Abstract: Physical activity, a cost-effective nonpharmacologic intervention, has been recommended by Chinese and international clinical guidelines as a core component of the management of gestational diabetes mellitus (GDM). To develop this guideline, we preliminarily identified clinical questions through a systematic literature review and semi-structured stakeholder interviews and defined the key questions via 2 rounds of Delphi consultation. We performed systematic reviews and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for the clinical questions selected. Recommendations were developed and iteratively revised through Delphi consultation rounds and structured expert consensus meetings, resulting in 30 recommendations addressing 9 key clinical questions concerning physical activity management in GDM. This guideline offers systematic, practical, and evidence-based support for healthcare institutions to carry out assessment, guidance, and management of physical activity in patients with GDM, thereby improving maternal and neonatal outcomes.