LEVEL OF PHYSICAL ACTIVITY DURING PREGNANCY: WOMEN'S PERCEPTION AND ITS MODIFIABLE BARRIERS

Ayman Abdullah Bukhari 1 , Bayan Abdulrahman Al-Deibani 2 , Bodour Saleh Alsalmi 2 , Amani Faleh Alhakami 2 and Nada Hamed Alsafari 2 . 1. Assistant professor and consultant in Obstetrics and Gynecology. 2. Medical intern KAU. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 4 (12), 1115-1120 1116 nutrients to the fetus; and premature labour (5). A lot of speculation regarding the adverse effects of exercise on pregnancy outcome due to culture and social percenters . with no scientific supporting . (6)The physical stress arising from leisure exercise has not been shown to increase the incidence of small for gestational age babies or premature labour; and may even decrease the incidence of both ( 7). During the last few decades a huge dramatically changes happened towards practicing exercises during pregnancy . (8)higher amounts of exercise have been associated with a reduced incidence of caesarean section and shorter hospitalization (9), Alsoamongwomen who deliver vaginally, physical fitness may also be associated with a shorter duration of active labor (9). On the basis of such evidence, American Congress of Obstetricians and Gynecologistsrecommendedon 2002 as update for its 1985 guideline that pregnant women can exercise moderately for 30 minutes on most days of the week, and in 2008 the U.S. Department of Health and Human Services published its guidelines and recommende pregnant women to participate in moderate physical activities at least 150 minutes per week ,in accordance with these recommendations, irrespective of the pregnant woman's physical fitness level, exercise should be low-impact, moderate-intensity, and regular. (9,10,11)In spite of these facts and recommendation, it is submitted that women are not meeting the exercise recommendations of the previous studies. A myriad of factors not limited to beliefs and attitudes of women with respect to exercise in pregnancy , level of knowledge, level of education, safety concern of the pregnant woman andher physician, race/ethnicity, and previous involvement in regular exercise have been implicated as important factors predisposing to exercise engagement or phobia among pregnant women . (9,10,11)This study focused on measuring awareness level of physical activity among pregnant women by using useful questionnaires in this regard., in order to identify factors that affect beliefs and behaviors would objectively encourage a change in attitude.

Method:-Ethicalapproval:-
The study was approvedfrom the ethical committee in faculty of medicine -King Abdulaziz University.

Study design:-
This cross-sectional survey , targeted pregnant women population who admitted to the inpatient department or visited the obstetrics and gynecology clinic from September2015 to Novemer2015 atking Abdul-Aziz University hospital in Jeddah Three hundred fifty six pregnant women werecruised to fill the questionnaires and from them only 56 refused to participate so the total responds were 300.

Questionnaires and measurements:-
The method of the study was adapted questionnaire from 40 articles the piloting was done on eight pregnant women it takes around 10 minutes to fill the survey.The subject informed about the purposes of this study and theconsent was taken. The questionnaire consists of different parts. First part was about personal information such as; name, nationality, address and phone number. Then ten multiple choices questions about the socio-demographic information included; age, race, residence, education, occupation status, income, body mass index, pregravida, BMI, general health and smoking. Thethird part was about women's obstetric history including the parity, pregnancy trimester, and total numbers of prenatal visits, place of prenatal care, any complication during pregnancy and any history of preterm stillbirth, abortion and mode of delivery. In this part collected information about women physical activity level including whether the subject habitually exercise before pregnancy or started during this pregnancy, what are the type of exercise,the duration of each session and what are the sources for their information about physical activity. The last part focused on the women's perception about the physical activity, if there any benefit of it and whether it consider safe to do it and the barrier.

Statistical analysis:-
For the data analysis and processing SPSS, version 20 used. Descriptive statistics ( number and percentage) was used for nonparametric data (demographic data, level of Exercise during this pregnancy, Modifiable barriers to physical activity during pregnancy and sources of physical activity (reported in percentage)) . Comparison done to assess the relationship between Pregnancy trimester , educational level, monthly income and occupation as categories and the Women's perception and belief by using Chisquare test with a set statistical significance cutoff of p <0.05.

Results:-
Tabel1showed the demographic characteristics of the 300 pregnant women participated in the study, of which 45 % were from group age 20-29 , more than half (57.7%) had university degree & reported multiparty, third quarter of the women (76.7%) were housewives . (Table 1) Almost two third (65.3% ) were not exercising during pregnancy, and when asking them about the barriers that prevent them to do the exercise 1% relived that they dislike exercise,5.3% of them have work related barriers (such as being too tired from work, not having enough time because of work duties or having a physically active job),13.3% having no time (i.e. having a lot of child care activities, school or cleaning up),15.4% dined having any kind of motivation (i.e. having no one to go with),32% have no knowledge about the benefit of exercise (i.e. lack of personal knowledge or inadequate advice provided from a health professional) and 33% have pregnancy related barriers (i.e. these included morning sickness, back pain and high risk pregnancies).  The results showed that workers women and from group higher monthly income have good perceptions of physical activities during pregnancy with no significant difference , while there was significant association between women with higher level of education (University level) and good perceptions of physical activities in the following items (continue exercises during pregnancy on a regular basic p=0.008, avoiding standing in one place for a long time p=0.03) . Regarding the comparison of women's perception depending of pregnancysemester , the results showed high perception of physical activities benefits during pregnancy among women in the third trimester followed by women in the second trimester with no significant difference . (2)Among all women who exercised during pregnancy walking was the leading activity (60.7%) , similar to that the results from Pennsylvania , USA study where authors reported that 81.6% pregnant women reported slow walking , (15)while (59.8%) of Nigerian pregnant women practicing relaxation and breathing the most ( 10) and in second Nigerian study Aerobic (43.5%) and stretching (33.4%) were the common exercises . (14)A , compared a comparison between the findings from the current study with the one from University of North Carolina, USabout women's perception and belief about physical activity during pregnancy was Illustrated in Table3 and showed improvementin the level of knowledge about the benefit of physical activities during pregnant. ( 11).

Limitation:-
Few limitations of the study should be noted. As majority of women were in their 2nd trimester, Physical activity perceptions may change throughout pregnancy,the sample size considered small, the study conducted at king Abdul-Aziz University hospital in Jeddah which is a coastal city doesn't properly represent the population in Saudi Arabia as well as some villages around Jeddah were not assessed and we suspect the results will be different due to the culture reasons.

Conclusion:-
Most pregnant women were not physically active during pregnancy and of their knowledge about the physical activity was from multimedia, and some of these information were not scientifically correct. We recommend the physician and health care provider to motivate them to be active as the British college recommended and heldmore awareness events lead by physician to provide pregnant women by the correct information , also advise women to attend prenatal exercise classes supervised by experienced trainer.