Physical activity during pregnancy: A descriptive exploration of practices, barriers, and beliefs among pregnant women

Abstract

BACKGROUND:

Physical activity in pregnancy is relevant, but for various reasons it is not performed. Therefore, the aim is to describe beliefs, barriers, and the types of physical activity performed during pregnancy.

MATERIALS AND METHODS:

A descriptive cross-sectional study was conducted in a public hospital in Peru, with a nonrandom sample of 334 pregnant women. Validated instruments were used to assess barriers, beliefs, and physical activity practices.

RESULTS:

Regarding maternal beliefs, the most common were that physical activity improves mood (82.4%) and reduces fatigue and stress (71.3%). Concerning fetal-related beliefs, approximately 20% of participants believed that physical activity poses a risk to the baby. Among intrapersonal barriers, the most frequently reported were lack of energy (70.4%), back and hip pain (60.8%), and cramps (60.2%). Interpersonal barriers included insufficient knowledge of how to engage in physical activity (53.9%) and lack of guidance or counseling (48.2%). The main socioeconomic barriers were the lack of exercise programs (37.1%) and adverse weather conditions (35.6%). The most reported endurance activity was walking (80.8%); for strength, stair climbing (58.1%); for flexibility, stretching exercises (42.2%); and for balance or coordination, dancing (50.6%).

CONCLUSION:

Relevant barriers and beliefs limiting physical activity during pregnancy were identified. Additionally, certain endurance, muscle and bone strength, flexibility, and balance or coordination activities were more frequently practiced.

Introduction

Pregnancy is a stage in a woman’s life associated with various psychological and physiological changes that can promote sedentary behaviors and/or a reduction in physical activity.[1] Physical activity during pregnancy is safe for both the mother and the fetus.[2] Therefore, it is recommended that pregnant women engage in at least 150 min of moderate-intensity aerobic exercise per week.[3,4] However, a review reported that physical activity levels were too low to provide any benefits for either the mother or her child.[5]

Pregnant women can and should perform a variety of gentle stretching exercises and muscle-strengthening activities, regardless of their gestational age.[6] Maintaining a healthy physical activity habit is essential to preventing excessive weight gain, preeclampsia, gestational diabetes, cesarean delivery, preterm birth, childbirth complications, neonatal complications, postpartum depression, and other adverse outcomes.[7]

Despite these recommendations, many pregnant women reduce their physical activity during this stage due to misconceptions and negative attitudes toward exercise during pregnancy.[8] Additionally, various psychological, physical, and social barriers have been identified, such as a lack of support, body image concerns, and the belief that exercise may cause miscarriages.[9]

A study conducted in Poland reported that the main reasons for not exercising included lack of time, lack of knowledge about appropriate exercises during pregnancy, and low energy levels. Furthermore, pregnant women mentioned hearing negative opinions about exercise, experiencing family disapproval, and believing that physical activity was harmful to the baby’s health.[10] Research conducted among Ethiopian women found that approximately 8 out of 10 engaged in physical activity irregularly, with walking being the most common practice.[11] In South Africa, a study concluded that, although pregnant women did not engage in physical activity, they had a positive perception of its benefits.[12]

In Peru, the prevalence of leisure-time physical activity among individuals aged 18–64 years is 8.9%.[13] Moreover, there are health guidelines that promote and provide recommendations for exercise during pregnancy.[14] However, due to social, economic, personal, or cultural factors, incorporating physical activity as part of a lifestyle remains complex and, in many cases, a privilege. This issue is exacerbated by the insufficient promotion of physical activity within healthcare institutions, limiting its positive impact during pregnancy.

It is essential to understand that physical inactivity during pregnancy can have short- and long-term adverse consequences for maternal and perinatal health.[2] In this context, prenatal care serves as an opportunity to promote healthy habits and provide evidence-based guidance on physical activity. Therefore, healthcare professionals must take an active role in educating and supporting pregnant women and their families by offering clear information, individualized strategies, and continuous encouragement to overcome barriers—whether personal, familial, or societal.

Based on the above, this study aimed to describe the beliefs, barriers, and types of physical activity performed during pregnancy.

Materials and Methods

Study design and setting

A descriptive cross-sectional study was conducted between February and March 2024 at the Sergio Bernales National Hospital in Lima, Peru, a tertiary-level healthcare facility that provides specialized and high-complexity care.

Study participants and sampling

Subjects were selected through nonrandom convenience sampling based on the following inclusion criteria: (i) pregnant women aged 18 years or older, (ii) those who voluntarily agreed to participate, and (iii) those attending prenatal consultations in the hospital’s outpatient clinics. Exclusion criteria included: (i) pregnant women with incomplete questionnaires and (ii) those diagnosed with psychiatric disorders. Based on these criteria, the final sample size consisted of 334 pregnant women.

Variables and data collection tool

Three variables were analyzed. The first was beliefs about physical activity, defined as the ideas or thoughts held by pregnant women that influence their decision to engage in physical activity. The second was barriers to physical activity, referring to challenges or obstacles preventing pregnant women from engaging in exercise during pregnancy. The third type of physical activity, conceptualized as any bodily movement that expends energy, is categorized into four components: endurance, muscular and bone strength, flexibility and balance, and coordination. Each of these variables was assessed using a questionnaire that had been previously validated by three maternal health professionals specializing in physical preparation during pregnancy.

Data analysis

A database was designed in MS Excel 2019, where the questionnaire data were entered for processing using Stata version 17 (Stata Corp, College Station, Texas). Categorical variables were reported as frequencies and percentages. Results were presented in tables.

Ethical consideration

The study was reviewed and approved by the research ethics committee of Sergio Bernales National Hospital under Act No. 006-2024. Additionally, informed consent was obtained to ensure voluntary participation. Throughout the study, no participants were exposed to risks, and confidentiality of their information was safeguarded.

Results

Nearly half of the pregnant women were between 25 and 34 years old. The majority were cohabiting (70.1%), had completed secondary education (55.4%), and were housewives (73.1%). Regarding gestational age, 82.3% were between 29 and 41 weeks, 22.8% had no previous pregnancies, and 85.3% had no medical conditions [Table 1].

Table 1.

General characteristics of pregnant women

General characteristics		n (%)
Age (years)
18–24		77 (23.1)
25–29		82 (24.6)
30–34		81 (24.3)
35 to more		94 (28.1)
Marital status
Single		59 (17.7)
Married		40 (12)
Cohabitant		234 (70.1)
Divorced		1 (0.3)
Educational level
No schooling		3 (0.9)
Elementary school		32 (9.6)
High school		185 (55.4)
Higher technical		77 (23.1)
Higher university		37 (11.1)
Occupation
Student		15 (4.4)
Housewife		244 (73.1)
Worker		75 (22.5)
Gestational age (weeks)
<13		10 (3.0)
13–28		49 (14.7)
29–41		275 (82.3)
Previous pregnancies
None		76 (22.8)
One pregnancy		105 (31.4)
Two or more pregnancies		153 (45.8)
Non-obstetric illness
Yes		49 (14.7)
No		285 (85.3)

Regarding prepregnancy physical activity, most participants reported engaging in it (62%). Among them, approximately 9 out of 10 exercised for less than 30 min, and around 75% did so only once or twice per week [Table 2].

Table 2.

Prepregnancy physical activity in pregnant women

Prepregnancy physical activity		n (%)
Prepregnancy physical activity
No		127 (38)
Yes		207 (62)
Time of physical activity*
Less than 30 min		198 (95.6)
More than or equal to 30 min		9 (4.4)
Frequency of physical activity*
One to two times per week		154 (74.4)
Three or more times per week		53 (15.6)

*Only pregnant women who were physically active were considered

The most reported maternal beliefs were that physical activity improves mood (82.4%), reduces fatigue and stress (71.3%), and alleviates muscle and back pain (68.3%). Concerning beliefs about the fetus, approximately 20% believed that physical activity poses a risk to the baby or increases the likelihood of complications, while 12.9% thought it raised the risk of miscarriage [Table 3].

Table 3.

Beliefs for not being active during pregnancy

Beliefs		n (%)
Maternal beliefs
Physical activity improves mood		275 (82,4)
Physical activity reduces muscle aches, back pain, etc.		228 (68.3)
Physical activity improves circulation and reduces swelling of legs, feet, and hands		201 (60.2)
Physical activity regulates weight gain		196 (58.7)
Physical activity reduces fatigue and stress		238 (71.3)
Physical activity reduces pain and exertion at the time of childbirth		205 (61.4)
Physical activity reduces hand and leg cramps		186 (55.7)
Physical activity decreases the likelihood of cesarean sections and complicated deliveries		170 (50.9)
Physical activity increases fatigue		118 (35.3)
Beliefs related to the fetus
Physical activity increases the likelihood of miscarriage		43 (12.9)
Physical activity is risky and puts the baby at risk		64 (19.3)
Physical activity increases the likelihood of bleeding or water breaking		66 (19.8)

Among intrapersonal barriers, the most common were lack of energy (70.4%), back and hip pain (60.8%), and cramps (60.2%). The most frequent interpersonal barriers were insufficient knowledge on how to perform physical activity (53.9%) and lack of guidance or counseling (48.2%), while 15% of pregnant women reported a lack of family or social support. The main socioeconomic barriers included the lack of exercise programs (37.1%) and weather conditions (35.6%) [Table 4].

Table 4.

Barriers to not being active during pregnancy

Barriers		n (%)
Intrapersonal barriers
Lack of energy makes it difficult to be physically active		235 (70.4)
Feeling nauseous makes it difficult to be physically active		191 (57.2)
Having pain in the back and hips makes it difficult to engage in physical activity		203 (60.8)
Swelling makes it difficult for you to be physically active		167 (50)
Having leg cramps makes it difficult to be physically active		201 (60.2)
Fear of injury makes it difficult to be physically active		165 (49.4)
Interpersonal barriers
Lack of knowledge about how to be physically active safely during pregnancy prevents me from being physically active		180 (53.9)
Lack of guidance or advice from my healthcare provider about physical activity prevents me from being physically active		161 (48.2)
Not having someone to exercise with prevents me from being physically active		82 (24.6)
Negative advice about physical activity from my environment prevents me from being physically active		70 (21)
In my Obstetric Psychoprophylaxis workshops, they do not recommend that I should be physically active		24 (7.2)
Lack of support and motivation from family and friends prevents me from being physically active		52 (15)
Socioeconomic barriers
Being in an unsafe neighborhood makes it difficult for me to be physically active		93 (27.9)
Lack of recreational facilities makes it difficult for me to be physically active		104 (31.1)
Lack of exercise programs for pregnant women makes it difficult for me to be physically active		124 (37.1)
The weather makes it difficult for me to be physically active		119 (35.6)

The most frequently reported endurance activity was walking (80.8%); for strength, it was stair climbing (58.1%); for flexibility, stretching exercises (42.2%); and for balance or coordination, dancing (50.6%) [Table 5].

Table 5.

Type of physical activity performed by pregnant women

Type of physical activity		n (%)
Endurance
Hiking		270 (80.8)
Swimming		20 (6.0)
Stationary bicycle		9 (2.7)
Muscle and bone strength
Activities involving pushing		93 (27.8)
Activities involving pulling		87 (26.0)
Activities involving carrying or lifting heavy things		87 (26.0)
Activities involving jumping		45 (13.5)
Activities involving climbing stairs		194 (58.1)
Flexibility
Stretching		141 (42.2)
Yoga		30 (9.0)
Pilates		18 (5.4)
Balance/coordination
Dancing		169 (50.6)
Rhythmic gymnastics		30 (9.0)
Tai chi		5 (1.5)

Discussion

The results of this study reflect various perceptions, barriers, and facilitators associated with physical activity during pregnancy. Regarding maternal beliefs, most pregnant women perceived physical activity as beneficial for both physical and mental health. These findings align with those reported by Shang et al., who found that over 90% of pregnant women believed exercise benefited both themselves and their babies.[15] Similarly, Tan et al. observed that 99% of pregnant women in Singapore considered physical activity during pregnancy beneficial.[16] However, misconceptions persist, such as the belief that physical activity poses a danger to the baby or increases the likelihood of complications. This was also documented by Gonçalves et al., who found that fear of miscarriage and other obstetric complications led most participants in their study to reduce or stop exercising.[17]

Regarding intrapersonal barriers, the most limiting factors identified were lack of energy (70.4%), back and hip pain (60.8%), and cramps (60.2%). This finding is consistent with previous studies, such as that of Mbada et al., who reported that intrapersonal factors are one of the main limitations to physical activity among pregnant Nigerian women.[18] Additionally, Shang et al. found that fatigue (56.6%) and low energy levels (54.7%) were frequent barriers to prenatal physical activity.[15] Complementarily, Sitot and Workye identified that 45.9% of pregnant women believed that prenatal physical activity prevented excessive weight gain and improved energy levels, highlighting a contradiction between their beliefs and actual engagement in exercise.[19]

For interpersonal barriers, the most frequently reported were insufficient knowledge about how to exercise (53.9%) and lack of guidance or counseling (48.2%). These findings are consistent with Okafor and Goon, who identified that a lack of prenatal counseling and contradictory information about physical activity were significant barriers.[20] Similarly, Stickford et al. noted that while most pregnant women considered low- and moderate-intensity exercise safe, they had limited knowledge about the safety of vigorous or resistance exercises, which could contribute to lower adherence.[21] Madhale et al. emphasized the importance of providing pregnant women with practical tools, such as progressive muscle relaxation or prenatal yoga, to enhance their knowledge and confidence in exercising.[22] Likewise, Jebashi et al. found that although most pregnant women had a favorable attitude toward physical activity, nearly half had inadequate knowledge on the subject, reinforcing the need for educational interventions to bridge the gap between positive perceptions and effective implementation of exercise routines.[23]

Socioeconomic and environmental barriers were also significant factors in the low levels of physical activity observed. The most common barriers identified in this study were the lack of structured exercise programs (37.1%) and adverse weather conditions (35.6%). Similar findings were reported by Suberu and Adeoye in Nigeria, where environmental and organizational barriers were highly prevalent.[24] Likewise, Gari et al. found that lack of time and fatigue were the main obstacles to prenatal exercise.[25] In this context, Simard et al. highlighted that social support and perceived approval from family and friends are crucial in motivating pregnant women to engage in physical activity.[26] This underscores the importance of community-based interventions that actively involve pregnant women’s social and familial networks.

These findings not only highlight an educational need but also a key opportunity for healthcare team intervention. From a clinical perspective, it is essential that prenatal care professionals, such as obstetricians, nurses, nutritionists, and physiotherapists, incorporate the promotion of physical activity as a routine component of comprehensive care. Personalized counseling, tailored to the individual characteristics and context of each pregnant woman, could help reduce unfounded fears and increase adherence to safe exercise routines. In addition, the development of programs led by healthcare centers, including group education sessions, practical workshops, or supervised exercise classes (such as prenatal yoga or guided walks), could be effective strategies to reduce both intrapersonal and environmental barriers. Finally, it is recommended to strengthen the training of healthcare personnel regarding updated guidelines on physical activity during pregnancy, so they can provide clear, consistent, and evidence-based information, thereby aligning clinical practice with the well-documented benefits of prenatal exercise.

Limitation and recommendation

This study had certain limitations. First, since participants were selected through nonrandom sampling, the findings cannot be generalized to the entire population. Second, data were collected using a self-administered questionnaire, making it impossible to verify whether the reported physical activity was performed. Third, there is a possibility of social desirability bias, where participants may have adjusted their responses to align with perceived expectations. Nevertheless, a strength of this study is that it is one of the first investigations on physical activity during pregnancy in Peru. Additionally, it was conducted with a substantial sample size, allowing for a comprehensive exploration of this topic.

Conclusion

Misconceptions and significant barriers continue to limit physical activity during pregnancy. Fatigue, pain, and lack of energy were identified as the main intrapersonal barriers, while insufficient knowledge about proper exercise techniques and lack of counseling were the most common interpersonal barriers. Additionally, the absence of structured programs and environmental conditions posed additional obstacles. These findings highlight the need to design personalized intervention strategies that address both individual and contextual barriers to effectively promote prenatal physical activity.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

The study was approved by the research ethics committee of Sergio Bernales National Hospital No. (N 006-2024), respecting the code of ethics.