Few moments in a client’s life involve as much physical change, and as much uncertainty about what to do next, as the months after having a baby. New mums arrive nervous and with many, many questions about the changes in their body. Is it safe to lift again? What about the pelvic floor? When can they run? The advice they have picked up tends to be cautious, and it leaves a lot of capable women sitting on the sidelines for far longer than they need to.
Part of the problem is that postpartum exercise has historically been framed around what women should not do. Do not lift anything heavier than the baby. Do not run for months. Do not do a sit-up ever again. The framing is protective in intent but it sends a quiet message that the postnatal body is fragile and that exercise is a threat to be managed rather than a tool for recovery. The evidence, however, now points in the other direction. Exercise, prescribed sensibly and progressed gradually, is one of the better things a new mum can do for her pelvic floor, her abdominal wall and her overall recovery.
And all this is now backed by research. In 2025 the Canadian Society for Exercise Physiology published a full guideline for physical activity throughout the first year postpartum (Davenport et al., 2025), built on a series of systematic reviews that looked specifically at how exercise affects pelvic floor disorders and diastasis recti. Alongside the UK return-to-running guidance that physiotherapists have used since 2019, it gives us a clear, confident framework. In this article we take a look at the research as well as the practical programming a PT would use with their postpartum clients.
Why Movement Helps Rather Than Harms
The single most useful thing a personal trainer can do for a postpartum client is to replace fear with an accurate picture of what is going on. The pelvic floor is a sling of muscle that sits at the base of the pelvis and supports the bladder, bowel and uterus. Pregnancy and birth stretch and load these muscles, and in some women they are left weaker or less coordinated than before. The abdominal wall changes too. During pregnancy the two halves of the rectus abdominis (the long paired muscle running down the front of the abdomen) separate to make room for the growing uterus. This separation is called diastasis recti, and to some degree it happens to almost everyone in late pregnancy. Both tissues are designed to recover, and both recover better when they are gently and progressively loaded.
The 2025 systematic review and meta-analysis that fed into the Canadian guideline provided the strongest evidence we have on this (Beamish et al., 2025). Looking at the randomised controlled trials, the authors found that pelvic floor muscle training in the first year postpartum reduced the odds of urinary incontinence by around 37 per cent and lowered the odds of pelvic organ prolapse. Abdominal muscle training reduced the gap between the two halves of the rectus abdominis, both at rest and during a head-lift task. In other words, the exercises new mums are often warned off actually help the tissue recover. That is a powerful message to be able to give a nervous client.
Let’s consider the cause and effect now, because clients will ask. Exercise does not simply repair tissue by force. What it does is restore strength, coordination and load tolerance to muscles that have been through a sizable physical event. A pelvic floor that contracts well on demand manages the pressure of coughing, lifting and running far better than one that has been left to recover passively. An abdominal wall that is gradually reloaded regains tension and function rather than staying soft and untrained. None of this requires heavy lifting or intense workouts. It requires a sensible starting point and steady progression.
On the emotional side, many new mums feel that their body has become unfamiliar, and that the things they used to do are now off-limits. Returning to training is not only about restoring strength. It is about restoring a sense of identity at a point in life when it can feel scrambled. A PT who treats the early sessions as a partnership, who explains the why behind each step and who celebrates small wins, builds the trust that keeps a client coming back. The exercise is the easy part. The coaching relationship is what carries someone through the months it takes to rebuild.
Start With the Pelvic Floor and the Core
The earliest postpartum work is about reconnecting with the deep muscles that have been stretched and offloaded for months. For most women this can begin gently within the first few days after an uncomplicated vaginal birth, and a little later after a caesarean, always guided by how things feel and by any advice from their midwife or GP.
Pelvic floor muscle training is the foundation. In plain terms this means teaching the client to draw the pelvic floor up and in, hold briefly, then fully relax. The relaxation half is as important as the contraction, because a pelvic floor that cannot let go is just as much of a problem as one that is weak. Early sessions are about quality, not quantity. A handful of well-controlled contractions, done well, is far better than a long set done with the wrong muscles. The UK Chief Medical Officer physical activity guidance after childbirth and the NICE postnatal care guideline (NG194) both place daily pelvic floor exercise at the centre of early recovery, and both are sensible reference points to mention to clients who want an authoritative source.
Alongside this sits gentle core reconnection. Breathing drills that coordinate the diaphragm with the deep abdominal muscles and the pelvic floor are far more useful in the early weeks than any crunch. The aim is to rebuild the natural teamwork between breathing, the deep core and the pelvic floor before adding external load. Once that coordination returns, progression to bodyweight movements, then light resistance, then heavier loading follows the same logic as any other deconditioned client, just with closer attention to symptoms.
Progressing Load With Confidence
Once the foundations are in place, postpartum strength training follows the same principles as any other return from a training break, with a few extra checkpoints. The temptation is to either hold back too long out of caution or rush ahead because the client feels fine on the surface. The middle ground is steady, progressive overload guided by control and symptoms. Begin with bodyweight patterns such as sit-to-stands, hip hinges and supported squats, confirm the client can perform them without doming along the midline, breath-holding or any leaking, then add load gradually.
The 2025 Canadian guideline recommends working towards around 120 minutes of moderate to vigorous physical activity each week across four or more days, combining aerobic and strength work, alongside daily pelvic floor exercise (Davenport et al., 2025). That’s a useful target to aim for, but it is a destination rather than a starting point. The early weeks are about frequency and quality of movement, not volume. As tolerance builds, sets, reps and load all increase the normal way. Compound lifts, kettlebell work and higher-effort conditioning will be doable, in time, provided the abdominal wall and pelvic floor manage the pressure each movement creates.
Diastasis Recti Without the Drama
Diastasis recti is the part of postpartum recovery there seems to be a lot of uncertainty about. Clients arrive convinced they have done permanent damage, that certain movements will make the gap worse, or that surgery is the only fix. The reality in most cases, however, is quite different. Some separation of the abdominal wall is a normal consequence of carrying a baby, and for most women it narrows substantially over the months after birth. Where it persists, the goal is not to obsess over closing the gap by a few millimetres but to restore the function and tension of the abdominal wall so it does its job.
The 2025 meta-analysis found that abdominal training reduced inter-rectus distance, which is the measured gap between the two halves of the muscle (Beamish et al., 2025). A 2024 Swedish longitudinal cohort that followed more than 500 women through the first year postpartum supported the findings with a small nuance (Vesting et al., 2024). Women who exercised, including those doing higher-impact activity, did not have worse abdominal separation or pelvic symptoms than those who did not. If anything the picture favoured those who stayed active. That should put to rest the idea that loading the abdominal wall is inherently risky.
For programming, this means we do not need to ban movements out of fear. We coach them. Teaching a client to manage intra-abdominal pressure, the pressure that builds inside the abdomen during effort, by breathing out on exertion and avoiding visible doming or bulging along the midline, allows progressive abdominal work to be performed safely. Movements are regressed or progressed based on what the abdominal wall can control, rather than by a blanket rule applied to everyone. A client who can perform a movement without doming, without holding their breath and without symptoms is a client who is ready for it.
Returning to Running and Higher-Impact Work
Running is where most clients have anxiety, and rightly so, because impact loads the pelvic floor heavily. The UK has led the field here. In 2019 a group of UK physiotherapists, Tom Goom, Grainne Donnelly and Emma Brockwell, published returning-to-running postnatal guidance that has since been adopted internationally and reinforced through the British Journal of Sports Medicine (Donnelly et al., 2020). The main recommendation is that higher-impact activity such as running typically starts from around 12 weeks postpartum, not before, to give the tissues time to recover from the load of pregnancy and birth.
The 12-week mark is a guide, not a definite. What actually decides readiness is whether the client can tolerate load without symptoms. A 2024 international consensus statement set out clear return-to-running readiness criteria (Christopher et al., 2024), and a companion paper described how to build and progress the running programme itself (Deering et al., 2024). The readiness work is within a PT’s scope. It includes load and impact tests such as walking briskly, single-leg work, hopping and jogging on the spot, alongside strength benchmarks for the calves, glutes and the rest of the lower limb. If a client can complete these without leaking, without heaviness or dragging in the pelvis and without pain, she is in good shape to begin a graded walk-run progression.
The progression itself is unglamorous and that is the point. Start with a walk-run structure, build duration before intensity and modify the plan around symptoms, sleep, energy levels and lactation rather than pushing through. A flare of symptoms is information, not failure. It usually means the last step was a little too much, and the answer is to drop back a level and continue from there, not to abandon running altogether. Clients find this enormously reassuring, because it tells them setbacks are expected and recoverable.
There is one more practical point worth making about impact readiness. The tests are not a one-off pass or fail. A client may clear them, run happily for a fortnight, then have an off week where symptoms reappear because she has slept badly or pushed the distance too quickly. That is normal, and it is why ongoing monitoring is essential. Checking in with the client to find out how they feel during and after each run, rather than only checking once at the start, is what makes the difference between a smooth return and a frustrating stop-start scenario.
It also helps to set the right expectations about sports bras, pelvic floor fatigue and the realities of running while still feeding. Lactation affects energy availability and tissue laxity, and broken sleep blunts recovery in a way no programme can overcome. None of this rules out a return to running. It simply means the plan has to be built around the life the client is actually living rather than the training week she had before pregnancy. A trainer who accounts for these factors, and who keeps the early runs short and the rest generous, gets a client back to consistent running far faster than one who treats the 12-week mark as a hard deadline.
Red Flags and When to Refer
Knowing the limits of our scope is part of coaching this population well. Most postpartum clients will progress smoothly with sensible programming, but some symptoms tell us a pelvic-health physiotherapist needs to be involved. Working closely with these specialists, often through groups such as Pelvic, Obstetric and Gynaecological Physiotherapy in the UK, is a strength rather than an admission of limitation, and clients respect a trainer who knows when to bring in another professional.
Persistent or worsening urinary or faecal incontinence, a sensation of heaviness, dragging or bulging in the vagina that points towards pelvic organ prolapse, pain during intercourse, ongoing pelvic or low-back pain, or an abdominal separation that is not improving and feels soft and unsupported under load all warrant referral. So does any leaking or heaviness that appears or worsens as running load increases. None of these mean exercise has to stop entirely. They mean the client needs assessment and a tailored plan, often running in parallel with the strength and conditioning work a PT continues to provide.
The most useful mindset is to see referral as part of the service rather than a handover that ends your involvement. A pelvic-health physiotherapist assesses and treats the specific dysfunction, while you continue to build the client’s overall strength, conditioning and confidence around it. The two roles complement each other. Clients who feel that their PT and their physio are working towards the same goal tend to stick with both, and the trainer who can speak the same language as the physio, and who knows when something is outside their remit, quickly becomes the trainer that local clinics are happy to refer new mums back to.
A Practical Postpartum Progression
Pulling the evidence together, a workable framework for returning a healthy postpartum client to exercise looks roughly like this. Every stage is symptom-guided, and timings shift with the individual and her birth.
| Stage | Typical Timing | Focus |
|---|---|---|
| Early reconnection | First few weeks | Daily pelvic floor muscle training, breathing and deep-core coordination, gentle walking |
| Foundation | Around weeks 4 to 8 | Bodyweight movement, light resistance, progressive abdominal work managing pressure and avoiding doming |
| Strength building | Around weeks 8 to 12+ | Graded loaded resistance training, full-range movements as control allows, readiness testing for impact |
| Return to impact | From around 12 weeks | Walk-run progression once readiness criteria are met, build duration before intensity, modify around symptoms |
| Refer out | Any stage | Incontinence, heaviness or prolapse signs, pain, non-improving diastasis under load, symptoms rising with running |
Used sensibly, this framework lets a PT take a new mum from her first gentle pelvic floor contractions all the way back to running and heavy lifting, with confidence on both sides about why each step comes when it does.
In Summary
The old script for postpartum exercise was built on caution and a quiet assumption that the postnatal body needed protecting from movement. The current evidence is far more encouraging. Pelvic floor and abdominal training in the first year postpartum lowers the odds of incontinence and prolapse and helps the abdominal wall recover, and staying active does not worsen pelvic symptoms or diastasis. Higher-impact work such as running has a sensible floor of around 12 weeks and a clear set of readiness criteria a trainer can apply.
Many of us find our clients have been left more frightened than informed about their postpartum bodies. A confident, evidence-led plan, built on early pelvic floor and core work, gradual progression and symptom monitoring, is one of the most valuable things a personal trainer can offer. It is also a rewarding population to work with, because the change from sidelined and anxious to strong and capable is one clients feel deeply. Getting a new mum back to strong, the right way, is good coaching and good business.
References
Davenport, M.H., Ruchat, S.M., Beamish, N.F., Dervis, S., Cherniak, A., et al. (2025). 2025 Canadian guideline for physical activity, sedentary behaviour and sleep throughout the first year post partum. British Journal of Sports Medicine, 59(8), pp.515-538. Click here to review the full research article.
Beamish, N.F., Davenport, M.H., Ali, M.U., Gervais, M.J., Sjwed, T.N., Bains, G., Sivak, A., Deering, R.E. and Ruchat, S.M. (2025). Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis: a systematic review and meta-analysis. British Journal of Sports Medicine, 59(8), pp.562-575. Click here to review the full research article.
Christopher, S.M., Donnelly, G., Brockwell, E., Bo, K., Davenport, M.H., De Vivo, M., Dufour, S., Forner, L., Mountjoy, M., Moore, I.S. and Goom, T. (2024). Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement. British Journal of Sports Medicine, 58(6), pp.299-312. Click here to review the full research article.
Deering, R.E., Donnelly, G.M., Brockwell, E., Bo, K., Davenport, M.H., De Vivo, M., Dufour, S., Forner, L., Mountjoy, M., Goom, T. and Moore, I.S. (2024). Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement. British Journal of Sports Medicine, 58(4), pp.183-195. Click here to review the full research article.
Donnelly, G.M., Rankin, A., Mills, H., De Vivo, M., Goom, T.S. and Brockwell, E. (2020). Infographic. Guidance for medical, health and fitness professionals to support women in returning to running postnatally. British Journal of Sports Medicine, 54(18), pp.1114-1115. Click here to review the full research article.
Vesting, S., Gutke, A., Olsen, M.F., Nilsson-Wikmar, L. and Larsson, M.E.H. (2024). The impact of exercising on pelvic symptom severity, pelvic floor muscle strength, and diastasis recti abdominis after pregnancy: a longitudinal prospective cohort study. Physical Therapy, 104(4), pzad171. Click here to review the full research article.
Become the Coach New Mums Trust
If this article has shown you how much a confident, evidence-led PT can do for postpartum clients, the natural next step is to formalise that knowledge. Working with new mums well means understanding the pelvic floor, the abdominal wall, return-to-impact criteria and when to refer, exactly the framework set out above. It is a specialism in strong demand, and one that most trainers in your local area will not have.
The Exercise for Pre & Post Natal Clients course takes you deep into the pregnancy and postpartum side specifically, from early pelvic floor and core work through to loading, impact readiness and knowing when to refer on.
Exercise for Pre & Post Natal Clients – In-Person, Live-Virtual & Distance Study
Build It Into Your Qualifications
The Women’s Health & Exercise Specialist and Master Diplomas™ build this expertise into your qualifications rather than bolting it on. Together with the Pre & Post Natal CPD they give you the confidence to coach a client safely from the early weeks after birth all the way back to running and heavy lifting, and the credibility to attract that client in the first place.
Women’s Health & Exercise Specialist & Master Diplomas™ – In-Person, Live-Virtual & Distance Study
