Barriers to physical activity during pregnancy among Saudi population on the Western region Al-Ziyadi SH, Almashyakhi SK, AlEssa HA, Turkistani OA, Al-Harthi RS

ORIGINAL ARTICLE

Year : 2021 | Volume : 10 | Issue : 3 | Page : 191-196

Barriers to physical activity during pregnancy among Saudi population on the Western region

Shatha Hallal Al-Ziyadi¹, Safa Khalaf Almashyakhi², Huda Abdullah AlEssa², Ola Abdullah Turkistani², Rahaf Sifran Al-Harthi²
¹ Department of Obstetrics and Gynecology, College of Medicine, Taif University, Taif, Saudi Arabia
² Medical Intern, College of Medicine, Taif University, Taif, Saudi Arabia

Date of Submission	03-May-2021
Date of Decision	10-Jun-2021
Date of Acceptance	29-Jul-2021
Date of Web Publication	6-Dec-2021

Correspondence Address:
Shatha Hallal Al-Ziyadi
Department of Obstetrics and Gynaecology, Taif University, Taif
Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/sjhs.sjhs_66_21

Abstract

Background: Physical inactivity and sedentary lifestyles among pregnant women have shown significant health risks that threaten the life of the mother and the child. Aim: This study aimed to assess the prevalence and barriers to regular physical activity (PA) during pregnancy among Saudi women in the western region. Materials and Methods: A cross-sectional study was done with 463 pregnant women using the Pregnant Physical Activity Questionnaire. A standardized questionnaire was used to collect the demographic details and information about the PA before and during pregnancy, work-related barriers, pregnancy-related barriers, and other barriers. Results: Only 22.9% of the participants engaged in PA during pregnancy, and not having enough time and intense exhaustion from work were the most common work-related reasons for not exercising during pregnancy. The most reported barriers to PA related to pregnancy were fear of injuring the fetus, feeling sick in the morning, muscle and joint pain, feeling exhausted after exercise, and lack of motivation. Younger pregnant women (<20 years of age) and those who participated in a certain form of PA before pregnancy were comparatively more engaged in PA during pregnancy (P < 0.05). Conclusion: The PA during pregnancy, as reported by the participants, was poor and the most commonly reported barrier to do PA among pregnant women was fear of injuring the fetus. Pregnant women should receive appropriate prenatal advice on the benefits of PA, and they should be made aware of the significance of PA in the promotion of healthy lifestyle practices.

Keywords: Exercise, health promotion, lifestyle, prenatal care

How to cite this article:
Al-Ziyadi SH, Almashyakhi SK, AlEssa HA, Turkistani OA, Al-Harthi RS. Barriers to physical activity during pregnancy among Saudi population on the Western region. Saudi J Health Sci 2021;10:191-6

How to cite this URL:
Al-Ziyadi SH, Almashyakhi SK, AlEssa HA, Turkistani OA, Al-Harthi RS. Barriers to physical activity during pregnancy among Saudi population on the Western region. Saudi J Health Sci [serial online] 2021 [cited 2023 Jun 9];10:191-6. Available from: https://www.saudijhealthsci.org/text.asp?2021/10/3/191/331779

Introduction

Physical activity (PA) is vital for improving and maintaining health throughout life, including during pregnancy.^[1],[2] PA has many health benefits for both the fetus and the mother during pregnancy, including reduced risk of preeclampsia, gestational diabetes mellitus, preterm birth, and control of excessive weight gain during pregnancy.^[3],[4] In addition, PA causes a reduction in mood disturbances, such as depression and anxiety, during pregnancy and leads to improvements in postpartum outcomes.^[5],[6],[7] According to the American College of Obstetrics and Gynecology recommendations, pregnant women should have at least 150 min of moderate-intensity PA per week.^[5] Despite the well-documented health benefits of regular exercise in pregnant women,^[8] compared to prepregnancy levels, PA, which includes occupational and household tasks, decreases during pregnancy.^[9] Due to this reason, daily PA is recommended for all pregnant women regardless of whether they were active or sedentary before pregnancy.^[3] Concurrently, before recommending any workout regimen for pregnant women, all medical and obstetric risks should be reviewed.^[5]

A study conducted among Saudi women in five prenatal clinics in Riyadh, Saudi Arabia (KSA) to evaluate prenatal health behaviors reported that only 38% of the mothers exercised regularly before pregnancy, and only one-third of them was engaged in exercise activities during pregnancy.^[10] Another recent study conducted in the Al-Qassim region among pregnant Saudi women showed that most women believed that PA was important during pregnancy and demonstrated a high level of awareness about the types and amounts of PA. The same study also reported that only 42% did some exercises, and the most commonly reported barrier was exhaustion (25.0%) followed by anxiety about injuring the fetus (18.1%), avoidance of exercise (16.7%), and lack of knowledge about the benefits of regular exercise (16.7%).^[11] Similar findings were seen from Riyadh, which reported that awareness regarding PA and its significance in giving birth was high among pregnant women and the commonly reported roadblock for PA was exhaustion.^[12]

Although life expectancy in the KSA has grown longer, the rate of chronic diseases and obesity has increased, including women of reproductive age.^[13] Proper assessment of the health risks in pregnant women is essential before advising initiation or continuation of PA. Considering the priority to increase PA levels among pregnant women, it is necessary to study the barriers they face in performing it. Understanding the roadblocks to adequate exercises would help the physicians plan interventions or strategies to motivate and maximize PA during pregnancy. To date, there is no precise data available from the Western region of KSA regarding self-perceived barriers to PA among pregnant women. Hence, this study was aimed to determine the prevalence and barriers to regular PA during pregnancy among Saudi women in the main cities of the Western region of KSA.

Materials and Methods

The study was conducted in Taif, Makkah, Jeddah, and Al-Madina, and other provinces in the Western region of KSA. We used a pretested and standardized pro forma to collect the data about participants' weight, height, age, city, jobs, number of children, prepregnancy PA, PA during pregnancy, work-related barriers (such as being too tired from work, not having enough time because of work duties), pregnancy-related barriers (included morning sickness, muscle or joint pain, swelling, and/or high-risk pregnancies), and other causes (women often felt too tired to exercise, lacked motivation, lack of knowledge of recommendations, inadequate advice provided from a health-care professional to limit PA in women without complications, in addition to lists of recommended and not recommended exercises during pregnancy. The Pregnant Physical Activity Questionnaire was used for our purpose as it is found to have good reliability and validity in measuring PA during pregnancy,^[2] and also previous studies done in the Kingdom have used the same.^[10],[11]

We estimated a minimum sample of 407, considering the values derived from a previous study done by Alaglan et al.^[11] However, considering the possibility of incomplete questionnaires, a loss of 10% is expected. Thus, the adjusted sample size is calculated to be 440. The questionnaire was distributed through an online platform after identifying appropriate candidates from the database of prenatal clinics of the eligible cities. This study was approved by the Research Ethics Committee of the chief investigators' institution (No: 42-0023). Participants were informed of the purpose of the survey, and online approval was obtained from all participants before sharing in the study.

Statistical analysis

The data obtained were entered in Microsoft Excel and then converted to analyzable forms for performing statistical analysis. An independent biostatistician performed statistical analysis using IBM Statistical Package for the Social Sciences software version 23.0 (SPSS Inc., Chicago, IL, USA). Statistical analysis included mainly descriptive analysis, with proportions and percentages for categorical variables. Quantitative data were expressed as mean and standard deviation in which the Mann–Whitney test was applied after checking the normality of the variables. Pearson's Chi-square test was applied to test the relationship between the variables. A significance value was set at P < 0.05 at 80% of the power of the study (β-error) and 95% confidence interval to be considered statistically significant.

Results

The participants' sociodemographic details showed that 30.5% of the participants belonged to 31–40 years, 29.4% were from Makkah city, and 59.6% were not working. Nearly half of the participants (41.9%) had a normal weight, and their mean body mass index (BMI) was 26.45 ± 7.22 kg/m² [Table 1]. The analysis showed that 36.1% of the participants reported that PA is a part of their daily routine before pregnancy, and 66.5% started a light activity, such as walking, after pregnancy. Only 22.9% reported engaging in PA during pregnancy, and the most common work-related reasons for not exercising during pregnancy were not enough time (17.7%) and extreme fatigue after working (16.2%) [Table 2].

Table 1: Distribution of the participants according to their characters and body mass index characteristics (n=463)

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Table 2: Distribution of the participants according to practicing physical activity before, during, and after pregnancy and work-related barriers during pregnancy (n=463)

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The most commonly reported PA-related barriers to exercising during pregnancy were fear of harming the fetus (32.8%) followed by muscle and joint pain (27.4%), morning sickness (27%), feeling tired after exercising (26.3%), and lack of motivation (25.5%) [Figure 1]. It was found that 82.7% of the participants reported “walking” as the most recommended exercise during pregnancy [Figure 2]. Similarly, the sports that are commonly not recommended by the participants during pregnancy included mountaineering (81.9%) and horse riding (77.5%) [Figure 3].

Figure 1: Frequency distribution of the participants according to pregnancy-related reasons for not exercising during pregnancy (n = 463)

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Figure 2: Frequency distribution of the participants according to their view about the best recommended exercises during pregnancy (n = 463)

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Figure 3: Frequency distribution of the participants according to their view about sports that are not recommended during pregnancy (n = 463)

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When we assessed the relationship of sociodemographic characters and PA, it was found that participants <20 years (45.8%), residents of Makkah city (34.6%), those not employed (26.4%), and those with the lower mean number of children (2.01 ± 1.66 versus 2.48 ± 1.97), those who engaged in a certain type of PA before pregnancy (32.5%), and those who continued to engage in PA after pregnancy (36.2%) had significantly more engaged in PA during pregnancy (P ≤ 0.05) [Table 3]. It was also observed that women with normal weight were more engaged in PA during pregnancy than those who had higher BMI that showed a statistically significant difference (χ² = 11.17, P = 0.011) [Figure 4].

Table 3: Relationship between practicing physical activity during pregnancy and participants' characteristics and undertaking physical activity pre and postpregnancy

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Figure 4: Relationship between practicing physical activity during pregnancy and body mass index categories

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Discussion

The study aimed to determine how common daily PA is during pregnancy and the barriers for Saudi women in the western region, KSA. The study findings showed that only 22.9% of women reported engaging in PA during pregnancy. The most common work-related explanations for not exercising during pregnancy were a lack of time (17.7%) and intense exhaustion after work (16.2%). In a recent Saudi survey, less than half of the pregnant women were walking properly (26%) or exercising (42%) during their pregnancy.^[11] According to a study conducted in Brazil, only 23% of pregnant women exercised, and almost half of the women in the study limited or avoided exercising due to their pregnancy.^[3] Another survey from the United States showed that 29% of women exercised both before and during pregnancy, and another 4% began exercising during pregnancy.^[14] According to other surveys, only 13.8% of pregnant women in the United States follow exercise guidelines in the general population,^[15] and that amount of exercise often decreases during pregnancy.^{[9],[11],[16],[17]}

Maintaining a regular exercise routine can be challenging, and many women do not meet their exercise requirements during their first trimester of pregnancy.^{[18],[19],[20]} Many studies have found a low prevalence of PA during pregnancy despite women being highly motivated to maintain a healthy lifestyle during pregnancy because barriers to exercise will discourage them from becoming physically active.^[21] Fear of injuring the fetus (32.8%), muscle and joint pain (27.4%), morning sickness (27%), feeling exhausted during workouts (26.3%), and lack of motivation were the most common pregnancy-related obstacles to exercising during pregnancy, according to the current report (25.5%). Fatigue (25.0%), anxiety (18.1%), dislike of exercise (16.7%), and lack of information concerning the benefits of exercise during pregnancy (16.7%) were the most common obstacles to undertaking PA during pregnancy, according to a recent Saudi study published in 2020.^[11] Lack of time was cited as a barrier to PA by 57.7% of respondents in a Portuguese survey of 123 women during their first trimester.^[22] An Australian study of 158 women in their first and third trimesters discovered that nausea persisted as a barrier during the first trimester, and fatigue persisted during pregnancy.^[17] Intra-personal factors, such as pregnancy-related symptoms, time constraints, and a lack of motivation, were frequently cited as the most common obstacles to exercise in other research. Inter-personal (such as social support) and environmental (such as lack of infrastructure and weather) variables were also major obstacles.^[23],[24] Since most women do not follow the advice for exercise during pregnancy, numerous studies have looked into the obstacles to exercise and have explored that that some socio-economic factors play a role in a woman's ability to maintain a healthy level of PA while pregnant.^[23],[24] By addressing these factors, interventions utilized should target to reduce the gap between exercisers and nonexercisers during pregnancy.^[25]

The present study found that those with a lower mean number of children presented a slightly higher percentage than those who practiced PA during pregnancy. Participants' ages, number of pregnancies, attitude toward exercise, and self-rated health were important correlates of adequate exercise during pregnancy in a previously reported Saudi study.^[11] This study also found that younger women ≤30 years were 1.7 times more likely to be adequately active than older women.^[11] Nonexercisers had a statistically significantly higher mean number of living children, and more nonexercisers tended to have at least one child, according to another report. This gap could be reduced by providing healthy, accessible places for mothers to exercise, including childcare.^[26] A previous Saudi study found that multiparous participants with two pregnancies were 2.4 times more likely to be sufficiently involved in PA.^[11] Furthermore, according to this report, women who engaged in a specific form of PA prior to pregnancy had a higher percentage of those who exercised PA during pregnancy. Other research found that women who had developed exercise routines faced fewer pregnancy-related challenges than those who did not.^[27]

Limitations

Our study may have faced some limitations. First, we used a nonrandom sampling technique to collect the data and this may have not given true representation of the pregnant women population. However, the larger sample size we included may have lessened this problem. Second, we used an online questionnaire for collecting data, and all the responses were self-reported by the participants, rather than observed, and so there may be a possibility of social desirability bias.

Conclusion

The study findings showed that the PA during pregnancy among pregnant women was not satisfactory in the western region of KSA. The most commonly reported barrier to exercising during pregnancy was fear of injury to the fetus, followed by morning sickness, muscle, joint pain, exhaustion after exercise, and lack of motivation. Physicians should recognize the obstacles to adequate exercise during pregnancy before advising appropriate measures considering the health risks. Hence, it is necessary to impart adequate knowledge about the importance of PA during pregnancy, the significance of prenatal therapy, and the benefits of healthy lifestyle practices to pregnant women.

Acknowledgment

The authors would like to thank each and every participant for their valuable time in responding to the questionnaire.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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