Reducing the Decline in Physical Activity during Pregnancy: A Systematic Review of Behaviour Change Interventions

Abstract

PurposePhysical activity (PA) typically declines throughout pregnancy. Low levels of PA are associated with excessive weight gain and subsequently increase risk of pre-eclampsia, gestational diabetes mellitus, hypertension disorders, delivery by caesarean section and stillbirth. Systematic reviews on PA during pregnancy have not explored the efficacy of behaviour change techniques or related theory in altering PA behaviour. This systematic review evaluated the content of PA interventions to reduce the decline of PA in pregnant women with a specific emphasis on the behaviour change techniques employed to elicit this change.Search and Review MethodologyLiterature searches were conducted in eight databases. Strict inclusion and exclusion criteria were employed. Two reviewers independently evaluated each intervention using the behaviour change techniques (BCT) taxonomy to identify the specific behaviour change techniques employed. Two reviewers independently assessed the risk of bias using the guidelines from the Cochrane Collaboration. Overall quality was determined using the GRADE approach.FindingsA total of 1140 potentially eligible papers were identified from which 14 studies were selected for inclusion. Interventions included counselling (n = 6), structured exercise (n = 6) and education (n = 2). Common behaviour change techniques employed in these studies were goal setting and planning, feedback, repetition and substitution, shaping knowledge and comparison of behaviours. Regular face-to-face meetings were also commonly employed. PA change over time in intervention groups ranged from increases of 28% to decreases of 25%. In 8 out of 10 studies, which provided adequate data, participants in the intervention group were more physically active post intervention than controls.Conclusions and ImplicationsPhysical activity interventions incorporating behaviour change techniques help reduce the decline in PA throughout pregnancy. Range of behaviour change techniques can be implemented to reduce this decline including goals and planning, shaping knowledge and comparison of outcomes. A lack of high quality interventions hampers conclusions of intervention effectiveness.

Physical activity in pregnancy and its impact on duration of labor and postpartum period

“…Less invasive and safer solutions for shortening the second stage of labor have been sought. Research shows that in some women it is possible to reduce the delivery time by introducing regular physical activity [21,35,36]. Properly trained pelvic floor muscles are more flexible and more resistant to damage, whilst systematically trained skeletal muscles are able to generate more power.…”

Influencia del programa SWEP (Study Water Exercise Pregnant) en los resultados perinatales: protocolo de estudio

“…Pero son escasos los estudios encontrados en los que se puedan comparar esos resultados en relación con un programa de ejercicios realizado en el medio acuático. En lo que se refiere a las particularidades de la actividad física, se ha podido verificar en diferentes revisiones que la actividad física más adecuada para las mujeres embarazadas es la que se lleva a cabo en el medio acuático y con un carácter moderado (11,53,54).…”

Feasibility, acceptability and efficacy of a web-based computer-tailored physical activity intervention for pregnant women - the Fit4Two randomised controlled trial

“…The development of the website content was guided by the Social Cognitive Theory (SCT) given that self-efficacy is a central determinant of the SCT theory, and increasing self-efficacy is recognised as one of the most important determinants of physical activity among pregnant women [16]. The intervention consisted of four weekly modules based on Social Cognitive Theory (SCT) [17] including: (1) information on how to set SMART (specific, measurable, achievable, realistic and timely) goals and develop action plans; (2) overcoming barriers such as environment or lack of time and/or motivation; (3) developing social support networks including work colleagues, family and friends; and (4) PA reinforcement such as identifying the benefits associated with meeting the guidelines, all of which have been previously identified as significant constructs to increasing PA among pregnant women [6, 16]. In addition to the weekly SCT module, participants were also provided with access to a weekly action planning tool, which guided participants in setting a detailed plan for their PA including when they would exercise, who they might exercise with, where the exercise would take place, and what barrier/s might come up, and how they would overcome them over the coming week.…”

“…These include barriers such as increased fatigue and tiredness and physical discomfort, lack of time, motivation and/or social support, and neighbourhood or environmental barriers such as bad weather or poorly maintained walking paths [5]. To assist pregnant women overcome these barriers, PA interventions using a variety of strategies have been implemented, including counselling, exercise and educational interventions [6, 7]. Most of these PA interventions have traditionally included face-to-face behaviour change programs conducted in a primary care environment by exercise specialists and/or health professionals such as medical practitioners [6, 7].…”

“…To assist pregnant women overcome these barriers, PA interventions using a variety of strategies have been implemented, including counselling, exercise and educational interventions [6, 7]. Most of these PA interventions have traditionally included face-to-face behaviour change programs conducted in a primary care environment by exercise specialists and/or health professionals such as medical practitioners [6, 7]. However, such face-to-face behaviour change programs can be time consuming, expensive and limited in reach [8, 9].…”