You were cleared in six weeks. Nobody told you what to do with that clearance. How much activity? How soon? And how do you tell normal soreness from a signal to slow down, such as leaking, pelvic heaviness, pain, or abdominal midline doming? Until recently, nobody had studied it properly. The 2025 Canadian Guideline for Physical Activity, Sedentary Behaviour and Sleep Throughout the First Year Postpartum finally answers those questions, and it's the first real update to postpartum movement guidance since 2003.

Below, I break down what it recommends, when you can start based on your delivery, how your pelvic floor and abdominal wall respond as activity increases, how to spot the signs you're pushing too hard, and where pelvic floor physical therapy fits into all of it.

Key Takeaways

• Build toward 120 minutes a week of moderate to vigorous activity, spread across 4 or more days, mixing aerobic work and strength training
• Daily pelvic floor muscle training sits inside the guideline as a core recommendation, not an optional add-on
• The guideline asks for progression based on your symptoms, not a fixed weekly schedule everyone follows
• Six weeks is a medical clearance date. Your pelvic floor and abdominal wall tissues may still be recovering four to six months later
• Leaking, heaviness, pain, or abdominal midline doming during or after activity means the load or movement strategy needs adjusting, not that you need to push harder
• The guideline names a pelvic floor physical therapist for pelvic floor training and identifies abdominal wall function as another area that may need professional support

How Much Physical Activity Do You Need After Having a Baby?

What the 2025 guideline recommends, once you have clearance and no restrictions:

120 minutes per week of moderate to vigorous activity, meaning your heart rate and breathing rise noticeably. Brisk walking counts. So does cycling.

Spread across 4 or more days, not stacked into one long session

A mix of aerobic and strength work. Aerobic activity trains your heart and lungs. Strength training rebuilds the muscle your body spent nine months redistributing. Doing only one leaves half the recovery unaddressed.

Pelvic floor muscle training daily, meaning deliberately contracting and fully releasing the muscles supporting your bladder, bowel, and uterus. This is one of the nine core recommendations, not a bonus.

Sitting under 8 hours a day, breaking up long stretches where you can

Those numbers carry weight because of what sits behind them. Published in the British Journal of Sports Medicine by the Canadian Society for Exercise Physiology, the guideline came out of a panel that reviewed roughly 19,000 studies over three years and produced seven systematic reviews covering 21 maternal and infant outcomes. Women who became more active had 45% lower odds of postpartum depression, 37% lower odds of urinary incontinence, and 28% lower odds of type 2 diabetes, with no increased injury risk and no effect on milk supply or infant growth.

If 120 minutes sounds impossible right now, the guideline says so directly: any movement toward the target improves your physical and mental health. Ten minutes counts.

When Can You Start, and Why the Six-Week Clearance Isn't the Whole Picture?

You can usually start gentle movement within days. What takes longer is the tissue underneath.

Here's what most women never get told. During delivery, the pelvic floor muscles stretch to roughly 250% of their resting length, and the abdominal wall reaches about 115% of its resting length by the end of pregnancy. The connective tissue running down the abdominal midline has stretched too, which is why diastasis recti and visible doming may still show up after medical clearance. Recovery of those muscles and their connective tissue generally takes four to six months. After a cesarean, the uterine scar is still remodeling at six weeks.

The six-week visit confirms you're healing safely. It was never designed to assess whether your deep core, abdominal midline, and pelvic floor coordinate well enough to absorb the force of running.

What You Can Start, and When

Two details in that table matter more than they look.

The 12-week mark isn't arbitrary. The guideline recommends returning to moderate activity within the first 12 weeks specifically because early movement protects your mental health, not only your fitness.



Bleeding is a signal, not a nuisance. If it picks up after you increase activity, your body is reporting that you outpaced your healing.

This stage is when women often come to me for pregnancy and postpartum physical therapy, usually after being told everything looks fine while something still feels wrong.

How Do You Know You're Progressing Safely, Not Pushing Through?

The guideline's most useful instruction is that progression should be individualized, gradual, and symptom-based. Your body sets the pace, not a calendar.

The consequences of ignoring that are measurable:

That last line is the one I want you to sit with. Symptoms you push past now do not reliably resolve on their own.

Signals to slow down:

Leaking urine or a heavy, dragging feeling in your pelvis. Your pelvic floor is not managing the pressure the activity created.

Tailbone, pubic bone, or SI joint pain during or after movement. The pelvis is a closed ring. Pain at the front usually means the back is compensating, and the reverse is also true.

Symptoms that appear 24 to 48 hours later. Delayed onset is common with pelvic floor strain, which is exactly why "I felt fine during my run" is not proof the run was appropriate.

A visible ridge or doming down the center of your belly during effort. Your abdominal wall is not yet managing tension across the midline. 

You may notice it when sitting up, getting out of bed, lifting your baby, coughing, or doing strength work. Doming often appears with diastasis recti, but it is not proof that you damaged the tissue. It shows that the current movement is creating more outward pressure than the abdominal wall is controlling, so the breathing, position, range, or load needs adjusting.

A practical benchmark before adding impact: walk 30 minutes with no symptoms during or in the two days after. If walking still provokes something, running will provoke more.

Where Does Pelvic Floor Physical Therapy Fit Into This?

The guideline answers this itself. It recommends that instruction on pelvic floor muscle training come from a pelvic floor physiotherapist, and separately lists pelvic floor and abdominal wall function as areas warranting professional support even without a formal diagnosis. National guidelines rarely name a specific profession that plainly.

Here's what women's pelvic floor physical therapy in Houston, Texas looks like in my practice: treating the pelvic floor and abdominal wall as parts of the same pressure-management system.

Rebuilding Pressure Control, Not Only Doing More Kegels

More Kegels can make some symptoms worse. Plenty of women arrive having done them faithfully for months with no improvement. Often the muscles are already holding too much tension, and more contraction on a muscle that never fully lets go raises the pressure instead of relieving it. Your breathing, abdominal wall, and pelvic floor may also be poorly coordinated when you lift, cough, or exercise. That is why leaking, diastasis recti, and doming are not managed with one standard set of Kegels. Assessment tells us whether you need release work, strengthening, breathing changes, movement retraining, or a combination. That distinction sits at the center of the women's urinary incontinence therapy in Spring Branch that I provide.

Pain or Doming That Only Shows Up When You Move

Tailbone pain when you sit, pubic bone pain when you roll over, a deep ache in one buttock when you lift your baby. These come from load moving through a pelvis that hasn't regained its stability, and they respond well to hands-on work paired with retraining how you move. The same principle applies when your abdominal midline domes during rolling, lifting, or exercise. We adjust the breathing, position, range, or load and then build the movement back up as your control improves. I treat this as pregnancy pelvic and tailbone therapy in Houston, and it's among the most common reasons women reach me.

A Plan That Follows Your Symptoms

An evaluation with me covers four things:

• How your pelvic floor muscles behave: tone, strength, and whether they can release, assessed externally or internally depending on your comfort
• How your breathing, deep core, abdominal midline, and pelvic floor coordinate during lifting, coughing, getting out of bed, and exercise
• Where pressure and load are going through your abdominal wall, back, hips, and pelvis
• What your specific goals are, whether that's lifting your baby without wincing or getting back to running

Every session is one-on-one in my home-based practice in West Memorial. No shared waiting rooms, no rushed appointments, and treatment starts at your first visit rather than a separate evaluation appointment. Most clients notice meaningful change within three to four visits.

With more than 40 years in physical therapy and 15 focused entirely on pelvic health, my job is telling you what your body specifically needs, the part a general clearance can't give you.

Your Recovery Isn't a Date on a Calendar

The most valuable thing in this guideline isn't the 120-minute target. It's the instruction that progression should be individualized and symptom-based, because that finally matches what I see in practice. Two women cleared on the same day are rarely ready for the same thing.

If you're unsure what your body is ready for, or something still feels off months later, that's reason enough to get looked at properly. That includes leaking, pain, heaviness, or a midline that domes every time you lift. I provide private, one-on-one postpartum physical therapy in Spring Branch, Memorial, Bellaire, and across the Houston area, with new patients typically seen within two weeks.

Call me at (281) 728-4604 to schedule your evaluation.

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