Towards an Understanding of Change in Physical Activity from Pregnancy Through Postpartum

A socio-ecological model of factors influencing physical activity in pregnant women: a systematic review

Physical activity (PA) is safe for most pregnant women, improving both maternal fitness and birth outcomes. Despite evidence of benefits, most pregnant women eliminate or reduce PA during pregnancy. This systematic review aimed to analyze the factors affecting maternal PA during pregnancy with reference to a socio-ecological model. A systematic search of relevant published studies between 2001 and 2022 was conducted through PubMed, Scopus, Web of Science, Academic Search Ultimate, Medline, and SPORTDiscus with full text via the EBSCO platform. A total of 32 studies that met the inclusion criteria were reviewed. The findings revealed that various study designs can lead to different outcomes in terms of what is identified as a PA facilitator or barrier. The factors that positively influenced PA in pregnant women were: higher levels of education, knowledge, and skills, as well as access to mass media. Conversely, lower levels of education, lack of knowledge and skills, low income, pregnancy discomforts, limited time, safety concerns, and societal perceptions of PA in pregnancy acted as barriers. Additionally, family, colleagues/friends, and partners could either support or hinder PA. Factors affecting overall maternal PA were somewhat different from those affecting the moderate-to-vigorous intensity of PA. Pregnant women receive little organizational and policy support. There is an urgent need to provide accessible information and resource systems for pregnant women. Since most pregnant women are motivated to engage in PA and susceptible to family advice, interventions should not be limited only to pregnant women, but should involve a family member, especially partners. There is a need to take global, systemic actions to promote an active lifestyle in pregnancy. Addressing safety concerns related to PA during pregnancy should be a significant part of these promotional activities.

The Importance of Social Networks for Support and Health Beliefs throughout Pregnancy

Pregnancy is a unique time when health care providers have more regular contact with women. Using this time to more fully understand the social influences at play can provide physicians an opportunity to leverage networks to improve health and wellbeing while stemming the exposure to health misinformation. Advocating for supportive social networks or exercise groups/programs can provide additional support and behavioral reinforcement which is needed for sustained behavior change. In this manner, fostering these networks is likely more beneficial to supporting healthy exercise behavior during pregnancy than education alone.

The impact of COVID-19 on the physical activity and sedentary behaviour levels of pregnant women with gestational diabetes

Background

The aim of this study was to understand how physical activity and sedentary behaviour levels of pregnant women with gestational diabetes in the UK have been affected by COVID-19.

Methods

An online survey exploring physical activity and sedentary behaviour levels of pregnant women with gestational diabetes during COVID-19 was distributed through social media platforms. Women who had been pregnant during the COVID-19 outbreak and had gestational diabetes, were resident in the UK, were 18 years old or over and could understand written English were invited to take part.

Results

A total of 724 women accessed the survey, 553 of these met the eligibility criteria and took part in the survey. Sedentary time increased for 79% of the women during the pandemic. Almost half of the women (47%) were meeting the physical activity guidelines pre COVID-19 during their pregnancy, this dropped to 23% during the COVID-19 pandemic. Fear of leaving the house due to COVID-19 was the most commonly reported reason for the decline. Significant associations were found between meeting the physical activity guidelines during COVID-19 and educational attainment, fitness equipment ownership and knowledge of how to exercise safely in pregnancy.

Conclusions and implications

These results show the impact of COVID-19 on physical activity and sedentary behaviour levels and highlight the need for targeted public health initiatives as the pandemic continues and for future lockdowns. Women with gestational diabetes need to know how it is safe and beneficial to them to engage in physical activity and ways to do this from their homes if fear of leaving the house due to COVID-19 is a barrier for them. Online physical activity classes provided by certified trainers in physical activity for pregnant women may help them remain active when face-to-face appointments are reduced and limited additional resources are available.

Exercise Behaviors and Beliefs Among Pregnant Women in Rural Communities

Exercise during pregnancy is safe and beneficial; however, most pregnant women do not meet evidence-based exercise recommendations. Further, data on pregnant women's physical activity are largely limited to women living in urban environments.

PURPOSE

The purpose of this study is to examine beliefs and behaviors regarding exercise during pregnancy in pregnant and postpartum women living in rural communities.

METHODS

Surveys were distributed in healthcare settings and via social media to pregnant and postpartum (< 3 months) women living in rural communities.

RESULTS

Seventy-five women (28.1 ± 5.4 year) participated. Nearly all believed light (96%) and moderate (89%) intensity exercise are safe to perform during pregnancy, while fewer agreed vigorous intensity (52%) or resistance (40%) exercise is safe. Most (88%) believed women can continue their exercise regimen, and 73% believed that previously inactive women can begin training while pregnant. Only one-third of women met recommendations for cardiorespiratory exercise. The majority (66%) never engaged in vigorous exercise, and most (73%) did not participate in resistance exercise.

CONCLUSION

Pregnant women in rural communities participate in light intensity exercise, but are largely not meeting guidelines for aerobic or resistance training. Knowledge related to safe exercises, particularly resistance training, during pregnancy is limited. Targeted education and programmatic planning are needed in this population regarding exercise guidelines.

A qualitative investigation of a prenatal yoga intervention to prevent excessive gestational weight gain: A thematic analysis of interviews

PURPOSE

To describe pregnant women's experiences and perceived facilitators/barriers of a prenatal yoga intervention to prevent excessive gestational weight gain (EGWG).

METHODS

Pregnant women (N = 13) were interviewed after participation in a 12-week prenatal yoga intervention to prevent EGWG. Interviews were summarized using thematic analysis.

RESULTS

Twelve themes were identified and organized into four categories: 1) experiences of prenatal yoga (positive experience/enjoyment, pain relief, connecting to body), 2) prenatal yoga and weight (increased mindfulness/self-awareness, increased physical activity, weight management), 3) barriers to prenatal yoga (physical body, commute/traffic, schedule), and 4) facilitators of prenatal yoga (healthy pregnancy, support from other pregnant women, the feeling from prenatal yoga).

CONCLUSION

Prenatal yoga may relieve pain and help women be more connected to their bodies. Prenatal yoga may also help women become more aware of their health behaviors and increases their physical activity which may have important implications for reducing EGWG.

Physical Activity Based on the BASNEF Model Constructs in Women with a Child Less Than Two Years of Age

Background: Lack of physical activity plays an important role in increasing blood pressure, diabetes, elevated lipids, and obesity. Postpartum women are at risk for low physical activity. Objectives: The aim of this study was to determine the status of physical activity based on beliefs, attitudes, subjective norms, and enabling factors (BASNEF) model constructs at the postpartum period in women attending the centers of comprehensive health services. Methods: This cross-sectional study was performed on 217 randomly selected mothers who had a child less than 2 years of age in Sanandaj, Kurdistan Province, northwest of Iran. A researcher-made questionnaire including demographic information and BASNEF model components was used to collect the data. Data were analyzed in SPSS software version 22 and using Pearson’s correlation coefficient, multiple linear regression, and logistic regression. Results: Results showed that 89% of mothers had low or no physical activity. According to the findings, despite the fact that all three components of knowledge, attitude, and subjective norms somewhat predicted the intention to engage in physical activity, the predictive ability of the subjective norms with a correlation coefficient of 0.34 was statistically significant (P < 0.001) in predicting the mother’s physical activity. Conclusions: The results of this study showed that the level of physical activity of studied women after childbirth was undesirable. Designing and implementing interventions by health managers and providers to change women’s behavior and encouraging them to do physical activity is necessary.

Deep Learning Approach for Imputation of Missing Values in Actigraphy Data: Algorithm Development Study

Background

Data collected by an actigraphy device worn on the wrist or waist can provide objective measurements for studies related to physical activity; however, some data may contain intervals where values are missing. In previous studies, statistical methods have been applied to impute missing values on the basis of statistical assumptions. Deep learning algorithms, however, can learn features from the data without any such assumptions and may outperform previous approaches in imputation tasks.

Objective

The aim of this study was to impute missing values in data using a deep learning approach.

Methods

To develop an imputation model for missing values in accelerometer-based actigraphy data, a denoising convolutional autoencoder was adopted. We trained and tested our deep learning–based imputation model with the National Health and Nutrition Examination Survey data set and validated it with the external Korea National Health and Nutrition Examination Survey and the Korean Chronic Cerebrovascular Disease Oriented Biobank data sets which consist of daily records measuring activity counts. The partial root mean square error and partial mean absolute error of the imputed intervals (partial RMSE and partial MAE, respectively) were calculated using our deep learning–based imputation model (zero-inflated denoising convolutional autoencoder) as well as using other approaches (mean imputation, zero-inflated Poisson regression, and Bayesian regression).

Results

The zero-inflated denoising convolutional autoencoder exhibited a partial RMSE of 839.3 counts and partial MAE of 431.1 counts, whereas mean imputation achieved a partial RMSE of 1053.2 counts and partial MAE of 545.4 counts, the zero-inflated Poisson regression model achieved a partial RMSE of 1255.6 counts and partial MAE of 508.6 counts, and Bayesian regression achieved a partial RMSE of 924.5 counts and partial MAE of 605.8 counts.

Conclusions

Our deep learning–based imputation model performed better than the other methods when imputing missing values in actigraphy data.

Effect of an Educational Intervention Based on the BASNEF Model on Promoting Physical Activity Among Postpartum Women

Background

Due to the prevalence of low physical activity (PA) among women, especially during the postpartum period, this study was conducted to investigate the effect of an educational program based on BASNEF (beliefs, attitudes, subjective norms, and enabling factors) model in promoting the postpartum PA among mothers.

Methods

This quasi-experimental study was carried out on 68 women of Kermanshah City in Western Iran during 2015 who were recruited through cluster random sampling method. Participants were randomly divided into two groups: intervention ( n = 33) and control ( n = 35). The subjects in the intervention group received the five educational sessions. The assessment of the participants was performed before and 6 weeks after the intervention. The researcher-made questionnaire based on the structures of the BASNEF model and the standard PA questionnaire was used to collect the data. Data were analyzed using SPSS-24 software.

Results

After educational intervention, there was a significant difference between the mean scores of knowledge, attitude, subjective norms, behavioral intention, enabling factors, number of steps, and the intensity of PA ( p < .001). In addition, there was no significant difference between groups toward the PA intensity before the intervention ( p = .590), but this relationship was significant after the intervention ( p = .001).

Conclusion

Based on the results, training the PA based on the BASNEF model can be effective in promoting the PA in the postpartum period; therefore, it is recommended that the educational programs be applied for all these mothers in postpartum period. In addition, if the theories and behavior change models be correctly applied in educational programs, the useful results will be obtained.

Sociodemographic factors associated with postpartum physical activity levels in working women

Postpartum physical activity is important but is often neglected owing to conflicting priorities. Given the poor activity levels in the general Saudi population, women are especially likely to have poor postpartum activity levels. This study measured postpartum physical activity of Saudi working women and investigated the relationship between physical activity levels and sociodemographic factors. Study design: Cross-sectional study. This was a cross-sectional study conducted between January and June 2017. Working, postpartum Saudi women completed an online questionnaire including demographic information and the International Physical Activity Questionnaire (IPAQ)-short form. Of 486 women responding to the online invitation, 142 (29.2%) were eligible and participated. Based on IPAQ data, 23 (16.2%), 31 (21.8%), and 88 (62.0%) participants performed high, moderate or low levels of physical activity, respectively. No significant associations were found between the physical activity levels and sociodemographic factors. The most common factors discouraging physical activity were lack of time (21.2%) and childcare responsibilities (19.1%). The majority of participating working Saudi women had low postpartum physical activity levels. No sociodemographic factors were significantly associated with the level of physical activity. Measures may be required to promote postpartum physical activity among Saudi women.

Examination of the association of physical activity during pregnancy after cesarean delivery and vaginal birth among Chinese women

Background

The goal was to study whether higher physical activity can increase the success rate of Vaginal Birth after Cesarean Delivery (VBAC).

Methods

We enrolled 823 patients with previous cesarean section delivery history (between January 2015 and December 2017) and measured their physical activity during pregnancy. A final number of 519 patients were included for the trial of labor after cesarean delivery (TOLAC). All patients signed informed consent forms.

Results

We conducted bivariate analyses and identified that several variables were associated with successful VBAC: Prior history of vaginal birth (odds ratio [OR] 2.4, 95% CI 1.8–3.9); previous indication for primary cesarean delivery (OR 2.2, 95% CI 1.5–3.0); age younger than 40 years (OR 2.1, 95% CI 1.3–3.4); Weight gain less than 20 kg (OR 1.5, 95% CI 1.3–2.4); high pelvic/birth weight score (OR 1.4, 95% CI 1.1–2.0); no induction of labor (OR 1.9, 95% CI 1.4–2.8); and estimated prenatal fetal weight (OR 1.4, 95% CI 1.2–1.5). We also found that the bivariate association between physical activity and VBAC was significant (p = 0.002). In addition, there was higher odds of VBAC in women who had active physical activity of more than 150 min/week (adjusted OR 1.86, 95% CI 1.69–2.07). Lower odds of VBAC was associated with older age, weight gain during pregnancy, induction of labor, and having estimated prenatal fetal weight more than 3500 g.

Conclusion

Physical activity during pregnancy may influence the success rate of VBAC in Chinese women. Future studies will be needed to prove the robustness of this association using more detailed exposure and outcome definitions.

A randomized trial to promote physical activity during pregnancy based on health belief model

BACKGROUND

The positive effects of physical activities during pregnancy are totally recognized but due to lack of knowledge and negative aspect toward it, physical activities decrease throughout the pregnancy period. To find the appropriate model to enhance physical activity during pregnancy, the education that are focused on health belief constructs about physical activity during pregnancy, were assessed.

MATERIALS AND METHODS

This was a semi-experimental study conducted on 90 pregnant women in their first trimester that were divided into two groups of control and intervention. After assessing health belief model (HBM) constructs and measuring the duration of severe/moderate-intensity) physical activity through a questionnaire, participants were divided into two groups of 45. The intervention group received education about physical activity based on HBM and the control group received dental health education. In the second trimester again, the constructs of HBM and the duration of physical activities were evaluated. Significant level was set at P < 0.05.

RESULTS

Data analysis showed that level of perceived susceptibility/severity and perceived benefits and also the level of appealing physical activity (P < 0.05), had a significant increase in the intervention group after the education, but the mean of the severe/moderate-intensity physical activity with did not rise to 150 min/week.

CONCLUSION

Study results showed that education based on HBM could lead to an increase in physical activity during pregnancy by increasing the level of health beliefs in pregnant women, but this increase does not reach the adequate level.

Bladder Symptoms, Fatigue and Physical Activity in Postpartum Women

PURPOSE

Physical activity is important for postpartum women. The objective of this study was to evaluate bladder symptoms, fatigue, and physical activity according to time after birth and birth modes.

METHODS

This was a cross-sectional study using web-based questionnaire or one-to-one contact. A total of 290 women after giving birth responded to self-administered questionnaires. Multivariate analysis of variance determined the differences in variables.

RESULTS

Bladder symptoms were significantly different by time after birth and birth mode; they were the highest in the first week after birth and in Cesarean birth. Postpartum fatigue showed a significant tendency by birth mode, but not by time after birth. Physical activity was significantly different by birth mode. The lowest level of physical activity was found for women who gave Cesarean birth. Moderate physical activity was also significantly different by time after birth, but vigorous physical activity was not significantly different.

CONCLUSION

In conclusion, bladder symptoms and physical activity are different by time after birth and birth mode in postpartum women. The first week after giving birth is an important period for postpartum women whose bladder symptoms and physical activity should be of concern.

Trajectories of objectively-measured physical activity and sedentary time over the course of pregnancy in women self-identified as inactive

There is a need for investigations that document the daily course of pregnancy-related changes in PA and sedentary behavior. The purpose of this study was to describe the trajectory of PA and sedentary behavior and whether they differ among weight status in pregnant women self-identified as inactive. Eighty inactive pregnant women (8-16 weeks) were recruited from a nationwide text-message intervention. PA was measured using a Fitbit. Chi-square analyses and t-tests were used to analyze univariate demographic and PA variables. Mixed model-repeated measures ANOVA was used to analyze trajectory changes in daily PA and sedentary behavior. Light activity (beta [SE] = 2.79 [0.30], p < .001), active time (b [SE] = 1.62 [0.16], p < .001), and steps (b [SE] = 112.21 [10.66], p < .001) increased during the second trimester followed by a precipitous decline during the third trimester. Sedentary behavior followed an opposite pattern (b = - 9.88 [1.07], p < .001). Overweight and obese women took significantly fewer steps/day (b [SE] = - 742.37 [362.57], p < .05 and - 855.94 [381.25], p < .05, respectively) than normal weight women, and obese women had less "active" minutes/day (~> 3.0 metabolic equivalents; b [SE] = - 12.99 [5.89], p < .05) than normal weight women (P's < 0.05). Women who self-identify as inactive, become more sedentary and less physically active as pregnancy progresses. This study was among the first to describe the trajectory of daily PA and sedentary behavior throughout pregnancy. This study may help inform health care provider and patient communication related to PA, sedentary behavior, and the time in which to communicate about these behaviors.

Missing value imputation for physical activity data measured by accelerometer

An accelerometer, a wearable motion sensor on the hip or wrist, is becoming a popular tool in clinical and epidemiological studies for measuring the physical activity. Such data provide a series of activity counts at every minute or even more often and displays a person's activity pattern throughout a day. Unfortunately, the collected data can include irregular missing intervals because of noncompliance of participants and therefore make the statistical analysis more challenging. The purpose of this study is to develop a novel imputation method to handle the multivariate count data, motivated by the accelerometer data structure. We specify the predictive distribution of the missing data with a mixture of zero-inflated Poisson and Log-normal distribution, which is shown to be effective to deal with the minute-by-minute autocorrelation as well as under- and over-dispersion of count data. The imputation is performed at the minute level and follows the principles of multiple imputation using a fully conditional specification with the chained algorithm. To facilitate the practical use of this method, we provide an R package accelmissing. Our method is demonstrated using 2003-2004 National Health and Nutrition Examination Survey data.

Modifiable barriers to leisure-time physical activity during pregnancy: a qualitative study investigating first time mother's views and experiences

BACKGROUND

Evidence suggests physical activity often declines during pregnancy, however explanations for the decline are not well understood. The aim of this study was to identify modifiable barriers to leisure-time physical activity among women who did not meet physical activity guidelines during pregnancy.

METHODS

Analyses were based on data from 133 mothers (~3-months postpartum) who were recruited from the Melbourne InFANT Extend study (2012/2013). Women completed a self-report survey at baseline in which they reported their leisure-time physical activity levels during pregnancy as well provided an open-ended written response regarding the key barriers that they perceived prevented them from meeting the physical activity guidelines during their pregnancy. Thematic analyses were conducted to identify key themes.

RESULTS

The qualitative data revealed six themes relating to the barriers of leisure-time physical activity during pregnancy. These included work-related factors (most commonly reported), tiredness, pregnancy-related symptoms, being active but not meeting the guidelines, lack of motivation, and a lack of knowledge of recommendations.

CONCLUSION

Considering work-related barriers were suggested to be key factors to preventing women from meeting the physical activity guidelines during pregnancy, workplace interventions aimed at providing time management skills along with supporting physical activity programs for pregnant workers should be considered. Such interventions should also incorporate knowledge and education components, providing advice for undertaking leisure-time physical activity during pregnancy.

Relationship between physical activity and quality of life in pregnant women

BACKGROUND

Physical activity is one of the important factors in predicting the quality of life, which varies between different cultures and countries. The aim of this study was to determine the relationship between physical activity and the quality of life in pregnant women.

MATERIALS AND METHODS

This cross-sectional study was carried on 380 pregnant women who were admitted to Isfahan healthcare centers and Shahid Beheshti Hospital, by using the two-stage sampling method (cluster convenience) in 2013. Demographic/pregnancy characteristics, physical activity (36Q) and prenatal quality of life questionnaires (26Q) were completed by the participants. The statistical analyses were performed with various statistical tests such as Student's t-test, one-way analysis of variance (ANOVA), Pearson correlation coefficient, linear regression, and SPSS statistical software version 16.

RESULTS

The findings showed that 91.6% of the subjects were 20-35 years old, 69% had a gestational age of 29-37 weeks, 60% had their first pregnancy, 98% had poor physical activities, and 43% had a good quality of life. There was also a negative correlation between physical activity and social support (P = 0.04, r = -0.11).

CONCLUSIONS

As the results show high percentage of poor physical activity and quality of life, and also the relationship between these variables, more attention should be dedicated to this problem. Furthermore, structured programs and educational approaches are also needed for pregnant women.

Exposure analysis methods impact associations between maternal physical activity and cesarean delivery

BACKGROUND

Previous studies report conflicting results regarding a possible association between maternal physical activity (PA) and cesarean delivery.

METHODS

Seven-day PA recalls were collected by telephone from pregnant women (n = 1205) from North Carolina, without prior cesarean, during 2 time windows: 17 to 22 weeks and 27 to 30 weeks completed gestation. PA was treated as a continuous, nonlinear variable in binomial regressions (log-link function); models controlled for primiparity, maternal contraindications to exercise, preeclampsia, pregravid BMI, and percent poverty. We examined both total PA and moderate-to-vigorous PA (MVPA) at each time. Outcomes data came from medical records.

RESULTS

The dose-response curves between PA or MVPA and cesarean risk at 17 to 22 weeks followed an inverse J-shape, but at 27 to 30 weeks the curves reversed and were J-shaped. However, only (total) PA at 27 to 30 weeks was strongly associated with cesarean risk; this association was attenuated when women reporting large volumes of PA (> 97.5 percentile) were excluded.

CONCLUSION

We did not find evidence of an association between physical activity and cesarean birth. We did, however, find evidence that associations between PA and risk of cesarean may be nonlinear and dependent on gestational age at time of exposure, limiting the accuracy of analyses that collapse maternal PA into categories.

Physical activity and depressive symptoms after stillbirth: informing future interventions

Background

In the United States, approximately one in 110 pregnancies end in stillbirth affecting more than 26,000 women annually. Women experiencing stillbirth have a threefold greater risk of developing depressive symptoms compared to women experiencing live birth. Depression contributes negatively to health outcomes for both mothers and babies subsequent to stillbirth. Physical activity may improve depression in these women, however, little is known about acceptable physical activity interventions for women after stillbirth. This is the purpose of this descriptive exploratory study.

Methods

Eligible women were between ages 19 and 45, and experienced stillbirth within one year of the study. An online survey was used to ask questions related to 1) pregnancy and family information (i.e., time since stillbirth, weight gain during pregnancy, number of other children) 2) physical activity participation, 3) depressive symptomatology, and 4) demographics.

Results

One hundred seventy-five women participated in the study (M age = 31.26 ± 5.52). Women reported participating in regular physical activity (at least 150 minutes of moderate activity weekly) before (60%) and during (47%) their pregnancy, as well as after their stillbirth (61%). Only 37% were currently meeting physical activity recommendations. Approximately 88% reported depression (i.e., score of >10 on depression scale). When asked how women cope with depression, anxiety, or grief, 38% said physical activity. Of those that reported using physical activity to cope after stillbirth, they did so to help with depression (58%), weight loss (55%), and better overall physical health (52%). To cope with stillbirth, women used walking (67%), followed by jogging (35%), and yoga (23%). Women who participated in physical activity after stillbirth reported significantly lower depressive symptoms (M = 15.10, SD = 5.32) compared to women who did not participate in physical activity (M = 18.06, SD = 5.57; t = -3.45, p = .001).

Conclusions

Physical activity may serve as a unique opportunity to help women cope with the multiple mental sequelae after stillbirth. This study provides data to inform healthcare providers about the potential role of physical activity in bereavement and recovery for women who have experienced stillbirth. Additional research is necessary in this vulnerable population.

Results of a randomized controlled trial to promote physical activity behaviours in mothers with young children

OBJECTIVE

Increasing levels of physical activity in mothers have long-term health benefits for the mother and family. The study aimed to evaluate the effect of a six-month, physical activity RCT for mothers of young children.

METHODS

Women were recruited via playgroups and randomly assigned to intervention (n=394) or control group (n=322). The intervention group received a six-month multi-strategy programme delivered via playgroups in Perth, Australia. measures were mean minutes per week of moderate (M) and vigorous (V) intensity physical activity (PA), and number of days/week of muscle strength exercises.

RESULTS

The intervention had a significant effect on mean time for vigorous (p=0.008), moderate (p=0.023) and total physical activity (p=0.001) when compared to the control group. The intervention group increased their vigorous activity by a mean of 24min/week, moderate activity by 23min/week and total physical activity by 72min/week.

CONCLUSIONS

A relatively minimum home based intervention was able to demonstrate modest but statistically significant improvements in physical activity in a hard to reach group. These changes if maintained over a longer period are likely to improve the health of mothers and have a positive impact on their partners and children. Australian and New Zealand Clinical Trials Registry ACTRN12609000735257.

A qualitative study exploring women's beliefs about physical activity after stillbirth

Background

Research provides strong evidence for improvements in depressive symptoms as a result of physical activity participation in many populations including pregnant and post-partum women. Little is known about how women who have experienced stillbirth (defined as fetal death at 20 or more weeks of gestation) feel about physical activity or use physical activity following this experience. The purpose of this study was to qualitatively explore women’s beliefs about physical activity following a stillbirth.

Methods

This was an exploratory qualitative research study. Participants were English-speaking women between the ages of 19 and 44 years who experienced a stillbirth in the past year from their recruitment date. Interviews were conducted over the phone or in-person based on participants’ preferences and location of residence and approximately 30–45 minutes in length.

Results

Twenty-four women participated in the study (M age = 33 ± 3.68 years; M time since stillbirth = 6.33 ± 3.06 months). Women’s beliefs about physical activity after stillbirth were coded into the following major themes: barriers to physical activity (emotional symptoms and lack of motivation, tired, lack of time, guilt, letting go of a pregnant body, and seeing other babies), benefits to physical activity (feeling better emotionally/mentally, helping women to cope or be therapeutic), importance of physical activity (working through grief, time for self), motivators for physical activity (body shape/weight, health, more children, be a role model, already an exerciser). Health care providers and their role in physical activity participation was also a major theme.

Conclusions

This is the first study to qualitatively explore beliefs about physical activity in women after a stillbirth. Women who have experienced stillbirth have unique beliefs about physical activity related to their experience with stillbirth. Findings from this study may help to improve the health and quality of life for women who have experienced stillbirth by utilizing physical activity as a strategy for improving depressive symptoms associated with experiencing a stillbirth. Future research in this area is highly warranted.

Perceived barriers to physical activity among pregnant women living in a rural community

OBJECTIVE

The purpose of this research was to describe perceived barriers to physical activity among pregnant women living in a rural community.

DESIGN AND SAMPLE

The project followed a simple descriptive design. The sample included 88 healthy pregnant women from a rural community in the southeast United States.

MEASURES

The women completed the International Physical Activity Questionnaire (IPAQ) and an open-ended item seeking a description of personal barriers to engagement in regular physical activity.

RESULTS

Scores on the IPAQ were generally equally distributed across categories of low, moderate, and high activity. A total of 42 barriers was described from 34% of the women. Seven themes emerged among the reported barriers: (1) symptoms of pregnancy, (2) family and childrearing activities, (3) lack of personal motivation, (4) time and employment demands, (5) perceptions of sufficient activity from daily life, (6) fear of injury, and (7) lack of a habit of activity.

CONCLUSIONS

Barriers reported by the rural women were similar to those identified in other settings. Some perceptions confirmed myths about the health value of exercise during pregnancy, but did not confirm barriers commonly cited or assumed for reduced physical activity among rural residents.

Impact of accelerometer wear time on physical activity data: a NHANES semisimulation data approach

BACKGROUND

Current research practice employs wide-ranging accelerometer wear time criteria to identify a valid day of physical activity (PA) measurement.

OBJECTIVE

To evaluate the effects of varying amounts of daily accelerometer wear time on PA data.

METHODS

A total of 1000 days of accelerometer data from 1000 participants (age=38.7 ± 14.3 years; body mass index=28.2 ± 6.7 kg/m(2)) were selected from the 2005-2006 National Health and Nutrition Examination Study data set. A reference data set was created using 200 random days with 14 h/day of wear time. Four additional samples of 200 days were randomly selected with a wear time of 10, 11, 12 and 13 h/day(1). These data sets were used in day-to-day comparison to create four semisimulation data sets (10, 11, 12, 13 h/day) from the reference data set. Differences in step count and time spent in inactivity (<100 cts/min), light (100-1951 cts/min), moderate (1952-5724 cts/min) and vigorous (≥5725 cts/min) intensity PA were assessed using repeated-measures analysis of variance and absolute percent error (APE).

RESULTS

There were significant differences for moderate intensity PA between the reference data set and semisimulation data sets of 10 and 11 h/day. Differences were observed in 10-13 h/day(1) for inactivity and light intensity PA, and 10-12 h/day for steps (all p values <0.05). APE increased with shorter wear time (13 h/day=3.9-14.1%; 12 h/day=9.9-15.2%, 11 h/day=17.1-35.5%; 10 h/day=24.6-40.3%).

DISCUSSION

These data suggest that using accelerometer wear time criteria of 12 h/day or less may underestimate step count and time spent in various PA levels.

More Active Mums in Stirling (MAMMiS): a physical activity intervention for postnatal women. Study protocol for a randomized controlled trial

Background

Many postnatal women are insufficiently physically active in the year after childbirth and could benefit from interventions to increase activity levels. However, there is limited information about the efficacy, feasibility and acceptability of motivational and behavioral interventions promoting postnatal physical activity in the UK.

Methods

The MAMMiS study is a randomized, controlled trial, conducted within a large National Health Service (NHS) region in Scotland. Up to 76 postnatal women will be recruited to test the impact of two physical activity consultations and a 10-week group pram-walking program on physical activity behavior change. The intervention uses evidence-based motivational and behavioral techniques and will be systematically evaluated using objective measures (accelerometers) at three months, with a maintenance measure taken at a six-month follow-up. Secondary health and well-being measures and psychological mediators of physical activity change are included.

Discussion

The (MAMMiS study will provide a test of a theoretical and evidence-based physical activity behavior change intervention for postnatal women and provide information to inform future intervention development and testing within this population.

Trial registration

Current Controlled Trials ISRCTN79011784

Strategies to Promote Physical Activity During Pregnancy: A Systematic Review of Intervention Evidence

Physical activity during pregnancy has been associated with significant health benefits, however most women in the United States do not meet current guidelines. This systematic review evaluates evidence for interventions to improve physical activity during pregnancy in order to identify best practices and inform future research. Electronic databases (PubMed, CINAHL, SportDISCUS, Embase, ERIC, Psych Info and ISI Web of Science) were searched in July 2011 for peer-reviewed journal articles. Studies were included if they were English-language randomized control trials that measured the efficacy of an intervention targeted to pregnant women and designed to change physical activity as a primary or secondary outcome. Out of 777 studies identified through the systematic search, nine interventions were identified for inclusion by multiple reviewers. Data was abstracted using an abstraction form modeled after the "Guide to Community Preventive Services." Of the nine interventions included in the review, three reported statistically significant positive results for physical activity. While interventions included a variety of strategies and techniques, none were uniquely associated with positive outcomes. Overall this review suggests that little is known about the efficacy of interventions for physical activity during pregnancy. We provide several recommendations for future research and intervention design.

Physical activity beliefs, barriers, and enablers among postpartum women

BACKGROUND AND METHODS

Physical activity during postpartum is both a recommended and an essential contributor to maternal health. Understanding the beliefs, barriers, and enablers regarding physical activity during the postpartum period can more effectively tailor physical activity interventions. The objective of this study was to document self-reported beliefs, barriers, and enablers to physical activity among a cohort of women queried at 3 and 12 months postpartum. Five questions about beliefs and two open-ended questions about their main barriers and enablers regarding physical activity and exercise were asked of 667 women at 3 months postpartum. Among the sample, 530 women answered the same questions about barriers and enablers to physical activity at 12 months postpartum.

RESULTS

Agreement on all five beliefs statements was high (>or=89%), indicating that women thought that exercise and physical activity were appropriate at 3 months postpartum, even if they continued to breastfeed. For the cohort, the most common barriers to physical activity at both 3 and 12 months postpartum were lack of time (47% and 51%, respectively) and issues with child care (26% and 22%, respectively). No barrier changed by more than 5% from 3 to 12 months postpartum. For the cohort, the most common enablers at 3 months postpartum were partner support (16%) and desire to feel better (14%). From 3 to 12 months postpartum, only one enabler changed by >5%; women reported baby reasons (e.g., baby older, healthier, not breastfeeding, more active) more often at 12 months than at 3 months postpartum (32% vs. 10%). Environmental/policy and organizational barriers and enablers were reported less often than intrapersonal or interpersonal barriers at both time points.

CONCLUSIONS

A number of barriers and enablers were identified for physical activity, most of which were consistent at 3 and 12 months postpartum. This study provides information to create more successful interventions to help women be physically active postpartum.