The First Real Guidelines for Moving After Birth: What 574 Studies Actually Say
The 2025 Canadian Guideline for Physical Activity, Sedentary Behaviour and Sleep Throughout the First Year Post Partum is the first comprehensive, evidence-based framework for postpartum movement. Based on seven systematic reviews covering 574 studies, these recommendations fill a critical gap in maternal care.
Here's what the research shows—and what it means for real life.
Why This Matters
Most postpartum women receive minimal guidance beyond "wait six weeks, then you're cleared." The first year after birth is a period of dramatic physiological change, yet evidence-based recommendations have been absent.
The result: women are left guessing about when to start moving, what's safe, and how to balance recovery with the demands of new parenthood.
The Development Process
This guideline followed rigorous GRADE methodology involving 7 systematic reviews, 574 unique studies, and input from 104 postpartum individuals and healthcare providers who prioritized 21 health outcomes. An international expert panel and extensive stakeholder consultation with 160 respondents shaped the final recommendations.
The recommendations are based on moderate-to-high certainty evidence, not expert opinion or theoretical concerns.
The Core Recommendation: 120 Minutes Weekly
Accumulate at least 120 minutes per week of moderate-to-vigorous physical activity, spread over 4 or more days, incorporating both aerobic exercise and resistance training. Meta-analysis showed this volume was associated with clinically meaningful reduction in body mass index (1.0 kg/m²), moderate effect size reduction in depressive symptoms, and improvements across multiple health outcomes.
This is a minimum target, not a maximum.
Start Light, Progress Gradually
Begin with light-intensity activity—gentle walking, pelvic floor exercises—as soon as you have capacity. Progress to moderate-vigorous activity once surgical incisions or perineal tears have sufficiently healed and vaginal bleeding doesn't increase with activity.
There's no universal timeline. Progression should be individualized, gradual, and symptom-based. Healing time varies by mode of delivery, complications, overall recovery, and individual circumstances.
Pelvic Floor Training: Daily and Non-Negotiable
Perform pelvic floor muscle training daily to reduce urinary incontinence risk and rehabilitate muscles impacted by pregnancy, labor, and delivery. The evidence shows this training reduced odds of urinary incontinence by 37% with high-certainty evidence.
Proper technique matters. Instruction from a pelvic floor physiotherapist is recommended for optimal results.
The First 12 Weeks: Critical Window for Mental Health
Beginning or returning to moderate-vigorous activity in the first 12 weeks postpartum showed greater reductions in postpartum depression severity compared to starting later. Since postpartum depression typically peaks in the fourth trimester, early movement—supported by adequate childcare and emotional support—may be protective.
This doesn't mean pushing through pain or ignoring your body. It means gentle, progressive movement as soon as you're able, with appropriate support systems in place.
Sleep: The Foundation Everything Else Builds On
The postpartum period is brutal for sleep. Night feedings, diaper changes, a newborn who hasn't figured out day from night yet—it's relentless. You can't eliminate the sleep deprivation entirely, but the research shows that what you can control makes a measurable difference.
Consistent sleep hygiene practices showed high-certainty evidence for improving mental health outcomes. Women who followed basic sleep principles experienced less severe depressive symptoms. The effect wasn't huge, but when you're already depleted, even small improvements matter.
The basics work. Keep a regular bedtime routine when possible—same sequence of activities signals to your body that sleep is coming. Make your bedroom dark, cool, and quiet. Blackout curtains help. White noise can mask the inevitable household sounds. Keep the room temperature slightly cool rather than warm.
Avoid screens before bed. The blue light from phones and tablets suppresses melatonin production, making it harder to fall asleep during those precious windows when the baby is actually sleeping. If you need to scroll or check something, use night mode or blue light filters, but ideally put the phone down 30-60 minutes before you plan to sleep.
Prioritize sleep when you can. This sounds obvious, but when the baby naps, the cultural expectation is to "get things done." Sometimes getting things done means sleeping. Dishes can wait. Laundry can wait. Your brain and body need rest to function.
The research also showed that exercise interventions improved sleep quality and reduced daytime fatigue. Women who met the activity recommendations reported better sleep and felt less exhausted during the day despite the same interrupted nights. Moving your body during the day helps you sleep more efficiently during the limited hours available.
This creates a positive cycle. Better sleep gives you more capacity to move. More movement improves sleep quality. Both independently improve mental health, and together they're more powerful than either alone.
Sleep Deprivation Isn't Your Fault
The guideline acknowledges what every new parent knows—sleep deprivation in the postpartum period is often unavoidable. You're not failing if you're exhausted. You're responding to a biological reality: newborns wake frequently, and you're the one keeping them alive.
But optimizing the sleep factors you can control—your sleep environment, your bedtime routine, how you spend the hour before bed—can improve the quality of the sleep you do get. You might not get more hours, but you can get better hours.
The Evidence: What Happens When You Follow These Guidelines
Moderate-certainty evidence shows postpartum physical activity results in substantial mental health improvements. Women who met the activity recommendations had 45% lower odds of depression—that's 127 fewer cases per 1,000 women. Depressive symptoms decreased with a moderate effect size. Anxiety symptoms decreased with a small effect size.
The combination of movement and sleep hygiene showed particularly strong effects. Women weren't just less depressed—they reported feeling less anxious, less fatigued, and more capable of managing the demands of new parenthood.
Physical health improvements were also significant. Urinary incontinence risk decreased 37%—that's 91 fewer cases per 1,000 women. Lumbopelvic pain severity decreased substantially. Average weight reduction was 1.34 kg with BMI reduction of 0.73 kg/m². Triglyceride levels improved. Fatigue decreased significantly.
Importantly, no adverse effects were found. Exercise didn't reduce breastmilk quality or quantity. It didn't negatively impact infant growth or development. It didn't increase injury risk when progressed appropriately.
When to Get Medical Guidance
The guideline introduces the "Get Active Questionnaire for Postpartum"—a screening tool to identify relative contraindications requiring medical consultation. These include severe abdominal pain, vaginal bleeding not associated with menses, postpartum cardiomyopathy, caesarean section with symptoms worsening with activity, uncontrolled high blood pressure above 140/90 mmHg, eating disorder or malnutrition, excessive fatigue suggesting anemia or low energy availability, and calf pain or swelling suggesting deep vein thrombosis.
Having these conditions doesn't mean complete activity restriction. It means discussing modifications with a healthcare provider to determine what's appropriate for your situation.
Limit Sedentary Time
Aim for 8 hours or less of total sedentary time daily, including no more than 3 hours of recreational screen time. Break up prolonged sitting when possible.
The evidence here is weaker—very low certainty, based primarily on general population data. But any reduction in sedentary time may improve cardiometabolic health. When you're holding or feeding a baby for hours, complete elimination of sitting isn't realistic. But shifting position, standing while holding the baby, or taking short walks can break up extended periods of immobility.
The Reality Check: These Targets Aren't Always Achievable
Feedback from 160 knowledge users and postpartum individuals indicated that 78.7% found the recommendations feasible and 82.8% found them acceptable. But that means 20-25% found them challenging to implement. And that's with motivated respondents who chose to provide feedback.
The postpartum period presents real barriers. Sleep deprivation makes everything harder. Lack of childcare means finding time to exercise is complicated. Physical recovery takes time and isn't linear. Hormonal fluctuations affect energy, mood, and motivation. Mental health challenges can make even basic tasks feel insurmountable. Social isolation is common. Financial constraints limit access to childcare, gym memberships, or equipment.
Even small progress toward these recommendations can improve health. Any reduction in sedentary behavior may benefit cardiometabolic health. Any improvement in sleep hygiene may reduce depression severity. The guidelines acknowledge this explicitly—meeting all recommendations at any given time may not be possible. And that's okay.
Special Considerations
Breastfeeding requires 450-500 extra calories daily. Adequate nutrition and hydration are essential—insufficient caloric intake can lead to low energy availability, affecting recovery, bone health, sleep quality, and causing fatigue. The research shows no adverse effects of exercise on breastmilk quality or quantity, but you need to fuel adequately.
Breastfeeding or pumping before exercise can reduce breast weight and mobility, making activity more comfortable. Supportive bras are essential for both comfort and tissue support.
For women who had caesarean sections, early mobilization has been associated with reduced postoperative complications. But healing time varies. Progression should be symptom-based. If incisional pain worsens with activity, that's a signal to modify until further healed.
Exercise improves mental health outcomes, but it's not a replacement for professional support when needed. If you're experiencing symptoms of depression, anxiety, or other mood disorders, addressing these alongside physical activity is important. Movement helps, but it's one tool among many.
Research Gaps
The guideline identifies critical needs for future research. Validated return-to-activity protocols don't exist. Specific recommendations by mode of delivery aren't possible due to limited research—this is a critical gap. The impact of vigorous-intensity activity on breastfeeding needs study. Optimal sleep duration recommendations are absent. Sedentary behavior thresholds aren't well-established. Most research includes primarily white participants, so diverse population studies are needed. Barriers and facilitators to implementation require investigation.
The Bottom Line
The 2025 Canadian Postpartum Guidelines provide evidence-based targets. Aim for 120 minutes weekly of moderate-vigorous activity spread over 4 or more days. Start with light activity as soon as you have capacity and progress gradually based on symptoms. Perform daily pelvic floor training. Prioritize the first 12 weeks for mental health benefits. Follow consistent sleep hygiene practices—regular routine, dark cool quiet room, avoid screens before bed, prioritize sleep when possible. Limit sedentary time when you can.
These recommendations are based on solid evidence. They're also challenging to implement without adequate support. You need robust social, emotional, and systemic support—from partners, family, healthcare providers, employers, and society—to make this achievable.
Sleep deprivation is real. The demands are relentless. Your body is recovering from a major physiological event. Optimize what you can control, knowing you can't control everything.
Your recovery. Your timeline. Your circumstances. Progress over perfection.
Davenport MH, Ruchat S-M, Jaramillo Garcia A, et al. 2025 Canadian guideline for physical activity, sedentary behaviour and sleep throughout the first year post partum. Br J Sports Med. 2025;59:515-526.
