Factors associated with women's perceptions of physical activity safety during pregnancy
Introduction
In 1985, the American College of Obstetricians and Gynecologists (ACOG) published the first US guidelines for exercise during pregnancy (American College of Obstetricians and Gynecologists, 1985). These guidelines were mainly concerned with preventing harm and advised women to limit strenuous activity and to keep heart rate below 140 beats per minute (American College of Obstetricians and Gynecologists, 1985). Since that time, several investigators have demonstrated that physical activity/exercise during pregnancy does not increase the risk of low birth weight, preterm labor, or other pregnancy complications (Hegaard, 2007, Kramer and Mcdonald, 2006). Recent literature even indicates a broad range of health benefits related to physical activity during pregnancy (American College of Sports Medicine, 2006, Hegaard, 2007, Weissgerber, 2006). Thus, current ACOG guidelines suggest that pregnant women obtain at least 30 min of moderate leisure-time physical activity on most days of the week in the absence of obstetric complications (American College of Obstetricians and Gynecologists, 2002). Although vigorous physical activity is not addressed directly, current guidelines do not limit activity based on heart rate and indicate that recreational and competitive athletes may maintain their activities, provided that contact sports and prolonged supine activity are avoided.
Unfortunately, few physicians counsel pregnant women on physical activity. Results from 211 women recruited from a private clinic showed that only 63% of patients discussed prenatal exercise with their doctors and that 50% of those conversations were patient-initiated (Krans et al., 2005). Additionally, 69% of women who received advice were told to restrict their activity according to the 1985 ACOG guidelines (Krans et al., 2005). Much consumer-based literature and websites also continue to offer outdated advice. Thus it is hardly surprising that women report receiving little and/or conflicting information regarding physical activity during pregnancy (Clarke and Gross, 2004).
The majority of pregnant women do not meet physical activity guidelines (Evenson et al., 2004). Reported barriers to physical activity during pregnancy include fatigue, lack of time, nausea, physical discomfort, and lack of child care (Albright, 2005, Evenson, 2009, Pereira, 2007, Symons Downs and Hausenblas, 2004, Symons Downs and Ulbrecht, 2006). Studies also indicate that some women fear that exercise might hurt their baby (Clarke and Gross, 2004; Doran and O'brien, 2007, Duncombe, 2007, Evenson, 2009). An Australian study of 158 married, high income/highly educated women showed that low intensity and/or pregnancy-specific exercises were rated as “very safe”; however, vigorous exercises were viewed as “unsafe” (Duncombe et al., 2007). Less active women in this study rated all forms of exercise as less safe; however, the investigators were unable to determine whether demographic factors influenced safety beliefs.
The purposes of this investigation were to determine physical activity participation rates and to evaluate perceptions of moderate and vigorous physical activity safety during pregnancy among an ethnically diverse sample of US pregnant women. We also sought to determine relationships among demographic characteristics, current physical activity participation, and safety perceptions.
Section snippets
Methods
This investigation was part of a larger cross-sectional study on attitudes towards research among pregnant women and their health care providers (Mudd, 2008, Nechuta, 2009). Ten practices were selected from a list of all prenatal care clinics provided by the Kent County (Michigan, USA) Health Department on the basis of the number of pregnant women seen annually and the number of African-American women seen annually. Selected practices encompassed private health care, Medicaid, bilingual clinics
Results
Of the 311 women interviewed, 296 (95%) provided complete information on physical activity and were used in these analyses. On average, women were in their 11th week of gestation at the time of interview (range: 2–36 wk) and were diverse in terms of race/ethnicity and income (Table 1). While over 88% of women reported participation in some moderate and/or vigorous physical activity over the past month, only 29% were classified as meeting ACOG guidelines. Women reported 144 ± 153 min of physical
Discussion
The purposes of this investigation were to determine physical activity participation rates and safety perceptions among a diverse sample of pregnant women, and to determine whether participant characteristics influenced physical activity participation and/or safety beliefs. The majority of women reported participation in physical activity, although, only 29% were meeting ACOG guidelines. Population-based data show that the percentage of pregnant women participating in any physical activity has
Conclusions
We found that most women participated in physical activity and perceived moderate physical activity as safe, but viewed vigorous physical activity more skeptically. Low education or income, non-White race/ethnicity, being in the 1st trimester, and not participating in any physical activity significantly increased the odds of feeling unsafe/unsure about moderate and/or vigorous physical activity during pregnancy. Nulliparity was also associated with feeling unsafe/unsure about vigorous intensity
Conflict of interest statement
The authors declare no conflicts of interest.
Acknowledgments
The authors thank the staff members at participating clinics and hospitals for their cooperation, as well as Brian Hartl, Barb Hawkins-Palmer, and other staff at the Kent County Health Department, the Grand Rapids Medical Education Research Center, and Brian Lamoreaux for the assistance in planning and implementing the study. We also acknowledge the MANCS Steering Committee which included, at the time this study was performed, Jan Bokemeier, Naomi Breslau, H. Dele Davies, and Nigel Paneth from
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