Top Physical Activity Amongst Pregnant Women - Research Paper Example

 Top Physical Activity Amongst Pregnant Women 1.0 Introduction and study rationale In general, it is recommended that pregnant women should engage in some degree of physical activity during their pregnancy to ensure health for themselves and their children, both emotional and physical. However, not all pregnant women engage in physical activity, or in varying degrees, despite these many recommendations and guidelines for best practice pregnancy. For some women, there are simply too many barriers to physical activity that complicate achieving these recommended levels. There is a significant gap in research illustrating what pregnant women specifically contribute to barriers that are perceived as being relevant for reducing physical activity levels. Whilst it is often said that physical activity during pregnancy is beneficial, only a marginal percentage of pregnant women in today’s society are physically active. This study can provide unique insights not available in many pre-existing empirical studies about what might represent the most common and dominant, perceived barriers that defy increased physical activity during pregnancy in a moderate-sized cohort of pregnant women. Chapter two constitutes a broad review of literature on the subject which underpins the methodological approach to a primary study in Chapter three. Attached is the proposed research instrument designed to measure this phenomenon, available in Appendix A. 2.0 Literature review Women who are pregnant are often promoted to engage in some degree of physical activity during the course of their pregnancies. The Mayo Clinic, a foremost health institution in the United States, suggests that physical activity can be beneficial for both the mother and her unborn child. Exercise is recognised as having benefits of reducing mothers’ back pain problems, improving mood levels, assisting in better sleep patterns, curbs excessive weight gain, and generally capable of increasing muscle strength (Mayo Clinic 2015). The American College of Obstetrics and Gynecology also recommends that pregnant women exercise for 30 minutes (or more) each day unless there is an obstetric complication related to pregnancy or a difficult medical condition. However, not all pregnant women prescribe to such advice and, instead, choose to forego the recommended levels of exercise and related physical activity suggested as appropriate by relevant and respected medical health professionals. Epidemiological data gathered by the National Health and Nutrition Examination Survey showed that just a marginal 15 percent of pregnant women actually were meeting contemporary recommendations for physical activity every week (Evenson and Wen 2010). This review of literature seeks to identify what might be driving a more sedentary stance related to physical activity and pregnancy through examination of empirical studies targeting pregnant and pre-natal women about their experiences with physical activity during pregnancy. 2.1 Inconsistency in health information Pregnant women are exposed to a plethora of health-related information stemming from physicians, the Internet and even social reference groups about the perceived benefits and hazards of engaging in physical activity during pregnancy. In a study conducted by Cioffi et al. (2010), interviews were conducted with 19 pregnant women in various stages of pregnancy, to discuss their experiences with engaging in physical activity. Some of the participants in the study asserted that information from health professionals, relatives and other information sources were often inconsistent. The women in the study identified that such information is not always reliable and, in some instances, even contradicting (Cioffi et al.). This same theme emerged as a perceived barrier to physical exercise in a study conducted by Weir, et al. (2010). In this study, 14 different pregnant women participated in semi-structured interviews. This qualitative study provided results consistent with women perceiving inconsistency of quality and relevant information about the potential benefits and hazards of physical activity during pregnancy. Insufficient advice and support systems conflicted whether the women in the study determined it would be beneficial to engage in physical activity until their post-partum condition. Yet another study conducted by Evenson, et al. (2009) identified this same theme; inconsistency of information stemming from various sources. In this study, recruiting 1,535 pregnant women to engage in a survey, it was found that conflicting advice from health professionals and social reference figures complicated whether physical activity was beneficial or a potential detriment during pregnancy. One participant was described as identifying that her mother advised some degree of physical activity whilst her physician warned against conducting high degrees of physical movement (Evenson, et al.). Interpersonally, this same participant in the study faced chastisement from her husband related to physical activity and suggested that this participant spend more time lying down to ensure the baby was not injured (Evenson, et al.). Clarke and Gross (2004) conducted a study which recruited 57 pregnant women to participate in semi-structured interviews. This study found that whilst 96 percent of the sample had received information and advice about physical activity, from books, magazines, family and social acquaintances, lack of health information consistency served as a barrier to engaging in regular physical activity during their pregnancies (Clark and Gross). This might tend to suggest that pregnant women should turn away from advices stemming from non-professional individuals in their social environment. The study by Clarke and Gross (2004) found that archaic beliefs from familial figures which warned of dangers to the mother and child through physical activity might be common with certain ethnic pregnant women, forcing them to avoid physical activity as a product of fear of causing harm to themselves and their unborn children. All of the aforementioned studies reveal that, during pregnancy, women are exposed to an over-abundance of information and advice which stems from many different sources, including health care field advice, familial and as presented by various media sources. Some of this information appears to provide advice that physical activity is a positive pursuit whilst other sources of advice and information indicate that there are risks to physical action. The study by Cioffi, et al. (2010) provided knowledge that pregnant women were frustrated and confused by various myths about physical activity. The studies indicated inconsistency of information highlights a need for all pregnant women throughout the world to have access to recent empirical data underpinning the recommended guidelines for physical activity so as to make informed decisions about what constitutes safe and effective participation in physical exercise. With contradiction and irregularities being provided through various informational sources, hence conflicting the amount of physical activity a women is willing to risk, it would seem to indicate that information and data inconsistencies contribute strongly to confusion about physical activity and the recommended levels that a pregnant woman should consider. Pregnant women, today, receive a wide variety of information offering recommendations for appropriate physical activity levels during pregnancy. Not all of this data is reliable and valid and can be found in social media, various periodicals, and irreputable websites. It is not necessarily surprising, therefore, that with conflicting information about the potential detriments to mother and child as a result of physical activity as compared to those sources that herald higher levels of exercise, women are reluctant to engage in regular physical activity during their pregnancies. Smith and Campbell (2013) suggest that, today, there are so many different guidelines about what constitutes recommended physical activity during pregnancy and women will either have low levels of activity or high levels of activity dependent on the type of guideline selected by pregnant women. With so many different advices and guidelines available in reputable and questionable information source forums, it seems to speak toward a need to establish universal guidelines and recommendations to potentially facilitate more motivation to engage in physical activity and avoid the confusion and/or frustration that might occur through constant exposure to conflicting information sources. 2.2 Lack of motivation and social support Thornton, et al. (2006) conducted a qualitative study which recruited 10 pregnant women and also 10 of their associated social influences (i.e. family and friends) to engage in semi-structured interviews. This study provided learning that social support for many pregnant women is a primary motivator to engage in physical activity and lack of this support serving as a de-motivator. Women indicated that social support provided a source of emotional well-being which underpinned more desire to exercise. Concurrently, women in the study indicated that lack of social companions to engage in mutual physical activity scenarios would limit the barriers they perceived to what underlined a lack of desire to be physically active during their pregnancies (Thornton, et al.). This study recommended that social support systems and positive family-related interventions would better serve to motivate pregnant women to be more physically active. Yet another study identified this same theme; social support barriers. In a study conducted by Evenson, Aytur and Borodulin (2009), 667 women who were three months post-partum were recruited to participate in face-to-face interviews about their experiences with physical activity during their pregnancies. Fifteen percent of women indicated that lack of support from their relevant partners de-motivated participation and served as a barrier to physical activity. Whilst 15 percent does not represent a substantial majority of recruited participants in this study, it does support that, to some degree, partner support is a relevant factor driving pregnant women to choose sedentary lifestyles rather than seeing more recommended levels of physical activity offered by many practicing health care professionals. Partner support problems were also identified in another study conducted by Symons-Downs and Hausenblas (2004) as being barriers to engaging in physical activity and exercise. This retrospective study recruited 74 different post-partum women to examine their general beliefs about exercise during pregnancy. Partner and relevant family member support was the most significant predictor of improving motivation to engage in exercise activities during pregnancy (Symons-Downs and Hausenblas). This same theme was asserted as the most significant motivator for engaging in physical activity in a study by Kanotra, et al. (2007). This study gathered qualitative data using the Pregnancy Risk Assessment Monitoring System instrument from 3,417 different pregnant and post-partum women, identifying that the need for social support was the most significant influencer that encouraged women to be more physically active during pregnancy (Kanotra, et al.). Leiferman, et al. (2011) found this same need for emotional support as a motivational predictor for pregnant women to be more physically active. In this study, interviews were conducted with 25 different pregnant women to determine what served as motivational aspects with the dominant theme being social and partner-based support. The need for familial, emotional and social support is not necessarily unexpected, as both sociological and psychological literature asserts that many humans are extrinsically motivated. Extrinsic motivations are those stemming from non-inherent stimulus, engaging in a particular activity not for its own sake or benefit, but as a means to an end (Vallerand and Rousseau 2001). Social persuasion and social support are very influential in giving individuals greater motivation as the receipt of esteem and social belonging from others maintains strong psychological incentives (King 2009). Social belonging and socially-based esteem are recognised as being primary and fundamental stimulus that drive motivation. Marquez, et al. (2009) provided further empirical support that social persuasion and support served as potent facilitators of the motivation to engage in physical activity. This study recruited 20 pregnant women to participate in qualitative focus groups with the intention to identify what were the most dominant barriers for exercise and physical action. Lack of social support was one of the most foundational and common obstructions in this capacity. Again, the Marquez, et al. study illustrates that social encouragement and relevant support are fundamental, perceived barriers for why pregnant women seek sedentary lifestyles rather than physical activity during their pregnancies. Hence, the many aforementioned studies which reinforce that extrinsic motivations, social, familial and partner support levels serves as appropriate evidence that such support systems should be promoted to ensure more dedication and commitment to engaging in physical activity during pregnancy. In the same capacity as Thornton, et al. (2006), this might speak to the need for family-based and community-oriented interventions and education to assist pregnant women in finding the emotional and motivational support required to ensure they are more physically active. 2.3 Fatigue Evenson, et al. (2007) found that fatigue contributed as a barrier to physical activity during pregnancy. Of the 667 women recruited for the study, 13 percent indicated weariness and lack of energy as being perceived barriers to engaging in exercise during their pregnancies. Marquez, et al. (2009) also found fatigue and lack of energy to be fundamental predictors of the intention for pregnant women to engage in physical activity in their qualitative study recruiting 20 different pregnant women. In yet another study by Symons-Downs and Ulbrecht (2006) the most common and dominant barrier to physical exercise was perceived as being fatigue. In this study which recruited 28 post-partum women asked to complete a mail survey, all sustaining diabetes, exhaustion and low energy contributed to less incentive to engage in exercise. Whilst fatigue might be considered a common outcome of diabetes, this study does reinforce that that fatigue as a result of pregnancy, might be a significant predictor of limited physical activity with pregnant women. A study conducted by Duncombe, et al. (2007) reinforces the aforementioned subjective assertion. Questionnaires in this study were mailed to 158 different pregnant women to measure beliefs about exercise during pregnancy and participant beliefs about exercise safety in the same capacity. Feeling tired and unhealthy was the most significant and common reason for not engaging in appropriate levels of physical activity during participant pregnancies (Duncombe, et al.). This dominant theme of being too tired or feeling unwell was generally consistent in all three trimesters and over 50 percent of respondents indicated fatigue and perceptions of generally poor health contributed to why participants in the study had chosen to forego exercise and related physical activity. During pregnancy, women often face sleep issues which has been documented in 30 years of research into sleep and pregnancies (Lee 1998). In fact, the National Sleep Foundation reports that 78 percent of women who participated in a 1998 Women and Sleep poll reported disturbed sleep during their pregnancies. This is due to fluctuating hormone levels that occurs during pregnancy, which has impact on muscles, increases snoring and sleep apnea, and causes pregnant women to frequently visit the restroom throughout the night, a discomfort and burden that interrupts sleep. Anxiety about the pregnancy can also contribute to insomnia which, in turn, causes significant sleepiness problems during the daytime hours. What is remarkable in the literature is that many studies have indicated that exercise can have many health benefits for the pregnant woman. Pivarnik, et al. (2006) iterate that physical activity can prevent musculo-skeletal problems, ensure weight gain is not excessive during pregnancy, reduce diabetes risks, and even shorten labour. Physical activity during pregnancy is also known to reduce instances of post-partum depression, prevent premature birth, and improve overall mental well-being. Furthermore, physical activity during pregnancy is effective to reduce anxiety and improve sleep patterns, however many pregnant women report that getting started with such a regime is complicated by recurring fatigue. It would appear that fatigued women who see this weariness as a barrier to physical activity might benefit from an intervention strategy that promotes the long-term benefits of physical activity to motivate more engagement in exercise during their pregnancies. Biddle, Fox and Boucher (2000) assert that even low-frequency aerobic exercise during pregnancy improves mental health of pregnant women, which might better incentivise attempting to overcome fatigue symptoms to experience the long-run benefits of physical activity on their physical and mental well-being. 2.4 Time constraints In the study conducted by Symons-Downs and Ulbrecht (2006), lack of time was the most common, substantial, and perceived barrier to engaging in physical activity with the recruited sample of 28 post-partum women recruited for the study. In this study, 75 percent of women recruited were busy professionals in the nursing field, management, marketing industries, education and areas of customer service (Symons-Downs and Ulbrecht). In an environment where households require the income contributions of women, it is not necessarily surprising that lack of time would be promoted as a perceived barrier to physical activity when juggling multiple familial and professional obligations during pregnancy. These same findings were achieved by Evenson, et al. (2009) where time constraints emerged as a dominant theme related to perceived barriers to exercise and physical activity. In yet another study conducted by May, et al. (2014), 200 women were recruited to participate in a mailed questionnaire to measure their level of routine, maternal physical activity. This study found that 97 percent of respondents had indicated time constraints as being a dominant factor for not engaging in recommended levels of physical activity during their pregnancies. This study also found a correlation between low levels of physical activity and cardiovascular health of the unborn child, with the study authors suggesting that this type of data would be a significant motivator to engage pregnant women who reported time constraints as a barrier to seek more significant physical activity during their pregnancies (May, et al.). Yet another study by Haakstad, et al. (2009) found that perceived time constraints contributed to why pregnant women in the third trimester begin reducing their physical activity levels. Whilst the specific drivers for what contributed to time constraints was not revealed, the authors suggest it could be complications from child-rearing obligations, professional obligations or other familial responsibilities. Jukic (2012) suggests that the commonality of time constraints as a barrier might be exacerbated when pregnant women do not, inherently, find the process of engaging in physical activity engaging and enjoyable. These authors suggest that exposing pregnant women to an array of differing physical activities might make it more simplistic to find a particular activity they might find engaging which will better motivate physical activity during their pregnancies (Jukic, et al.). 2.5 Chapter summary Whilst there may be other perceived barriers for pregnant women to engage in physical activity, this review of literature identified the most dominant themes gleaned through empirical data. These include inconsistency and uncertainty about conflicting health information stemming from multiple sources, both socially and in the health field. Additionally, many women in various studies reported lack of motivation and social support as being dominant drivers causing pregnant women to forego physical activity and exercise. Fatigue and a general feeling of not being well also strongly contributed as a dominant theme for why pregnant women do not engage in appropriate or recommended levels of physical activity. Having identified the most common and prevailing perceived barriers to physical activity, it would be important for gaining an understanding of why pregnant women select to forego exercise and physical action in a method that transcends the theoretical. Though the studies identified in this study assist in developing a relevant framework for understanding of this phenomenon, more information is necessary to identify whether these have remained dominant catalysts and, potentially, the extent to which each identified factor might influence not achieving recommended levels of physical activity. The following chapter describes the methodological approach to primary research determined to focus more in-depth on all identified factors, including inconsistent health information, poor motivation, poor social support, and fatigue during pregnancy. 2.6 The research aim The aim of this study is to investigate what real-world pregnant women claim serve as barriers to increasing physical activity during their many stages of pregnancy. The study seeks to answer the prevailing research question, what are the most dominant and common barriers to engaging in physical activity during pregnancy? 3.0 Methodology Because the review of literature identified a potential plethora of catalysts underpinning a lack of desire for pregnant women to engage in physical activity, the qualitative approach to research was more appropriate. Quantitative research approaches attempt to isolate a singular criteria that can be measured statistically. However, this study’s review of literature identified that some barriers reported by other pregnant women were socio-psychological in nature, complex human behavioural characteristics that cannot be measured utilising statistical methods. Measuring attitudes is a multi-faceted phenomenon that cannot be achieved through quantitative measurement (Henerson, Morris and Fitzgibbon 1987) , instead requires a researcher to explore deep sociological and psychological characteristics to uncover the potential whys and hows of a phenomenon. Quantitative approaches do not provide for the intensity of interpreting phenomenon associated with the specific meanings that individuals apply to a phenomenon. The research method selected for this qualitatitive study, therefore, is the semi-structured interview, an approach utilised by many researchers identified in this study’s review of literature that provided unique results that was capable of understanding the more multi-faceted aspects of human behaviour. The interview provides the ability of the researcher to gather complicated data and unique perspectives not accomplishable through surveys or other statistical measurement instruments. 4.0 Sampling strategy/population The sample for this study will be selected utilising non-probability/purposive sampling. This sampling method maintains the purpose of obtaining a participant group that meets a specific criterion, in this case being women in varying degrees of current pregnancy. This study’s review of literature did not indicate that any pregnant women that maintained common beliefs about what constituted barriers to physical activity were of a certain age group, ethnicity or other demographic characteristic. Hence, maximum variation sampling is appropriate for this study, providing the most significant and wide-ranging attitudes and perspectives related to the phenomenon being measured, in this case perceived barriers to physical activity during pregnancy. Purposive sampling takes into consideration that different participants may share a wide range of different experiences, attitudes, and behaviours related to this phenomenon. Maximum variation sampling as part of purposive sampling allows a researcher to identify any commonalities or congruencies (themes) that might be emergent among the whole sample. Purposive sampling in qualitative research has been criticised for not being relevant for representing attitudes of an entire population (in this case every pregnant woman throughout the world). However, this should not be viewed as a weakness in qualitative research. Due to researcher resources and capability, it would not be feasible to recruit a much larger sample to engage in interviews longitudinally. It would require considerable researcher competency and resource availability to utilise probability sampling that would gain the perspectives of a much broader group of pregnant women throughout the world. Purposive sampling allows the researcher to utilise inference, required of an in-depth qualitative study, and apply this deduction to a relevant-sized group of pregnant women where responses will require correlation, subjectivity and objectivity to fully analyse the varying (or congruent) responses provided by the sample. The purposive sampling approach will seek between 10 to 20 pregnant women with different demographic backgrounds and varying levels of current pregnancy, an acceptable sample for a researcher without the capabilities to recruit and interview a much larger sample population. By limiting the volume of participants, the researcher’s current competencies in conducting inferred analysis are addressed. This study’s review of literature indicated that fatigue, lack of consistent health information, social support issues, motivational issues, and time constraints were some of the most dominant, perceived barriers to physical activity during pregnancy. These were the most congruent and emergent themes identified through pre-existing empirical studies. The researcher does not maintain the competencies necessary to attempt to explore other, potential criteria and provide a sociologically-based and psychologically-based evaluation that would be deemed by the research community as reliable and dependable. Purposive sampling methods allow the researcher to focus only on the aforementioned five dominant themes and ensure that the researcher gleans appropriate socio-psychological learnings (facilitated through exploration of relevant secondary literature sources) to be able to fully analyse responses and interpretations by the smaller sample group. Purposive sampling is also criticised for providing researchers with a haphazard sample that contributes to researcher bias. Critics argue that the judgment of the researcher is not sufficient for reducing bias that is achieved more effectively through probability sampling techniques. However, this literature review provided that the congruent sentiment about potential barriers from previous samples of pregnant women, hence giving the researcher a very clear criteria to build a theoretical framework for study. This required less subjectivity in determining the potential phenomenon that is to be measured, making purposive sampling relevant and far less subjective that does not rely on predisposed judgment, but having a solid scaffolding by which to explore the phenomenon in the capacity capable of the researcher. The only criterion for purposive sampling to be relevant and appropriate for this study is that women recruited for this study are currently pregnant. This singular criterion ensures that all recruited participants have fresh and unsullied perspectives on the challenges of pregnancy and their perspectives on physical activity and what might constitute a barrier to this process. Without the underlying literature suggesting that certain demographics might maintain differing attitudes and beliefs over that of other pregnant women, purposive sampling allows the researcher to make generalisations about whether congruent attitudes might be representative of a larger population of pregnant women. 5.0 Conclusion As illustrated, the most dominant themes identified in the literature review in what posed barriers to physical activity were fatigue, lack of quality health information, social support and motivational problems, and time constraints. Whether these are the only factors posing barriers is not necessarily relevant, however to find the most dominant themes is the aim of this research, and these conceptions which were consistent throughout the literature on the subject underpin the development of this proposed research study. This study found considerable research support that justified and supported these aforementioned dominant themes, which will provide a focused primary research study that can competently address these factors and determine whether they have remained dominant throughout the years, thus impacting pregnant women’s intentions and motivations to engage in recommended levels of physical activity during their pregnancies. This study can provide unique, real-world findings on modern attitudes not necessarily reflected in previous empirical studies. References Biddle, S., Fox, K. R., and Boutcher, S. H. (2000). Physical activity and psychological well-being. London: Routledge. Cioffi, J., Schmied, V, Dahlen, H., Mills, A., Thornton, C., et al. (2010). Physical activity in pregnancy: women’s perceptions, practices and influencing factors, Journal of Midwifery & Women’s Health, 55(5), pp.455-461. Clarke, P.E. and Gross, H. (2004). Women’s behaviour, beliefs and information sources about physical exercise in pregnancy, Midwifery, 20(2), pp.133-141. Duncombe, B.B., Wertheim, E.H., Skouteris, H., Paxton, S.J. and Kelly, L. (2007). Factors related to exercise over the course of pregnancy including women’s beliefs about the safety of exercise during pregnancy, Midwifery, 25, pp.430-438. Evenson, K.R. and Wen, F. (2010). National trends in self-reported physical activity and sedentary behaviours among pregnant women: NHANES 1999-2006, Preventative Medicine, 50, pp.123-128. Evenson, K.R., Moss, M., Carrier, K. and Siega-Riz, A. (2009). Perceived barriers to physical activity among pregnant women, Maternal and Child Health Journal, 13(3), pp.364-375. Evenson, K.R., Aytur, S.A. and Borodulin, K. (2009). Physical activity beliefs, barriers and enables among postpartum women, Journal of Women’s Health, 18(12), pp.1925-1934. Haakstad, L., Voldner, N., Henriksen, T. and Bo, K. (2009). Why do pregnant women stop exercising in the third trimester?, Acta Obstetrica et Gynecologica Scandanavica, 88, pp.1267-1275. Henerson, M.E., Morris, L.L. and Fitz-Gibbon, C.T. (1987). How to Measure Attitudes. Newbury Park: Sage Publications. Jukic,A.Z., Evenson, K.R., Herring, A., Wilcox, A.J., Hartmann, K.E. and Daniels, J.L. (2012). Correlates of physical activity at two time points during pregnancy, Journal of Physical Activity and Health, 9, pp.325-335. Kanotra, S., D’Angelo, D., Phares, T., Morrow, B., Barfield, W.D. and Lansky, A. (2007). Challenges faced by new mothers in the early post-partum period: an analysis of comment data from the 2000 Pregnancy Risk Assessment Monitoring System survey, Maternal and Child Health Journal, 11(6), pp.549-558. King, P.W. (2009). Climbing Maslow’s pyramid: choosing your own path through life. Leicester: Matador. Lee, K. (1998). Alterations in sleep during pregnancy and post-partum: a review of 30 years of research, Sleep Medicine Reviews, 2, pp.231-242. Leiferman, J., Swibas, T., Koiness, K., Marshall, J. and Dunn, A. (2011). My baby, my move: examination of perceived barriers and motivating factors related to antenatal physical activity, Journal of Midwifery and Women’s Health, 56, pp.3-40. Marquez, D.X., Bustamante, E., Bock, B., Markenson, G., Tovar, A. and Chasan-Taber, L. (2009). Perspectives of Latina and non-Latina white women on barriers and facilitators to exercise in pregnancy, Women’s Health, 49(6), pp.505-521. May, L.E., Drake, W.B., Suminski, R.R. and Terry, M.J. (2014). Effects of exercise during pregnancy on pediatric heart measures, Journal of Cardiobiology, S(1). Mayo Clinic. (2015). Pregnancy and exercise: Baby, let’s move! [online] Available at: http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-and-exercise/art-20046896 (accessed 3 May 2015). Pivarnik, J. M., Chambliss, H. O., Clapp, J. F., Dugan, S. A., Hatch, M. C., Lovelady, C. A., Mottola, M. F., and Williams, M. A. (2006). Impact of physical activity during pregnancy and postpartum on chronic disease risk, Medicine & Science in Sports & Exercise, 38, pp.989–1006. Smith, K.M. and Campbell, C.G. (2013). Physical activity during pregnancy: impact of applying different physical activity guidelines, Journal of Pregnancy. [online] Available at: http://www.hindawi.com/journals/jp/2013/165617/ (accessed 4 May 2015). Symons-Downs, D. and Ulbrecht, J.S. (2006). Understanding exercise beliefs and behaviours in women with gestational diabetes mellitus, Diabetes Care, 29(2), pp.236-240. Symons-Downs, D. and Hausenblas, H. (2004). Women’s exercise beliefs and behaviours during their pregnancy and postpartum, Journal of Midwifery and Women Health, 49, pp.138-144. Thornton, P.L., Keiffer, E.C., Salabarria-Peria, Y., Odoms-Young, A., et al. (2006). Weight, diet and physical activity-related beliefs and practices among pregnant and post-partum Latino women: the role of social support, Maternal and Child Health Journal, 10(1), pp.95-103. Vallerand, R.J. and Rousseau, F.L. (2001). Intrinsic and extrinsic motivation in sport and exercise: a review using the Hierarchical Model of Intrinsic and Extrinsic Motivation, in R.N. Singer, H.A. Hausenblas and C.M. Janelle (eds.) Handbook of Sport Psychology, 2nd edn. New York: Wiley. Weir, Z., Bush, J., Robson, S.C., McParlin, C., Ranking, J. and Bell, R. (2010). Physical activity in pregnancy: a qualitative study of the beliefs of overweight and obese pregnant women, BMC Pregnancy and Childbirth, 10(18), pp.1-7. Appendix A: Data collection instrument The following represents that qualitative, semi-structured interview template that will be utilised for approaching the recruited sample to gain their perspectives on what might constitute barriers to physical activity during pregnancy: -------------------------------------- 1. Please indicate your current level of physical activity that you engage in whilst pregnant. 2. Do you feel that this level of physical activity is appropriate? Why or why not? 3. Research indicates that few pregnant women (only 15%) are currently engaging in the recommended volume of physical activity. Why do you, personally, think this might be? 4. It has been offered in several studies that many women believe there are challenges to being physically active during different stages of pregnancy. Do you have any personal experiences with such barriers and challenges and, if so, what might they be? 5. Today, many pregnant women have family obligations and professional careers that they must fulfil when pregnant. Do you believe that these or other barriers might contribute to why a pregnant woman foregoes physical activity? Why? 6. Tell me, please, about any barriers that you, yourself, might have experienced in being more physically active during your pregnancy? 7. In today’s globalised environment, pregnant women are exposed to many different information sources about pregnancy and physical activity. These can be from media sources, family and friends, or even relevant health professionals. Which of these sources do you believe is most reliable? Which sources do you most often listen to when thinking about physical activity and exercise while you are pregnant? 8. Do you believe that information about physical activity and pregnancy is consistent through all the different mediums available to you? What have been your personal experiences with sorting and making sense of this information in determining the amount of physical activity you have determined appropriate during pregnancy? 9. Do you believe that being physically active during pregnancy is important for you and/or your unborn child? Why or why not? 10. Being pregnant can be challenging and many pregnant women throughout the world have reported higher levels of fatigue and general tiredness during pregnancy. Have you ever experienced this? If so, did it have any impact on the level of physical activity you decided to undertake while pregnant? 11. Many pregnant women have supportive husbands/partners, family members and friends that give pregnant women encouragement throughout all stages of their pregnancies. Do you have these social resources available to you during your pregnancy? Has social factors such as this been at all instrumental or influential in your physical activity levels during pregnancy? How or why? 12. It is often difficult for people who are not pregnant to become motivated to engage in exercise and other related physical activity. Have you had any motivational issues in similar fashion? If so, please do your best to describe them and what type of influence it might have had on the volume of physical activity you engaged with during your pregnancy? 13. Do you personally believe that physical activity and exercise, during pregnancy, is beneficial for long-term health of yourself and your child? Why do you say this? 14. Critics and proponents of physical activity throughout the world have differing viewpoints about what constitutes healthy physical activity during pregnancy. What types of guidelines have you referred to when determining what level of physical activity you might engage in and why? 15. Please answer this question with only a yes or no response: Too much physical activity during pregnancy is dangerous for the child and could cause injury to the unborn child. 16. If your physician informed you that you should lessen your physical activity, would you do so? Why do you say this? 17. If you had a very good friend that was willing to exercise with you, would it impact the amount of physical activity you would undertake? Why and for what reasons? 18. Overall, do you think that physical activity during pregnancy is enjoyable and engaging? Why do you say this? 19. If you had one negative thing to say about physical activity during pregnancy, what would you want to share with me? 20. Please offer any other information, comments or feelings that you might wish to share about pregnancy and physical activity during pregnancy that you think would be relevant to you, personally. 21. Please indicate what you might think could be an incentive for physical activity whilst pregnant that might improve your desire or motivation to be more physically active. . Read More