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A Guide to Postpartum Training and Return to Sport

BY Claire Badenhorst

Navigating return to sport postpartum can be tricky for both athlete and coach. Here are some important factors to consider, from bone density changes to overall wellbeing.

It’s an exciting time in sports for women. The upcoming Paris Games will be the first in history to feature an equal number of men and women athletes. In 2023, the FIFA Women’s World Cup broke attendance records with the largest crowds and ticket sales for a women’s sporting event. Twenty-four million viewers tuned into the NCAA Women’s Basketball Championship, the first time in history that a women’s final drew more viewers than the men’s. On top of that, Nebraska volleyball broke the world record for attendance at women’s sporting event with 92,003 fans.

These are just a few examples showing the increasing support and interest in women’s sports. And it doesn’t stop with professionals and high-level collegiate athletes. Women’s participation in sports and activities has increased in recent years. But what about sports research dedicated to female physiology?

Women’s Sports Research Needs To Catch Up

The increase in women’s physical activity participation and interest in sports isn’t mirrored by increased research for women. As a result, clinicians, coaches, and health professionals use research primarily focused on men to guide their practice. This isn’t ideal for women, especially those who are pregnant or postpartum.

In fact, one area that requires substantial research is the postpartum period. There is a considerable lack of consistent and definitive guidelines on return to activity and sport for new mothers. This can be incredibly challenging for women and the professionals they work with.

Pregnancy’s Impact on the Body

Pregnancy significantly impacts nearly every system in the body, causing many physical and physiological changes over nine months. Some of these changes include increased ability to deliver oxygen and nutrients around the body and increased sacroiliac joint laxity. 

Changes in Bone Mass and Bone Mineral Density

One of the lesser-known changes in postpartum and pregnant women is the decline in bone mass and bone mineral density. Research suggests that a woman may lose between one to nine percent of her bone mass, which may not rebound in the first year postpartum

Postpartum bone mineral density losses have been observed in the femur, lumbar spine, and total body. Bone loss from these specific regions increases the risk of bony stress injuries. Bone demineralization during the postpartum period is especially prevalent if the mother is breastfeeding, as breast milk requires calcium. 

Possible Pelvic Floor Dysfunction

Changes to bone mass are not the only considerations for women returning to sport post-pregnancy. A rapid return to sport may cause pelvic floor dysfunction, while the combination of breastfeeding, hormonal changes, and lack of sleep may contribute to the woman unintentionally undereating. This may increase the risk of problematic low energy availability (LEA) and health and performance consequences of Relative Energy Deficiency in Sport Syndrome (REDs). 

Going Beyond The Physical 

Physical and physiological factors are not the only aspects of health to consider when supporting postpartum women in their return to sport/activity. Feelings of fatigue, low energy, low motivation, lack of support, work, and time constraints are other important factors. Many women may also experience symptoms of urinary incontinence, fear of movement, and/or general pain that might impact their return to activity or contribute to ‘dropping out’ of sport. 

Each woman’s pregnancy experience is unique and different, and we should think about how we can provide safe environments that encourage mothers to train and learn about their bodies. 

Postpartum Women Need Our Support

Exercise is beneficial in both the short and long term for new mothers. Some of these benefits include improved fitness and muscular strength, decreased postpartum depression severity, body weight management, and improved pelvic health symptoms. Researchers found that women who were encouraged to exercise by clinicians and health professionals were more likely to do so compared to those who did not have these discussions. This shows the importance of supporting postpartum women in their fitness journey, as long they meet basic evidence-based recommendations. 

Available recommendations suggest returning to activity and sport once medically safe or cleared (this varies on the individual, but it’s usually around 6 weeks). Making sure a medical professional provides support to start exercising safely is key to building back into activity and sport. 

Slow and Steady Wins the Race

Starting the return to sport or activity conservatively is a good idea, especially as the woman adjusts to motherhood. A few studies suggest building to ~150 min of moderate exercise per week as a good starting point. 
Take into account all factors impacting sport and activity levels. This includes mental well-being (e.g., mood, motivation, and fatigue), nutritional intake, breastfeeding, sleep, any fear of movement, pelvic floor distress or pelvic symptoms, support (e.g., childcare support), and work, to name a few. A holistic view of what influences physical activity needs to be considered to adequately support the mother in her personal fitness and sporting goals.

Many areas of sport and exercise science and medicine research in women’s health are now being completed. This means that many women and their coaches and health practitioners might soon have access to new information to help guide them. In the meantime, it is of the utmost importance to provide safe and supportive strategies and ensure the mother can be healthy. 

Each new mother’s journey returning to sport is unique, and taking a holistic approach ensures that they have a strategy that supports consistency in their physical activity levels, health, and overall well-being.


Albracht-Schulte, K., García-González, Á., Wilson, S, & Robert-McComb, J. (2023, February). Nutritional Guidelines and Energy Needs During Pregnancy and Lactation for Active Women. Retrieved from https://www.researchgate.net/publication/368864132_Nutritional_Guidelines_and_Energy_Needs_During_Pregnancy_and_Lactation_for_Active_Women

Deering, R., & Mountjoy, M. (2023, September 26). REDs and the lactating athlete: an evidence gap. Retrieved from https://bjsm.bmj.com/content/57/17/1065

Donnelly, G., et al. (2022, March). Beyond the Musculoskeletal System: Considering Whole-Systems Readiness for Running Postpartum. Retrieved from https://journals.lww.com/jwphpt/abstract/2022/01000/beyond_the_musculoskeletal_system__considering.7.aspx

Fink, J. (2013, October 13). Female athletes, women’s sport, and the sport media commercial complex: Have we really “come a long way, baby”? Retrieved from https://www.tandfonline.com/doi/full/10.1016/j.smr.2014.05.001

Krans, E., et al. (2005, March). Pregnant women’s beliefs and influences regarding exercise during pregnancy. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15822648/

Kyle, E. et al. (2022, February). Changes in Bone Mineral Density and Serum Lipids across the First Postpartum Year: Effect of Aerobic Fitness and Physical Activity. Retrieved from https://pubmed.ncbi.nlm.nih.gov/35277062/

Rebullido, T., & Stracciolini, A. (2019, July). Pelvic Floor Dysfunction in Female Athletes: Is Relative Energy Deficiency in Sport a Risk Factor? Retrieved from https://journals.lww.com/acsm-csmr/fulltext/2019/07000/pelvic_floor_dysfunction_in_female_athletes__is.4.aspx

Schulz, J., et al. (2023, October 28). Navigating the ‘new normal’: what guidelines exist for postpartum return to physical activity and sport? A scoping review. Retrieved from https://bjsm.bmj.com/content/57/24/1573

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About Claire Badenhorst

Dr. Claire Badenhorst is a Senior Lecturer at Massey University in Auckland, New Zealand. Her research focuses on female-specific health outcomes which she aims to share with females, their families, and communities. Her current research projects focus on iron deficiency risk and the impact of menstruation, the menstrual cycle as a source of female health monitoring, menstrual cycle health literacy, and how the menstrual cycle may be affected by sport and life stressors. Dr. Badenhorst has always loved sports and completed triathlons (both half and full Ironman distances) for nearly 10 years. She now enjoys running and gym workouts while she focuses on her research and enabling other females to achieve their best health and performance goals.

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