Standards and Norms: Expert Consensus on Exercise for Pregnant and Postpartum Women (2026 Revision)

Abstract

Exercise during pregnancy and the postpartum period is important for maternal and infant health. To standardize clinical practice regarding exercise for pregnant and postpartum women in China, the Chinese Society of Perinatal Medicine of the Chinese Medical Association and the China Institute of Sport Science, General Administration of Sport of China, jointly developed this expert consensus. This consensus was informed by the latest evidence from clinical research, relevant guidelines, and expert opinion. It was developed using the Delphi method through three rounds of expert consultation, together with multidisciplinary discussions, resulting in the expert consensus. This consensus addresses key topics, including eligible populations for exercise during pregnancy, exercise contraindications, exercise prescription components, and postpartum exercise, and provides 10 key recommendations. It aims to offer scientific, practical, and actionable guidance for exercise interventions among pregnant and postpartum women in China and to promote the integration of sports and medicine in perinatal health management.

Physical activity is an important component of a healthy lifestyle and plays a key role in health promotion across the life course.¹ Although pregnancy and the postpartum period are special stages in a woman’s life, traditional Chinese beliefs often encourage reduced physical activity during pregnancy and postpartum confinement. In contrast, based on extensive high-quality evidence, the World Health Organization recommends that women engage in appropriate and regular physical activity during pregnancy. Such activity can help improve or maintain physical fitness and reduce the risk of certain pregnancy complications.^2,3

This concept is consistent with China’s national Proactive Health strategy and is important for scientific weight management and the prevention and control of chronic diseases among pregnant and postpartum women. The Professional Committee on Pregnancy with Diabetes of the China Maternal and Child Health Association has previously published the Expert Consensus on Exercise During Pregnancy (Draft),³ which provides a useful summary of exercise management during pregnancy. However, that document provides limited guidance on specific exercise types and methods.

Therefore, the Chinese Society of Perinatal Medicine reviewed a substantial body of high-level evidence and considered the Chinese clinical context. After extensive consultation, the Society drafted this expert consensus on exercise for pregnant and postpartum women. The consensus was further discussed and revised in collaboration with national experts in the integration of sports and medicine. It aims to provide practical guidance for clinical practice and to support appropriate exercise during pregnancy and the postpartum period.

1. Guideline development methodology

Consensus development process: The development of this consensus followed standard procedures for clinical practice guideline development. A multidisciplinary expert panel was convened, including specialists in obstetrics, sports medicine, rehabilitation medicine, nursing, informatics, and evidence-based medicine. The project was initiated in June 2024. Based on clinical needs and the Chinese healthcare context, the panel identified 10 key clinical questions and structured them using the Population, Intervention, Comparison, and Outcome framework to guide evidence retrieval and synthesis.

Preliminary recommendations were drafted from available evidence, relevant domestic and international guidelines, and existing expert consensus statements. They were refined through multidisciplinary discussion and three rounds of Delphi surveys. The final recommendations were established through iterative revision, expert feedback, and panel voting, considering both the best available evidence and clinical applicability in China.

Literature search strategy: During the development of this consensus, the expert panel systematically searched Chinese and international databases, including CNKI, Wanfang Data, and PubMed. The search focused on key clinical questions related to exercise for pregnant and postpartum women. The search strategy combined subject headings and free-text terms. MeSH terms and keywords were used for international databases, and subject terms and keywords were used for Chinese databases. The main keywords included pregnancy exercise, postpartum exercise, integration of sports and medicine, exercise intervention, and maternal and infant health.

Eligible literature included systematic reviews and meta-analyses, randomized controlled trials, cohort studies, case-control studies, clinical guidelines, expert consensus statements, and relevant references. The initial search covered January 1, 2010, to December 30, 2024, and was updated to April 2026 during revision. Basic studies limited to cell or animal experiments were excluded. After screening, deduplication, and prioritization by relevance and evidence level, 45 publications were included as the evidence base. When multiple types of evidence addressed the same clinical question, recommendations prioritized higher-level evidence, followed by lower-level evidence and supportive references.

Evidence grading standards and recommendation strength: This consensus referred to guidelines and expert consensus statements on exercise for pregnant and postpartum women from academic organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the Society of Obstetricians and Gynecologists of Canada (SOGC), as well as recent clinical evidence. The evidence grading system and recommendation categories are shown in Table 1.

Table 1.

Evidence grading standards and recommendation strength used in this consensus.

Evidence level and recommendation strength	Description
Evidence grade
Ia	Evidence from meta-analyses of randomized controlled trials
Ib	Evidence from at least one randomized controlled trial
IIa	Evidence from at least one well-designed non-randomized controlled study
IIb	Evidence from at least one well-designed experimental study
III	Evidence from at least one well-designed non-experimental descriptive study
IV	Evidence from expert committee reports or authoritative expert opinion
Recommendation strength
Strong recommendation	Supported by good, consistent scientific evidence (typically Level I evidence)
Moderate recommendation	Supported by limited or inconsistent literature (typically Level II or III evidence)
Weak recommendation	Based primarily on expert consensus (typically Level IV evidence)

Recommendations supported by level III or higher evidence and strongly or moderately recommended in international guidelines were directly adopted. For topics supported by lower-level evidence, or those weakly recommended or not addressed in international guidelines, recommendations were developed through the Delphi process. After three rounds of expert consultation, consensus recommendations adapted to the Chinese clinical context were formulated and classified as weak recommendations in this consensus.

Formation process of recommendations: Based on the clinical evidence review prepared by the writing group, the expert panel drafted preliminary recommendations on exercise for pregnant and postpartum women. On January 3, 2025, the panel held a hybrid meeting with both in-person and virtual participation. During the meeting, experts reviewed, revised, and voted on each draft recommendation. Recommendations approved by ≥ 85% of the expert panel were accepted. The accepted recommendations were then circulated to all panel members for further review. Additional feedback was collected by email and WeChat from February to May 2025. After multiple rounds of revision and refinement, the final version of this consensus was established.

2. Relationship between exercise during pregnancy and postpartum and maternal and infant health

Question 1: Is exercise during pregnancy and postpartum beneficial for maternal and infant health?

Existing evidence suggests that light physical activity and exercise during pregnancy are low risk and beneficial for most pregnant women.^1,2 Numerous high-quality randomized controlled trials have shown that moderate exercise during pregnancy promotes maternal, fetal, and neonatal health. Specifically, it may reduce the risks of excessive gestational weight gain, gestational diabetes mellitus, gestational hypertension, preeclampsia, delivery-related complications, preterm birth, and neonatal complications.^3,4,5,6 Therefore, reasonable exercise during pregnancy is recommended to prevent and reduce pregnancy complications. Moreover, exercise during pregnancy is not significantly associated with increased risks of fetal malformations, miscarriage, preterm birth, low birth weight, or delivery complications.^7,8

Exercise interventions may also improve metabolic status and ovarian function before pregnancy, thereby improving embryo quality and implantation rates in women undergoing assisted reproduction.⁹ During the postpartum period, rapid hormonal changes and changes in family structure may increase the risk of postpartum depression. Randomized clinical trials have shown that exercise during pregnancy and postpartum can help prevent perinatal and postpartum depression.¹⁰ Appropriate early postpartum pelvic floor muscle training is also beneficial for preventing and reducing pelvic floor damage and postpartum urinary incontinence.^11,12 In addition, exercise during pregnancy and postpartum may influence offspring physical development, neurobehavioral development, and chronic disease risk by regulating the maternal internal environment, suggesting potential intergenerational health benefits.¹³ These findings support the important role of exercise across the continuum of reproduction, pregnancy, postpartum recovery, and offspring health.

Recommendation 1: Exercise during pregnancy helps reduce the risk of some pregnancy complications, and postpartum exercise can prevent and reduce pelvic floor damage and postpartum depression (Ia–Ib evidence, strong recommendation).

3. Appropriate population and contraindications for exercise during pregnancy

Question 2: Which populations are suitable for exercise during pregnancy?

Before an exercise plan is developed, pregnant women should undergo a comprehensive clinical assessment to exclude medical contraindications. The assessment should include vital signs and relevant clinical indicators, such as blood pressure, heart rate, and blood glucose.¹⁴ Because pregnancy involves substantial anatomical and physiological changes, exercise type, frequency, and intensity should be adjusted accordingly.¹⁵ Sports with a risk of physical contact, falls, or injury, as well as high-altitude exercise, should be avoided.¹⁶

Absolute contraindications to exercise during pregnancy include, but are not limited to, severe cardiac or respiratory disease, severe preeclampsia or eclampsia, uncontrolled hypertension, severe thyroid disease, uncontrolled type 1 diabetes, preterm premature rupture of membranes, threatened preterm labor, unexplained persistent vaginal bleeding, placenta previa after 28 weeks of gestation, cervical insufficiency, severe anemia, fetal growth restriction, and higher-order multiple pregnancy, such as triplets or more.^12,17 For these women, moderate- or higher-intensity exercise is generally contraindicated. Whether light physical activity or activities of daily living are appropriate should be determined by a specialist after individualized assessment. For example, some women may perform basic daily activities under guidance, whereas those requiring strict bed rest, such as women with preterm premature rupture of membranes, may be advised to perform limb movements in bed to prevent thrombosis.

Relative contraindications include mild to moderate cardiac or respiratory disease, a history of recurrent miscarriage or preterm birth, severe pathological obesity (e.g., body mass index (BMI) ≥ 35 kg/m² or obesity with metabolic abnormalities), malnutrition or very low body weight (BMI < 12 kg/m²), twin pregnancy after 28 weeks of gestation, and unstable epilepsy. In these circumstances, pregnant women should receive detailed professional assessment. Clinicians should weigh the risks and benefits of exercise according to the type of complication and gestational stage, and then provide individualized recommendations on whether exercise is appropriate, as well as the type, frequency, and intensity of exercise.¹⁸

For pregnant women without contraindications, moderate-intensity physical activity is recommended because it provides health benefits and may reduce pregnancy complications.¹⁹ Pregnant women should also monitor warning symptoms during exercise to ensure maternal and fetal safety. Exercise should be discontinued if vaginal bleeding, abdominal pain, contractions, rupture of membranes, dyspnea, dizziness, headache, chest pain, muscle weakness affecting balance, calf pain, swelling, or other concerning symptoms occur. In such cases, pregnant women should stop exercising immediately and seek professional medical advice.

Recommendation 2: For women with absolute contraindications to exercise during pregnancy, whether light physical activity or activities of daily living are appropriate should be determined after individualized specialist assessment. Women with relative contraindications should undergo professional risk-benefit assessment before participating in exercise, and an individualized exercise plan should be developed (III–IV evidence, weak recommendation).

Recommendation 3: Pregnant women without contraindications to exercise during pregnancy should engage in planned, regular exercise under professional guidance (IIa–IIb evidence, moderate recommendation).

4. Recommendations on exercise structure

Question 3: How should pregnant women exercise?

Pregnant women without pre-pregnancy exercise habits should start with light-intensity exercise and progress gradually. Women who regularly performed high-intensity aerobic exercise before pregnancy may continue during pregnancy and postpartum under professional guidance.²⁰ Throughout pregnancy, exercise plans should be adjusted according to maternal health status and medical advice to ensure maternal and fetal safety.

4.1. Exercise type: Aerobic exercise refers to sustained moderate-intensity activity that improves cardiorespiratory function and circulatory efficiency. It may enhance physiological adaptation, slow gestational weight gain, reduce lower limb edema, relieve fatigue, and maintain muscle strength, thereby benefiting fetal development and delivery.²¹ Common aerobic exercises suitable for pregnancy include brisk walking, jogging, swimming, dancing, and aerobics.

Resistance exercise involves muscle training against gravity or external resistance. It can improve muscle strength and endurance, promote bone health, and improve posture.²² Suitable resistance exercises during pregnancy include elastic band training, water-based resistance exercises, and localized muscle training with simple equipment.

Flexibility and balance training may also be beneficial during pregnancy by improving lower limb proprioception and reducing fall risk. Safe and feasible movements, such as supported side leg lifts and simplified pelvic tilt exercises, are recommended. Single-leg balance exercises and unstable movements requiring high core strength should be avoided.

Both aerobic and resistance exercises are generally safe and beneficial during pregnancy, but exercise programs should be individualized according to maternal condition and medical advice. Pregnant women should choose exercises appropriate for their physical condition, consult healthcare professionals or qualified trainers when needed, and adjust exercise intensity and frequency according to bodily responses.

Recommended specific exercise content is as follows.²³

For resistance exercise, suitable options include elastic band training, low-load equipment training, water-based exercises, and flexibility or balance exercises. Elastic band training can activate different muscle groups through movements such as shoulder presses, glute bridges, and standing rows. Low-load equipment, such as dumbbells, water bottles, or resistance balls, may be used for simplified strength exercises, including seated shoulder presses and wall push-ups. Water-based exercises provide resistance with low joint impact and may include water walking, leg swings, and pushing or pulling movements in water. Flexibility and balance exercises, such as standing pelvic tilts, wall-supported leg lifts, and small side steps, should be performed with support to ensure safety.

Several precautions should be followed during resistance training in pregnancy. Pregnant women should consult a physician before starting resistance exercise, choose appropriate loads, avoid excessive resistance, and maintain correct posture. Professional guidance may help ensure proper technique and reduce injury risk. Normal breathing should be maintained during exercise, and breath-holding should be avoided. Evidence suggests that combined aerobic and resistance exercise may provide greater maternal and infant health benefits than aerobic exercise alone.^24,25 Therefore, pregnant women without contraindications are encouraged to combine both types of exercise.¹⁸ Sports involving physical contact or a high risk of falls, such as horseback riding and skiing, should be avoided and replaced with lower-risk aerobic activities, such as brisk walking, swimming, or stationary cycling.

Warm-up and cool-down activities are recommended before and after exercise. Before exercise, pregnant women should perform at least 5 minutes of warm-up, such as gentle aerobic activity, joint mobility exercises, and mild stretching. Stretching should focus on the major muscle groups involved in exercise, while overstretching and jerky movements should be avoided. After exercise, activity intensity should be reduced gradually, followed by slow walking or static stretching to help normalize heart rate and breathing and promote muscle recovery.

Pregnant women should avoid strenuous exercise, excessive fatigue, overexertion, high-temperature environments, and activities that markedly increase intra-abdominal pressure. High-risk activities include intense ball games, skiing, scuba diving, heavy lifting, and high-intensity training. Adequate rest and recovery should be ensured after each exercise session. Exercise in hot environments, such as hot yoga rooms or saunas, should be avoided, and core temperature should be kept below 38°C.²⁶

For pregnant and postpartum women, sedentary behavior generally refers to low-energy sitting or lying time while awake, including during work, study, household activities, and transportation. Because direct evidence in pregnant and postpartum women remains limited, recommendations are extrapolated from evidence in general adults. Overall, reducing sedentary behavior is considered to have benefits that outweigh potential risks in pregnant and postpartum women.

Recommendation 4: Exercise during pregnancy should primarily include aerobic and resistance exercise, with moderate stretching also being beneficial (III–IV evidence, weak recommendation).

Recommendation 5: Pregnant women should limit sedentary time. Replacing sedentary time with physical activity of any intensity, including light-intensity activity, is beneficial for health (IV evidence, weak recommendation).

4.2. Exercise frequency: The frequency of exercise should be sufficient to maintain continuous metabolic, cardiovascular, musculoskeletal, and psychological benefits while minimizing prolonged sedentary time. Evidence from systematic reviews and guideline syntheses supports accumulating at least 150 minutes of moderate-intensity physical activity per week, preferably distributed across the week.^27,28 This amount of activity has been associated with reduced risks of gestational diabetes mellitus and hypertensive disorders of pregnancy, and may also support healthier gestational weight gain and better mental health. For practical implementation, daily exercise is encouraged when feasible, as it may help pregnant women establish stable behavioral habits and avoid long periods of inactivity. If daily exercise is not achievable because of fatigue, work schedules, pregnancy-related discomfort, or other barriers, exercise should be performed on at least 3 days per week, with activity sessions flexibly arranged to reach the weekly target.²⁹

Recommendation 6: Pregnant women are encouraged to exercise daily. If daily exercise is not feasible, they should exercise at least 3 days per week and accumulate at least 150 minutes of moderate-intensity exercise per week (IIa-IIb evidence, moderate recommendation).

4.3. Exercise intensity: Physical activity can be classified as light, moderate, or vigorous intensity. Compared with light activity, moderate-to-vigorous activity provides greater health benefits.¹⁸ Light activity generally corresponds to 1.6–2.9 metabolic equivalents (METs) and includes daily activities such as slow walking and light housework. Moderate-to-vigorous aerobic activities include brisk walking, swimming, stationary cycling, low-impact aerobics, jogging, modified yoga, and modified Pilates.³⁰

Although studies have shown a dose-response association between higher exercise intensity and lower risks of gestational diabetes mellitus, gestational hypertension, and preeclampsia,^28,31 there is insufficient evidence that vigorous-intensity exercise provides additional benefits or safety during pregnancy. Therefore, both ACOG and SOGC recommend moderate-intensity exercise for pregnant women without contraindications. SOGC recommends heart rate monitoring to assess exercise intensity and defines moderate intensity as 40%–59% of heart rate reserve (HRR) (Table 2).²

Table 2.

Heart rate grading for exercise intensity in pregnant women.

Item	Heart rate (beats/min)
< 30 years old
Light	102–124
Moderate intensity	125–146
High intensity	147–169
≥ 30 years old
Light	101–120
Moderate intensity	121–141
High intensity	142–162

ACOG notes that heart rate may lag behind exercise intensity and recommends perceived exertion as a practical method for assessing intensity. Common methods include the Borg rating of perceived exertion (RPE) scale and the Talk Test. The Borg scale ranges from 6, no exertion, to 20, maximal exertion. For moderate-intensity exercise, the recommended RPE is 13–14, perceived as “somewhat hard” (Table 3). The Talk Test means that the pregnant woman feels mildly exerted but can still maintain a normal conversation during exercise.

Table 3.

Borg rating of perceived exertion scale.

Score	Level
6	Resting
7–8	Extremely light
9–10	Very light
11–12	Fairly light
13–14	Somewhat hard
15–16	Hard
17–18	Very hard
19–20	Extremely hard

This consensus recommends using the Borg scale during exercise, maintaining an RPE of 13–14, combined with the Talk Test for self-monitoring. These methods are simple, practical, and suitable for all pregnant women. For women with access to devices, heart rate and oxygen consumption monitoring may further improve the accuracy of exercise assessment and support individualized guidance.

For easier interpretation, light exercise includes slow walking and daily chores and is generally perceived as relaxed and effortless. Moderate-intensity exercise includes brisk walking and water-based activities, usually accompanied by mild sweating while still allowing conversation. Vigorous exercise, such as running, jumping rope, or fast cycling, often causes marked breathlessness and difficulty speaking and is generally not recommended during pregnancy.

Intensity assessment differs between aerobic and resistance exercise. Aerobic intensity can be assessed using the Borg Scale or heart rate. For resistance exercise, assessment should consider movement difficulty, repetitions, and fatigue level. For example, an intensity perceived as “somewhat hard” after 8–12 repetitions is generally appropriate.

Recommendation 7: Moderate-intensity exercise is recommended during pregnancy, corresponding to an RPE score of 13–14 (IIa–IIb evidence, moderate recommendation).

4.4. Exercise individualization: Exercise plans during pregnancy should be individualized according to each woman’s clinical condition.^32,33 When developing an exercise plan, clinicians should consider maternal health status, gestational age, pregnancy complications, comorbidities, and current exercise habits.

Exercise prescriptions should be designed according to the six elements of exercise prescription: frequency, intensity, time, type, volume, and progression/monitoring.³⁴ Pregnancy may be divided into the first trimester (≤ 13 weeks), second trimester (14–27 weeks), and third trimester (≥ 28 weeks), with specific exercise types, intensities, and monitoring points defined for each stage to improve scientific rigor and clinical feasibility.

For women with obesity or no pre-pregnancy exercise habits, ACOG and SOGC recommend starting with light-intensity exercise of short duration and gradually increasing to the recommended intensity and duration according to individual capacity. This gradual approach helps ensure safety and effectiveness. Severe pathological obesity, such as BMI ≥ 35 kg/m² or obesity with metabolic abnormalities, should be distinguished from general overweight. General overweight is not a contraindication to exercise, and these women should be encouraged to exercise under professional guidance.

Individualized exercise management may be further supported by health information technologies. Wearable devices, physiological monitoring, and mobile health applications can help track exercise behavior and identify individual risks. Information systems may also facilitate remote communication and feedback between clinicians and patients, improving the scientific basis and adherence of individualized exercise prescriptions.

For women with gestational diabetes mellitus, high-quality studies have shown that exercise during pregnancy can reduce fasting glucose and improve short-term postprandial glucose control.³⁵ In women using insulin therapy, exercise may also reduce insulin requirements. Therefore, exercise volume should be adjusted according to glycemic control and individual tolerance. Fasting or random blood glucose should be checked before exercise, and hypoglycemia should be closely monitored during exercise. If palpitations, sweating, dizziness, or other hypoglycemic symptoms occur, carbohydrate intake should be provided immediately and exercise should be stopped. An interactive monitoring approach integrating exercise, medication, and blood glucose is recommended to record glycemic changes, exercise load, and medication adjustments, thereby improving individualized management.

For women with hypertensive disorders of pregnancy, limited evidence suggests that exercise may improve blood pressure control and reduce adverse maternal and fetal outcomes, although high-quality evidence remains insufficient. Based on extrapolation from national hypertension prevention and management guidelines,³⁶ pregnant women with well-controlled hypertensive disorders may exercise under professional guidance. Blood pressure should be measured before exercise. If systolic blood pressure persistently exceeds 140 mmHg (1 mmHg = 0.133 kPa), exercise should be suspended and risks reassessed. Blood pressure and symptoms should be monitored during exercise, and exercise should be stopped immediately if dizziness, headache, or other abnormal symptoms occur.

Heart rate monitoring may also support safe exercise during pregnancy. Baseline heart rate is usually similar to the pre-pregnancy level in early pregnancy. In the second and third trimesters, heart rate may increase by 10–15 beats per minute due to increased blood volume, peak at approximately 32 weeks of gestation, and remain elevated until delivery.³⁷ In general, an exercise heart rate below (220 − age) × 70% is considered safe; if this threshold is exceeded, exercise intensity should be reduced or exercise should be stopped. Exercise volume should be adjusted according to maternal physical condition, energy expenditure, perceived exertion, and gestational age. Exercise recommendations for special pregnant populations are summarized in Table 4.^34,38 However, current recommendations are limited by the availability of high-quality clinical evidence. Further studies are needed to clarify effective exercise counseling strategies and optimal exercise type, frequency, and intensity during pregnancy.

Table 4.

Exercise recommendations for special pregnant populations.

Population category	Recommended exercise types	Recommended intensity	Frequency and duration	Contraindications and precautions	Monitoring points
Gestational diabetes mellitus	Brisk walking, swimming, stationary cycling, aerobics, prenatal yoga	Moderate intensity	≥ 3 times/week, 30–60 min/session	Avoid exercising on an empty stomach; be aware of hypoglycemia risk; avoid high-intensity interval training	Monitor fasting/random blood glucose before exercise; watch for hypoglycemia symptoms during exercise, supplement sugar if necessary; record exercise-medication-blood glucose response
Hypertensive disorders of pregnancy	Breathing exercises, low-impact aerobic exercise, prenatal gymnastics, stretching exercises	Light to moderate intensity	3–5 times/week, 20–40 min/session	Suspend exercise if systolic BP > 140 mmHg; avoid sudden postural changes and breath-holding maneuvers	Measure BP before exercise; monitor for abnormal symptoms like dizziness, chest tightness, blurred vision during exercise
Obesity (BMI ≥ 28 kg/m2), non-severe pathological obesity	Water exercises, stationary cycling, elastic band training, slow walking	Start light, gradually transition to moderate intensity	≥ 150 min/week, distributed daily	Avoid high knee-load or high fall-risk exercises; avoid overheating and dehydration during exercise	Monitor heart rate and sweating; recommend using Borg scale or talk test combined with assessment
History of preterm birth or cervical surgery	Breathing exercises, prenatal yoga, upper limb and shoulder resistance exercises	Light intensity	3 times/week, 20–30 min/session	Contraindicated: any exercise causing mechanical traction on the uterus or increased intra-abdominal pressure, e.g., deep squats, jumping	Monitor for abdominal pain, contractions, changes in vaginal discharge; stop exercise promptly if abnormalities occur
Heart disease during pregnancy (if assessed and permitted by doctor)	Breathing exercises, upper limb activities, seated stretching exercises	Very light to light intensity	Individualized, ≤ 30 min/session	Contraindicated: supine exercises, repeated squatting and standing movements; should be performed with professionals present	Monitor heart rate, palpitations, fatigue, chest pain; stop exercise promptly if abnormalities occur

BMI: Body mass index; BP: Blood pressure; 1 mmHg = 0.133 kPa.

Recommendation 8: Exercise plans should be individualized according to each pregnant woman’s needs. Recommendations on exercise type, frequency, duration, and intensity should be based on the woman’s medical and physical condition (IIa–III evidence, moderate recommendation).

5. Postpartum exercise

Question 4: How soon after delivery can exercise begin?

Current evidence and major guidelines support the early initiation of appropriate postpartum exercise, particularly pelvic floor muscle training, to promote recovery and reduce pelvic floor dysfunction and urinary incontinence. However, the available evidence is heterogeneous, and exercise programs vary in frequency, intensity, and duration. Therefore, the timing and progression of postpartum exercise should be individualized according to delivery mode, maternal recovery, and the presence of complications. Clinical studies suggest that moderate training initiated between 3 days and 4 weeks postpartum may facilitate tissue repair, but exercise load should be increased gradually and symptoms of pelvic floor dysfunction should be closely monitored.³⁹

For women after vaginal delivery, light exercise, such as walking and basic yoga, may generally begin 3 days postpartum if recovery is adequate. Exercise should be postponed in women with marked fatigue or complications, such as excessive lochia or perineal laceration. For women after cesarean delivery, exercise initiation should consider abdominal wound healing.⁴⁰ Because of the risk of thrombosis, daily activities, such as bed exercises and lower limb movements, should be resumed as early as medically safe. Light activities, including standing breathing exercises, walking, and gentle stretching, may be gradually resumed 2–3 weeks postpartum according to recovery status.⁴¹ At the 6-week postpartum follow-up, if recovery is satisfactory, exercise intensity may be gradually increased until the woman returns to her pre-pregnancy exercise level. Regardless of delivery mode, postpartum exercise should be performed under professional guidance. Women at high risk, such as those with hypertensive disorders or diabetes, should receive individualized exercise recommendations based on clinical assessment.

Recommendation 9: For women after vaginal delivery, light exercise is recommended from 3 days postpartum. For women after cesarean delivery, daily activities should be resumed as early as safely possible, and light activities may be gradually resumed 2–3 weeks postpartum (IV evidence, weak recommendation).

Question 5: How should postpartum exercise be conducted?

Postpartum exercise should be conducted in stages according to maternal recovery. In the early postpartum phase, from 3 days to 6 weeks postpartum, exercise should focus on light restorative activities, such as gentle walking, deep breathing exercises, and basic postpartum yoga. These activities may promote blood circulation, reduce edema, and support physical recovery. Strenuous exercise should be avoided during this phase to prevent excessive burden on the recovering body.

In the intermediate phase, from 6 weeks to 3 months postpartum, exercise intensity may be gradually increased if recovery is adequate. Light aerobic activities, such as cycling and swimming, may be introduced. The goals during this phase are to improve cardiorespiratory function, skeletal muscle strength, and endurance, while supporting abdominal muscle recovery, particularly recovery of the rectus abdominis, to reduce postpartum abdominal laxity.⁴²

In the late recovery phase, beginning 3 months postpartum, women may gradually resume moderate-intensity exercise, including faster walking, structured aerobic exercise, physical training, and weight-bearing training.⁴³ Strength training, such as dumbbell exercises and core strengthening, may also be introduced gradually to improve muscle strength, body composition, and physical fitness.

The main goals of postpartum exercise are to restore physical strength, improve skeletal muscle endurance, support body shape recovery, promote mental health, and alleviate symptoms such as postpartum depression. More importantly, postpartum exercise should support recovery of physiological function, including pelvic floor function, core stability, postural control, and motor coordination.^44,45 During all stages, exercise should follow the principle of gradual progression and avoid overload. Appropriate warm-up and cool-down should be performed before and after each session to reduce injury risk. Women should monitor bodily signals carefully. If increased bleeding, pain, or discomfort occurs, exercise should be stopped and medical advice should be sought.

Recommendation 10: Postpartum exercise should increase gradually in intensity, follow the principle of gradual progression, avoid overload, and be adjusted according to delivery mode and individual recovery status (IIb–III evidence, moderate recommendation).

In summary, this consensus provides scientific and systematic guidance for exercise interventions in pregnant and postpartum women. It aims to promote maternal and infant health and improve the prevention and management of pregnancy-related complications. Although substantial evidence supports the benefits of exercise during pregnancy and postpartum, individual responses vary. Future studies should further investigate optimal exercise modes, intensities, and timing, with particular attention to individualized programs for different populations. With continued progress in the integration of sports and medicine, exercise interventions are expected to play an increasingly important role in perinatal health management and provide more precise and practical strategies for life-course health promotion in pregnant and postpartum women (Table 5).

Table 5.

Exercise recommendations during pregnancy and postpartum.

Clinical question	Recommendation	Evidence level	Strength
Question 1 Is exercise during pregnancy and postpartum beneficial for maternal and infant health?	1 Exercise during pregnancy may reduce pregnancy complications; postpartum exercise may reduce pelvic floor damage and postpartum depression.	Ia–Ib	Strong
Question 2 Which populations are suitable for exercise during pregnancy?	2 Women with absolute or relative contraindications should receive individualized professional assessment before exercise.	III–IV	Weak
	3 Pregnant women without contraindications should perform planned, regular exercise under professional guidance.	IIa–IIb	Moderate
Question 3 How should pregnant women exercise?	4 Aerobic and resistance exercises are recommended; moderate stretching may also be beneficial.	III–IV	Weak
	5 Pregnant women should limit sedentary time and replace it with physical activity of any intensity.	IV	Weak
	6 Daily exercise is encouraged; otherwise, exercise at least 3 days per week, totaling ≥ 150 min/week.	IIa–IIb	Moderate
	7 Moderate-intensity exercise is recommended, corresponding to an RPE score of 13–14.	IIa–IIb	Moderate
	8 Exercise plans should be individualized by medical and physical condition.	IIa–III	Moderate
Question 4 How soon after delivery can exercise begin?	9 Light exercise may start 3 days after vaginal delivery; after cesarean delivery, daily activity should resume early and light activity after 2–3 weeks if safe.	IV	Weak
Question 5 How should postpartum exercise be conducted?	10 Postpartum exercise should progress gradually, avoiding overload and adjusting to delivery mode and recovery status.	IIb–III	Moderate

List of the Consensus Development Working Group Members (Names listed in no particular order)

Leader: Hongbo Qi (Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University); Huixia Yang (Department of Obstetrics and Gynecology, Peking University First Hospital); Xue Xiao (Department of Obstetrics, West China Second University Hospital, Sichuan University); Xiangchen Li (China Institute of Sport Science, General Administration of Sport of China).

Consultant Experts: Xinghui Liu (Department of Obstetrics, West China Second University Hospital, Sichuan University); Jian Li (West China Medical Sports Center, Sichuan University); Jingwei Cao (China Institute of Sport Science, General Administration of Sport of China).

Writing Experts: Xin Li (Prenatal Diagnosis Center, West China Second University Hospital, Sichuan University); Jingquan Sun (School of Physical Education, Sichuan University); Luyao Wang (West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University)

Delphi Method Expert Group: Peng Bai (West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University);

Binghong Gao (School of Competitive Sports, Shanghai University of Sport / Faculty of Health Sciences and Sports, Macao Polytechnic University);

Fei Gao (Institute of Zoology, Chinese Academy of Sciences);

Yan Gao (Department of Obstetrics and Gynecology, Sichuan Provincial Maternal and Child Health Care Hospital);

Guolin He (Department of Obstetrics, West China Second University Hospital, Sichuan University);

Yaqiang Hong (West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University);

Ting Hu (Prenatal Diagnosis Center, West China Second University Hospital, Sichuan University);

Xiaoying Jia (West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University);

Mingming Lei (School of Sports Medicine and Health, Chengdu Sport University / Affiliated Sports Hospital of Chengdu Sport University);

Da Li (Center for Reproductive Medicine, Shengjing Hospital of China Medical University);

Jian Li (West China Medical Sports Center, Sichuan University);

Qintong Li (West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University);

Xiangchen Li (China Institute of Sport Science, General Administration of Sport of China);

Xue Li (School of Sports Medicine and Health, Chengdu Sport University);

Yalan Li (Department of Psychiatry, West China Second University Hospital, Sichuan University);

Yi Lin (Center for Reproductive Medicine, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine);

Yonghong Lin (Department of Gynecology, Chengdu Women’s and Children’s Central Hospital);

Hongqian Liu (Prenatal Diagnosis Center, West China Second University Hospital, Sichuan University);

Tianjiao Liu (Department of Obstetrics and Gynecology, Chengdu Women’s and Children’s Central Hospital);

Weina Liu (School of Physical Education and Health, East China Normal University);

Qingzhan Ma (West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University);

Jie Mei (Department of Obstetrics and Gynecology, Sichuan Provincial People’s Hospital);

Jingquan Sun (College of Physical Education, Sichuan University);

Jing Tan (Clinical Epidemiology and Evidence-based Medicine Center, West China Hospital, Sichuan University);

Xiaoxu Wang (Statistical Information Center, National Health Commission of the People’s Republic of China);

Peng Yuan (Department of Obstetrics and Gynecology, Bazhong Maternal and Child Health Care Hospital);

Qiang Zhang (Department of Gynecology, Chengdu Women’s and Children’s Central Hospital);

Yaoyao Zhang (Department of Reproductive Medicine, West China Second University Hospital, Sichuan University);

Cheng Zhao (Department of Obstetrics, Peking University Third Hospital);

Huo Zhao (Department of Obstetrics, West China Second University Hospital, Sichuan University);

Jianyuan Zhao (Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine);

Jie Zhuang (School of Exercise and Health, Shanghai University of Sport).

Discussion Experts: Guolian Ding (Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University);

Junjun Ding (Stem Cell and Tissue Engineering Research Center, Zhongshan School of Medicine, Sun Yat-sen University);

Ling Li (Clinical Epidemiology and Evidence-based Medicine Center, West China Hospital, Sichuan University);

Yi Lin (Center for Reproductive Medicine, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine);

Weina Liu (School of Physical Education and Health, East China Normal University);

Xinhua Liu (China Institute of Sport Science, General Administration of Sport of China);

Biru Luo (Department of Nursing, West China Second University Hospital, Sichuan University);

Fang Ma (Translational Medicine Research Center, West China Second University Hospital, Sichuan University);

Hongbo Qi (The First Affiliated Hospital of Chongqing Medical University);

Ting Shu (National Institute of Hospital Administration, National Health Commission of the People’s Republic of China);

Chen Wang (Department of Obstetrics, Peking University First Hospital);

Qian Wang (National Center for Women and Children’s Health, National Health Commission of the People’s Republic of China);

Qiang Wang (State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University);

Ru Wang (School of Exercise and Health, Shanghai University of Sport);

Shuai Wang (Statistical Information Center, National Health Commission of the People’s Republic of China);

Xiaoxu Wang (Statistical Information Center, National Health Commission of the People’s Republic of China);

Zhengzhen Wang (School of Sports Medicine and Rehabilitation, Beijing Sport University);

Keliang Wu (Shandong University Affiliated Reproductive Hospital / Institute of Women, Children and Reproductive Health, Shandong University);

Yankai Xia (Research Institute, Nanjing Medical University);

Wenming Xu (West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University);

Huixia Yang (Department of Obstetrics and Gynecology, Peking University First Hospital);

Yang Yu (Clinical Stem Cell Research Center, Peking University Third Hospital);

Xintao Zhang (Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital);

Yaoguang Zhang (Statistical Information Center, National Health Commission of the People’s Republic of China);

Jianyuan Zhao (Institute of Cardiovascular Development and Regenerative Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine);

Wei Zhao (Statistical Information Center, National Health Commission of the People’s Republic of China);

Jingbin Zhou (Department of Sports and Rehabilitation Medicine, Beijing Chaoyang Hospital, Capital Medical University);

Jie Zhuang (School of Exercise and Health, Shanghai University of Sport);

Juan Zou (Department of Pathology, West China Second University Hospital, Sichuan University).

Acknowledgements

We would like to appreciate the support from all of the members of Chinese Society of Perinatal Medicine, China Medical Association; China Institute of Sport Science, General Administration of Sport of China.

Funding

This work was supported by National Key Research and Development Program of China (2022YFC3600304).

Conflicts of Interest

None.

Editor Note

Huixia Yang is one of the Editors-in-Chief of Maternal-Fetal Medicine. Hongbo Qi is one of the deputy of Editors-in-Chief of Maternal-Fetal Medicine. The article was subject to the journal’s standard procedures,with peer review handled independently of this editor and the associated research groups.