Aerobic exercise, maternal self-esteem, and physical discomforts during pregnancy

Evaluation of Physical Activity Level and Related Factors in Pregnancy During the COVID-19 Period

Objectives: It was aimed to determine the level of physical activity and related factors in pregnant women. Methods: The study is a mixed methods study. The participants are women applied to the pregnancy outpatient clinic of a hospital. The level of physical activity was assessed with the Pregnancy Physical Activity Questionnaire. Sociodemographic questions and seven questions of the International Physical Activity Environment Module were asked. Besides, in-depth interviews were conducted with 14 women. Results: The study was conducted with 304 women. The median age was 29.0 (18.0-40.0) years. The mean total activity and sedentary activity scores were 195.8 ± 107.9 and 37.22 ± 31.08 MET-hours/week, respectively. Pregnant women were mostly involved in light-intensity and housework/caregiving activities. Most of the participants mentioned that they were less active than pre-pregnancy period. The most common reasons for being less active were weakness, fatigue, lack of time and complaints such as low back pain and nausea. Conclusion: More than half of the pregnant women mentioned that they were less active during pregnancy. Thus, interventions should be planned to increase physical activity level of pregnant women.

Effect of prepartum exercise on lying behavior, labor length, and cortisol concentrations

The objective of this study was to assess the effect of exercise and pasture turnout on lying behavior, labor length, and cortisol concentrations around the time of parturition in dairy cows. Twenty-nine primiparous and 31 multiparous, pregnant, nonlactating Holstein (n = 58) and Jersey × Holstein cross (n = 2) dairy cows were assigned to control (n = 20), exercise (n = 20), or pasture (n = 20) treatments at dry-off using rolling enrollment. Control cows remained in the dry cow group pen. Exercise cows were removed from the dry cow group pen 5 times per week and walked for 1.4 ± 0.1 h at 1.88 ± 0.58 km/h. Pasture cows were moved to an outdoor paddock 5 times per week for 1.8 ± 0.3 h/d. Cows were housed in deep-bedded sand freestalls in a naturally ventilated, 4-row freestall barn. Cows were moved into maternity pens on the day of projected calving or when cows displayed signs that calving was imminent (restlessness, raised or lifted tail, ruptured amniotic sac, or swollen vulva), and treatments were discontinued. Cameras continuously recorded cows from entry into the pen until farm staff noted a calf, and one observer continuously watched video for two visually observable periods throughout the calving process: time from initial observation of amniotic sac to initial observation of calf's feet, and time from initial observation of calf's feet to full expulsion of calf. Assisted calvings were excluded. Accelerometers were attached to the rear fetlocks of cows 3 d before dry-off and removed 14 d postpartum. Activity was summarized by day for the 7 d before and after delivery time recorded from video observation into lying time (hours per day), lying bout frequency (bouts per day), lying bout duration (minutes per bout), and steps (number per day). Plasma total cortisol concentration was measured on d 0 and 3 postpartum and determined by a radioimmunoassay procedure using a commercially available kit. Data were analyzed using mixed linear model. During calving, time from appearance of the amniotic sac to appearance of the calf's feet was longer for pasture cows compared with control. Control cows engaged in fewer lying bouts and less overall lying time compared with pasture and exercise cows. Cortisol concentrations were higher on the day of calving compared with 3 d later, regardless of treatment. Understanding the effects of lying alterations around calving and increases in labor period length may allow for physical activity recommendations for late-gestation dairy cows.

Experiences of physical activity during pregnancy resulting from in vitro fertilisation: an interpretative phenomenological analysis

OBJECTIVE

To explore the qualitative experiences and decision-making processes surrounding physical activity (PA) for women who have undergone IVF treatment.

BACKGROUND

PA during pregnancy is safe for both mother and fetus in the majority of cases, including for women who have undergone in vitro fertilisation (IVF) treatment; however, there is a paucity of research into decision-making and PA in this population.

METHODS

Eight women, who had undergone successful IVF treatment and were currently pregnant or had given birth within the last two years, participated in semi-structured interviews about their experiences of infertility and PA during pregnancy. Interview transcripts were analysed using interpretative phenomenological analysis.

RESULTS

Three superordinate themes emerged from the data: 'navigating away from childlessness and towards motherhood', 'negotiating a safe passage' and 'balancing the challenges of pregnancy with the needs of the self'. Ten subthemes indicated the processes adopted to navigate experiences of infertility, the IVF process, and subsequent decision-making about PA during pregnancy.

CONCLUSION

PA during pregnancy was experienced as a way to soothe the self and control the experience of pregnancy; however, this was mediated by concerns about safety and physical limitations on PA. Limitations of the study are considered, as well as implications for clinical practice and directions for future research.

Non-occupational physical activity during pregnancy and the risk of preterm birth: a meta-analysis of observational and interventional studies

A meta-analysis was conducted to evaluate the association between non-occupational physical activity (PA) during pregnancy and the risk of preterm birth (PTB). By searching PubMed and EMBASE from inception to August 20, 2016, 25 observational studies (18 cohorts and 7 case-controls) and 12 interventional studies were identified. Comparing the highest to the lowest category of leisure-time PA during pregnancy, the pooled relative risk (RR) of PTB was 0.83 [95% confidence interval (CI) = 0.74-0.93] for cohort studies and 0.60 (95% CI = 0.43-0.84) for case-control studies. No overall significant association was found between domestic or commuting PA and the risk of PTB. In addition, PA intervention did not indicate significant beneficial effect on the risk of PTB. Evidence from the observational studies suggested that leisure-time, but not domestic or commuting, PA during pregnancy was inversely associated with the risk of PTB. The findings were not supported by small-scale and short-term interventional studies. Further research with objective measurement on leisure-time PA is warranted.

mHealth Physical Activity Intervention: A Randomized Pilot Study in Physically Inactive Pregnant Women

INTRODUCTION

Physical inactivity is prevalent in pregnant women, and innovative strategies to promote physical activity are strongly needed. The purpose of the study was to test a 12-week mobile health (mHealth) physical activity intervention for feasibility and potential efficacy.

METHODS

Participants were recruited between December 2012 and February 2014 using diverse recruitment methods. Thirty pregnant women between 10 and 20 weeks of gestation were randomized to an intervention (mobile phone app plus Fitbit) or a control (Fitbit) group. Both conditions targeted gradual increases in physical activity. The mHealth intervention included daily messages and a mobile phone activity diary with automated feedback and self-monitoring systems.

RESULTS

On monthly average, 4 women were screened for initial eligibility by telephone and 2.5 were randomized. Intervention participants had a 1096 ± 1898 step increase in daily steps compared to an increase of 259 ± 1604 steps in control participants at 12 weeks. The change between groups in weekly mean steps per day during the 12-week study period was not statistically significant (p = 0.38). The intervention group reported lower perceived barrier to being active, lack of energy, than the control group at 12-week visit (p = 0.02). The rates of responding to daily messages and using the daily diary through the mobile app declined during the 12 week study period.

DISCUSSION

It was difficult to recruit and randomize inactive women who wanted to increase physical activity during pregnancy. Pregnant women who were motivated to increase physical activity might find using mobile technologies in assessing and promoting PA acceptable. Possible reasons for the non-significant treatment effect of the mHealth intervention on physical activity are discussed. Public awareness of safety and benefits of physical activity during pregnancy should be promoted. Clinicaltrials.Gov Identifier NCT01461707.

Prediction and prevention of Gestational Diabetes: an update of recent literature

A diagnosis of Gestational Diabetes (GDM) confers adverse risk to the health of the mother and fetus both in pregnancy and later life. The background rate in pregnancy varies between 2 and 14% with incidences reported to be as high as 40% in obese populations. GDM diagnoses are escalating because of rising numbers of overweight and obesity in the reproductive age group but also because of different screening and diagnostic criteria. Lifestyle modification in those diagnosed with GDM has been proven to be an effective treatment in attenuating the metabolic dysregulation associated with this and potentially avoiding the need for medical therapy with either metformin or insulin. Emerging evidence in previous years suggests lifestyle interventions (dietary±physical activity and behavior modification) either pre-pregnancy or antenatally may reduce the incidence of GDM. The first trimester is also becoming an important interrogation period for the prediction of many adverse obstetric outcomes including abnormal glucose metabolism. This review outlines the most contemporary evidence on the prediction and non-pharmacological antenatal prevention strategies used for Gestational Diabetes.

Association of physical activity and sedentary behavior with biological markers among U.S. pregnant women

BACKGROUND

To examine the association between objectively measured light-intensity and moderate-to-vigorous-intensity physical activity (MVPA), sedentary behaviors, and biological markers in a national sample of U.S. pregnant women, as few studies have examined these relationships among this population.

METHODS

The sample of noninstitutionalized U.S. civilians was selected by a complex, multistage probability design. Data from the 2003-2006 National Health and Examination Survey were used. Two hundred six pregnant women were included in the data analysis. Physical activity and sedentary data were objectively measured via accelerometry (ActiGraph 7164). Biomarker data was obtained in the mobile examination center from urine, blood samples, blood pressure, and anthropometric measurements. Urine and blood samples were obtained to determine pregnancy status, C-reactive protein (CRP), high-density lipoprotein (HDL) cholesterol, total cholesterol, and cotinine as well as fasting glucose, fasting triglycerides, and fasting low-density lipoprotein (LDL) cholesterol data. Multivariable regression was employed to examine the association between physical activity, sedentary behavior, and biomarker levels.

RESULTS

There was a positive association between sedentary behavior and CRP levels (beta coefficient [b]=0.001, p=0.02) and LDL cholesterol (b=0.12, p=0.02). There was an inverse association between light-intensity physical activity and CRP (b=-0.003; p=0.008) and diastolic blood pressure (b=-0.03; p=0.02), with those engaging in higher levels of MVPA having higher HDL cholesterol (b=6.7; p=0.01).

CONCLUSION

Physical activity and sedentary behavior were favorably associated with various biomarkers among pregnant women, suggesting that healthcare providers should encourage pregnant women to participate in safe forms of physical activity behaviors while also reducing their amount of time spent in sedentary behaviors.

Influence of a single physical exercise class on mood states of pregnant women

The aim of the research was to define the influence of a single physical exercise class on mood states of pregnant women and to establish the socio-demographic and personality predictors of mood changes. The sample was comprised of a total of 109 pregnant women aged 19-37 years. Of the group, 62 women participated in physical exercise for pregnant women (the experimental group) and 47 women participated in traditional childbirth education classes (the control group). Emotional states were assessed with the UWIST Mood Adjective Checklist; personality traits were measured with the NEO-FFI, LOT-R and STAI questionnaires. Socio-demographic data were collected with a survey developed by the authors. A single physical exercise class improved the emotional state of pregnant women significantly more than a traditional childbirth education class. Within the experimental group, a significant improvement of mood was observed in all dimensions, while in the control group only hedonic tone increased. Greater improvements in mood can be expected in a group of women who are younger, less optimistic, and who evaluate their health better but physical fitness worse. As a single session of exercise helps improve the mood of pregnant women, this may be an effective strategy to prevent the deterioration of mood state during pregnancy.

Development of a scale for pregnancy-related discomforts

AIM

The purpose of this study was to develop a new scale of pregnancy-related discomforts for evaluating expectant women's psychosomatic states during each trimester.

METHODS

The study population comprised 786 expectant women (response rate: 38.2%) who underwent antenatal examinations in 13 hospitals located in eight regions of Japan. Respondents answered questions about the incidence of 95 well-known symptoms related to pregnancy. Responses were divided into three groups based on the gestational period. Three scales were then prepared based on item and factor analyses, and reliability and validity were confirmed.

RESULTS

The resultant global scales for the first, second, and third trimester consisted of 15, 13, and 13 items, respectively. The three global scales could be divided into three, three, and two subscales, respectively. The reliability coefficients of the global and subscales were 0.7 or more. Validity was confirmed by the conventional group method.

CONCLUSIONS

This is the first study to develop scales for pregnancy-related discomforts in Japanese women in order to evaluate psychosomatic states during each trimester of pregnancy. Because the number of scale items had decreased by more than half as compared to previous scales, this new, more feasible scale may be useful in clinical settings.

Antenatal depression: a rationale for studying exercise

BACKGROUND

Major depressive disorder (MDD) in pregnancy or antenatal depression poses unique treatment challenges and has serious consequences for mothers, unborn babies, and families when untreated. This review presents current knowledge on exercise during pregnancy, antidepressant effects of exercise, and the rationale for the specific study of exercise for antenatal depression.

METHOD

A systematic literature review was performed using English language articles published in Medline, PsycINFO, CINAHL, and the Cochrane Library from 1985 to January 2010.

RESULTS

There is a broad literature supporting the antidepressant effects of exercise, but a paucity of studies specifically for antenatal depression. A small number of observational studies have reported that regular physical activities improve self-esteem and reduce symptoms of anxiety and depression during pregnancy. To date, there have not been randomized controlled studies of exercise for the treatment of MDD in pregnant women.

CONCLUSIONS

Systematic studies are needed to assess exercise as a treatment alternative for MDD during pregnancy. In consideration of the benefits of exercise for the mother and baby, and the burden of depression, studies are needed to determine the role of exercise for pregnant women with depression.

Exercise in obese pregnant women: the role of social factors, lifestyle and pregnancy symptoms

Background

Physical activity may reduce the risk of adverse maternal outcomes, yet there are very few studies that have examined the correlates of exercise amongst obese women during pregnancy. We examined which relevant sociodemographic, obstetric, and health behaviour variables and pregnancy symptoms were associated with exercise in a small sample of obese pregnant women.

Methods

This was a secondary analysis using data from an exercise intervention for the prevention of gestational diabetes in obese pregnant women. Using the Pregnancy Physical Activity Questionnaire (PPAQ), 50 obese pregnant women were classified as "Exercisers" if they achieved ≥900 kcal/wk of exercise and "Non-Exercisers" if they did not meet this criterion. Analyses examined which relevant variables were associated with exercise status at 12, 20, 28 and 36 weeks gestation.

Results

Obese pregnant women with a history of miscarriage; who had children living at home; who had a lower pre-pregnancy weight; reported no nausea and vomiting; and who had no lower back pain, were those women who were most likely to have exercised in early pregnancy. Exercise in late pregnancy was most common among tertiary educated women.

Conclusions

Offering greater support to women from disadvantaged backgrounds and closely monitoring women who report persistent nausea and vomiting or lower back pain in early pregnancy may be important. The findings may be particularly useful for other interventions aimed at reducing or controlling weight gain in obese pregnant women.

A prospective investigation of the relationships among sleep quality, physical symptoms, and depressive symptoms during pregnancy

The aim of this study was to examine the prospective relationship between pregnancy physical discomforts experienced during the second trimester and late pregnancy depressive symptoms, as well as the mediating effect of sleep quality on antenatal depressive symptomatology. Healthy pregnant women (N=257) completed the Physical Symptoms Questionnaire, the Beck Depression Inventory, and the Pittsburgh Sleep Inventory at early-mid second trimester, and then again at late third trimester. Physical symptoms and sleep quality at the first time point were both correlated moderately with depressive symptoms at late pregnancy. Discomfort associated with physical symptoms was a better predictor of depressive symptoms than Frequency of symptoms, although a score combining Frequency, Discomfort and Effect of symptoms on life was the strongest predictor of depressive symptoms. Results of the hierarchical regression analyses of the mediation model indicated that physical symptoms at early-mid second trimester predicted depressive symptoms in the last trimester both directly, and via poor sleep quality (prospectively), which mediated the relationship. The clinical implications of these findings for antenatal care are discussed.

Exercise and pregnancy

Exercise is an important component of a healthy lifestyle and, as such, is recommended during pregnancy. However, the response to exercise of both the expectant mother and fetus varies depending on the fitness level of the woman. The response to exercise is also affected by the known musculoskeletal and physiologic changes associated with pregnancy, such as increased ligament laxity, weight gain, change in the center of gravity, and carpal tunnel syndrome. Although the physiologic responses of the pregnant woman and fetus have been well studied, the literature contains comparatively few studies investigating response to exercise. When performed properly, activities such as aerobics, impact and nonimpact activities, resistance training, and swimming may be beneficial during pregnancy.

How well do women adapt to changes in their body size and shape across the course of pregnancy?

This study examined body image across pregnancy. Pregnant women ( N = 158) completed measures of general attractiveness, feeling fat, fitness and strength, salience of weight and shape, and ideal and current body size at pre-pregnancy (retrospective), and in early, middle and late pregnancy. Body image was found to be fairly stable across pregnancy such that women who started with greater body concerns maintained them over time. Although women were least satisfied with their stomach size at late pregnancy, women's ideal body shape increased in parallel with increases in body size. Women with the most body concerns reported more depressive symptoms, tendency towards dieting, and smoking during pregnancy suggesting they were at greater risk in terms of health and well-being during pregnancy.

Examination of a multi-factorial model of body-related experiences during pregnancy: the relationships among physical symptoms, sleep quality, depression, self-esteem, and negative body attitudes

The aim of this cross-sectional study was to investigate relationships among women's body attitudes, physical symptoms, self-esteem, depression, and sleep quality during pregnancy. Pregnant women (N=215) at 15-25 weeks gestation completed a questionnaire including four body image subscales assessing self-reported feeling fat, attractiveness, strength/fitness, and salience of weight and shape. Women reported on 29 pregnancy-related physical complaints, and completed the Beck Depression Inventory, Rosenberg Self-esteem Scale, and Pittsburgh Sleep Quality Index. In regressions, controlling for retrospective reports of body image, more frequent and intense physical symptoms were related to viewing the self as less strong/fit, and to poorer sleep quality and more depressive symptoms. In a multi-factorial model extending previous research, paths were found from sleep quality to depressive symptoms to self-esteem; self-esteem was found to be a mediator associated with lower scores on feeling fat and salience of weight and shape, and on higher perceived attractiveness.

Impact of physical activity during pregnancy and postpartum on chronic disease risk

Research over the past 20 years has focused on the safety of physical activity during pregnancy. Guidelines for health care providers and pregnant/postpartum women have been developed from the results of these studies. The overwhelming results of most studies have shown few negative effects on the pregnancy of a healthy gravida, but rather, be beneficial to the maternal-fetal unit. Recently, researchers have begun to consider the role of maternal physical activity in a more traditional chronic disease prevention model, for both mother and offspring. To address the key issues related to the role of physical activity during pregnancy and postpartum on chronic disease risk, the American College of Sports Medicine convened a Scientific Roundtable at Michigan State University in East Lansing, MI. Topics included preeclampsia, gestational diabetes, breastfeeding and weight loss, musculoskeletal disorders, mental health, and offspring health and development.

A Review of Physical Activity Patterns in Pregnant Women and Their Relationship to Psychological Health

Regular physical activity contributes positively to physical and psychological health. Adverse consequences of inactivity may be an especially important problem among pregnant women. Up to 60% are inactive during pregnancy. This review found consistent evidence that physical activity is reduced during pregnancy; however, few investigators have sought to quantify physical activity patterns among pregnant women using well validated measures. Some of the barriers to physical activity during pregnancy, such as depression, anxiety and fatigue, have been shown to be attenuated by regular exercise performed by non-pregnant samples. There is a need to better understand the relationships between these factors and physical activity during pregnancy. Available retrospective and prospective results suggest that both leisure time and work-related physical activities are decreased across pregnancy. Intensity and duration decrease both during pregnancy compared with pre-pregnancy and in the third trimester compared with the first. There is a need for well designed longitudinal investigations that document pregnancy-related changes in physical activity at frequent intervals during pregnancy using validated and more precise measures of physical activity. Reductions in physical activity and a worsening mood are common during pregnancy. If the relationship between physical inactivity and mood disturbances is indeed observed and maintained during pregnancy, then decreases in physical activity in the third trimester would be expected to result in a worsening mood. In recent years, increased attention has been paid to antenatal mood disturbances, and this research has yielded a host of important findings. Prior correlational and experimental research with non-pregnant samples has demonstrated a consistent relationship between physical inactivity and mood disturbances. Whether this relationship occurs among pregnant women and/or is maintained as women progress during pregnancy is uncertain. Prior investigations have revealed that there is higher rate of mood disturbance during pregnancy than following pregnancy but little is known about the mechanisms that cause these mood disturbances. It is important to better understand changes in mood with pregnancy because mood disturbances can have major negative consequences for a pregnant woman. The major adverse consequences of depression among pregnant women are largely the same as those of non-pregnant individuals. Only six investigations have quantified the relationship between changes in physical activity and changes in mood during pregnancy. The available evidence suggests that inactivity is associated with worse mood. Additional research into this topic is warranted due to the limited number of published papers and the design and methodology limitations of these investigations.

Physical activity and mood during pregnancy

PURPOSE

To compare three physical activity (PA) measures in pregnant women and examine mood correlates of physical activity changes during pregnancy.

METHODS

A sample of 12 pregnant women (PW) was recruited during their first trimester and 12 nonpregnant women (NPW) (baseline age = 30.7 +/- 4.4 yr) were matched to the PW (29.8 +/- 4.2 yr). Once monthly, for seven consecutive months, total weekly energy expenditure (TWEE) was assessed using a physical activity diary (PAD) and a recall interview (PAR). Accelerometers were worn for 3 d each month. Mood was also assessed. A two-factor mixed-model ANOVA was used to analyze the data (2 groups [PW vs NPW] x 7 times across pregnancy).

RESULTS

Mean PAR TWEE and daily mean MTI counts were positively and moderately correlated with mean PAD TWEE (PW: r = 0.40 and NPW: r = 0.50, P < 0.001). The MTI counts decreased significantly in PW by 23% from gestational weeks 12 to 36 compared with a 5% decrease in NPW. Fatigue and vigor scores improved from gestational weeks 12 to 16 and worsened from weeks 32 to 36 in PW. Changes in PA were not correlated to changes in mood in either group.

CONCLUSIONS

The results provide some evidence for the validity of the 7-d PAR and accelerometer as measures of physical activity in pregnancy. Healthy women who maintain an above average level of physical activity during the second and third trimesters can enjoy mood stability.

Immediate blood pressure changes and aquatic physiotherapy

OBJECTIVE

No studies to date have examined the effect on Blood pressure (BP) when pregnant women participate in aquatic physiotherapy (AP) classes; although, previous studies have indicated that there may be a detrimental outcome to the pregnant mother and fetus when there is a significant rise in the maternal BP. At least three components may contribute to BP changes: temperature, exercise, and immersion. This study examines BP changes in pregnant women attending AP classes.

METHOD

An experimental same-subject, repeated measures design was employed. Forty-five sets of data were collected from pregnant women attending routine, existing, nonaerobic AP classes. Blood pressure measurements were taken preimmersion, 2-5 minutes after entering the pool, immediately following the 50 minute AP class (while immersed), and 8-12 minutes after exiting the water.

RESULTS

Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) data were analyzed using a repeated measures analysis of variance (ANOVA). For all sets of data a highly significant difference was observed (p = 0.0000). Post-hoc Tukey test results showed BP to decrease significantly on entering the water (MAP mean difference of 10.52 mm Hg, 95% CI 8.75 to 12.29), to remain at this low level postexercise while still immersed, and then return to preimmersion values 8-12 minutes after exiting the water.

CONCLUSION

These results indicate that AP classes are safe for nonhypertensive pregnant women in their third trimester. The use of AP in the antenatal care of women with unstable BP or who are hypertensive needs further research.

Women's behaviour, beliefs and information sources about physical exercise in pregnancy

OBJECTIVE

To examine the potential effect of low-risk pregnancy on women's recreational activity patterns and to explore pregnant women's beliefs and information sources regarding physical exercise participation.

DESIGN

Preliminary, prospective survey

SETTING

Participants' homes in the East Midlands, UK.

PARTICIPANTS

Fifty-seven nulliparous, pregnant women.

MEASUREMENTS

Levels of maternal physical activity participation were assessed by semi-structured interview at 16, 25, 34 and 38 weeks gestation. The modified Baecke questionnaire provided a measure of women's habitual sport and leisure activities in the 12 months prior to pregnancy. A 10-item scale assessed maternal beliefs regarding the importance of physical activity in pregnancy. The fetal health locus of control scale measured the extent to which women believed their own behaviour, the behaviour of others and/or chance would influence fetal health. Open-ended questions assessed women's information sources.

FINDINGS

Fourteen of the 36 (39%) women who reported participating in some form of weekly exercise before pregnancy did not report pursuing any similar activities during pregnancy. Rest and relaxation were perceived as being significantly more important during pregnancy than was regular exercise or the maintenance of an active lifestyle. Fifty-five respondents (96%) indicated that they had received advice about physical activity at least once during pregnancy. At 16 weeks gestation, women obtained most of their information from books and magazines. Between 25 and 38 weeks gestation, most advice came from family and friends. Participants who reported receiving this advice were significantly older, more educated and of a higher activity level pre-pregnancy.

KEY CONCLUSIONS

Levels of maternal exercise may decline during pregnancy both as a result of the physical changes of pregnancy and from a combination of social and psychological factors. Present health education may be failing to correct inaccurate perceptions of the risks associated with physical exercise in pregnancy.

IMPLICATIONS FOR PRACTICE

Improving the quantity and quality of information related to physical exercise has the potential to correct inaccurate perceptions and confer several benefits on maternal and fetal health. Effective intervention strategies should focus not only on the pregnant woman but also extend to her family, friends and exercise provider.

Correlates of recreational physical activity in early pregnancy

OBJECTIVE

Despite the well-documented benefits of a physically active lifestyle, over 25% of American adults report that they never engage in regular recreational physical activity. Little is known about the determinants of physical activity among pregnant women. We investigated the predictors of physical activity in 386 normotensive pregnant women.

METHODS

Participants provided information about the type, frequency and duration of each physical activity performed during the first 20 weeks of pregnancy. We calculated odd ratios (OR) for active compared with inactive women using logistic regression models.

RESULTS

Approximately 61% of women reported participating in some regular physical activity during pregnancy. Walking, swimming, gardening and jogging were the most common activities. Physical activity as an adolescent (OR 4.0) and during the year before pregnancy (OR 48.9) were the strongest predictors of physical activity in pregnancy. Active women who continued to exercise during pregnancy decreased the average intensity of their exercise and the weekly duration of exercise compared with the year before pregnancy. Nulliparas were twice as likely to engage in physical activity as compared with multiparas. Education and income were positively related with physical activity. Non-White women were 40-60% less likely to engage in physical activity as compared with White women. Smokers were also less likely to engage in physical activity. High protein intake was positively associated with physical activity, while the opposite was true for high carbohydrate intake.

CONCLUSIONS

The identification of determinants of physical activity in pregnancy has important implications for developing strategies aimed at promoting a physically active lifestyle among young women.

Changes in body image satisfaction during pregnancy: a comparison of high exercising and low exercising women

OBJECTIVE

This study aimed to compare ratings of body image satisfaction (BIS) from 6 months prepregnancy to 23-30 weeks' gestation for high exercising and low exercising pregnant women. The authors also aimed to assess and compare expectations of BIS for the post-partum period in high and low exercising women.

DESIGN

A partial prospective approach was implemented.

SAMPLE

A total of 71 healthy pregnant women (40 high exercisers and 31 low exercisers) participated.

METHODS

Participants completed a series of questionnaires at 15-22 weeks' gestation and 23-30 weeks' gestation.

MAIN OUTCOME MEASURES

There were two main outcome measures. At 15-22 weeks' gestation there was an exercise inventory and two versions of the Body Cathexis Scale (BCS) (retrospective prepregnancy BIS and current BIS). At 23-30 weeks' gestation there was an exercise inventory and two versions of the BCS (current BIS and projected post-partum BIS).

RESULTS

At 15-22 weeks' gestation, high exercisers demonstrated significantly higher levels of BIS compared to low exercisers. There were no other significant differences between groups. Within groups, high exercisers were significantly more satisfied with their bodies at 15-22 weeks' gestation compared to 6 months prepregnancy, and expected to be less satisfied with their bodies at 6 weeks' post-partum than they were during pregnancy. Low exercisers demonstrated no significant changes over time.

CONCLUSIONS

The findings suggest that women are able to assimilate the bodily changes of pregnancy without a negative shift in BIS. However, women who exercise during pregnancy may respond more favourably to changes in their bodies at early pregnancy compared to women who remain sedentary.

Exercise-related changes in umbilical and uterine artery waveforms as assessed by Doppler ultrasound scans

OBJECTIVE

The purpose of this study was to assess the effect of strenuous symptom-limited exercise on umbilical and uterine blood flow.

STUDY DESIGN

Twenty-two primiparous women between 30 and 34 weeks of gestation were recruited. At rest, umbilical and uterine artery waveforms were assessed by measuring the pulsatility index. This was followed by a symptom-limited incremental exercise test. Fetal umbilical and maternal uterine artery circulations were assessed after exercise.

RESULTS

Strenuous maternal exercise was demonstrated by the significant change in physiologic parameters, which was associated with an immediate increase in fetal heart rate, a significant increase in the right uterine artery pulsatility index, and a reduction in the umbilical artery pulsatility index.

CONCLUSION

The modest change in the uterine artery pulsatility index without an adverse change in the umbilical artery pulsatility index indicates that a single bout of maximum symptom-limited exercise does not have immediate adverse fetal or maternal cardiovascular effects.

The benefits of physical activity during pregnancy

The aims of this paper are (1) to comment on the evidence relating to the health risks and benefits of physical activity (PA) for pregnant women and their unborn foetuses. and (2) to discuss the public health benefits of participation in appropriate physical activity during pregnancy. Evidence from recent original research and review papers suggests that there are potential benefits of appropriate PA in terms of maternal weight control and fitness, which are likely to have significant long term public health benefits. Concerns about the potential ill-effects of PA during pregnancy, such as hyperthermia, shortened gestational age and decreased birth weight are not supported by the most recent scientific reviews. The physiological adaptations to exercise during pregnancy appear to protect the foetus from potential harm and, while an upper level of safe activity has not been established, the benefits of continuing to be active during pregnancy appear to outweigh any potential risks. All decisions about participation in physical activity during pregnancy should however be made by women in consultation with their medical advisers.

Predictors of pregnancy-associated change in physical activity in a rural white population

OBJECTIVE

The objective of this study was to examine the relationship of sociodemographic and psychosocial characteristics and exercise prior to pregnancy to change in physical activity (PA) during pregnancy.

METHODS

This study was part of the Bassett Mothers' Health Project (BMHP), a prospective cohort study of women who enrolled for prenatal care in the Bassett Healthcare system between November 7, 1994, and November 15, 1996. Six hundred twenty-two women met the eligibility criteria and were enrolled in the study. Sociodemographic and psychosocial characteristics and exercise behavior were assessed prenatally using the medical record and an anonymous mailed questionnaire. Staged linear regression analysis was used to predict change in physical activity with the psychosocial and sociodemographic characteristics as the independent variables and prepregnancy exercise frequency as a control variable.

RESULTS

Women who were older, more educated, and had higher household incomes were more likely to exercise prior to pregnancy (p < .05). Change in PA after becoming pregnant was associated with prepregnancy exercise frequency (p < .001). Women who exercised frequently moderated their activity, while sedentary women maintained or increased their PA after becoming pregnant. Exercise self-efficacy (the belief in one's ability to exercise regularly) and body mass index (BMI) were positive predictors of change in PA (p < .05), while prepregnancy exercise frequency remained significant as a control variable.

CONCLUSION

Interventions that aim to help women maintain or increase their PA during the perinatal period should be designed to increase exercise self-efficacy.

Exercise in pregnancy

Exercise has become an integral part of the life styles of many women. However, many women stop exercising during pregnancy because of concerns regarding the well-being of the fetus. Although pregnancy is associated with several physiologic changes and response to exercise is different in the pregnant state than in the nonpregnant state, exercise can be beneficial to the pregnant woman in the absence of obstetric or medical complications. There are certain contraindications to exercise during pregnancy, including pregnancy-induced hypertension, preterm rupture of membranes, preterm labor, incompetent cervix, intrauterine growth retardation, and persistent second- or third-trimester bleeding. In addition, certain guidelines should be followed in order to prevent harmful effects on the fetus. This article reviews the maternal and fetal responses to exercise, benefits and potential risks of exercise during pregnancy, and recent guidelines for exercise during pregnancy. It is important to note, however, that objective data regarding exercise during pregnancy is limited and that further research is warranted regarding this topic.

Body image and psychological well-being in pregnancy. A comparison of exercisers and non-exercisers

This study compared the perceptions of body image and psychological well-being between exercising and non-exercising pregnant women. A prospective longitudinal study was conducted with 65 nulliparous women (mean age years = 30.3, range = 23-39) who were allocated to 2 groups based on level of recreational exercise participation; 25 exercisers were compared with 18 non-exercisers. A self-report exercise history questionnaire and a 10 item Body Cathexis Scale were completed on two occasions during the pregnancy, at approximately 17 weeks and 30 weeks of gestation. The General Health Questionnaire (GHQ-28) was administered in late pregnancy. There was a significant difference between the exercise group and the non-exercise group in late pregnancy for some items on the Body Cathexis Scale. The exercise group had a lower level of probable caseness on the GHQ-28 with reduced frequency of somatic symptoms, anxiety and insomnia, and a higher level of psychological well-being.

Exercise during pregnancy and type of delivery in nulliparae

OBJECTIVE

To assess the association between participation in aerobic exercise during the first two trimesters of pregnancy and type of delivery in nulliparous women.

DESIGN

Nonexperimental, retrospective.

SETTING

A large metropolitan area in the southwestern United States.

PARTICIPANTS

137 nulliparous women.

OUTCOME MEASURES

Method of delivery.

RESULTS

An unadjusted odds ratio showed that sedentary women (n = 93) were 2.05 times more likely to deliver via cesarean section than active women (n = 44), but this relationship was not statistically significant. Through logistic regression analysis with control for the mother's prepregnancy exercise program, age, use of epidural anesthesia, change in prepregnancy to delivery body mass index, labor length, whether labor was induced, and the hospital of birth, the odds of cesarean delivery were found to be 4.5 times greater for sedentary women than for active women.

CONCLUSION

Regular participation in physical activity during the first two trimesters of pregnancy may be associated with reduced risk for cesarean delivery in nulliparous women.

Physical activity and prevention and treatment of weight gain associated with pregnancy: current evidence and research issues

PURPOSE

The purpose of this study was to examine the evidence in the literature for a relationship between physical activity and weight development during and after pregnancy.

METHODS

A retrospective analysis of the literature, mainly based on an extended MEDLINE search and the Pregnancy and Childbirth Database (Cochrane), was conducted.

RESULTS

Weight development during pregnancy is the result of numerous interacting factors, with physical activity being one important determinant of weight outcome and eventually also overweight and obesity. Several methodological matters complicate the interpretation of the interrelationships: generally body weight and not fat has been measured, sociobehavioral confounders have rarely been accounted for, and the time frame to determine the effect of pregnancy on later weight development has been highly variable. Most studies concentrate on the role of physical activity, such as recreational activity and sports, on the safety of the pregnant mother and the fetus. The few studies that address the question of exercise and fat deposition found slightly a smaller increase in skinfold measures in pregnant women who exercised. Factors such as the self-selection of well-educated women under study and of normal body weight, as well as the lack of controls, limit the possibilities to which these results can be extrapolated.

CONCLUSION

Little information is available on these issues and the quality of information is at most at the evidence type D level, according to the NHLBI classification system. Future research priorities include proper prospective control trials of this important aspect of an obesity preventing life style tool, as well as studies concerning the preventive effects of physical activity on weight retention after pregnancy, an issue not as yet addressed in the literature.

Exercise during pregnancy: safe and beneficial for most

Regular, moderate exercise does not significantly affect length of gestation or birth weight, and it may ease pregnancy and labor. Active pregnant women should maintain adequate hydration and nutrition, avoid hyperthermia, and take precautions if obstetric or medical complications are present. Supine exercise, contact sports, high-altitude exertion, and scuba diving should be avoided, and some women, including those who lift weights or do high-impact exercise, may need to modify their routines. Most women can begin or continue to exercise during pregnancy.

Maternal physical activity in pregnancy and infant size for gestational age

PURPOSE

To estimate the effect of several types of maternal physical activity in pregnancy on size for gestational age and length of gestation.

METHODS

Telephone interviews, birth certificates, and medical records provided data on physical activity and other factors for a random sample of 291 Colorado residents. Backward polychotomous logistic regression modeling yielded estimates of the odds ratios for size for gestational age (appropriate versus small or large) and length of gestation (term versus pre-term or post-term) in relation to second and third trimester maternal physical activity.

RESULTS

Performance of any moderate or vigorous physical activity for two hours per week or more in any month was associated with a decreased risk of large infant size for gestational age (LGA; odds ratio = 0.3, 95% confidence interval = 0.2, 0.7), but had no significant effect on risk of small infant size for gestational age (SGA; odds ratio (OR) = 0.8, 95% confidence interval (CI) = 0.3, 2.3). Length of gestation was not affected by prenatal physical activity.

CONCLUSIONS

These results suggest that prenatal physical activity may decrease risk of LGA, as might be expected given its salutary effects on glucose tolerance.

Maternal leisure-time exercise and timely delivery

OBJECTIVES

This study investigated whether, in a general obstetric population, exercise in pregnancy affects the timeliness of delivery. The hypothesis was that maternal exercise would not raise the risk of preterm birth.

METHODS

A community cohort of 557 prenatal patients was followed up until the time of delivery. Data were collected on exercise in each trimester: none, low-moderate (< 1000 kcal [4184 kJ]/wk in energy expenditure), or heavy (> or = 1000 kcal/wk). Timely delivery was adopted as an outcome criterion. Thus, in the analysis, a term birth was treated as optimal and survival techniques were used to estimate risks for both preterm and postdates delivery.

RESULTS

No association was found between low-moderate exercise and gestational length. Heavier exercise appeared to reduce, rather than raise, the risk of preterm birth. The adjusted relative risk among conditioned heavy exercisers was 0.11 (95% confidence interval = 0.02, 0.81). After term, conditioned heavy exercisers delivered faster than nonexercisers.

CONCLUSIONS

The most important finding was the lack of evidence that vigorous maternal exercise is a risk factor for preterm delivery. A promising finding was that conditioned heavy exercisers have timely deliveries.

Development of a scale to measure discomfort during pregnancy

During pregnancy fundamental changes occur in a woman's body that make physical discomforts almost unavoidable. Extensive literature searches revealed that there was no psychometrically acceptable tool available to assess accurately maternal physical discomfort. This paper presents the procedures undertaken to develop the Maternal Physical Discomfort Scale (MPDS), an assessment instrument designed to quantify the type and number of maternal physical discomforts. The MPDS, a scale consisting of 36 items, was developed and psychometrically evaluated using factor analysis, item response theory and reliability measures. The initial version of the scale was validated by a sample of 307 pregnant women. Based on the result from this sample, the MPDS was modified to 33 items and validated by a further sample of 125 pregnant women. The MPDS developed in this study was demonstrated to have content and construct validity and to be reliable.

Antenatal exercise: a personal perspective

Antenatal exercise sessions are offered to pregnant women in a variety of ways by different professional groups. These include midwives, physiotherapists, swimming teachers, trained and non-trained exercise instructors. Several questions have to be asked. Have these exercise sessions kept apace with the demands of fit healthy pregnant women who wish to carry on exercising throughout their pregnancy? Are there contraindications? Who should teach the women? Is the research information now available and incorporated into advantageous exercise sessions that help pregnant women cope with the massive physiological adaptation that occurs throughout pregnancy and the postpartum period? This paper presents an overview of what is currently available and attempts to establish a framework for standard setting and teacher training. This would ensure uniformity of knowledge, prevent conflicting advice and give opportunity for interprofessional liaison and development.

Pregnancy outcome: physical activities inside versus outside the workplace

There is concern that the thermal, cardiovascular, metabolic, and biophysical changes which accompany physical activity may have detrimental effects on both mother and fetus. Research focused on physical activity in the workplace has identified four specific physical stresses (quiet standing, long hours, protracted ambulation, and heavy lifting) that are associated with an increased incidence of both prematurity and low birth weight. The physiological basis for these is believed to be that these activities cause intermittent but protracted reductions in uterine blood flow. Research focused on recreational physical activity during pregnancy has not identified similar associations. Indeed, these data indicate that the overall impact of regular recreational exercise on pregnancy outcome is positive for both mother and fetus. The physiological basis for these beneficial effects is believed to be that the interaction between the physiological adaptations to both exercise and pregnancy improve maternal cardiovascular reserve, maternal mechanisms for heat dissipation, and placental growth and functional capacity. Finally, there is preliminary evidence suggesting that the vibratory and auditory stimuli associated with regular recreational exercise may enhance functional maturation of the fetal brain.

Pregnancy outcomes among active and sedentary primiparous women

OBJECTIVE

To describe the relationship between exercise during the last trimester of pregnancy and physiologic outcomes of mothers and newborns to determine whether differences exist between active and sedentary exercise patterns on these variables.

DESIGN

Nonexperimental, descriptive.

SETTING

Physicians' offices, Lamaze classes, and hospitals.

PARTICIPANTS

One hundred one primiparous women (48 sedentary and 53 active), 20-30 years of age, with no medical complications, whose length of gestation was at least 32 weeks.

OUTCOME MEASURES

Weight gain, weeks of gestation, length of labor, common discomforts of pregnancy, occurrence of cesarean section, birth weight, and Apgar scores.

RESULTS

Brisk walking was the preferred physical activity among 47% of the participants. Regular, active exercise had no significant effect on maternal weight gain or neonate birth weight. Twenty-five percent of the women in the active exercise group reported five or fewer discomforts compared with 6% of the women in the sedentary group (X2 = 7.45, p < 0.01). For the discomforts of swelling, leg cramps, fatigue, and shortness of breath, 44% of the women in the active group reported having only one or two of them, compared with 21% of the women in the sedentary group (X2 = 6.15, p = 0.01).

CONCLUSION

Women who engaged in active exercise during the last trimester of pregnancy had fewer of the common discomforts associated with pregnancy.

The interaction between regular exercise and selected aspects of women's health

The public health initiative to increase women's participation in regular recreational exercise to the 90% level raises multiple theoretic concerns about its impact on the reproductive health of women. However, at all points in a woman's life the overall effect of regular exercise to appetite appears to be beneficial rather than harmful, and in the absence of other stressors, exercise performance must significantly exceed usual recreational levels to have an adverse effect on any aspect of a woman's reproductive life. Therefore even in elite athletes abnormalities of any part of the reproductive process (puberty, menstrual cyclicity, pregnancy, lactation, and menopause) should not be attributed solely to exercise without complete evaluation. While generally beneficial, the interaction between exercise and skeletal integrity is influenced by hormonal status and multiple exercise variables. Thus, whereas regular exercise at all ages appears to provide both short- and long-term benefit, the characteristics of the exercise regimen need to vary at different time points.

Aerobic exercise, psychological well-being, and physical discomforts during adolescent pregnancy

The effects of participation in a 6-week aerobic exercise program (AEP) on pregnant adolescents' depression, self-esteem, and physical discomforts of pregnancy were examined. The sample was comprised of 58 ethnically diverse subjects ranging in age from 14 to 20 years. Subjects in the AEP were observed to have a significant decrease in depressive symptoms over time and an increase in total self-esteem; those in the comparison group reported a significant increase in physical discomforts associated with pregnancy. These findings suggest that exercise programs such as the AEP should be considered an important aspect of prenatal self-care for healthy pregnant adolescents.