How does a lifestyle intervention during pregnancy influence perceived barriers to leisure-time physical activity? The Norwegian fit for delivery study, a randomized controlled trial

Abstract

BackgroundTo develop effective health promotional and preventive prenatal programs, it is important to understand perceived barriers to leisure-time physical activity during pregnancy, including exercise and sport participation. The aims of the present study was 1) to assess the effect of prenatal lifestyle intervention on the perceived barrier to leisure-time physical activity during pregnancy and the first year after delivery and 2) identify the most important perceived barriers to leisure-time physical activity at multiple time points during and after pregnancy.MethodsThis secondary analysis was part of the Norwegian Fit for Delivery study, a combined lifestyle intervention evaluated in a blinded, randomized controlled trial. Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥ 18 years and body mass index ≥19 kg/m2 were recruited via healthcare clinics in southern Norway, including urban and rural settings. Participants were randomized to either twice-weekly supervised exercise sessions and nutritional counselling (n = 303) or standard prenatal care (n = 303). The principal analysis was based on the participants who completed the standardized questionnaire assessing their perceived barriers to leisure-time physical activity at inclusion (gestational week 16, n = 589) and following intervention (gestational week 36, n = 509), as well as six months (n = 470) and 12 months (n = 424) postpartum.ResultsFollowing intervention (gestation week 35.4 ± 1.0), a significant between-group difference in perceived barriers to leisure-time physical activity was found with respect to time constraints: “... I do not have the time” (intervention: 22 vs. control: 38, p = 0.030), mother-child safety concerns: “... afraid to harm the baby” (intervention: 8 vs. control: 25, p = 0.002) and self-efficacy: “... I do not believe/think that I can do it” (intervention: 3 vs. control: 10, p = 0.050). No positive effect was seen at postpartum follow-up. Intrapersonal factors (lack of time, energy and interest) were the most frequently perceived barriers, and consistent over time among all participants.ConclusionThe intervention had effect on intrapersonal perceived barriers in pregnancy, but not in the postpartum period. Perceived barriers to leisure-time physical activity were similar from early pregnancy to 12 months postpartum.Trial registrationClinicalTrials.gov: NCT01001689, registered July 2, 2009.

Impact of prenatal exercise on neonatal and childhood outcomes: a systematic review and meta-analysis

“…For decades, women have avoided prenatal exercise for fear of raising the risk of adverse pregnancy outcomes, including growth restriction and preterm birth 166. Early research in this area raised concerns of growth restriction or preterm birth as a result of exercise-induced redirection of blood flow and nutrients away from the growing baby and towards the working maternal muscle 43–46.…”

Exploring Beliefs About Exercise Among Pregnant Women in Rural Communities

“…19 A decrease in energy levels is a concern for women because of the already increased level of fatigue they may be experiencing during pregnancy, especially during the first trimester. 20 Interestingly, improvement in energy levels is one of the known benefits of engaging in exercise during pregnancy, 21 along with an improvement in mood, 21 decreased risk of prenatal depression, 22 and improved sleep. 23 This may indicate that future prenatal exercise promotional efforts among women in rural settings should consider including information about the benefits of exercise during pregnancy and maternal energy levels.…”

“…41,42 Several other studies in rural and urban women report pregnancy-related symptoms as one of the most common barriers to physical activity during pregnancy across settings (urban and rural). 20,43 It is important to ensure that future knowledge translation efforts include information about the protective effects of exercise during pregnancy for nausea, fatigue, and discomfort, as this may significantly influence their decision to engage in activity. Because women in the present study reported support systems as facilitators of physical activity during pregnancy, it also may be helpful to engage individuals that women identified as supporters of exercise during pregnancy (ie, family members and partners) in future intervention strategies.…”

“…In fact, few women report a lack of access to resources as a barrier in previous studies in a combination of women in rural and urban areas. 20 Because activity-related resources may be sparser or harder to physically reach in rural areas, this is a barrier to exercise that may be unique to women living in rural settings. Likewise, there is a known lack of access to prenatal care in rural communities, 11 and the present study supports the notion that this lack of access may extend to other areas of health care including physical activity advice and facilities.…”

The impact of a randomized controlled trial of a lifestyle intervention on postpartum physical activity among at-risk hispanic women: Estudio PARTO

“…Few prior studies have evaluated the impact of their intervention on PA self-efficacy [35,36]. In their clinic-based trial among Taiwanese pregnant women, Huang et al [36] found significantly greater improvements in postpartum self-efficacy scores in the intervention group…”