The Power of Believing: Salient Belief Predictors of Exercise Behavior in Normal Weight, Overweight, and Obese Pregnant Women

Physical activity during pregnancy: key beliefs to support intervention

Background

Physical activity (PA) provides maternal and fetal health benefits, but only 27.5% of Canadian pregnant women meet PA recommendations. Theory-based interventions like the theory of planned behavior (TPB) are useful in explaining what drives behavior. The first objective of this study was to validate the TPB model to predict prenatal moderate-to-vigorous physical activity (MVPA), including testing of the novel interaction between intention and perceived behavioral control (PBC). The second objective was to identify which specific beliefs predict intention toward prenatal MVPA to support intervention.

Method

We used a prospective correlational design. Healthy pregnant women completed two electronic questionnaires: at baseline, to assess TPB constructs, and one month later, to assess MVPA practice. Structural equation modeling was conducted with Latent Moderated Structural Equations. The interaction was interpreted with the pick-a-point method and the Johnson-Neyman graphical method.

Results

The sample consists of 193 women (M age = 31.2±3.6). Results indicate that prenatal MVPA at one month was marginally predicted by intention (β = 0.149; p < 0.10) and PBC (β = 0.322; p < 0.05, MVPA R 2 = 20%), but when their interaction was added to the model, MVPA R 2 increased to 44%. Specifically, the relationship between intention and MVPA is stronger when PBC is high (0.5 standard deviation over the mean). In the full model including the interaction, attitude (β = 0.59; p < 0.001), subjective norm (β = 0.20; p < 0.01) and PBC (β = 0.26; p < 0.05) all made a significant contribution to predicting MVPA intention (R 2  = 88%). Finally, the following beliefs displayed significant indirect paths toward the intention of being physically active: behavioral beliefs: unlikely to be more tired and likely feel better mentally; normative beliefs: approval from friends and from mother/father; and control beliefs: being tired and missing social support.

Conclusion

Interventions aiming to promote regular MVPA during pregnancy should prioritized the six significant beliefs identified to significantly predict intention toward prenatal MVPA.

Visiting natural open spaces in urban areas during pregnancy and its association with daily physical activity

We examined the association between visiting natural open spaces (NOS) and physical activity (PA) at different trimesters of pregnancy. We used GPS and accelerometer data from women residing in Donostia-San Sebastian and Barcelona. Daily visits to NOS were associated with an increase of circa 8 min of moderate to vigorous physical activity (MVPA) in the first and second trimesters of pregnancy. Women who visited NOS were more likely to meet the WHO daily PA guidelines during the first trimester. Visiting NOS can promote PA consistently during pregnancy, improving maternal health and well-being in urban settings.

Effects of physical health beliefs on college students' physical exercise behavior intention: mediating effects of exercise imagery

OBJECTIVE

This study explores the relationship between physical health beliefs and physical exercise behavior intention of college students and constructs a mediation model through the mediation role of exercise imagery.

METHODS

Using the stratified cluster sampling method, 1356 college students were measured in group psychology by using the Physical Health Beliefs Scale, Exercise Imagery Inventory, and Physical Exercise Behavior Intention Scale. The statistical software Mplus 8.1, SPSS 22.0 and SPSS PROCESS 3.3 were used for statistical processing. The common method deviation test was carried out by Harman single-factor control method. Finally, the bootstrap sampling test method and process plug-in were used to test the significance of intermediary effect.

RESULTS

(1) physical health beliefs have a significant predictive effect on physical exercise behavior intention (β = 0.32, p < 0.001); (2) exercise imagery (β = 0.13, p < 0.001) mediate the relationship between physical health beliefs and physical exercise behavior intention (physical health beliefs → exercise imagery → physical exercise behavior intention (95% Cl: 0.14, 0.32)).

CONCLUSION

physical health beliefs can directly improve the physical exercise behavior intention of college students, which can also affect college students' physical exercise behavior intention indirectly through exercise imagery. The findings suggest that exercise imagery are important variables that mediate the effect of the college students' physical health beliefs on their physical exercise behavior intention.

Investigating psychological variables for technologies promoting physical activity

Background

Many technological interventions designed to promote physical activity (PA) have limited efficacy and appear to lack important factors that could increase engagement. This may be due to a discrepancy between research conducted in this space, and software designers' and developers' use of this research to inform new digital applications.

Objectives

This study aimed to identify (1) what are the variables that act as barriers and facilitators to PA and (2) which PA variables are currently considered in the design of technologies promoting PA including psychological, physical, and personal/contextual ones which are critical in promoting PA. We emphasize psychological variables in this work because of their sparse and often simplistic integration in digital applications for PA.

Methods

We conducted two systematized reviews on PA variables, using PsycInfo and Association for Computing Machinery Digital Libraries for objectives 1 and 2.

Results

We identified 38 PA variables (mostly psychological ones) including barriers/facilitators in the literature. 17 of those variables were considered when developing digital applications for PA. Only few studies evaluate PA levels in relation to these variables. The same barriers are reported for all weight groups, though some barriers are stronger in people with obesity.

Conclusions

We identify PA variables and illustrate the lack of consideration of these in the design of PA technologies. Digital applications to promote PA may have limited efficacy if they do not address variables acting as facilitators or barriers to participation in PA, and that are important to people representing a range of body weight characteristics.

Changes in physical activity across pregnancy among Chinese women: a longitudinal cohort study

Background

Sufficient physical activity (PA) during pregnancy is beneficial for a woman’s health; however, the PA levels of Chinese women at different pregnancy stages are not clear. The aim of our study was to investigate PA changes during pregnancy and the association of population characteristics with PA change among Chinese women.

Methods

Data were obtained from 2485 participants who were enrolled in the multicentre prospective Chinese Pregnant Women Cohort Study. PA level was assessed in early pregnancy (mean = 10, 5–13 weeks of gestation) and again in mid-to-late pregnancy (mean = 32, 24–30 weeks of gestation) using the International Physical Activity Questionnaire short form (IPAQ-SF). Sufficient PA (≥ 600 MET min/week) in early pregnancy and insufficient PA in mid-to-late pregnancy indicated decreasing PA. Insufficient PA in early pregnancy and sufficient PA in mid-to-late pregnancy indicated increasing PA. The associations between demographic, pregnancy and health characteristics and PA changes were examined by multivariable logistic regression.

Results

Total energy expenditure for PA increased significantly from early (median = 396 MET min/week) to mid-to-late pregnancy (median = 813 MET min/week) (P < 0.001), and 55.25% of the participants eventually had sufficient PA. Walking was the dominant form of PA. Women with sufficient PA levels in early pregnancy were more likely to have sufficient PA in mid-to-late pregnancy (OR 1.897, 95% CI 1.583–2.274). Women in West China and those in Central China were most and least likely, respectively, to have increasing PA (OR 1.387, 95% CI 1.078–1.783 vs. OR 0.721, 95% CI 0.562–0.925). Smoking was inversely associated with increasing PA (OR 0.480, 95% CI 0.242–0.955). Women with higher educational levels were less likely to have decreasing PA (OR 0.662, 95% CI 0.442–0.991).

Conclusions

PA increased as pregnancy progressed, and walking was the dominant form of PA among Chinese women. Further research is needed to better understand correlates of PA change.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01377-3.

What Accounts for Physical Activity during Pregnancy? A Study on the Sociodemographic Predictors of Self-Reported and Objectively Assessed Physical Activity during the 1st and 2nd Trimesters of Pregnancy

Physical activity (PA) during pregnancy has positive health implications for both mother and child. However, current literature indicates that not all pregnant women meet the international recommendations for PA (at least 150 min/week of moderate-to-vigorous PA). The main objective of this study was to assess PA levels among pregnant women in the city of Donostia-San Sebastian and identify their main sociodemographic predictors. We recruited 441 women in the 12th week of pregnancy from the local public obstetric health services. Women wore an accelerometer for one week during two separate time points (1st and 2nd trimesters of pregnancy) and completed a questionnaire assessing several sociodemographic variables as well as self-reported PA. With this information, we estimated women’s overall PA levels during both time points. The fulfillment of PA recommendations raised up to 77% and 85% during the first and second trimesters, respectively. We found that a higher number of children and a greater preference for exercise positively predicted light-to-moderate PA, being the most consistent predictors. The availability of a greater number of cars negatively predicted moderate-to-vigorous PA.

A Prospective Examination of Physical Activity Predictors in Pregnant Women with Normal Weight and Overweight/Obesity

BACKGROUND

Scant research has examined the relationship between exercise behavior and weight status in pregnant women.

METHODS

A prospective study was conducted in which pregnant women (N = 332) completed self-report measures at each trimester. Repeated measures multivariate analysis of covariance (controlling for race, education, and parity) examined changes in the motivational determinants of exercise over time and by weight status. Regression analyses were conducted to understand how the motivational determinants predicted exercise behavior and to examine the impact of prepregnancy weight status.

RESULTS

A significant main effect for time was observed, with an increase in early pregnancy followed by a decrease in late pregnancy for the motivational determinants of exercise and exercise behavior. A significant main effect for weight status was observed such that normal weight pregnant women had significantly greater attitude and intention for exercise when compared with pregnant women with overweight/obesity. The primary predictors of intention were perceived behavioral control (first to second trimester) and attitude (second to third trimester). The primary predictor of exercise behavior was intention. Prepregnancy weight status provided no unique contributions.

CONCLUSIONS

Findings from this study suggest that interventions designed to promote exercise in pregnancy should consider targeting perceived behavioral control in early pregnancy and attitude in later pregnancy. Improving exercise attitude in women with overweight or obesity may further strengthen their motivation to be active in pregnancy. Customized interventions may need to be designed to address the unique needs of women because their motivational determinants change over the course of pregnancy.

Perceived Barriers to Exercise in the First Trimester of Pregnancy

Regular physical activity has been shown to improve pregnancy outcomes. We sought to identify barriers to exercise during the first trimester of pregnancy. Five hundred forty-nine pregnant women in their first trimester rated barriers to exercise on a scale of 1 (not a barrier) to 5 (a huge barrier) and recorded physical activity (minutes/week). Women were placed into one of three classifications, nonexercisers (zero exercise), infrequent exercisers (<150 minutes/week), or exercisers (≥150 minutes/week). The greatest barriers (mean) were nausea/fatigue (3.0) and lack of time (2.6). Exercisers reported significantly lower barrier levels. Nausea/fatigue was a greater barrier for nonexercisers compared to exercisers (3.6 vs 2.8, p < .001). Focusing education and interventions on these barriers may help pregnant women achieve healthy exercise levels.

Individually Tailored, Adaptive Intervention to Manage Gestational Weight Gain: Protocol for a Randomized Controlled Trial in Women With Overweight and Obesity

Background

High gestational weight gain is a major public health concern as it independently predicts adverse maternal and infant outcomes. Past interventions have had only limited success in effectively managing pregnancy weight gain, especially among women with overweight and obesity. Well-designed interventions are needed that take an individualized approach and target unique barriers to promote healthy weight gain.

Objective

The primary aim of the study is to describe the study protocol for Healthy Mom Zone, an individually tailored, adaptive intervention for managing weight in pregnant women with overweight and obesity.

Methods

The Healthy Mom Zone Intervention, based on theories of planned behavior and self-regulation and a model of energy balance, includes components (eg, education, self-monitoring, physical activity/healthy eating behaviors) that are adapted over the intervention (ie, increase in intensity) to better regulate weight gain. Decision rules inform when to adapt the intervention. In this randomized controlled trial, women are randomized to the intervention or standard care control group. The intervention is delivered from approximately 8-36 weeks gestation and includes step-ups in dosages (ie, Step-up 1 = education + physical activity + healthy eating active learning [cooking/recipes]; Step-up 2 = Step-up 1 + portion size, physical activity; Step-up 3 = Step-up 1 + 2 + grocery store feedback, physical activity); 5 maximum adaptations. Study measures are obtained at pre- and postintervention as well as daily (eg, weight), weekly (eg, energy intake/expenditure), and monthly (eg, psychological) over the study period. Analyses will include linear mixed-effects models, generalized estimating equations, and dynamical modeling to understand between-group and within-individual effects of the intervention on weight gain.

Results

Recruitment of 31 pregnant women with overweight and obesity has occurred from January 2016 through July 2017. Baseline data have been collected for all participants. To date, 24 participants have completed the intervention and postintervention follow-up assessments, 3 are currently in progress, 1 dropped out, and 3 women had early miscarriages and are no longer active in the study. Of the 24 participants, 13 women have completed the intervention to date, of which 1 (8%, 1/13) received only the baseline intervention, 3 (23%, 3/13) received baseline + step-up 1, 6 (46%, 6/13) received baseline + step-up 1 + step-up 2, and 3 (23%, 3/13) received baseline + step-up 1 + step-up 2 +step-up 3. Data analysis is still ongoing through spring 2018.

Conclusions

This is one of the first intervention studies to use an individually tailored, adaptive design to manage weight gain in pregnancy. Results from this study will be useful in designing a larger randomized trial to examine efficacy of this intervention and developing strategies for clinical application.

Registered Report Identifier

RR1-10.2196/9220

Influences of prior miscarriage and weight status on perinatal psychological well-being, exercise motivation and behavior

OBJECTIVES

women who have experienced miscarriage may be at increased risk for elevated depressive and anxiety symptoms in subsequent pregnancies. Exercise may be a useful strategy for coping with these symptoms. Little is known about how miscarriage influences prenatal exercise behavior. The study purpose was to examine the influences of miscarriage history and prepregnancy weight status on pregnant women's psychological health, exercise motivation, and behavior using the Theory of Planned Behavior.

PARTICIPANTS/SETTING

Pregnant women (N=203; 41 with prior miscarriage; 72 overweight/obese; BMI > 25.0) in the northeast United States.

DESIGN

Women prospectively reported their depressive/anxiety symptoms and exercise motivation/behavior in the 1st, 2nd, and 3rd trimesters via mailed surveys. Group differences in depressive/anxiety symptoms, exercise behavior, and its motivational determinants were examined using Chi Square analyses and Univariate and Multivariate Analyses of Covariance.

MEASUREMENTS AND FINDINGS

Women with a history of miscarriage had higher 1st and 2nd trimester depressive/anxiety symptoms and lower 1st trimester attitudes about exercise and 1st and 2nd trimester perceived behavior control than women without a history of miscarriage. Overweight/obese women had higher 1st and 2nd trimester pregnancy depressive/anxiety symptoms, engaged in less prepregnancy exercise, and had lower levels of exercise intention, attitude, and perceived behavior control throughout pregnancy than normal weight women.

KEY CONCLUSIONS

Women with a history of miscarriage and overweight/obese women have poorer psychological health and lower motivation to exercise during pregnancy than women without a history of miscarriage and normal weight women.

IMPLICATIONS FOR PRACTITIONERS

Interventions and healthcare provider communications aimed at promoting perinatal exercise behavior and psychological health should take into account pre-pregnancy weight status and pregnancy history to identify strategies to help women, particularly overweight/obese women with a history of miscarriage, to overcome exercise barriers.

Obesity in Special Populations: Pregnancy

Perinatal overweight and obesity is a major public health and clinical care issue that requires deliberate and immediate attention. Preconception and prenatal assessment and counseling should address the risks associated with obesity, recommendations for weight gain, proper nutrition and dietary intake, and physical activity. Nutrition and exercise guidance should be offered to all perinatal overweight and obese women with an emphasis on effective strategies to overcome barriers. All women should be encouraged to adopt a healthy lifestyle and achieve a healthy weight before becoming pregnant.