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Pregnancy to postpartum fitness: Here’s how to return to exercise after childbirth

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Pregnancy to postpartum fitness: Here’s how to return to exercise after childbirth

Giving birth to a new life is considered to be one of the most cherished event for a woman but how can we forget that pregnancy and childbirth brings so many changes in a woman’s body from these three aspects – anatomical, physiological and emotional. These three parameters are the pillars for every individual’s wellbeing.

Pregnancy to postpartum fitness: Here’s how to return to exercise after childbirth (File Photo)

In an interview with HT Lifestyle, Priya Singh, Women’s Health Physiotherapist and Lactation Consultant at Cloudnine Group of Hospitals in Vashi and Navi Mumbai, highlighted that the documented changes that occur during the course of pregnancy are:

  • Changes in the hormonal secretions
  • Overall increase in body fluid
  • Laxity of joints and ligaments due to relaxin hormone
  • Changes in the curvature of the lumbar spine
  • Stretching of the abdominal muscles to accommodate the growing fetus.
  • Changes in the skin
  • The most important: weight gain

According to Priya Singh, there are many other changes that a woman’s body may go through but the above changes mentioned are the most common ones and visible ones.

Why are we discussing changes during pregnancy while we discuss ‘return to exercise after childbirth’?

Priya Singh explained, “That is for you to understand that the changes that have occurred during child birth would certainly require some time to return back to normal, as how it was! You can make your bounce back process a little easier by staying active during pregnancy as exercising would help you maintain your fitness level, the muscle strength, stamina and flexibility which in return helps you to combat the expected pregnancy discomforts and that allows you to start your post-partum fitness journey soon after you give birth.”

She elaborated, “The most common concerns that every women has after child birth are “why this belly still looks bigger after the baby is born, what can be done to have this belly go in, how much time will it take, what all activities can I do”, will wearing a belt help?. The uterus is made up of smooth muscles and it grows in size with progressing weeks of pregnancy and so the abdominal muscles also stretch to accommodate the growing fetus. After childbirth the uterus is still big in size. Which shrinks and reduces naturally on its own with time. This process is referred as Involution.”

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Now let us discuss something that also causes the abdominal muscles to bulge is Diastasis recti; the separation of the rectus abdominal muscle that is more than more than 2 cm would require your attention. There are 4 types of Diastasis recti and that are:

  1. Open Diastasis
  2. Open below Naval
  3. Open Above Naval
  4. Completely Open

As per Priya Singh, 2-3 weeks after childbirth it is recommended to get checked from a physiotherapist so that they can prescribe exercises as per the assessment and type of Diastasis recti present.

What the role of abdominal belt to play here? Let’s discuss.

The criteria for wearing a belt are–

  1. Always consult your healthcare provider before using one for yourself.
  2. If you have a loose, saggy abdominal muscle and basic daily activities are affected without support.
  3. Less strength in core muscles
  4. Twin pregnancy
  5. If you are a Multiparous women.

Priya Singh suggested, “One may require to use a belt initially for about 6-12 weeks which is enough. An abdominal belt offers you a good posture and support but avoid prolonged usage as it will lead to muscle wasting, work on the muscle consistently with core exercises as per one’s existing muscle strength. A physiotherapist can help you with wearing the belt correctly and guide you with the right core exercises to begin with.”

The fitness expert advised, “The exercises that can be started soon after giving birth are abdominal muscles contraction or activation, Deep breathing exercises along with the core activation & other muscle activation exercises can be considered.”

She added a few suggestions that mothers may follow to avoid any injury, discomfort while they are returning to exercise after giving birth –

  • Take it slow, allow your body to heal for about 4-6 weeks.
  • One can start basic mobility and muscle activation exercises soon after childbirth as it allows the joints and muscles to retain its basic function.
  • Intensity of the exercises can be increased and mild to moderate intensity exercises for upper body, back and abdomen can be started after 6 weeks.
  • Moderate strength training can be started to strengthen upper and lower body with weights of up to 3-3.5 kg for beginners along with core activation exercises. Avoid lifting heavy weights during daily chores or as a part of exercise, weight training is an important part of the exercise routine but the weights must be increased in gradual manner to avoid any injury.
  • Mild to moderate Cardio exercises like walking and brisk walking can be started after 6 weeks. Avoid HITT (high intensity interval training).

Priya Singh concluded, “I would recommend mothers to take professional advice on which exercise to begin with. Evaluation of muscles strength plays a vital role in forming an exercise program of an individual. The result of not having a good core strength is having multiple discomforts out of which the most common is backache. A Physiotherapist can help you with having a safe exercise routine post childbirth by keeping all the exercise guidelines in mind. The aim of your exercise program shall focus on building a strong system instead of weight loss. Weight loss is the byproduct of life style that we have, eating habits, consistency and patience.”

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I’ve been doing the bird dog exercise instead of planks to improve my core strength – it’s even better for beginners

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I’ve been doing the bird dog exercise instead of planks to improve my core strength – it’s even better for beginners

While the bird dog exercise mainly works the core muscles, improving stability and strength, it also targets the lower back, shoulders, hamstrings, and glutes, making it one of the better full-body exercises you can do.

Over the years, I’ve done plank after plank and seen few benefits. It’s just not the exercise for me. I can hold the position for about a minute before everything starts shaking and my forehead starts sweating. Even with practice, it feels torturous.

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Boutique Fitness Is Redefining How Americans Work Out. Which Drop-In Classes Are Worth Booking?

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Boutique Fitness Is Redefining How Americans Work Out. Which Drop-In Classes Are Worth Booking?


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I pushed myself too hard at the gym – and ended up in the hospital

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I pushed myself too hard at the gym – and ended up in the hospital

In January 2025, I attended my first bootcamp class.

I had spent the day hunched over my laptop, anxious and craving an intense workout that would dispel my worries. I booked the class at a nearby gym, and the five-star reviews promised the all-consuming exercise I wanted: “Militant style instructor, but very motivating,” read one. Another: “Hardest workout of my life; extremely rewarding.”

The gym was no-frills – just a room with a mirror. After a standard warm-up, we did four sets of lateral shuffle push-ups across the floor, interspersed with standing, weight-bearing exercises.

When my turn came, I dropped to plank position and started doing steady, shallow reps, focusing on my form.

But caution soon fell away. Upbeat music was booming and someone was always advancing beside me. When the instructor encouraged us to lower all the way down, I obeyed, even though my form suffered. I had rarely done more than a handful of pushups at a time, and in the final set, I was exhausted, collapsing on every rep and barely prying my torso off the floor.

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The rest of class was a blur. I became nauseated, told the instructor I needed to pause, and stepped outside to suck cold winter air into my lungs.

Back in the studio, I sat on the sidelines and waited for the dizziness to recede before slinking to my spot for the core section and cooldown.

Later that night, I felt what I thought was typical post-workout muscle soreness. I was satisfied; the ache was proof of a successful workout.

But the next day, lifting my arms to wash my face was exhausting. Searing pain kept me awake that night. Two days after the class, my arms were so stiff I couldn’t raise them more than a few inches, even to brush my teeth.

When I Googled my symptoms – pain, weakness and a new one, dark urine – something frightening came up: exertional rhabdomyolysis, a condition wherein extreme exercise causes muscle cell contents to flood the bloodstream, potentially overwhelming the kidneys. One article warned that debilitating pain after a new, intense activity was a sign to visit the emergency room.

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I went to the ER but suspected I was overreacting. After all, the internet always offers the worst possibility.

Doctors use bloodwork to test for exertional rhabdomyolysis; typically, they diagnose it if a patient has too much of a muscle enzyme called creatine kinase (CK) in their blood – at least 1,000 units per liter, or five times the normal range. However, there is little consensus on this number, says Dr Barry Boden, an orthopaedic surgeon at The Orthopaedic Center in Maryland, who specializes in sports medicine. Some recent guidelines suggest that only higher amounts – as much as 10,000 units – warrant diagnosis and inpatient treatment.

My CK count was so high the machine in the emergency room couldn’t measure it; a nurse had to do a second blood draw and send it to a more precise lab. They put me on an IV drip and eventually reported the exact number: 57,000.

Thus began my seven-day hospital stay. My mom and sister traded shifts, acting as my arms for the week – scrubbing my teeth, feeding me, washing my face. I had never felt so helpless and irresponsible. What had I done to myself?

What is exertional rhabdomyolysis?

Normally, during exercise, muscles tear a little and then rebuild. There may be a little extra CK in a person’s blood as a result, which healthy kidneys can filter out.

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But excessive exercise can harm muscle cells so much that their contents – including CK and a protein called myoglobin – overload the system. “When the cell membrane starts to break down, the chemicals within the muscle cells start to get released, which can cause damage to other organs around the body,” said Boden. “ If there’s enough of those chemicals from the muscle that reach the kidney, it can cause damage to the kidney.”

The symptoms are muscle pain (even while at rest), weakness and dark urine, though few people experience all three. Treatment involves early and aggressive administration of IV fluids to help the kidneys filter the toxins. It’s possible to manage a mild case with at-home oral hydration, but it’s always important to consult a doctor because mild symptoms don’t always mean low CK elevation, said Dr Petr Schlegel, a CrossFit trainer and professor at the department of physical education and sports at the University of Hradec Králové in the Czech Republic.

Exertional rhabdomyolysis is dangerous and fatal in very rare cases; researchers estimate that 10% of patients develop acute kidney injury (AKI), and some suffer other serious complications.

How common is exertional rhabdomyolysis?

Before I had rhabdomyolysis, I had never heard of it; I thought the worst that could come from a workout was a broken bone or a regurgitated lunch. I now know it can happen to anyone, although people with certain conditions, such as sickle-cell trait and hypokalemia, are predisposed. Despite the common misconception that only unfit people can get it, even elite athletes are susceptible.

 “Anybody can get it – anybody that’s pushed to an extreme, taking a big jump in their exercise level, or doing something they’re not used to doing,” said Boden. “Everybody has muscles, and if the muscles are damaged enough, you can develop rhabdomyolysis.”

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Boden authored a study estimating there were over 40,000 exertional rhabdomyolysis cases in US hospitals from 2000 to 2019. But he said it’s impossible to get a precise count, as no organization collects the data.

This number is likely an underestimate, as the condition is probably under-reported, said Schlegel. Since the symptoms closely resemble those of delayed onset muscle soreness – the normal ache people expect after a workout – individuals may not seek care.

Data indicate exertional rhabdomyolysis is on the rise. In Norway, Australia and the US, researchers have observed an increase in hospital records between the 2000s and 2010s. This year, hospitals in a Canadian province reported a surge in cases.

Researchers suspect the popularity of high-intensity workouts is behind the rise. They are efficient and produce measurable progress, but are risky if misused, said Schlegel: “Evidence suggests that high-intensity exercise, especially when combining strength and endurance elements, carries the greatest potential to induce [exertional rhabdomyolysis].”

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Can you prevent exertional rhabdomyolysis?

Prevention guidance has been pretty consistent since the earliest studies from the 1960s: vary exercises to avoid overloading one muscle group, incorporate rest, and gradually build intensity when starting something new or after time off.

Starting low is especially important when targeting large muscle groups – such as biceps, triceps and quads. “It’s that hyperintense going from zero to 100, really intense workouts of large muscle groups, that puts people at risk,” said Dr Bryant Walrod, a sports medicine physician and the head team physician for the Ohio State Buckeyes. Weight matters, but so do reps; an outrageous number of low-weight exercises or calisthenics – hundreds of pushups or squats, for example – is the trigger in many cases. Walrod also advises doing a different kind of workout from one day to the next.

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Eccentric exercises like push-ups – where muscles lengthen – are particularly likely to cause injury. In a 2024 article about how to prevent rhabdomyolysis in student athletes, the National Federation of State High School Associations called push-ups the “No 1 cause” of rhabdomyolysis. In April, Texas families filed a lawsuit against a charter school after 20 children were hospitalized after hundreds of pushups.

Walrod said collegiate sports professionals became more vigilant about prevention after University of Iowa football players were hospitalized with exertional rhabdomyolysis in 2011. “That case spurred better control of workouts, better monitoring, and better input from the trainers and strength coaches.”

“Where we see most of the cases is that athletes are being pushed or threatened or punished [contrary to industry standards],” said Dr Rebecca Stearns, COO at the Korey Stringer Institute for preventing sudden death in sports. Coaches are not exercise physiologists, and even when well-intentioned may not have adequate training to prevent overexertion, said Boden.

Similarly, there’s no guarantee fitness instructors understand the risk. “People may be going in unconditioned and doing too much too soon,” said Walrod of these classes. CrossFit incorporated prevention into its trainer curriculum after reports of severe cases among participants, but in general, class participants should self-monitor.

How do you identify overexertion?

I was discharged from the hospital with a firm instruction: no exercise except walking for a month. I had to learn what an appropriate challenge felt like – how to self-monitor, discern between safe discomfort and overexertion, and advocate for myself. But when is hard too hard?

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Unfortunately, sensing that something is wrong is a subjective measure; there is no universal metric.

“I never have a very satisfying answer to that, but I do think it’s a line we need to be vigilant about always, and it changes from day to day,” said Dr Natalia Petrzela, author of Fit Nation: The Gains and Pains of America’s Exercise Obsession, longtime fitness instructor, and professor of history at The New School.

“You know your body the best, and if you feel like something isn’t right, it’s time to speak up,” said Walrod. Sports medicine physicians advise people to stop exercise immediately if unusual pain occurs; in the event that there is excessive muscle breakdown, it’s critical to stop the movement right away.

Speaking up in a class setting can be difficult. Many feel self-conscious about pausing or modifying activity, especially if an instructor is singling them out. Petrzela said that she motivates participants in her class but also expresses a key caveat: “Only you know what you can do today.” She said this language “helps [them] find that very important and difficult-to-discern line”, adding that this nuance might get lost in classes with less experienced instructors who give inflexible instructions.


During that fateful class, I ignored the alarm bells. Maybe I was desperately chasing endorphins or wanted to prove to myself that I wasn’t weak. Ironically, my arms atrophied to below baseline as a result.

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Over a year later, I’m still building my strength back – but not at bootcamp. I opt for low-impact methods such as barre and pilates where I can modify if needed, and there is no need to keep pace with others.

Sometimes I tell instructors about my medical history, so they understand what’s happening if I pause. Verbalizing it also reminds me to be careful. Finally, I avoid anything new or especially difficult when I’m having a hard day.

Fitness culture taught me that pain is gain – but now I know that’s not always true.

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