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Amiri-Farahani L, Ahmadi K, Hasanpoor-Azghady SB, Pezaro S. Development and psychometric testing of the 'barriers to physical activity during pregnancy scale' (BPAPS). BMC Public Health 2021; 21:1483. [PMID: 34325684 PMCID: PMC8323252 DOI: 10.1186/s12889-021-11511-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pregnancy can affect the amount of physical activity that women engage in, so ensuring adequate physical activity in pregnant women can be a challenge. Therefore, there is a need to explore and identify barriers to physical activity in this population. Consequently, this study was conducted in order to develop and validate a scale to assess barriers to physical activity in pregnant populations. METHODS The study was conducted in two phases. During phase 1, a comprehensive review of the most relevant literature from electronic databases on barriers to physical activity was carried out and appropriate scale items were extracted using a deductive approach. During phase 2, the psychometric properties of the extracted scale items were determined using face, content and construct validity, internal consistency and stability. Qualitative and quantitative face validity was assessed via face-to-face interviews with 30 and 10 pregnant women, respectively. To confirm the qualitative and quantitative content validity, 10 experts in the field of research and instrument design were invited to complete the resulting scale. To assess construct validity, the scale items were further tested among 320 pregnant women attending perinatal clinics at health centers in Ilam, Iran, where data were collected via continuous sampling. The internal consistency and stability of the study were measured by Cronbach's alpha and intra-class correlation coefficient (ICC), respectively. RESULTS Following a review of the relevant literature, 48 items for the BPAPS were extracted. Subsequent to the assessment of face and content validity, the number of items was reduced to 38. Through a subsequent exploratory factor analysis, the number of items dropped further to 29. These items were then structured under four major factors. Finally, the internal consistency and stability of the scale was confirmed by a Cronbach alpha coefficient of 0.824 and a test-retest reliability score of 0.87. CONCLUSION Findings show that the 29-item scale to assess barriers to physical activity in pregnant populations is a valid and appropriate instrument.
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Affiliation(s)
- Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Postal code, Tehran, 1996713883 Iran
| | - Katayon Ahmadi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Syedeh Batool Hasanpoor-Azghady
- Department of Reproductive Health and Midwifery, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Postal code, Tehran, 1996713883 Iran
| | - Sally Pezaro
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Coll CDVN, Domingues MR, Stein A, da Silva BGC, Bassani DG, Hartwig FP, da Silva ICM, da Silveira MF, da Silva SG, Bertoldi AD. Efficacy of Regular Exercise During Pregnancy on the Prevention of Postpartum Depression: The PAMELA Randomized Clinical Trial. JAMA Netw Open 2019; 2:e186861. [PMID: 30646198 PMCID: PMC6324311 DOI: 10.1001/jamanetworkopen.2018.6861] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited. OBJECTIVE To assess the efficacy of regular exercise during pregnancy on the prevention of postpartum depression. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial examines a prespecified secondary outcome of the Physical Activity for Mothers Enrolled in Longitudinal Analysis (PAMELA) Study, a parallel-group, randomized clinical trial. This trial was nested in the 2015 Pelotas (Brazil) Birth Cohort Study. Between August 27, 2014, and March 14, 2016, pregnant women between 16 and 20 weeks of gestation with no contraindications to exercise were randomized 1:2 to the intervention group or control group via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018. INTERVENTIONS Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week. MAIN OUTCOMES AND MEASURES Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary analysis was performed on a complete case basis (90% of participants who had the primary end point ascertained). RESULTS A total of 639 participants (mean [SD] age, 27.1 [5.1] years; mean gestational age, 16.5 [1.5] weeks) were randomly assigned to the intervention group (n = 213) or control group (n = 426). Compliance with the protocol, defined as having engaged in at least 70% of exercise sessions, was low (40.4%). There was no significant difference in mean (SD) scores for postpartum depression between the intervention group (4.8 [3.7]) and the control group (5.4 [4.1]) (mean difference, -0.6; 95% CI, -1.3 to 0.1). There was also no significant difference in rates of postpartum depression between the intervention group (12 of 192 [6.3%]) and the control group (36 of 387 [9.3%]) (odds ratio, 0.65; 95% CI, 0.33-1.28). Instrumental variable analysis indicated that noncompliance may have attenuated the effect estimates obtained in the primary analysis. CONCLUSIONS AND RELEVANCE Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise. The point estimates for this study are in the same direction as the previous randomized clinical trial on this topic. Future studies on how to promote regular exercise during pregnancy to improve compliance, particularly targeting young and less educated women, are warranted before further trials are undertaken. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02148965.
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Affiliation(s)
| | - Marlos Rodrigues Domingues
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Diego Garcia Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fernando Pires Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | | | | | - Shana Ginar da Silva
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Andréa Dâmaso Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Guardino CM, Hobel CJ, Shalowitz MU, Ramey SL, Dunkel Schetter C. Psychosocial and demographic predictors of postpartum physical activity. J Behav Med 2018; 41:668-679. [PMID: 29740746 PMCID: PMC6814308 DOI: 10.1007/s10865-018-9931-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/24/2018] [Indexed: 10/17/2022]
Abstract
Physical activity promotes better health outcomes across the lifespan, and provides physical and mental health benefits for women who have recently given birth. However, research has not adequately characterized physical activity levels or risk factors for inadequate physical activity during the postpartum period. The objective of the present study was to describe levels and correlates of physical activity at 6 months postpartum in mothers of diverse race/ethnicity (55% African American, 23% White, 22% Hispanic/Latina), with the majority living in or near poverty. We analyzed data collected by the five-site Community Child Health Network study. Women (n = 1581) were recruited shortly after the birth of a child. Multinomial logistic regression models tested associations of demographic factors and self-reported stress in several life domains with total physical activity levels at 6-9 months postpartum, including activities done at work, at home, for transportation, and leisure. Thirty-five percent of participants in this sample reported low levels of physical activity. African American race, Latina ethnicity, and living in a rural area were associated with low levels of physical activity, whereas working outside the home was associated with high physical activity. Contrary to hypotheses, chronic stress was not associated with physical activity with the exception of financial stress, which predicted greater likelihood of being highly physically active. These findings suggest that optimal postpartum care should integrate physical activity promotion, and that African American, Latina, and rural-dwelling women may benefit most from efforts to promote activity following birth.
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Affiliation(s)
- Christine M Guardino
- Department of Psychology, Dickinson College, P.O. Box 1773, Carlisle, PA, 17013-2896, USA.
| | - Calvin J Hobel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Madeleine U Shalowitz
- North Shore University Health System Research Institute and Department of Pediatrics, University of Chicago, Evanston, IL, USA
| | - Sharon L Ramey
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, VA, USA
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Harvey ST, Bennett JA, Burmeister E, Wyder M. Evaluating a nurse-led community model of service for perinatal mental health. Collegian 2018. [DOI: 10.1016/j.colegn.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Hutt RL, Moore GA, Mammen MA, Symons Downs D. Postpartum Mothers' Leisure-Time Exercise Behavior is Linked to Positive Emotion During Partner Discussions. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2017; 88:447-454. [PMID: 29048261 DOI: 10.1080/02701367.2017.1375450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Marital dissatisfaction and conflict often increase for couples after the birth of a child and are evident in fewer positive family interactions and more negative family interactions. Because exercise is known to increase positive emotions and decrease negative emotions, the current study examined the extent to which higher levels of mothers' exercise during the postpartum period were related to more positive and fewer negative emotion-expressive behaviors with their infants' fathers. METHOD Mothers' (N = 46; M = 8 months postpartum) positive and negative expressive behaviors were coded during couples' discussions of current conflict and positive family experiences. Mothers self-reported their leisure-time exercise behavior. RESULTS First-time mothers and mothers with higher levels of leisure-time exercise behavior displayed higher levels of positive expressive behaviors during couples' discussions. CONCLUSIONS Exercise may be associated with increased positive emotion and, in turn, can have great potential to improve family relationships during the postpartum period when marital stress normatively increases, particularly for mothers with more than 1 child. Future longitudinal studies are needed to understand exercise patterns across the postpartum period to identify the most effective timing and optimal level of exercise that lead to more positive expressive behaviors.
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Feeley N, Bell L, Hayton B, Zelkowitz P, Carrier ME. Care for Postpartum Depression: What Do Women and Their Partners Prefer? Perspect Psychiatr Care 2016; 52:120-30. [PMID: 25711930 DOI: 10.1111/ppc.12107] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/09/2015] [Accepted: 01/29/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare the preferences of those who accept a mental health assessment and those who do not. DESIGN AND METHODS Thirty couples participated in a qualitative study. Nineteen couples accepted a mental health assessment and 11 declined. FINDINGS Acceptors wanted more contact with professionals. Decliners preferred support from their informal network, parental leave, and exercise. However, acceptors also cited these preferences. PRACTICE IMPLICATIONS Nurses should tailor care to couples' preferences, helping them identify and utilize preferred resources. Mental health care might be more acceptable to decliners if provided in obstetrical care.
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Affiliation(s)
- Nancy Feeley
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.,Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Linda Bell
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Barbara Hayton
- Perinatal Mental Health Service, Institute of Community and Family Psychiatry, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Institute of Community and Family Psychiatry, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marie-Eve Carrier
- Institute of Community and Family Psychiatry, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
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Da Costa D, Zelkowitz P, Bailey K, Cruz R, Bernard JC, Dasgupta K, Lowensteyn I, Khalifé S. Results of a Needs Assessment to Guide the Development of a Website to Enhance Emotional Wellness and Healthy Behaviors During Pregnancy. J Perinat Educ 2016; 24:213-24. [PMID: 26834443 DOI: 10.1891/1058-1243.24.4.213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In preparation for developing a website to enhance emotional wellness and healthy lifestyle during the perinatal period, this study examined women's informational needs and barriers. Seventy-four women who were pregnant or had given birth completed an online survey inquiring about information needs and preferred sources related to psychosocial aspects and lifestyle behaviors. Information related to healthy diet choices and weight management, followed by exercise, was rated highly as a need. Information related to depression, stress, and anxiety was also rated as important. Health-care providers and the Internet were found to be preferred sources of information. Evidence-based websites can serve as a powerful low-cost educational resource to support and reinforce the health promotion advice received from their health-care providers.
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Abstract
OBJECTIVE To carry out a systematic review exploring the interconnections between oxytocin, postnatal depression (PND), and parenting. Questions include: (1) How does PND affect parenting? (2) How does oxytocin affect parenting? (3) How does oxytocin affect PND? METHODOLOGY To review English articles in major medical databases. RESULTS Compared to nondepressed controls, mothers with PND interact with their infants less sensitively, report feeling less competent, and less often choose recommended practical-parenting strategies. Psychological interventions for mothers with PND generally have positive effects on mother-infant interactions. The administration of oxytocin in community samples tends to improve parental behaviors. Findings exploring the association between oxytocin and PND were inconsistent, with some evidence that oxytocin has a negative impact on mood. CONCLUSIONS Oxytocin is potentially useful in improving parental behaviors of mothers with PND, but more research is needed to establish its safety because of the uncertain impact of OT on maternal mood.
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What can inactivity (in its various forms) reveal about affective states in non-human animals? A review. Appl Anim Behav Sci 2015. [DOI: 10.1016/j.applanim.2015.08.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Lovell GP, Gordon JAR, Mueller MB, Mulgrew K, Sharman R. Satisfaction of Basic Psychological Needs, Self-Determined Exercise Motivation, and Psychological Well-Being in Mothers Exercising in Group-Based Versus Individual-Based Contexts. Health Care Women Int 2015; 37:568-82. [PMID: 26252897 DOI: 10.1080/07399332.2015.1078333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We compared mothers who exercised predominantly in group settings, those who exercised predominantly in individual settings, and those who exercised equally in group and individual contexts among the following: (a) satisfaction of basic psychological needs (autonomy, competence, and relatedness); (b) self-determined exercise motivation; and (c) psychological well-being. With clear implications for mothers' exercise interventions we found that exercising either predominantly in group contexts or in mixed group and individual settings was associated with mothers having significantly higher satisfaction of basic psychological needs and self-determined exercise motivation than those exercising predominantly alone.
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Affiliation(s)
- Geoff P Lovell
- a School of Social Sciences , University of the Sunshine Coast , Maroochydore , Queensland , Australia
| | - James A R Gordon
- a School of Social Sciences , University of the Sunshine Coast , Maroochydore , Queensland , Australia
| | - Marcus B Mueller
- b Department of Management , Sacred Heart University , Luxembourg
| | - Kate Mulgrew
- a School of Social Sciences , University of the Sunshine Coast , Maroochydore , Queensland , Australia
| | - Rachael Sharman
- a School of Social Sciences , University of the Sunshine Coast , Maroochydore , Queensland , Australia
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Lovell GP, Huntsman A, Hedley-Ward J. Psychological distress, depression, anxiety, stress, and exercise in Australian and New Zealand mothers: A cross-sectional survey. Nurs Health Sci 2014; 17:42-48. [PMID: 24810921 DOI: 10.1111/nhs.12128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/04/2013] [Accepted: 12/20/2013] [Indexed: 11/30/2022]
Abstract
Postnatal psychological well-being is a complex issue characterized by major changes in physical, social, and emotional health. In response to addressing limitations of previous research this study aimed to: (i) quantify psychological distress, depression, anxiety, and stress in a large sample of Australian and New Zealand mothers and to compare to Australian norm data; and (ii) identify any significant differences in psychological distress, depression, anxiety, and stress of the mothers when grouped according to their self-reported exercise incidence. Self-reported short-form version Depression Anxiety Stress Scale data were collected from 3601 Australia and New Zealand mothers with at least one child under the age of 5 years. Results demonstrated that this sample of mothers had significantly poorer psychological well-being than the general Australian population. Furthermore, with the exception of anxiety, psychological well-being of mothers who reported exercising three to four times per week was significantly and meaningfully more positive compared to those mothers that reported not to exercise.
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Affiliation(s)
- Geoff P Lovell
- Faculty of Arts and Social Sciences, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Angela Huntsman
- The Australian Institute of Human Development, Maroochydore, Queensland, Australia
| | - Jodie Hedley-Ward
- Faculty of Arts and Social Sciences, University of the Sunshine Coast, Maroochydore, Queensland, Australia
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Da Costa D, Ireland K. Perceived benefits and barriers to leisure-time physical activity during pregnancy in previously inactive and active women. Women Health 2013; 53:185-202. [PMID: 23517515 DOI: 10.1080/03630242.2012.758219] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study compared perceived benefits and barriers to leisure-time physical activity during pregnancy among women who were insufficiently active or inactive before pregnancy. Eighty-two pregnant women completed questionnaires assessing leisure-time physical activity benefits/barriers, exercise self-efficacy, social support, depressed mood, pre-pregnancy and current physical activity and fatigue. Multivariable regression analyses identified factors associated with exercise benefits/barriers for the two pre-pregnancy leisure-time physical activity groups. Both pre-pregnancy leisure-time physical activity groups reported more benefits than barriers to exercise during pregnancy. Previously inactive women reported fewer perceived benefits and greater perceived barriers to leisure-time physical activity during pregnancy. Higher self-efficacy for exercise during pregnancy was significantly associated with greater benefits of leisure-time physical activity during pregnancy for both groups. Less family support for exercise and lower self-efficacy for exercise were significantly related to greater leisure-time physical activity barriers during pregnancy for previously inactive women. Lower self-efficacy for exercise, higher depressed mood scores, and younger age were associated with greater leisure-time physical activity barriers for active women. Findings suggest that the intensities of perceived leisure-time physical activity benefits and barriers during pregnancy differ for women, depending on their pre-pregnancy leisure-time physical activity status. Consideration of pre-pregnancy leisure-time physical activity status may thus be important when tailoring strategies to overcome barriers to promote initiation and maintenance of physical activity during pregnancy.
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