Pregnant women’s exercise behaviours, and influences on exercise during pregnancy
Bronwyn HAMILTON1, Baki BILLAH2, Bronwen ELDRIDGE1
1 Department Obstetrics and Gynaecology Box Hill Hospital, Victoria, Australia
2 School of Public Health and Preventative Medicine Monash University, Victoria, Australia
Introduction
There is increasing evidence that exercise in
pregnancy can now be safely carried out in all
trimesters of pregnancy. Health benefits of physical
activity during pregnancy include prevention of GDM,
Preeclampsia, Preterm birth and musculoskeletal
conditions including lower back pain and can assist
with maintenance of healthy weight.
The American College of Obstetricians and
Gynecologists (ACOG) recommends 30 minutes of
moderate-intensity exercise per day most days of the
week (≥ 2 hours/week) during pregnancy in the
absence of medical or obstetric complications.
Sports Medicine Australia’s statement on Exercise in
pregnancy endorsed by Royal Australian and New
Zealand College of Obstetricians and Gynaecologists
(RANZCOG) suggests healthy women with
uncomplicated pregnancies can continue their preconceptual aerobic exercise during pregnancy and
sedentary women can begin a light to moderate
exercise program in consultation with their doctor..
Despite documented health benefits, women usually
decrease their amount of physical activity during
pregnancy.
Objectives
To investigate physical activity levels during pregnancy,
influences on exercise participation rates, and women’s
attitudes towards exercise in pregnancy
Materials & Methods
Pregnant women were recruited from Box Hill Hospital
and Monash Medical Centre, two hospitals in
Melbourne’s Eastern Suburbs between 2010-2014
A self-reporting questionnaire was completed between
24-28 weeks collecting information regarding exercise
levels and attitudes towards exercise in pregnancy
Results
Advice about exercise in pregnancy
212 out of 286 participants (74.1%) received advice about exercise in pregnancy.
The most common source of advice being from a medical professional (44.1% of
respondents) followed by magazine/book/newspaper (39.5%) and Internet (33.6%).
Only 46.6% of participants were aware of the recommended guidelines for physical
activity (4-7 times/ week).
Beliefs about exercise in pregnancy
Women who believed exercise was safe were more likely to participate in exercise
in pregnancy. Those believing exercise can have adverse effects more likely to be
inactive in pregnancy (OR = 2.085 95% CI: 1.3- 3.2).
152 women (53.1%) believed that exercise can have adverse effects on their
pregnancy. The most common fear being that exercise may cause pregnancy loss
(31.5% of participants) or cause bleeding (23.8%), or that it may tire them out(17.8%).
Positive influences on exercise in pregnancy
Women were more likely to exercise during pregnancy if they enjoy exercise (OR =
2.0, 95% CI: 1.4-2.9), and understand the health benefits of exercise (OR = 3.1, 95%
CI: 1.7-5.5). Not surprisingly, pre-pregnancy exercise status also increases the
likelihood of women being active in their pregnancies. Women receiving advice
regarding exercise in pregnancy were also much more likely to exercise (OR = 2.14,
95% CI: 1.25-3.69).
Negative influences on exercise in pregnancy
Barriers to exercise included family responsibilities, exercise facilities being ‘too far’
away, lack of motivation/time, having a medical condition, cost of exercise,
unsupportive families. Pregnancy symptoms such as nausea and musculoskeletal pain
also negatively influenced exercise rates.
Socio-demographic factors associated with lower uptake of exercise in pregnancy
including Indian/Asian ethnicity and BMI >30 kg/m2. Participants of Asian/Indian
descent were also more likely to believe exercise can lead to pregnancy
loss/complications and believe exercise activities are unsafe in pregnancy
Dr Bronwyn Hamilton
Senior O&G Registrar
Box Hill Hospital, Victoria, Australia
[email protected]
Table 1 : Unadjusted and adjusted relative risks (RR), 95% confidence intervals (CI) and p-values to
physical activity (less than <1 hours vs ≥1 hours) during pregnancy – significant values
Variable
BMI >30
Ethnicity
(ref:Asian/Indian)
Others/caucasian
Advice re: exercise
(ref:no)
Yes
Ideal exercise
frequency (ref:≤3
times/wk)
>3 times/wk
Pre-pregnancy
exercise (ref<2 hrs)
2 hours or more
Perceived health
benefits
Perceived
improvements in
body function
Unadjusted OR
(95% CI)
0.4 (0.2-0.8)
4.9 (2.6-9.2)
p-value
0.014
<0.001
Adjusted for p-value
motivators
0.3(0.1-0.8) 0.013
5.2(2.1-13.2) <0.001
Adjusted
p-value
for barriers
0.2(0.1-0.7) 0.011
5.8(2.3<0.001
14.6)
2.1(1.2-3.7)
0.006
2.9(1.4-6.2)
0.006
2.9(1.3-6.3) 0.007
3.4 (2.1-5.6)
<0.001
2.5(1.3-4.9)
<0.007
2.2(1.1-4.4) 0.024
11.5(6.6-20.1)
<0.001
8.3(4.0-17.1) <0.001
8.6(4.118.1)
<0.001
3.1(1.7-5.5)
<0.001
7.5(1.0-54.0) 0.046
n/a
n/a
2.4(1.3-4.3)
0.004
0.1(0.01-0.6) 0.017
n/a
n/a
Conclusion
• A significant proportion of women are insufficiently active in pregnancy and many are not aware
of the ACOG guidelines
• Many women still believe that exercise can be harmful, and reduce the amount of exercise during
pregnancy particularly those not receiving advice
• Facilitators to exercise in pregnancy include normal BMI, Caucasian ethnicity, enjoyment of
exercise. Positive factors which may be modified include receiving advice in pregnancy, good
family support, being active pre-pregnancy and being aware of the health benefits of being active
during pregnancy
• Barriers/negative influences include low social support, poor time management, lack of
motivation and lack of low-cost and close-by exercise facilities. Non-modifiable negative factors
include educational status, Indian/Asian ethnicity and BMI >30kg/m2.
• More research is required into promoting education for pregnant women and women of
childbearing age regarding exercise recommendations and safety of exercise in pregnancy in
addition to providing easier access to family-friendly exercise options
• Women considering a pregnancy should be encouraged to be active
Conclusions