AbstractBackground: Physical activity (PA) during pregnancy provides physical and psychological benefits for mother and child. U.S. guidelines recommend ≥ 30 min of moderate exercise for healthy pregnant women most days of the week; however, most women do not meet these recommendations. Theory assists in identifying salient determinants of health behavior to guide health promotion interventions; however, the application of theory to examine PA among pregnant women has not been examined cohesively among multiple levels of influence (e.g., intrapersonal, interpersonal, neighborhood/environmental, and organizational/political). Subsequently, this systematic review aims to identify and evaluate the use of health behavior theory in studies that examine PA during pregnancy.
Methods: Articles published before July 2014 were obtained from PubMed and Web of Science. Inclusion criteria applied were:(1) empiricallybased; (2) peer-reviewed; (3) measured factors related to PA; (4) comprised a pregnant sample; and (5) applied theory. Fourteen studies were included. Each study's application of theory and theoretical constructs were evaluated.
Results: Various theories were utilized to explain and predict PA during pregnancy; yet, the majority of these studies only focused on intrapersonal level determinants. Five theoretical frameworks were applied across the studies-all but one at the intrapersonal level. Few determinants identified were from the interpersonal, neighborhood/environmental, or organizational/political levels.
Conclusion: This systematic review synthesized the literature on theoretical constructs related to PA during pregnancy. Interpersonal, community, and societal levels remain understudied. Future research should employ theory-driven multi-level determinants of PA to reflect the interacting factors influencing PA during this critical period in the life course.
Erika L. Thompson, Cheryl A. Vamos, Ellen M. Daley. Physical activity during pregnancy and the role of theory in promoting positive behavior change: A systematic review[J]. Journal of Sport and Health Science, 2017, 6(2): 198-206.
Gavard JA, Artal R. Effect of exercise on pregnancy outcome. Clin Obstet Gynecol 2008;51:467-80.
Lewis B, Avery M, Jennings E, Sherwood N, Martinson B, Crain AL. The effect of exercise during pregnancy on maternal outcomes:practical implications for practice. Am J Lifestyle Med 2008;2:441-55.
Poudevigne MS, O'Connor PJ. A review of physical activity patterns in pregnant women and their relationship to psychological health. Sports Med 2006;36:19-38.
Pivarnik JM, Chambliss HO, Clapp JF, Dugan SA, Hatch MC, Lovelady CA, et al. Impact of physical activity during pregnancy and postpartum on chronic disease risk. Med Sci Sports Exerc 2006;38:989-1006.
Nehring I, Schmoll S, Beyerlein A, Hauner H, von Kries R. Gestational weight gain and long-term postpartum weight retention:a meta-analysis. Am J Clin Nutr 2011;94:1225-31.
American College of Obstetricians and Gynecologists. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol 2002;99:171-3. Reaffirmed 2009.
Evenson KR, Wen F. National trends in self-reported physical activity and sedentary behaviors among pregnant women:NHANES 1999-2006. Prev Med 2010;50:123-8.
Gaston A, Cramp A. Exercise during pregnancy:a review of patterns and determinants. J Sci Med Sport 2011;14:299-305.
Allender S, Hutchinson L, Foster C. Life-change events and participation in physical activity:a systematic review. Health Promot Int 2008;23:160-72.
Phelan S. Pregnancy:a "teachable moment" for weight control and obesity prevention. Am J Obstet Gynecol 2010;202:135.e131-8.
Glanz K, Rimer BK, Viswanath K. The scope of health behavior and health education. In:Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education:theory, research, and practice. Vol. 4. San Francisco, CA:John Wiley & Sons, Inc.; 2008.
McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q 1988;15:351-77.
Downs DS, Chasan-Taber L, Evenson KR, Leiferman J, Yeo S. Physical activity and pregnancy:past and present evidence and future recommendations. Res Q Exerc Sport 2012;83:485-502.
Currie S, Sinclair M, Murphy MH, Madden E, Dunwoody L, Liddle D. Reducing the decline in physical activity during pregnancy:a systematic review of behaviour change interventions. PLoS One 2013;8:e66385. doi:10.1371/journal.pone.0066385
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement. Ann Intern Med 2009;151:264-9.
Whittemore R, Knafl K. The integrative review:updated methodology. J Adv Nurs 2005;52:546-53.
Sanderson S, Tatt ID, Higgins JP. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology:a systematic review and annotated bibliography. Int J Epidemiol 2007;36:666-76.
Downs DS, Hausenblas HA. Exercising for two:examining pregnant women's second trimester exercise intention and behavior using the framework of the theory of planned behavior. Womens Health Issues 2003;13:222-8.
Downs DS, Hausenblas HA. Pregnant women's third trimester exercise behaviors, body mass index, and pregnancy outcomes. Psychol Health 2007;22:545-59.
Hausenblas HA, Downs DS. Prospective examination of the Theory of Planned Behavior applied to exercise behavior during women's first trimester of pregnancy. J Reprod Infant Psychol 2004;22:199-210.
Hausenblas HA, Downs DS, Giacobbi P, Tuccitto D, Cook B. A multilevel examination of exercise intention and behavior during pregnancy. Soc Sci Med 2008;66:2555-61.
Goodrich K, Cregger M, Wilcox S, Liu J. A qualitative study of factors affecting pregnancy weight gain in African American women. Matern Child Health J 2013;17:432-40.
Sui Z, Turnbull DA, Dodd JM. Overweight and obese women's perceptions about making healthy change during pregnancy:a mixed method study. Matern Child Health J 2012;17:1879-87.
Weir Z, Bush J, Robson SC, McParlin C, Rankin J, Bell R. Physical activity in pregnancy:a qualitative study of the beliefs of overweight and obese pregnant women. BMC Pregnancy Childbirth 2010;10:18. doi:10.1186/1471-2393-10-18
Cramp AG, Bray SR. A prospective examination of exercise and barrier self-efficacy to engage in leisure-time physical activity during pregnancy. Ann Behav Med 2009;37:325-34.
Evenson KR, Bradley CB. Beliefs about exercise and physical activity among pregnant women. Patient Educ Couns 2010;79:124-9.
Gaston A, Wilson PM, Mack DE, Elliot S, Prapavessis H. Understanding physical activity behavior and cognitions in pregnant women:an application of self-determination theory. Psychol Sport Exerc 2013;14:405-12.
Hausenblas HA, Giacobbi P, Cook B, Rhodes R, Cruz A. Prospective examination of pregnant and nonpregnant women's physical activity beliefs and behaviours. J Reprod Infant Psychol 2011;29:308-19.
Santos PC, Abreu S, Moreira C, Lopes D, Santos R, Alves O, et al. Impact of compliance with different guidelines on physical activity during pregnancy and perceived barriers to leisure physical activity. J Sports Sci 2014;32:1398-408.
Evenson KR, Moos MK, Carrier K, Siega-Riz AM. Perceived barriers to physical activity among pregnant women. Matern Child Health J 2009;13:364-75.
Muzigaba M, Kolbe-Alexander TL, Wong F. The perceived role and influencers of physical activity among pregnant women from low socioeconomic status communities in South Africa. J Phys Act Health 2013;11:1276-83.
National Research Council, Committee on Physical Activity, Land Use, and Institute of Medicine. Does the built environment influence physical activity?:examining the evidence. No. 282. Transportation Research Board, 2005.
Humpel N, Owen N, Leslie E. Environmental factors associated with adults' participation in physical activity:a review. Am J Prev Med 2002; 22:188-99.
Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach to creating active living communities. Annu Rev Public Health 2006;27:297-322.
House JS. Work stress and social support. Reading, MA:Addison-Wesley Longman, Inc.; 1981.
Bauer PW, Broman CL, Pivarnik JM. Exercise and pregnancy knowledge among healthcare providers. J Womens Health (Larchmt) 2010;19:335-41.
Evenson KR, Pompeii LA. Obstetrician practice patterns and recommendations for physical activity during pregnancy. J Womens Health (Larchmt) 2010;19:1733-40.
Ferrari RM, Siega-Riz AM, Evenson KR, Moos MK, Carrier KS. A qualitative study of women's perceptions of provider advice about diet and physical activity during pregnancy. Patient Educ Couns 2013;91:372-7.
Zhang J, Savitz DA. Exercise during pregnancy among US women. Ann Epidemiol 1996;6:53-9.
Gaston A, Vamos CA. Leisure-time physical activity patterns and correlates among pregnant women in Ontario, Canada. Matern Child Health J 2013;17:477-84.
Fell DB, Joseph KS, Armson BA, Dodds L. The impact of pregnancy on physical activity level. Matern Child Health J 2009;13:597-603.
Mottola MF, Campbell MK. Activity patterns during pregnancy. Can J Appl Physiol 2003;28:642-53.
Campbell F, Johnson M, Messina J, Guillaume L, Goyder E. Behavioural interventions for weight management in pregnancy:a systematic review of quantitative and qualitative data. BMC Public Health 2011;11:491. doi:10.1186/1471-2458-11-491
Gardner B, Wardle J, Poston L, Croker H. Changing diet and physical activity to reduce gestational weight gain:a meta-analysis. Obes Rev 2011;12:e602-20.
Rhodes RE, Pfaeffli LA. Review mediators of physical activity behaviour change among adult non-clinical populations:a review update. Int J Behav Nutr Phys Act 2010;7:37-48.
Bartholomew LK, Parcel GS, Kok G. Intervention mapping:a process for developing theory-and evidence-based health education programs. Health Educ Behav 1998;25:545-63.