program is written for the general population, it should be said that I believe this guideline is just a recommendation, not necessarily a hard 12 week mark. Everyone’s rehab, athletic ability, fitness background and injury history is very different. Therefore, use 12 weeks as a guide but see a pelvic floor PT if you want a personalized assessment for return to running.