Physical Activity during Pregnancy: Recommendations and Assessment Tools

Abstract

The literature that supports and recommends the practice of exercise during pregnancy is extensive.However, although a more complete research on ways to evaluate the physical activity performed by pregnant women has been perfomed, it is found that there is no gold standard and that the articles in the area are inconclusive. Thus, the objective of the present article is to review relevant aspects, such as, technique and applicability of the different methods for the assessment of physical activity during pregnancy to provide more reliable and safe information for health professionals to encourage their pregnant patients to engage in the practice of physical activity. This review concluded that all tools for the analysis of physical activity have limitations. Thus, it is necessary to establish the objectives of evaluation in an appropriate manner, as well as to determine their viability and cost-effectiveness for the population under study.

Resumo

A literatura que apoia e recomenda a prática do exercício durante a gravidez é extensa. Apesar disso, embora tenha sido feita uma pesquisa mais completa sobre as formas de avaliar a atividade física realizada por mulheres grávidas, verifica-se que não há padrão ouro, e que os artigos na área são inconclusivos. Assim, o objetivo do presente artigo é revisar aspectos relevantes, como a técnica e a aplicabilidade dos diferentes métodos de avaliação da atividade física durante a gestação, a fim de fornecer aos profissionais de saúde informações mais confiáveis e seguras para encorajar as pacientes grávidas à prática de atividade física. Esta revisão concluiu que todas as ferramentas para a análise da atividade física têm limitações. Assim, é necessário estabelecer os objetivos da avaliação de forma adequada, bem como determinar a sua viabilidade e custo-efetividade para a população em estudo.

Keywords

physical exercise questionnaire - physical activity - evaluation - pregnancy

Palavras-chave

questionário de exercício físico - atividade física - avaliação - gravidez

• References

• 1 Gavard JA, Artal R. Effect of exercise on pregnancy outcome. Clin Obstet Gynecol 2008; 51 (02) 467-480
• 2 Prather H, Spitznagle T, Hunt D. Benefits of exercise during pregnancy. PM R 2012; 4 (11) 845-850 , quiz 850
• 3 Gaston A, Cramp A. Exercise during pregnancy: a review of patterns and determinants. J Sci Med Sport 2011; 14 (04) 299-305
• 4 Evenson KR, Bradley CB. Beliefs about exercise and physical activity among pregnant women. Patient Educ Couns 2010; 79 (01) 124-129
• 5 Pescatello LS, Arena R, Riebe D, Thompson PD. ACSM's guidelines for exercise testing and prescription. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2014
• 6 Barbanti V. O que é esporte?. Rev Bras Ativ Fís Saúde. 2006; 11 (01) 54-58
• 7 Clapp III JF. Exercise during pregnancy. A clinical update. Clin Sports Med 2000; 19 (02) 273-286
• 8 ACOG Committee Opinion No. 650: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol 2015; 126 (06) e135-e142
• 9 Tobias DK, Zhang C, van Dam RM, Bowers K, Hu FB. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis. Diabetes Care 2011; 34 (01) 223-229
• 10 McAuley SE, Jensen D, McGrath MJ, Wolfe LA. Effects of human pregnancy and aerobic conditioning on alveolar gas exchange during exercise. Can J Physiol Pharmacol 2005; 83 (07) 625-633
• 11 Stafne SN, Salvesen KÅ, Romundstad PR, Eggebø TM, Carlsen SM, Mørkved S. Regular exercise during pregnancy to prevent gestational diabetes: a randomized controlled trial. Obstet Gynecol 2012; 119 (01) 29-36
• 12 Dempsey JC, Butler CL, Williams MA. No need for a pregnant pause: physical activity may reduce the occurrence of gestational diabetes mellitus and preeclampsia. Exerc Sport Sci Rev 2005; 33 (03) 141-149
• 13 Brown W. The benefits of physical activity during pregnancy. J Sci Med Sport 2002; 5 (01) 37-45
• 14 Clapp III JF, Kim H, Burciu B, Lopez B. Beginning regular exercise in early pregnancy: effect on fetoplacental growth. Am J Obstet Gynecol 2000; 183 (06) 1484-1488
• 15 Barakat R, Pelaez M, Lopez C, Montejo R, Coteron J. Exercise during pregnancy reduces the rate of cesarean and instrumental deliveries: results of a randomized controlled trial. J Matern Fetal Neonatal Med 2012; 25 (11) 2372-2376
• 16 Davies GA, Wolfe LA, Mottola MF. , et al; SOGC Clinical Practice Obstetrics Committee, Canadian Society for Exercise Physiology Board of Directors. Exercise in pregnancy and the postpartum period. J Obstet Gynaecol Can 2003; 25 (06) 516-529
• 17 ACOG Committee Obstetric Practice. ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol 2002; 99 (01) 171-173
• 18 Negrato CA, Montenegro Jr RM, Mattar R. , et al. Dysglycemias in pregnancy: from diagnosis to treatment. Brazilian consensus statement. Diabetol Metab Syndr 2010; 2: 27
• 19 American College of Sport Medicine. ACSM's guidelines for exercise testing and prescription. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2000
• 20 American Diabetes Association. Standards of medical care in diabetes–2015: summary of revisions. Diabetes Care 2015; 38 (Suppl. 01) S4
• 21 National Institute for Health and Care Excellence [Internet]. Weight management before, during and after pregnancy. Public Health guideline (PH27). 2010 [cited 2016 Oct 10]. Avaliable from: https://www.nice.org.uk/guidance/ph27/chapter/1-recommendations
• 22 Ainsworth BE, Haskell WL, Leon AS. , et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993; 25 (01) 71-80
• 23 Evenson KR, Chasan-Taber L, Symons Downs D, Pearce EE. Review of self-reported physical activity assessments for pregnancy: summary of the evidence for validity and reliability. Paediatr Perinat Epidemiol 2012; 26 (05) 479-494
• 24 Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act 2008; 5: 56
• 25 Beets MW, Bornstein D, Beighle A, Cardinal BJ, Morgan CF. Pedometer-measured physical activity patterns of youth: a 13-country review. Am J Prev Med 2010; 38 (02) 208-216
• 26 Sternfeld B, Goldman-Rosas L. A systematic approach to selecting an appropriate measure of self-reported physical activity or sedentary behavior. J Phys Act Health 2012; 9 (Suppl. 01) S19-S28
• 27 Schmidt MD, Freedson PS, Pekow P, Roberts D, Sternfeld B, Chasan-Taber L. Validation of the Kaiser Physical Activity Survey in pregnant women. Med Sci Sports Exerc 2006; 38 (01) 42-50
• 28 Mâsse LC, Ainsworth BE, Tortolero S. , et al. Measuring physical activity in midlife, older, and minority women: issues from an expert panel. J Womens Health 1998; 7 (01) 57-67
• 29 Hui AL, Back L, Ludwig S. , et al. Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy Body Mass Index in a randomized control trial. BMC Pregnancy Childbirth 2014; 14: 331
• 30 Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, Freedson PS. Development and validation of a pregnancy physical activity questionnaire. Med Sci Sports Exerc 2004; 36 (10) 1750-1760
• 31 Takito MY, Neri LCL, Benício MHD. [Evaluation of the reproducibility and validity of a physical activity questionnaire for pregnant women]. Rev Bras Med Esporte 2008; 14 (02) 132-138 Portuguese
• 32 Silva FT, Araujo Júnior E, Santana EF, Lima JW, Cecchino GN, Silva Costa FD. Translation and cross-cultural adaptation of the Pregnancy Physical Activity Questionnaire (PPAQ) to the Brazilian population. Ceska Gynekol 2015; 80 (04) 290-298
• 33 Adeniyi AF, Ogwumike OO. Physical activity and energy expenditure: findings from the Ibadan Pregnant Women's Survey. Afr J Reprod Health 2014; 18 (02) 117-126
• 34 Chen KY, Janz KF, Zhu W, Brychta RJ. Redefining the roles of sensors in objective physical activity monitoring. Med Sci Sports Exerc 2012; 44 (01) (Suppl. 01) S13-S23
• 35 Chandonnet N, Saey D, Alméras N, Marc I. French Pregnancy Physical Activity Questionnaire compared with an accelerometer cut point to classify physical activity among pregnant obese women. PLoS One 2012; 7 (06) e38818
• 36 Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 1982; 36 (05) 936-942
• 37 Fell DB, Joseph KS, Armson BA, Dodds L. The impact of pregnancy on physical activity level. Matern Child Health J 2009; 13 (05) 597-603
• 38 Hendelman D, Miller K, Baggett C, Debold E, Freedson P. Validity of accelerometry for the assessment of moderate intensity physical activity in the field. Med Sci Sports Exerc 2000; 32 (9, Suppl) S442-S449
• 39 Ainsworth B, Cahalin L, Buman M, Ross R. The current state of physical activity assessment tools. Prog Cardiovasc Dis 2015; 57 (04) 387-395
• 40 Ainslie P, Reilly T, Westerterp K. Estimating human energy expenditure: a review of techniques with particular reference to doubly labelled water. Sports Med 2003; 33 (09) 683-698
• 41 Richardson CR, Newton TL, Abraham JJ, Sen A, Jimbo M, Swartz AM. A meta-analysis of pedometer-based walking interventions and weight loss. Ann Fam Med 2008; 6 (01) 69-77
• 42 Freak-Poli RL, Cumpston M, Peeters A, Clemes SA. Workplace pedometer interventions for increasing physical activity. Cochrane Database Syst Rev 2013; (04) CD009209
• 43 Meijer GA, Westerterp KR, Verhoeven FM, Koper HB, ten Hoor F. Methods to assess physical activity with special reference to motion sensors and accelerometers. IEEE Trans Biomed Eng 1991; 38 (03) 221-229
• 44 Crouter SE, Schneider PL, Karabulut M, Bassett Jr DR. Validity of 10 electronic pedometers for measuring steps, distance, and energy cost. Med Sci Sports Exerc 2003; 35 (08) 1455-1460
• 45 Lubans DR, Morgan PJ, Tudor-Locke C. A systematic review of studies using pedometers to promote physical activity among youth. Prev Med 2009; 48 (04) 307-315
• 46 Marshall SJ, Levy SS, Tudor-Locke CE. , et al. Translating physical activity recommendations into a pedometer-based step goal: 3000 steps in 30 minutes. Am J Prev Med 2009; 36 (05) 410-415
• 47 Ogilvie D, Foster CE, Rothnie H. , et al; Scottish Physical Activity Research Collaboration. Interventions to promote walking: systematic review. BMJ 2007; 334 (7605): 1204
• 48 Kang M, Marshall SJ, Barreira TV, Lee JO. Effect of pedometer-based physical activity interventions: a meta-analysis. Res Q Exerc Sport 2009; 80 (03) 648-655
• 49 Freak-Poli RL, Wolfe R, Walls H, Backholer K, Peeters A. Participant characteristics associated with greater reductions in waist circumference during a four-month, pedometer-based, workplace health program. BMC Public Health 2011; 11: 824
• 50 Clarke KK, Freeland-Graves J, Klohe-Lehman DM, Milani TJ, Nuss HJ, Laffrey S. Promotion of physical activity in low-income mothers using pedometers. J Am Diet Assoc 2007; 107 (06) 962-967
• 51 Normand MP. Increasing physical activity through self-monitoring, goal setting, and feedback. Behav Interv 2008; 23 (04) 227-236
• 52 Melanson EL, Knoll JR, Bell ML. , et al. Commercially available pedometers: considerations for accurate step counting. Prev Med 2004; 39 (02) 361-368
• 53 Bouten CV, Westerterp KR, Verduin M, Janssen JD. Assessment of energy expenditure for physical activity using a triaxial accelerometer. Med Sci Sports Exerc 1994; 26 (12) 1516-1523
• 54 Crouter SE, Kuffel E, Haas JD, Frongillo EA, Bassett Jr DR. Refined two-regression model for the ActiGraph accelerometer. Med Sci Sports Exerc 2010; 42 (05) 1029-1037
• 55 Puyau MR, Adolph AL, Vohra FA, Zakeri I, Butte NF. Prediction of activity energy expenditure using accelerometers in children. Med Sci Sports Exerc 2004; 36 (09) 1625-1631
• 56 Plasqui G, Bonomi AG, Westerterp KR. Daily physical activity assessment with accelerometers: new insights and validation studies. Obes Rev 2013; 14 (06) 451-462
• 57 Brage S, Wedderkopp N, Franks PW, Andersen LB, Froberg K. Reexamination of validity and reliability of the CSA monitor in walking and running. Med Sci Sports Exerc 2003; 35 (08) 1447-1454
• 58 Bassett Jr DR, Ainsworth BE, Swartz AM, Strath SJ, O'Brien WL, King GA. Validity of four motion sensors in measuring moderate intensity physical activity. Med Sci Sports Exerc 2000; 32 (9, Suppl) S471-S480
• 59 Butte NF, Ekelund U, Westerterp KR. Assessing physical activity using wearable monitors: measures of physical activity. Med Sci Sports Exerc 2012; 44 (01) (Suppl. 01) S5-S12
• 60 Bell R, Tennant PW, McParlin C. , et al. Measuring physical activity in pregnancy: a comparison of accelerometry and self-completion questionnaires in overweight and obese women. Eur J Obstet Gynecol Reprod Biol 2013; 170 (01) 90-95
• 61 Dishman RK, Washburn RA, Schoeller DA. Measurement of physical activity. Quest 2001; 53 (03) 295-309
• 62 Livingstone MB. Heart-rate monitoring: the answer for assessing energy expenditure and physical activity in population studies?. Br J Nutr 1997; 78 (06) 869-871
• 63 Schrack JA, Zipunnikov V, Goldsmith J, Bandeen-Roche K, Crainiceanu CM, Ferrucci L. Estimating energy expenditure from heart rate in older adults: a case for calibration. PLoS One 2014; 9 (04) e93520
• 64 Leonard WR. Measuring human energy expenditure: what have we learned from the flex-heart rate method?. Am J Hum Biol 2003; 15 (04) 479-489
• 65 Kang TH, Merritt CR, Grant E, Pourdeyhimi B, Nagle HT. Nonwoven fabric active electrodes for biopotential measurement during normal daily activity. IEEE Trans Biomed Eng 2008; 55 (01) 188-195
• 66 Lagerros YT, Lagiou P. Assessment of physical activity and energy expenditure in epidemiological research of chronic diseases. Eur J Epidemiol 2007; 22 (06) 353-362
• 67 Lamonte MJ, Ainsworth BE. Quantifying energy expenditure and physical activity in the context of dose response. Med Sci Sports Exerc 2001; 33 (6, Suppl) S370-S378 , discussion S419–S420
• 68 Schoeller DA. Recent advances from application of doubly labeled water to measurement of human energy expenditure. J Nutr 1999; 129 (10) 1765-1768
• 69 LaPorte RE, Montoye HJ, Caspersen CJ. Assessment of physical activity in epidemiologic research: problems and prospects. Public Health Rep 1985; 100 (02) 131-146
• 70 Ainsworth BE, Caspersen CJ, Matthews CE, Mâsse LC, Baranowski T, Zhu W. Recommendations to improve the accuracy of estimates of physical activity derived from self report. J Phys Act Health 2012; 9 (Suppl. 01) S76-S84
• 71 Harrison CL, Thompson RG, Teede HJ, Lombard CB. Measuring physical activity during pregnancy. Int J Behav Nutr Phys Act 2011; 8: 19
• 72 Haakstad LA, Gundersen I, Bø K. Self-reporting compared to motion monitor in the measurement of physical activity during pregnancy. Acta Obstet Gynecol Scand 2010; 89 (06) 749-756