It’s not a race! A co-designed, interdisciplinary approach to return to running postpartum

Despite its ease of access and multifaceted health benefits, engagement in running decreases during pregnancy and remains low postpartum. To date, there is a lack of evidence-based guidance to help facilitate re-engagement with physical activity after childbirth. While a biopsychosocial approach is recommended for postpartum return to running, to adopt this, greater understanding of running-specific barriers and facilitators is needed. The aim of this thesis was to co-design an interdisciplinary, biopsychosocial intervention for return to running for mothers following childbirth. Following the iterative Double Diamond co-design framework to “Discover” and “Define” the problem and then “Develop” solutions to the problem, a series of studies were undertaken. The first study identified barriers and facilitators of return to running, as well as considerations for a return to running postpartum intervention, through an e-survey and follow-up focus groups (“Discover”). Four themes were identified regarding what needs to be considered in a return to running postpartum intervention: a) fitting it in, b) physical considerations, c) psychosocial considerations, and d) external considerations. Participants highlighted their negative psychological and physical experiences of pelvic floor dysfunction and desire for pregnancy and postpartum-specific graded rehabilitation. Existing graded loading pathways are typically based on variables associated with lower limb injury, for example peak ground reaction force. However, due to different shock attenuation strategies, these variables may not reflect the load that reaches the pelvis. The second study (biomechanical approach) assessed the basis for the development of a graded loading pathway that is specific to the pelvis (“Discover”). Compared to normal running, grounded running demonstrated lower pelvic acceleration loading and was suggested to be a suitable transition exercise prior to return to running. The lack of association between kinetic and pelvic acceleration variables indicated that local measures of loading are needed to adequately inform pelvic graded loading pathways, and a graded pelvic acceleration loading pathway was produced. The key aspects from the “Discover” phase were then used to “Define” the problem and identify initial solutions for a return to running postpartum intervention that would be further developed in Study 3. Due to previous postpartum exercise and running guidance being predominantly targeted at clinicians, there is a need for guidance to be tailored for end-users. Study 3 aimed to co-design an intervention for return to running following childbirth underpinned by clinical recommendations, existing literature and the findings of Study 1 and 2 (“Develop”). Following iterative co-design with an Advisory Group of postpartum runners, alongside consultation with a pelvic health clinician and the supervisory team, a biopsychosocial, person-centred guide for return to running postpartum was produced. It is hoped that this guide may foster increased re-engagement with running postpartum in the future.