Carolina de Vargas Nunes Coll

Perceived barriers to leisure-time physical activity during pregnancy: A literature review of quantitative and qualitative evidence

OBJECTIVES Identify perceived barriers to leisure-time physical activity during pregnancy to inform future interventions aimed at improving physical activity levels in pregnancy. DESIGN PubMed/Medline and Web of Science databases were systematically searched using a reference period between 1986 and January/2016. METHODS A comprehensive search strategy was developed combining the following keywords: (barriers OR constraints OR perceptions OR attitudes) AND (physical activity OR exercise OR motor activity) AND (pregnancy OR pregnant women OR antenatal OR prenatal). Thematic synthesis was conducted to analyze the data. A socioecological model was used to categorize the reported barriers. RESULTS Twelve quantitative studies and 14 qualitative studies were included. Barriers belonging to the intrapersonal level of the socioecological model were the most reported in the studies and were categorized in five themes as follows: (1) Pregnancy-related symptoms and limitations; (2) Time constraints; (3) Perceptions of already being active, (4) Lack of motivation and (5) Mother-child safety concerns. At the interpersonal level, barriers were coded into two descriptive themes: (1) Lack of advice and information and (2) Lack of social support. Two other themes were used to summarize Environmental, Organizational and Policy barriers: (1) Adverse weather and (2) Lack of resources. CONCLUSIONS A range of relevant barriers to leisure-time physical-activity engagement during pregnancy were identified in this literature review. Pregnancy-related symptoms and limitations barriers were the most reported in studies, regardless of study design. Mother-child safety concerns, lack of advice/information and lack of social support were also important emphasized pregnancy-related barriers to be targeted in future interventions.

Burden of physical inactivity and hospitalization costs due to chronic diseases

OBJECTIVE To evaluate the physical inactivity-related inpatient costs of chronic non-communicable diseases. METHODS This study used data from 2013, from Brazilian Unified Health System, regarding inpatient numbers and costs due to malignant colon and breast neoplasms, cerebrovascular diseases, ischemic heart diseases, hypertension, diabetes, and osteoporosis. In order to calculate the share physical inactivity represents in that, the physical inactivity-related risks, which apply to each disease, were considered, and physical inactivity prevalence during leisure activities was obtained from Pesquisa Nacional por Amostra de Domicílio (Brazil’s National Household Sample Survey). The analysis was stratified by genders and residing country regions of subjects who were 40 years or older. The physical inactivity-related hospitalization cost regarding each cause was multiplied by the respective share it regarded to. RESULTS In 2013, 974,641 patients were admitted due to seven different causes in Brazil, which represented a high cost. South region was found to have the highest patient admission rate in most studied causes. The highest prevalences for physical inactivity were observed in North and Northeast regions. The highest inactivity-related share in men was found for osteoporosis in all regions (≈ 35.0%), whereas diabetes was found to have a higher share regarding inactivity in women (33.0% to 37.0% variation in the regions). Ischemic heart diseases accounted for the highest total costs that could be linked to physical inactivity in all regions and for both genders, being followed by cerebrovascular diseases. Approximately 15.0% of inpatient costs from Brazilian Unified Health System were connected to physical inactivity. CONCLUSIONS Physical inactivity significantly impacts the number of patient admissions due to the evaluated causes and through their resulting costs, with different genders and country regions representing different shares.

Changes in Leisure-Time Physical Activity From the Prepregnancy to the Postpartum Period: 2004 Pelotas (Brazil) Birth Cohort Study

BACKGROUND The aim of this study was to evaluate changes in leisure-time physical activity (LTPA) and its correlates from prepregnancy to the postpartum period in mothers enrolled in a Brazilian birth cohort study. Our hypothesis was that LTPA would decline considerably during pregnancy. METHODS Maternal LTPA in the 3 months before pregnancy and during each trimester of pregnancy was assessed soon after delivery. A follow-up visit was conducted 3 months later. Weekly frequency and duration of each session of LTPA in a typical week were assessed for each period and a cut-off point of 150 minutes per week was used to classify women as active or not. RESULTS The proportion of women active in leisure time declined from 11.3% in the prepregnancy to 2.3% in pregnancy and 0.1% in the postpartum period (P for trend <0.001). When considering any LTPA practice, the decline ranged from 15.4% to 4.4% and 7.5% (p for trend <0.001), respectively. Higher income, higher education and lower parity were the main predictors of LTPA practice. CONCLUSIONS LTPA declined considerably during pregnancy and did not return to prepregnancy levels at 3 months postpartum. Mothers must be advised on the benefits of LTPA prepregnancy, during, and postpregnancy.

Physical Activity at 11 Years of Age and Incidence of Mental Health Problems in Adolescence: Prospective Study

AIM To evaluate the longitudinal association between physical activity behavior at 11 years of age and the incidence of mental health problems from 11 to 15 years of age. METHODS Individuals born in the city of Pelotas, Brazil, in 1993 have been followed up since birth. At 11 and 15 years of age, mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ). At 11 years of age, physical activity was assessed through a validated questionnaire. The continuous SDQ score at 15 years was used as the outcome variable. The main exposure was physical activity behavior at 11 years of age divided into 3 categories (0, 1-299, ≥ 300 min/wk). RESULTS The incidence of mental health problems from 11 to 15 years was 13.6% (95% CI, 12.4-14.9). At 11 years, 35.2% of the adolescents achieved 300 min/wk of physical activity. In the unadjusted analysis, physical activity was inversely related to mental health problems (P = .04). After adjustment for confounders, the association was no longer significant in the whole sample but was still significant among boys. CONCLUSION Physical activity appears to be inversely related to mental health problems in adolescence, but the magnitude of the association is weak to moderate.

Temporal Trends of Physical Activity and Sedentary Behavior Simultaneity in Brazilian Students

OBJECTIVE To evaluate trends in physical activity and sedentary behavior simultaneity among Brazilian students from 2009 to 2015 and its association with independent variables. METHODS This study presents a panel of 3 cross-sectional studies carried out in 2009, 2012, and 2015 (Pesquisa Nacional de Saúde do Escolar-PeNSE). The population was comprised of ninth-grade public and private schools students from Brazilian capitals. Physical activity and sedentary behavior variables were combined to create the outcome of simultaneity of these risk factors. RESULTS A large proportion of students were simultaneously inactive and sedentary in the 3 surveys. However, it was possible to observe a downward trend (2009: 56.4%; 95% confidence interval, 55.7-57.1; 2012: 53.7%; 95% confidence interval, 53.0-54.4; 2015: 51.9%; 95% confidence interval, 51.2-52.7). In 2015, estimates of physical inactivity and sedentary behavior simultaneity were greater than 48% for 20 out of 27 of the Brazilian states. Significant declining trends were observed among mideast residents, females, nonwhite, and those attending private schools. Only around 5%-7% of the adolescents were both active and nonsedentary in the 3 surveys. CONCLUSION Despite of a slight decreasing trend in the proportion of Brazilian students simultaneously inactive and sedentary throughout the period, the prevalence remained elevated across the surveys.