Exercise can be a great way to increase energy, keep your body strong, and help clear your mind. Treating your body kindly with modified exercise before and after surgery is especially imperative to assist in the healing process. However, it’s important to know how much and what type is okay. Today, we’re breaking down what types of exercise you can incorporate into your recovery routine and how they can help your body feel its best after gender affirming surgery.

Remember that this is just a guide. Only YOU know your body and your limits. While there may be movements that are uncomfortable after surgery, never do anything that causes you pain or causes you to bleed. Know your body’s limits and be sure to take care of it.

Pre-Op:

Prior to your surgery, it’s best to make time for daily exercise. While each person is unique, take time to discover what exercises feel good and prepare your body best for surgery. Since you likely won’t be able to be active for some time after surgery, it’s important to get your exercise in and make it count.

1. Foam rolling: You can buy these in most stores or online and they can be used to help sore or tight muscles. Use a foam roller daily the week before surgery (or earlier than that) to soothe any tight muscles. Do what feels right for your body, but refer to this article for five beginner-friendly positions. 
2. Core exercises: Core work can help your posture and strengthen your core. Here are some core moves to incorporate into your exercises before your surgery. 
3. Stretching: Stretching isn’t just for before or after a workout. Stretching can help with tight muscles, improve flexibility, release tension, and more. Find a stretching routine that works for you. 
4. Pelvic floor exercises: Prior to bottom surgery–like vaginoplasty, metoidioplasty, or phalloplasty–pelvic floor exercises can be extremely helpful in preparing the body. One exercise we recommend involves imagining you’re picking up a marble or closing a drawstring purse with your perineum. Pick it up, hold for a moment, then let it go. This exercise can both strengthen and relax your pelvic floor muscles prior to surgery. If you have any pre-existing pain or issues with urination, contact a pelvic physical therapist to discuss what’s best for your body. 

Post-Op:

After your surgery, you may notice your body feels and moves differently. It’s important to be sure to balance out your healing with both rest and movement to help your body in its recovery. Take each move slowly, paying attention to how your body is feeling.

1. Slow walks: Unless you’re on bed rest (which may be the case for bottom surgery), try going for a slow walk around the block the day after surgery. If you’re on bed rest, start this the day you’re off bed rest. Bring a buddy with you to keep you company and assist you if needed. Rather than going for longer walks, go for shorter walks more often. A good rule of thumb is to aim for three one-block walks every day in the first week, then increase to a few blocks at a time if you’re up to it. Many doctors recommend you keep your walks short, around less than 15 minutes until two or more weeks post-op. 
2. Ankle exercises: Start with pointing and flexing your toes 20 times every two hours. Then, make circles with your ankles 10 times in each direction to promote circulation and prevent deep vein thrombosis. This is recommended to be done every two hours while lying in bed. Ankle pumps are simply moving your ankle up and down. To do ankle pumps, plantarflex one foot as if pressing down on an imaginary gas pedal. Then, dorsiflex your feet by pulling your toes up toward your shins as if letting off the gas. Repeat with the other foot and alternate sides for 20 repetitions. This is great when you’re on bed rest, such as after phalloplasty, metoidioplasty, or vaginoplasty.
3. Deep breathing: Not necessarily an exercise, but a great way to check in with yourself and your body. If at any point you need to relax, breathe through discomfort, or put your mind at ease, practice deep breathing through your nose. Let your belly and chest expand all the way from the tops of your shoulders to your pelvic floor, and sideways to expand your ribs. Feel the air fill your lungs and exhale slowly through the mouth. Do this however often you’d like, with a recommendation of two or more minutes, two or more times per day. Yes, this exercise is ok to do after top surgery (mastectomy, chest masculinization, or breast augmentation); you may feel some discomfort but should not feel pain.
4. Shoulder rolls: With a surgeon’s consent, stand or sit comfortably with your arms relaxed at your sides. In a circular motion, bring your shoulders forward, up, backward, and down. Try to make the circle as large as you can and move both of your shoulders at the same time, doing this 10 times. If you have tightness across your incision or chest, start with smaller circles and increase the size as the tightness decreases. After your series of 10, switch directions and do 10 shoulder rolls in the backward direction. Bring your shoulders backward, up, forward, and down. You may find that the backward direction is a little tighter across your chest than the forward direction. Rest assured knowing that this will get better with practice.
5. “Chicken wings:” Also called shoulder wings, these are done by placing your hands on your chest or collarbone, wherever is most comfortable. Raise your elbows upwards out to the side, limiting your range of motion as instructed by your healthcare team. Slowly lower your elbows. Do this 10 times, imitating a chicken wing, and then slowly lower your hands back down to your lap. If you feel discomfort while doing this exercise, hold your position and do the deep breathing exercise above. If the discomfort doesn’t go away, don’t raise your elbows any higher. If the discomfort does go away, finish the exercise in a range of motion that’s comfortable for you.
6. Arm side circles: With a surgeon’s consent, stand with your feet slightly apart to help you balance. Raise each arm, one at a time, out to the side as high as you can. Gently, start making slow, backward circles in the air with your arm. Be sure you’re moving your arm from your shoulder, not your elbow, and keep your elbow straight. Increase the size of the circles until they’re as large as you can comfortably make them, limiting your range of motion as instructed by your healthcare team. Be sure to complete at least 10 full backward circles. If you feel any aching or if your arm is tired, take a break. Continue doing the exercise when you feel better. Slowly lower your arm to your side to rest your arm for a moment. Repeat the exercise at your comfort level, this time making slow, forward circles instead. 
7. Hand pumps: These can help reduce swelling in the chest and should be done three times a day. Open and close the fists ten times, holding for a few moments in between. 
8. Other exercises: Three slightly more advanced poses to help with surgical recovery are “happy baby pose,” “child’s pose,” and side bends. You can use a pillow under your knees in child’s pose if it’s uncomfortable. Wait to start these until you have surgeon approval as they require a little more range of motion. 

Remember: If you can’t eat, drink, and/or urinate, or have a fever, chills, an infection, trouble breathing, unusual bleeding, redness, feel unwell, or have a hot feeling in the surgical site, call your doctor or go to the emergency room. Ask your surgeon what signs you should look for regarding post-surgical complications.

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This information is for educational purposes only, please consult a healthcare provider before exercising and always follow your surgeon’s advice.