An interdisciplinary, co-designed guide for return to running postpartum-a mixed-methods study

Despite its ease of access and multifaceted health benefits, compared to pre-pregnancy, engagement in running decreases following childbirth (postpartum). While a biopsychosocial approach is recommended to help women return to running postpartum, greater understanding of running-specific barriers and facilitators is needed to support this. To date, there is a lack of evidence-based, co-designed guidance to help facilitate re-engagement with running postpartum. The aims of this study were therefore to: 1) investigate the barriers to and facilitators of postpartum return to running; and 2) co-design a postpartum return to running intervention that is underpinned by clinical recommendations.

The study adopted the iterative Double Diamond co-design framework to "Discover" and "Define" the problem and then "Develop" solutions to the problem. First, barriers and facilitators of return to running, as well as considerations for a postpartum return to running intervention, were identified through an e-survey and follow-up focus groups ("Discover"). The findings from the "Discover" phase were used to "Define" the problem and identify initial solutions for a postpartum return to running intervention. The research team and an Advisory Group of postpartum runners then co-designed the intervention ("Develop").

Four themes were identified regarding what needs to be considered in a return to running 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. Following iterative co-design with an Advisory Group of postpartum runners, a biopsychosocial, person-centred guide for return to running was developed.

This study culminated in the co-design of a biopsychosocial, clinically endorsed guide for postpartum return to running. Future research should aim to test the feasibility and effectiveness of the guide ("Deliver"), which, it is hoped, may foster increased re-engagement with running postpartum in the future.