Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement.

Returning to running postpartum presents challenges such as musculoskeletal pain and pelvic floor dysfunction for some females, but there is little guidance on developing and progressing postpartum training programmes. This study aims to establish expert consensus recommendations on designing and modifying a postpartum return-to-running training programme, highlight costs and access to qualified professionals as potential barriers and discuss clinical, research and sports policy implications.A three-round Delphi survey of clinical and exercise professionals working with postpartum runners was conducted. Round I consisted of open-ended questions related to designing the training plan, modifications based on biopsychosocial factors, key muscle groups to train and referral and payment sources. Rounds II and III involved Likert-scale voting to identify consensus (≥75% agreement).118 participants completed Round I, 107 completed Round II (response rate 90.6%) and 95 completed Round III (response rate 80.5%). Consensus was reached in 42/47 (89%) statements, including recommendations for a period of relative rest, gradual increases in duration and intensity, starting with a walk-run protocol and incorporating strength training. Training should be modified based on musculoskeletal or pelvic symptoms, sleep, mental health, lactation or energy availability concerns. Cost and access to experienced postpartum running professionals were identified as potential barriers for runners to receive care.Consensus recommendations for a postpartum return-to-running programme include an individualised exercise prescription, gradual increases in physical activity, walk-run protocols and targeted muscle strengthening. Further research and improved access to clinical and exercise professionals are needed to inform and facilitate best practices.

Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement.

Female athletes have identified a lack of guidance as a barrier to successfully returning to running postpartum, and existing guidelines are vague. Our aim was to define the current practice of determining postpartum run-readiness through a consensus survey of international clinicians and exercise professionals in postpartum exercise to assist clinicians and inform sport policy changes.A three-round Delphi approach was used to gain international consensus from clinicians and exercise professionals on run-readiness postpartum. Professionals who work with postpartum runners participated in an online survey to answer open-ended questions about the following postpartum return-to-running topics: definitions (runner and postpartum), key biopsychosocial milestones that runners need to meet, recommended screening, timeline to initiate running, support items, education topics and factors that contribute to advising against running. Consensus was defined as ≥75% participant agreement.One hundred and eighteen professionals participated in round I, 107 participated in round II (response rate 90.6%) and 95 participated in round III (response rate 80.5%). Responses indicated that, following a minimum 3-week period of rest and recovery, an individualised timeline and gradual return to running progression can be considered. Screening for medical and psychological concerns, current physical capacity, and prior training history is recommended prior to a return to running.This study proposes recommendations for the initial guidance on return-to-running postpartum, framed in the context of current research and consensus from professionals. Future research is needed to strengthen and validate specific recommendations and develop guidelines for best practice when returning-to-running after childbirth.

Impact of heavy resistance training on pregnancy and postpartum health outcomes.

INTRODUCTION AND HYPOTHESIS: Participation in Olympic weightlifting, the Valsalva maneuver, and acute or prolonged supine weightlifting during pregnancy are cautioned against; however, these recommendations are based on expert opinions as opposed to empirical evidence. The aim of this study was to examine the training and health outcomes of individuals who engaged in heavy resistance training during pregnancy. METHODS: A total of 679 individuals who lifted at least 80% one-repetition maximum during pregnancy participated in an online survey. RESULTS: Participants were primarily recreational athletes (88%, 332 out of 675) engaged in CrossFit™ (61%, 410 out of 675) and/or weightlifting (49%, 332 out of 675) during pregnancy. Most participants reported no complications during pregnancy or delivery (66%, 388 out of 589), whereas 57% (241 out of 426) reported urinary incontinence following pregnancy. Participants who maintained pre-pregnancy training levels until delivery reported significantly less reproductive complications than those who ceased training levels prior to delivery (p = 0.006). Most respondents engaged in Olympic lifting (72%, 311 out of 432) and lifting in a supine position (71%, 306 out of 437), whereas fewer reported use of the Valsalva maneuver during pregnancy (34%, 142 out of 412). Most returned to weightlifting following delivery (89%, 400 out of 447, average: 3.2 ± 3.0 months), including Olympic lifting (81%, 300 out of 372, average: 4.0 ± 3.4 months) and Valsalva (62%, 213 out of 341, average: 4.5 ± 3.6 months). CONCLUSIONS: Individuals who engaged in heavy prenatal resistance training had typical perinatal and pelvic floor health outcomes that were not altered whether they engaged in, or avoided Olympic lifting, Valsalva or supine weightlifting.

Do women runners report more pelvic floor symptoms than women in CrossFit®? A cross-sectional survey.

INTRODUCTION AND HYPOTHESIS: Women who perform high-impact activities might be at greater risk of pelvic floor dysfunction (PFD) than those participating in low-impact exercise; however, little is known about whether PFD is more common in one type of high-impact activity than another. The aim of this study was to compare the prevalence of PFD symptoms in women who engage in high-impact activity compared with CrossFit®-brand training (CF). METHODS: An online survey collected data from 1,379 women (521 runners, 858 CF) on exercise participation, parity, and PFD symptoms, via the Pelvic Floor Distress Inventory (PFDI-20). Specific questions from each PFDI-20 subscale further investigated symptoms of pelvic organ prolapse (POP), anal incontinence (AI), as well as stress (SUI) and urgency (UUI) urinary incontinence. RESULTS: Symptoms of POP and AI were significantly higher in runners (POP 12.7%, AI 34.0%) than in CF (POP 7.8%, p = 0.003; AI 27.7%, p = 0.014). There was no significant difference in SUI symptoms between groups (37.0% vs 41.0% respectively, p = 0.141). Vaginally parous runners reported significantly more symptoms of POP (19.0% vs 12.2%, p = 0.023), AI (39.3% vs 27.2%, p = 0.001), and UUI (36.3% vs 29.0%, p = 0.037) than CF. CONCLUSION: Women, particularly parous women, who participate in running, have a higher prevalence of POP and AI symptoms than women who participate in CF. This suggests that CrossFit®-brand training might not be more detrimental to PFD symptoms than other high-impact activity, such as running. This study does not conclude a pelvic floor health benefit of one exercise over another, but highlights that exercise options can be provided to women.

Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to determine the prevalence of symptoms of pelvic organ prolapse (POP), defined as the sensation of a vaginal bulge, and associated risk factors in women over 18 years of age who lift light (≤15 kg), moderate (16-50 kg), and heavy (>50 kg) weights for exercise, and those who do not lift weights for exercise. METHODS: Women completed an online survey about risk factors for pelvic floor dysfunctions, physical activity history, and pelvic floor symptoms. A question about a vaginal bulge sensation from the validated Pelvic Floor Distress Inventory (PFDI-20) was used to indicate symptoms of POP. Relationships between symptoms of POP and possible risk factors were assessed through logistic regression analysis. RESULTS: Of the 3,934 survey participants, the total prevalence of POP symptoms was 14.4% (n = 566). Category of weight lifted, age, vaginal parity, history of constipation or hemorrhoids, and family history of POP were significantly associated with symptoms. Physically active women lifting weights ≤15 kg were more likely to report symptoms of pelvic organ prolapse than women lifting weights greater than 50 kg (59.7% vs 15.2%; adjusted odds ratio 2.1; 95% confidence interval 1.7-3.4). There was no relationship between POP symptoms and body mass index, forceps delivery, cesarean section, hysterectomy, or menopausal status. CONCLUSION: Physically active women who lift heavy weights for exercise do not have an increased prevalence of POP symptoms. Advice on the contribution of heavy weight lifting as part of a physical activity regime to the pathophysiology of POP requires further investigation.