How to promote physical activity during pregnancy : A systematic review

Counselling on physical activity in Danish antenatal care: A qualitative study of experiences from both the pregnant woman's and the care provider's perspective

OBJECTIVES

Physical activity during pregnancy is beneficial to maternal and fetal health, but most pregnant women do not achieve the recommended level of physical activity. To investigate how antenatal care can promote physical activity during pregnancy, this study explores experiences of physical activity counselling from the perspectives of pregnant women and antenatal care providers.

METHODS

In a qualitative design with an inductive approach individual semi-structured interviews with 19 pregnant women and seven antenatal care providers were performed and analyzed using thematic analysis.

RESULTS

The themes "Experiencing inadequate counselling", "Benefiting from individualized guidance", and "Voicing a need for enhanced support" cover the perspectives from the participating pregnant women. They often experienced insufficient physical activity counselling that left them insecure about proper physical activity during pregnancy. The pregnant women desired individualized and concrete advice and early and continuous support. From antenatal care providers the themes "Providers' perceived barriers in counselling", "Balancing the act of counselling", and "Acknowledging potential for enhanced counselling" were identified. They perceived barriers towards counselling including time restraints, lack of interest, and doubts about certain physical activity during pregnancy but expressed trying to adjust the counselling to meet the woman's individual situation. They acknowledged that continuous support during pregnancy and updated knowledge and increased focus among providers might improve physical activity counselling.

CONCLUSIONS

Pregnant women received scarce counselling on physical activity in antenatal care, while care providers described several barriers towards counselling on physical activity. Both pregnant women and antenatal care providers recognized opportunities for enhanced physical activity counselling.

The Impact of a Single Supervised Exercise Session in the Third Trimester of Pregnancy on the Physical Activity Levels of Pregnant Women-A Pilot Study

BACKGROUND

Despite the numerous beneficial effects of physical exercise during pregnancy, the levels of physical activity remain low. The aim of the study is to investigate the impact of a single supervised physical exercise session on the overall physical activity levels of pregnant women.

METHODS

During the third trimester, pregnant women attending our outpatient clinic were requested to assess their physical activity levels using the International Physical Activity Questionnaire (IPAQ). Additionally, they were invited to participate in a supervised 30 min mild-moderate-intensity aerobic exercise session (stationary bike ergometer) under the guidance of medical personnel. Subsequently, physical activity levels were reevaluated at the time of delivery.

RESULTS

Prior to the intervention, 3 out of 50 (6%) women engaged in mild-moderate physical activity for 150 min per week, while 20 out of 50 (40%) women participated in mild-moderate activity for 15-30 min, twice a week. Following the intervention, these percentages increased to 10 out of 50 (20%) and 31 out of 50 (62%), respectively (p < 0.05).

CONCLUSIONS

This pilot study suggests that a single exercise session supervised by medical personnel may significantly improve the low physical activity levels observed in pregnant women.

It's time to increase physical activity promotion among pregnant women in France

BACKGROUND

The lockdown linked to COVID-19 was shown to have negative effects on healthy behaviors in the general population, prompting the implementation of adapted public health measures. However, more vulnerable populations, such as pregnant women, were not specifically taken into account. At the time of writing this study, we know little about how the COVID-19 pandemic impacted the physical activity (PA) behavior of pregnant women in France. Given the many reports in the literature about women's low level of PA throughout pregnancy and the negative effects of the COVID-19 lockdown on behaviors in the general population; however, we might assume that their sedentary behaviors increased. The current study aimed to analyze the French recommendations and PA promotion among pregnant women.

MATERIALS AND METHODS

A literature search was done using PubMed for the key terms "physical activity/physical activity promotion," "pregnant women/pregnancy,", and "French population/France." All the relevant studies were included to support the argument for this narrative review.

RESULTS

Efforts to promote PA for pregnant women often seem ineffective and even unrealistic, and many women become overweight or obese during pregnancy. Health professionals need evidence-based guidelines and continuous training and skills development in order to convincingly encourage women to be more active during pregnancy and the postpartum period.

CONCLUSION

Health policies should strengthen PA promotion among pregnant women with detailed evidence-based guidelines on PA during postpartum.

Understanding Barriers and Facilitators to Physical Activity Engagement to Inform a Precision Prescription Approach during Pregnancy

Physical activity during pregnancy is an important health behavior. However, many pregnant individuals are provided with little-to-no guidance to adequately engage in physical activity. The purpose of this quantitative and quasi-qualitative study of currently or previously pregnant women was to examine physical activity behaviors in pregnancy and understand barriers and facilitators to achieving physical activity recommendations. Overall, 431 women (18+ years), White/Caucasian (84.5%), married (84.9%), and currently pregnant (66.6%), completed an online survey study. Most women (69.4%) reported engaging in cardio-based physical activity and willing to engage in physical activity to meet guidelines between 2 and 5 days per week (77.4 -88.8%). The most frequently reported barriers were feeling too tired (72.8%) or uncomfortable (71.8%) and childcare needs (57.8%). Being able to choose time of day (96.0%), accessing home workouts (92.9%), and having a personalized prescription (95.6%) were the most reported facilitators. Open comment feedback resulted in additional barriers, such as ensuring proper energy intake, while motivation and support from other pregnant individuals were fundamental facilitators. Individualized physical activity prescription is lacking in routine prenatal care. To support pregnant individuals to achieve physical activity recommendations, developing a prescription with suitable modalities, at-home options, and consideration for physical activity timing are required.

Physical activity in pregnancy: a mixed methods process evaluation of the FitMum randomised controlled trial interventions

BACKGROUND

Physical activity (PA) at moderate intensity is recommended for healthy pregnant women. The three-arm FitMum randomised controlled trial showed that it was possible to increase PA level during pregnancy with structured supervised exercise training (EXE) compared to standard care. Motivational counselling on PA (MOT) did not increase PA. This process evaluation aims to understand the implementation and mechanisms of impact of EXE and MOT.

METHODS

A mixed methods process evaluation was conducted using the UK Medical Research Council's process evaluation framework by assessing implementation (reach, fidelity, and dose) and mechanisms of impact of the two interventions provided to pregnant women in FitMum. Data was collected both quantitatively (n = 220) and qualitatively (n = 20).

RESULTS

The FitMum trial reached educated pregnant women (80% having an educational level ≥ bachelor's degree) with high autonomy of everyday life. Most participants (58%) were recruited at their first-trimester ultrasonic scan. Reasons to participate were personal (91%) and altruistic (56%). The intervention dose was delivered as intended with high fidelity in the original physical intervention setup and in the altered online setup during the COVID-19 restrictions. A low dose received in EXE (1.3 [95% CI, 1.1; 1.5] sessions/week) was partly explained by the pre-scheduled EXE sessions favouring participants with a flexible everyday life and a supportive social network. Dose received in EXE increased during online intervention delivery. Participants in MOT received 5.2 [4.7; 5.7] of 7 sessions. Mechanisms of impact comprised a perception of intervention commitment among participants in EXE due to the scheduled EXE sessions, whereas participants in MOT considered themselves as PA self-determined. PA was considered as constrained activities in EXE and included in daily activities in MOT.

CONCLUSION

The FitMum interventions was delivered with high fidelity. During COVID-19, the dose received in EXE increased compared to the previous physical setup. Mechanisms of impact as commitment, perception of empowerment and perception of PA as well as the paradox between prioritising PA and family and the need of a flexible everyday life need to be considered when offering pregnant women PA interventions. Future interventions should consider a combination of physical and online exercise training for pregnant women.

Effectiveness of interventions to increase device-measured physical activity in pregnant women: systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Interventions that provide pregnant women with opportunities to access and participate in physical activity have been shown to be beneficial to their health. Much of this evidence however has been based on self-reported physical activity data, which may be prone to inflated effects due to recall bias and social desirability bias. No previous synthesis of randomised controlled trials has assessed the effectiveness of these interventions using only device measured data, to assess their health benefits more accurately in pregnant women. This systematic review and meta-analysis aimed to address this evidence gap.

DATA SOURCES

Cochrane Central Register of Controlled Trials, Medline, SportDiscus, APA PsycINFO, Embase and Web of Science databases were queried from inception up to December 2, 2021. An updated search of PubMed was conducted on May 16, 2022.

STUDY ELIGIBILITY CRITERIA

Randomised controlled trials that recruited pregnant women, participating in any physical activity intervention (excluding interventions aimed entirely at body conditioning), compared with standard antenatal care (comparators), using device-measured total physical activity as an outcome were eligible for inclusion.

METHODS

3144 titles and abstracts were screened for eligibility, and 18 met the inclusion criteria. Data were analysed using random effect models, (standardised mean difference and mean difference), using data from baseline to last available follow-up (primary end point), and until between 24 to 30 weeks gestation. Gestational weight gain was also assessed at these timepoints in the included trials.

RESULTS

No significant differences between the groups were found for total physical activity at last available follow-up or 24 to 30 weeks gestation (95% CI 0.03 to 0.27, p = 0.10: 95% CI -0.05 to 0.33, p = 0.15) respectively. On average, pregnant women randomised to a physical activity intervention completed 435 and 449 more steps per day than comparators at last available follow-up and at 24 to 30 weeks gestation (95% CI -0.5-870.6, p = 0.05: 95% CI 5.5-892.7, p = 0.05) respectively. Intervention participants also gained 0.69 kg less (95% CI -1.30 to -0.08, p = 0.03) weight than comparators.

CONCLUSION

Based on device-measured data, interventions to promote physical activity during pregnancy have small but important effects on increasing physical activity and managing excessive gestational weight gain.

Feasibility, acceptability, and preliminary efficacy of a single-arm, remotely-delivered health coaching intervention to increase physical activity and reduce sedentary behavior during pregnancy

Background

Interventions targeting physical activity and sedentary behavior concurrently in pregnancy may be an ideal strategy to reduce the risk of pregnancy complications. We assessed the feasibility, acceptability, and preliminary efficacy of a single-arm, remotely-delivered health coaching intervention to promote physical activity and reduce sedentary behavior in pregnancy.

Methods

Women (n = 34) between 8 and 12 weeks gestation were recruited to take part in the INcreasing Steps in PREgnancy (INSPiRE) study. Participants were given an activity tracker (Fitbit Inspire) and met virtually with their health coach throughout the second and third trimesters of pregnancy. Feasibility was based on enrollment, retention, and adherence rates. Acceptance was assessed using a process evaluation survey. Intervention efficacy was based on activPAL data obtained at baseline and the end of the second trimester.

Results

Feasibility objectives were met, with greater than 70% enrollment, 97% retention, and 99% adherence. All participants reported high levels of satisfaction with the program. ActivPAL data indicated statistically significant increases in daily steps (+ 1715.8 steps/day, Cohen’s d = 0.97), stepping time (+ 1.9%, d = 0.75), standing time (+ 2.3%, d = 0.29), and decreases in total sedentary time (− 4.2%, d = 0.43) and sedentary bouts of 30 minutes (− 4.1%, d = 0.36) from baseline to the end of the second trimester, all p < 0.05. Decreases were also observed in sedentary bouts of 60 minutes (− 3.9%, d = 0.40), but this was not statistically significant.

Conclusions

The INSPiRE study demonstrated feasibility, high acceptability, and preliminary efficacy for improving movement behaviors in women during pregnancy, supporting future testing in a randomized controlled trial.

Self-reported exercise or physical activity level: what matters to a better quality of life in the third trimester of pregnancy?

This study evaluated the relationship of self-reported exercise, physical activity (PA) level, and Quality of Life (QoL) among women in their third trimester of pregnancy and verified which factors are associated with physical exercise (PE) and QoL. A cross-sectional study was performed with women who have been pregnant for at least 28 weeks and who can engage in PE. Data on self-reported exercise, sociodemographic characteristics, PA level, and QoL were collected through the International Physical Activity Questionnaire (IPAQ) and the World Health Organization Quality of Life Questionnaire BREF version (WHOQOL-BREF). Frequencies, bivariate analyses, and logistic and linear regression were performed. Among 405 pregnant women, 103 (25.43 percent) reported practicing PE. The self-reported PE was associated with better scores in the physical and environmental domains of the WHOQOL-BREF. Several IPAQ variables and the WHOQOL-BREF environmental score were associated with self-reported exercise. The majority classified as "active" by the IPAQ was due to employment and not the PE practice. A correct conceptual approach to PA and PE during antenatal care has a different impact on health and QoL during pregnancy.

Effects of Structured Supervised Exercise Training or Motivational Counseling on Pregnant Women's Physical Activity Level: FitMum - Randomized Controlled Trial

Background

Physical activity (PA) during pregnancy is an effective and safe way to improve maternal health in uncomplicated pregnancies. However, compliance with PA recommendations remains low among pregnant women.

Objective

The purpose of this study was to evaluate the effects of offering structured supervised exercise training (EXE) or motivational counseling on PA (MOT) during pregnancy on moderate-to-vigorous intensity physical activity (MVPA) level. Additionally, complementary measures of PA using the Pregnancy Physical Activity Questionnaire (PPAQ) and gold standard doubly labeled water (DLW) technique were investigated. The hypotheses were that both EXE and MOT would increase MVPA in pregnancy compared with standard care (CON) and that EXE would be more effective than MOT. In addition, the association between MVPA and the number of sessions attended was explored.

Methods

A randomized controlled trial included 220 healthy, inactive pregnant women with a median gestational age of 12.9 (IQR 9.4-13.9) weeks. A total of 219 women were randomized to CON (45/219), EXE (87/219), or MOT (87/219). The primary outcome was MVPA (minutes per week) from randomization to the 29th gestational week obtained by a wrist-worn commercial activity tracker (Vivosport, Garmin International). PA was measured by the activity tracker throughout pregnancy, PPAQ, and DLW. The primary outcome analysis was performed as an analysis of covariance model adjusting for baseline PA.

Results

The average MVPA (minutes per week) from randomization to the 29th gestational week was 33 (95% CI 18 to 47) in CON, 50 (95% CI 39 to 60) in EXE, and 40 (95% CI 30 to 51) in MOT. When adjusted for baseline MVPA, participants in EXE performed 20 (95% CI 4 to 36) minutes per week more MVPA than participants in CON (P=.02). MOT was not more effective than CON; EXE and MOT also did not differ. MVPA was positively associated with the number of exercise sessions attended in EXE from randomization to delivery (P=.04). Attendance was higher for online (due to COVID-19 restrictions) compared with physical exercise training (P=.03). Adverse events and serious adverse events did not differ between groups.

Conclusions

Offering EXE was more effective than CON to increase MVPA among pregnant women, whereas offering MOT was not. MVPA in the intervention groups did not reach the recommended level in pregnancy. Changing the intervention to online due to COVID-19 restrictions did not affect MVPA level but increased exercise participation.

Trial Registration

ClinicalTrials.gov NCT03679130; https://clinicaltrials.gov/ct2/show/NCT03679130

International Registered Report Identifier (IRRID)

RR2-10.1136/bmjopen-2020-043671

Development and Validation of Prenatal Physical Activity Intervention Strategy for Women in Buffalo City Municipality, South Africa

Women rarely participate in physical activity during pregnancy, despite scientific evidence emphasising its importance. This study sought to develop an intervention strategy to promote prenatal physical activity in Buffalo City Municipality, Eastern Cape Province, South Africa. A multi-stage approach was utilised. The Strength, Weakness, Opportunity and Threat (SWOT) approach was applied to the interfaced empirical findings on prenatal physical activity in the setting. Subsequently, the Build, Overcome, Explore and Minimise model was then used to develop strategies based on the SWOT findings. A checklist was administered to key stakeholders to validate the developed strategies. Key strategies to promote prenatal physical activity include the application of the Mom-Connect (a technological device already in use in South Africa to promote maternal health-related information for pregnant women) in collaboration with cellphone and network companies; the South African government to integrate prenatal physical activity and exercise training in the medical and health curricula to empower the healthcare providers with relevant knowledge and skills to support pregnant women in prenatal physical activity counselling; provision of increased workforce and the infrastructure necessary in antenatal sessions and antenatal physical exercise classes and counselling; the government, in partnership with various stakeholders, to provide periodical prenatal physical activity campaigns based in local, community town halls and clinics to address the lack of awareness, misrepresentations and concerns regarding the safety and benefits of physical activity during pregnancy. The effective implementation of this developed prenatal physical activity by policymakers and health professionals may help in the promotion of physical activity practices in the context of women in the setting.

Encouraging Physical Activity during and after Pregnancy in the COVID-19 Era, and beyond

Physical activity is known to decline during pregnancy and the postnatal period, yet physical activity is recommended during this time due to the significant health benefits for mothers and their offspring. As a result of the COVID-19 pandemic and the restrictions imposed to reduce infection rates, pregnant and postnatal women have experienced disruption not just to their daily lives but also to their pregnancy healthcare experience and their motherhood journey with their new infant. This has included substantial changes in how, when and why they have engaged with physical activity. While some of these changes undoubtedly increased the challenge of being sufficiently active as a pregnant or postnatal woman, they have also revealed new opportunities to reach and support women and their families. This commentary details these challenges and opportunities, and highlights how researchers and practitioners can, and arguably must, harness these short-term changes for long-term benefit. This includes a call for a fresh focus on how we can engage and support those individuals and groups who are both hardest hit by COVID-19 and have previously been under-represented and under-served by antenatal and postnatal physical activity research and interventions.