Pilates for Post-Partum? Research finds improved pelvic floor function, energy, mood and fitness.

What are the recommendations and guidelines for exercise implementation in the post-partum phase? More specifically, how does one determine when, how much, and the expected benefits of exercising and movement? A sample recommendation of a daily exercise routine will be provided below and would be after 4-6 weeks post-partum. Why Some research studies have demonstrated safety and effectiveness of some exercise like Pilates as early as a few days post-partum. However, there is still some controversy and variability, hence this recommendation stays conservative, but evidence suggest early exercise will be optimal. Another reason for the 4-6 week window has to deal with the management of the OB/GYN if using one. The early acute phase of post-partum would necessitate a different approach to movement/ exercise and usually the OB/GYN will give permission for formal exercise after this period if the birth was without complications (Pruett & Caputo, 2011).

The intensity, duration, frequency, and volume all should be reduced in the post-partum phase compared to conditioning level present towards the end of the 3^rd trimester (Pruett & Caputo, 2011). Thus, the actual starting point will vary per individual. We can use my wife as an example. She had hyperemesis gravida up until the beginning of the 2^nd trimester. The 2^nd trimester involved severe fatigue. Now is the 3^rd trimester abdominal pain has been debilitating most days.  She has only been able to maintain 4-5 days/ week of a short 10-20 minute yoga and flexibility sessions and rarely walks more than 10-20 minutes at any given time with average daily steps around 7,000. Therefore, her aerobic and strength conditioning is sub-par and the post-partum training’s MEV (minimal effective volume) can be low to still elicit the improvements of the exercises.

The specific plan below is based on the research framework of the “Active Mums” postpartum recovery exercise periodization to improve aerobic, posture, flexibility, strength, abdominal and pelvic floor musculature (Brites-Lagos et al., 2024). The study participants had to be within the 4-12 week post-partum period to be considered. Participants were also instructed to complete questionnaire’s such as the PAR-Q+, Pelvic Girdle Questionnaire, Edinburgh Postpartum Depression Scale and others before, during, and after the training program.

The suggested regimen below is suggested to be performed 3 days per week and lasts for 3 mesocycles resulting in about a 16 week periodized program. Beginning at the 6 week mark is the beginning mesocyle which focusing on adaptation and re-acclimation to pre-birth fitness and function. My example below would be part of this phase. It could be akin to GPP (general physical preparedness) training. A recent systematic review reveal that exercise programs postpartum may have a high drop-out rate which is why I chose swimming and yoga (activities my wife enjoys), and walking with the baby (to add resistance but also bonding time making it more feasible Mullins, Sharma S & McGregor, 2021).

Pilates had been researched in postpartum exercise programs and outcomes have found it can improve maternal fatigue ratings (Multidimensional Fatigue Inventory) by nearly 40% which is amazing to know since postpartum fatigue a be detrimental to mothers and my wife already struggles with fatigue syndrome-like issues. An RCT by Shrafinia et al. (2015). looked into 80 postpartum women and divided it into 40 control and 40 at-home Pilates intervention groups. No adverse effects were noted by the Pilates group. Not only were improvement in energy (less fatiage) noted, but also increased strength, balance/ stability, flexibility and positive mental attitudes.  In this study, the Pilates began 72 hours postpartum.

A caveat was these women had 3 weeks of training in the same regime the last few weeks of their pregnancy to acclimate and familiarize the patient to the movement. Recommendation were to perform 13 moves of Pilates which takes about 30 mintutes and to be done for 5 days a week for eight weeks. Progression of Pilates is via gradual increase of the number of repetitions and intensity of the exercise.

Some programs already exist like this one below (I am not affiliated with this company)

 Postnatal Pilates | Pilates Anytime

Sample Day (i.e. Monday) 4 weeks post-partum
Walking baby in stroller	10min in AM 10min in PM	Intensity: able to hold a conversation (Borg scale 11-13 out of 20)
Yoga or Pilates at home focusing on moves/ positions for hips and shoulders and core.	10-20 min in AM	Intensity: Can hold positions up to an RPE of 5 or less if pain > 3/10 is present.
Pelvic Floor muscle training	5 min PM	Using a rest-pause technique. Pain is the guide of intensity. >3/10 needs to reduce intensity
Bodyweight TRX rows superset with regression of deadbugs	3 sets of 12-15 reps (rows) 3 sets of deadbugs (approximately 10min)	Intensity: RPE of 5 or less if pain > 3/10 is present.
Easy swim/ tread water at the home pool	10min in either AM or PM	Intensity: RPE of 5 or less if pain > 3/10 is present.
Total time: Aerobic 30min
Total time: Strength/ mobility 30min

References:

Ashrafinia, F., Mirmohammadali, M., Rajabi, H., Kazemnejad, A., Sadeghniiat Haghighi, K., & Amelvalizadeh, M. (2015). Effect of Pilates exercises on postpartum maternal fatigue. Singapore medical journal, 56(3), 169–173. https://doi.org/10.11622/smedj.2015042

Brites-Lagos, C., Maranhão, C., Szumilewicz, A., & Santos-Rocha, R. (2024). Development and validation of the physical exercise program "Active Mums" for postpartum recovery: application of the CReDECI-2 guidelines. BMC pregnancy and childbirth, 24(1), 378. https://doi.org/10.1186/s12884-024-06387-1

Mullins E, Sharma S, McGregor AH

Postnatal exercise interventions: a systematic review of adherence and effect

BMJ Open 2021;11:e044567. doi: 10.1136/bmjopen-2020-044567

Pruett, Michele Dell PhD, ATC1; Caputo, Jennifer L PhD, CSCS2. Exercise Guidelines for Pregnant and Postpartum Women. Strength and Conditioning Journal 33(3):p 100-103, June 2011. | DOI: 10.1519/SSC.0b013e31821c3261