Returning to Exercise Post-Hysterectomy

The doctor said, “You have healed well and you’re free to do what you want.“ 

It’s been over nine weeks since surgery.  I've had very little physical activity during those weeks, not even walking, because I was instructed to restrict even that.  The challenge now is building slowly while challenging my body appropriately.

Prior to surgery I was teaching up to seven Jazzercise classes per week and a lot of that was cardio. I was lifting moderately heavy weights. I've lost cardiovascular endurance and strength. Cardiovascular conditioning declines more quickly than muscular conditioning but both areas will require a re-building phase.  No matter what fitness levels were prior to surgery, we all share several important considerations as we start to exercise post-hysterectomy.  

Listening to Your Body

We hear a lot about listening to our bodies these days.  What does that mean?

During recovery, I bet you got pretty good at understanding what was too much; I sure did.  An increase in odd pains and fatigue served as a reminder of what my body had been through and that it wasn’t ready for what I was doing.  Even though the first phase of recovery is over, we still need to pay attention to those reminders. You are healed enough to be released but your tissues are still healing.

We shouldn’t ignore pain or any “this doesn’t feel right” sensations. During my first full class back on stage at Jazzercise five days after release, I attempted to teach an abdominal routine and my abdomen was like, “nope!” so I went through the motions and cued rather than actually performing the exercises. 

Be flexible with plans depending on how you are feeling, especially the first few weeks back.  A good mantra for the next month:  I give myself permission to be flexible with my training plans.  I give myself permission to lower the intensity during a session.  I give myself permission to rest when needed. 

Focus on building back consistency and adding time and intensity slowly rather than focusing on performance goals.  Now is not the time to push to the max; it's a good idea to leave a bit more in the tank than typical of pre-surgery exercise sessions. At least for a month or two!

Fatigue may still be significant.  Sleep will need to remain a priority and naps, when feasible, may be needed some days.  One study published in the Journal of Obstetrics and Gynecology, found that on average, fatigue lasted 10 weeks, though about a third of women reported still feeling tired six months after hysterectomy.   Build in rest days in order to minimize fatigue  and ensure adequate recovery between sessions.

Pelvic Floor Considerations

If you’ve been on any post-hysterectomy forums or read anything about exercise and hysterectomy, you’ve probably come across pelvic floor dysfunction or pelvic organ prolapse.  If you had prolapse repair along with your hysterectomy or you were diagnosed with prolapse prior to surgery, you need to address the health of your pelvic floor as you return to exercise.  A pelvic floor physical therapist is a good place to start.  Ask your doctor for a referral if needed. 

If you have no known issues with your pelvic floor, it’s still a good idea to consider the health of those muscles. The doctor clearing you to resume all normal activities doesn’t mean go full steam ahead! Practice connection breath to re-establish a link with those important muscles.  Increase the loads slowly over time and consider the risk vs. reward for exercises that place a lot of strain on the pelvic floor (max lift back squats, for example).

If you are now in menopause as a result of your surgery, the pelvic floor muscles can be affected by the lack of estrogen.  Talk to your doctor if you notice any changes, particularly an increase in urinary leakage.

Getting Back to It

Cardio
Start with low impact, lower intensity exercises for a couple of weeks.  If your aim is to return to high impact exercise,  "test” short periods at a time. If you are a runner, start with walking and increase the speed and distance over a couple of weeks.  Add in periods of jogging but pay attention. If you start to feel pelvic heaviness or discomfort, ease back.  If you feel anything unusual or concerning, seek advice from a doctor or pelvic floor specialist.

Since my preferred cardio is high impact and somewhat core heavy (Jazzercise), I will need to start slow and short and build from there.  My first session at home was 20 minutes, low impact, moderate intensity (I kept my effort to a rate of perceived exertion of about 5 or 6). If you aren’t familiar with rate of perceived exertion, no worries, I’ll include some information in the newsletter for you next week!  

My plan is to return to teaching classes two to three times a week, low impact, moderate intensity. At the end of each week, I will evaluate how I feel, my fatigue levels, soreness, and how hard my classes felt to determine if/when I should up the intensity or frequency. My goal is over the course of the next four to six weeks to return to some high impact and higher intensity songs and work my way up to teaching 4 or 5 classes per week. At this point, I can’t say how long it will be because it really depends on how my body responds. I want to challenge myself while still honoring my body’s need for continued healing.  

Strength
A good starting point is to begin strength training with weights appropriate for 2 to 4 sets of 8-12 reps on one to two days per week.  I will be using lighter weights than what I was using when I left off.  My muscles haven’t had a large demand placed on them in a while. Plus, I tend to get sore fairly easily and I don’t want to be in so much pain that I don’t want to move!  Soreness is not the goal…strengthening and building muscle is!

A sampling of strength exercises I will be doing - not all in the same session ;)
Glute Bridge variations
Dead Bugs
Goblet Squats
Overhead Press
Elevated Tall Planks
Single Leg Romanian deadlift
Three Point Stance Row
Chest Press
Step-Ups
Paloff Press
Band Pull-Throughs
Band Pull Aparts
Banded Lateral Walks

I’m posting snippets of my strength sessions in the Reuna Fitness Circle on Facebook.  Join us there!
 
I’m thrilled to be at this point in my recovery.  Some days, especially during that rough week 6, I doubted feeling this good! As you are returning to exercise, remember that everyone is different and where you begin and how you proceed will need to fit with your body, your goals and your life.  You've been through a lot and it will take time to get stronger and feel fit. The biggest pitfalls will be trying to do too much at once, expecting results too soon, and not listening to your body.

Glute Bridges are one of my favorites.

I appreciate everyone who has followed me through my hysterectomy journey.  If you'd like to hear more, I shared some of the story with Pamela Hernandez on the Fit in 417 podcast.  You can listen to part 1 here. 

Recovery is on-going.  Peri-menopause and menopause is around the corner, and possibly a bit sooner for me (women who have hysterectomy and keep one or both ovaries may be likely to have earlier ovarian failure). These are important women's health topics so you can bet I'll be sharing all about that too!

Approaching middle age isn't quite what I expected.  In many ways it's fabulous and in many ways it's not (no one told me about how my eyebrows would simultaneously thin yet grow wild...!)  If you are interested, subscribe to my newsletter and follow Reuna Fitness on Facebook for relevant information on wellness in midlife and beyond.

Thank you for reading!