Physical activity postpartum: A systematic review and quality appraisal of clinical guidelines

BACKGROUND: Postpartum physical activity (PA) is crucial in supporting maternal health, contributing to mental health and well-being, weight management, and overall physical fitness. Although multiple health organizations have issued PA recommendations for postpartum women, the content and quality of these guidelines have not yet been systematically evaluated. OBJECTIVES: To evaluate the quality of published guidelines on PA for postpartum women and to summarize their recommendations to provide clearer guidance for healthcare providers and postpartum women. DESIGN: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES AND METHODS: Six electronic databases were searched for guidelines related to PA for postpartum women. Gray literature was also reviewed. Guidelines were included if they were developed by recognized health organizations, provided PA (including structured supervised exercises) recommendations for postpartum women, and were published or updated within the last 10 years. Data extraction and quality appraisal were independently conducted by pairs of reviewers using the Appraisal of Guidelines Research and Evaluation Tool (AGREE II). RESULTS: Eighteen guidelines were included, with AGREE II scores ranging from 50% to 92%. Seven guidelines (39%) met the criteria for satisfactory methodological quality. Most guidelines recommended that postpartum women engage in at least 150 min of moderate-intensity aerobic PA per week, while the 2025 Canadian guideline supports a minimum of 120 min based on meta-analytic evidence. Common recommendations included pelvic floor muscle training, strengthening exercises, and other exercises, with advice to seek healthcare guidance for women with special conditions. CONCLUSION: There is a universal agreement across guidelines that postpartum women should aim for at least 120-150 min of moderate-intensity PA weekly. Future research should strengthen the evidence for specific types of PA, delivery mode considerations, and implementation strategies. REGISTRATION: International Prospective Register of Systematic Reviews: PROSPERO (CRD42023447331).