The biopsychosocial barriers and enablers to being physically active following childbirth: a systematic literature review

Parous women perform less moderate to vigorous physical activity than their nulliparous peers: a population-based study in Denmark

OBJECTIVES

The World Health Organization (WHO) highlights parous women as a key population for monitoring trends of physical activity (PA). We aimed to estimate the proportion of Danish women non-adhering to WHO PA guidelines in parous women compared with nulliparous women and to describe leisure-time PA intensity in each of these groups.

STUDY DESIGN

Cross-sectional study.

METHODS

This population-based study builds on a sample of 27,668 women aged 16-40 years from the Danish National Health Survey 2021. These data were linked with childbirth data from the Danish National Birth Registry. The primary outcome was self-reported weekly hours of moderate to vigorous leisure-time PA (MVPA) dichotomized into: (i) adhering to WHO guidelines for MVPA or (ii) not adhering to WHO guidelines for MVPA. Binomial regression analysis was used to calculate prevalence proportions (PP) and prevalence proportion ratios (PPR).

RESULTS

Of the 27,668 women, a total of 20,022 were included; 9338 (46.6%) parous women and 10,684 (53.4%) nulliparous women. The PP of women non-adhering to WHO PA guidelines was 63.8% (95% CI 62.9-64.8) for parous and 51.3% (95% CI 50.4-52.3) for nulliparous women, corresponding to a PPR of 1.24 (95% CI 1.21; 1.27).

CONCLUSIONS

The proportion of parous women who did not adhere to WHO PA guidelines for MVPA was 24% higher than that of nulliparous women. This highlights parous women as a subgroup of the adult population at increased risk of non-adherence to WHO PA guidelines. These findings call for future research to inform new strategies aiming to promote PA in parous women.

Affective Response to Exercise and Affective Judgments as Predictors of Physical Activity Intention and Behavior among New Mothers in their first 6-Months Postpartum

BACKGROUND

Understanding the predictors of moderate to vigorous physical activity (MVPA) during early postpartum is important to improve promotion efforts. Affect-related constructs are key predictors of MVPA but have limited research in mothers during the postpartum period.

PURPOSE

To examine two affect-related constructs (affective response to exercise and affective judgments) as predictors of MVPA intention and behavior across three months, among a sample of new mothers.

METHODS

Participants were 105 mothers (M age = 30.64 years; SD = 3.93) who completed measures during postpartum at 2-months post-birth of their first child. The affective response to exercise (assessed at baseline [2-months postpartum] during a submaximal treadmill test), affective judgments and intention (baseline, 6-weeks after baseline), and MVPA (baseline, 6- and 12-weeks after baseline) were assessed via self-report.

RESULTS

Path analysis, using ordinary least squares regression, showed that the affective response during exercise was a significant predictor of intention (baseline, 6-weeks), as well as change in intention from baseline to 6-weeks. By contrast, affective judgments predicted intention at 6-weeks, but not at baseline or in the change model. Past MVPA did not moderate these findings, although the affective response during exercise also had a significant indirect effect on MVPA through intention at 6-weeks and 12-weeks.

CONCLUSIONS

Interventions targeting women's affective response during exercise may be important during postpartum, perhaps through self-paced physical activity guidance. Affective judgments may not be predictive of MVPA, in part due to unanticipated changes during early postpartum leading to inaccurate expectations of the physical activity experience.

A review of the behaviour change techniques used in physical activity promotion or maintenance interventions in pregnant women

BACKGROUND

The proportion of women meeting the recommended physical activity requirement is low. Evidence suggests behaviour change techniques (BCTs) can be effective in initiating and maintaining behaviour change and improving physical activity.

PURPOSE

To synthesise the evidence related to the attributes of BCT-based physical activity interventions targeted at pregnant women.

METHODS

A systematic search of studies was made. Randomised controlled trials aiming to improve or maintain physical activity in pregnant women were included. Trials were categorised into 'very promising', 'quite promising', or 'non-promising' according to the intervention effectiveness. One-way analysis of variance was used to determine the difference in mean BCTs implemented in promising/ non-promising studies.

FINDINGS

A total of 18,966 studies were identified and 10 studies were included. 'Problem solving', 'social support (unspecified)', 'graded tasks', 'goal setting (behaviour)', 'instruction on how to perform a behaviour', 'self-monitoring of behaviour', 'demonstration of the behaviour', and 'action planning' were rated as promising BCTs.

DISCUSSION

Specific types of BCTs might be associated with physical activity promotion or maintenance during pregnancy. More high-quality randomised controlled trials investigating the effectiveness of individual or combinations of BCTs on physical activity in pregnant women are needed.

What research evidence exists about physical activity in parents? A systematic scoping review

OBJECTIVES

Despite the known benefits of physical activity (PA) to physical and mental health, many people fail to achieve recommended PA levels. Parents are less active than non-parent contemporaries and constitute a large potential intervention population. However, little is known about the breadth and scope of parental PA research. This scoping review therefore aimed to provide an overview of the current evidence base on parental PA.

METHODS

Four databases (MEDLINE, Embase, PsycINFO and Scopus) were systematically searched to identify peer-reviewed articles focusing on parental PA from 2005 onwards, including interventional, observational or qualitative study designs. Title and abstract screening was followed by duplicate full-text screening. Data extracted for all articles (100% checked by a second reviewer) included study design, proportion of fathers and ages of children. For interventional/observational studies, PA assessment method and factors examined or targeted based on the socio-ecological model were extracted, and questions addressed in qualitative studies.

RESULTS

Of 14 913 unique records retrieved, 213 articles were included; 27 articles reported on more than one study design; 173 articles reported on quantitative (81 cross-sectional, 26 longitudinal and 76 interventional) and 58 on qualitative data. Most articles originated from North America (62%), and 53% included only mothers, while 2% included only fathers. Articles most frequently represented parents of infants (56% of articles), toddlers (43%), preschoolers (50%) and primary-school aged children (49%). Most quantitative articles only reported self-reported PA (70%). Observational articles focused on individual correlates/determinants (88%). Likewise, most interventions (88% of articles) targeted individual factors. Most qualitative articles explored PA barriers and facilitators (57%).

CONCLUSIONS

A range of quantitative and qualitative research has been conducted on parental PA. This review highlights opportunities for evidence synthesis to inform intervention development (such as barriers and facilitators of parental PA) and identifies gaps in the literature, for example, around paternal PA.

REVIEW REGISTRATION

osf.io/qt9up.

Group-based physical activity interventions for postpartum women with children aged 0-5 years old: a systematic review of randomized controlled trials

BACKGROUND

It is estimated that less than one third of women (28%) worldwide, are not sufficiently active, and there is evidence indicating physical activity (PA) participation is lower during pregnancy and the postpartum period. Despite the importance of educating and encouraging postpartum women to engage in PA, existing systematic reviews have only focused on examining the impact of individually tailored PA interventions and on specific postpartum populations such as women who are inactive (i.e., do not meet PA recommendations) or women at risk of gestational diabetes mellitus or postnatal depression. This review aims to fill this gap by examining the impact of group-based PA interventions on postpartum women's PA levels or other health behavior outcomes.

METHODS

A systematic literature search was conducted using four electronic databases (MEDLINE, CINAHL, EMBASE and PsychInfo) of published studies between 1st January 2000 and 31st October 2020. Studies were included if they targeted postpartum women with no current health conditions, had children aged 0-5 years, and engaged postpartum women in a group-based PA program that reported PA or other health behavior outcomes. Out of a total of 1091 articles that were initially identified, six were included.

RESULTS

Group-based PA interventions were moderately successful in changing or increasing postpartum women's self-reported PA levels and psychological wellbeing in the first 2 years of their offspring's life. Overall, group-based PA interventions were not successful in changing or increasing postpartum women's objectively measured PA levels, but only one study objectively measured postpartum women's PA levels. Narrative synthesis highlights the heterogeneity of the outcomes and methodologies used, and the low to medium risk of bias in the included studies.

CONCLUSION

To strengthen the evidence-base for group-based PA programs with postpartum women there is an on-going need for more rigorous randomised controlled trials of appropriate length (at least 3 months in duration) with an adequate dose of group-based PA sessions per week (to meet PA guidelines), and that utilise objective measures of PA. In addition, future PA interventions for this population should include, at the very least, fidelity and process data to capture the characteristics or design features that appeal most to postpartum women.

Barriers and Facilitators to Healthy Eating and Physical Activity Postpartum: A Qualitative Systematic Review

BACKGROUND

Postpartum weight retention increases the risk of long-term overweight and obesity and associated comorbidities. Healthy eating and physical activity are important lifestyle behaviors for achieving and maintaining a healthy weight. However, these habits may be hard for women to adopt or maintain during the postpartum period.

OBJECTIVE

To identify and describe barriers and facilitators to healthy eating and physical activity among postpartum women in the United States.

METHODS

A qualitative systematic review was conducted. Qualitative studies on women's experiences with weight loss, healthy eating, and physical activity in the postpartum period were identified using a comprehensive search strategy. The quality of included studies was assessed using the Critical Appraisal Skills Programme checklist. Data were qualitatively analyzed using thematic synthesis. Resulting themes were mapped onto components of the Social-Ecological Model for Food and Physical Activity Decisions.

RESULTS

Thirteen qualitative studies were included in the review. Barriers and facilitators to healthy eating and physical activity during the postpartum period included individual factors (emotional and mindless eating, physical limitations, and social support), settings and sectors (food environments, childcare needs, and structured information and support), and social and cultural norms (time constraints, and prioritization of maternal responsibilities).

CONCLUSIONS

Researchers and practitioners should consider how factors within various levels of the Social-Ecological Model may influence healthy eating and physical activity in the postpartum period.

The impact of demographic and self-management factors on physical activity in women

AIM

Guided by the Individual and Family Self-Management Theory, this study examines demographic and self-management variables that impact the outcome of physical activity.

BACKGROUND

Multiple sources indicate relationships between physical activity and reduced incidence of cardiovascular disease. Women engage in significantly less physical activity than guidelines recommend.

METHODS

Data collected in women included demographic/situational factors and external influencing level factors including knowledge and beliefs, social facilitation, and outcome expectancy. The outcome behavior physical activity was also assessed. Correlation and hierarchical multiple regression were used to examine the relationship of demographic/situational and external influencing factors to physical activity.

RESULTS

The sample included 119 women (mean age 40.96, 89.1% Caucasian, 51.3% Married, 95% high school graduates). Education was positively correlated with exercise benefits (r = 0.235,p = .010). Gross family income (r = 0.191,p = .043), work status (r = 0.238,p = .009), and health insurance(r = 0.228,p = .013) were positively correlated to family participation, and work status was positively correlated to friend participation (r = 0.263.p = .004). In the final model, demographic/situational factors (step 1) explained 12.9% of the variance in physical activity (p < .05). Knowledge and beliefs, social support, and outcome expectancy (step added an additional 0.9% of variance physical activity levels).

CONCLUSIONS

Findings suggest that demographic/situational factors contribute more to explaining variability in physical activity levels than external influencing factors. This suggests that in addition to considering demographic variables, further research to explore other demographic/situational and external influencing factors that affect physical activity specifically in women is necessary.