Factors influencing physical activity in postpartum women during the COVID-19 pandemic: a cross-sectional survey in Japan

Abstract

Background

The aim of this study was to investigate factors influencing postpartum physical activity (PA), taking into consideration psychosocial perceptions during the coronavirus disease 2019 (COVID-19) pandemic by comparing health-related quality of life (HRQoL) scores.

Methods

A web-based cross-sectional survey of 787 postpartum women was conducted between March and October 2021. After applying the exclusion criteria, 590 women were analyzed. The International Physical Activity Questionnaire Short Form was used to assess the level and amount of PA. The Short Form-12 Health Survey version 2 (SF-12v2) was used to measure HRQoL. Multiple linear regression analyses were used to determine whether sociodemographic factors and psychosocial perceptions during the COVID-19 pandemic were associated with total weekly PA. Based on the current national guidelines for exercise in Japan, respondents were classified by weekly PA level as an Inactive group and an Active group to assess the influence of PA on HRQoL.

Results

Mean total PA was 19.3 total metabolic equivalents hour/week, and the prevalence of an inactive lifestyle was 45.9% among respondents. The most important explanatory factor on PA was anxiety symptoms (β = -0.115, p = 0.017), which was negatively associated with total PA. Multiparity (β = 0.101, p = 0.040) and greater number of days since delivery (β = 0.107, p = 0.017) correlated positively with total PA. Having someone to talk about childcare and the individual’s partner (β = 0.093, p = 0.042) was also associated with total PA. The Active group had significantly higher HRQoL scores than the Inactive group in the following scales: physical component summary (p < 0.001), mental component summary (p = 0.041).

Conclusions

The most influential factor for total PA was a perception of anxiety during the COVID-19 pandemic, which correlated negatively with PA. Longer duration after childbirth and multiparity showed positive effects on PA levels. The presence of someone with whom can talk to about childcare and partner issues was significantly associated with the maintenance of higher PA among postpartum women, suggesting that factor as a positive influence on PA under unsettled conditions.

Background

On 11 March 2020, the World Health Organization (WHO) declared the novel coronavirus disease (COVID-19) outbreak a global pandemic, resulting in significant restrictions to movement in the daily life globally. The Japanese government implemented a mild lockdown policy to reduce social interactions without legal restrictions, such as "stay at home" and “social distancing” recommendations, but the number of steps per day decreased by 15% from the pre-declaration level for 24 days after the pandemic declaration [1]. The impacts of such preventive measures on physical and mental health are anticipated to be high, and may disproportionately affect high-risk populations. One of the most vulnerable populations is postpartum women, since most support systems and services were canceled at birth facilities and public health centers under the new infection control measures. Several studies have indicated a number of deleterious consequences of isolation among pregnant and postpartum women, including increases in depression and anxiety [2], and reduced physical activity (PA) [3]. The prevalence of postpartum depression in Japan was 11.5–16.3% in a meta-analysis covering 1994 to 2017 [4], and 28.7% in a survey conducted in October 2020, after the pandemic was declared [5]. However, a recent study also indicated that women who met guidelines of at least 150 min/week of moderately intense PA during the pandemic were significantly less depressed and anxious than women who did not [3].

An active lifestyle is well established to be associated with numerous maternal health benefits and quality of life (QoL). Therefore, during the COVID-19 outbreak, while mental health disorders and other health risks increase, PA related health seems likely to decrease [6]. Moreover, pregnancy and postpartum represent critical periods associated with significant physical and psycho-social changes that usually result in decreased PA [7]. Recent reports have reported subjective changes in postpartum PA before and after the pandemic [3, 8], but quantitative measurements of PA (e.g., energy consumption and activity level) and related factors during the COVID-19 pandemic have not been elucidated. Factors related to PA under this unsettled emergency situation thus need to be investigated and measures to promote PA considered. To clarify the impact of the COVID-19 pandemic, interactions between individual, interpersonal and environmental factors need to be explored, consistent with a socioecological approach [9]. During the postpartum period, individual factors could include general and mental health, and lifestyle behaviors; interpersonal factors could include working and income status, and childcare support; and environmental factors could include the availability of the resources needed to exercise [10–12]. However, these factors, particularly mental health and childcare support have changed due to the COVID-19 pandemic and may also affect PA. Actually, postpartum women who experienced COVID-19-related social restrictions (e.g., loss of support from parents or other family members, loss of opportunities to consult with friends about childcare) were twice as likely to experience postpartum depression [5].

The aim of this study was to investigate factors influencing postpartum PA, taking into consideration the psychosocial perceptions during the COVID-19 pandemic by comparing the health-related QoL (HRQoL) scores of postpartum women in Japan.

Methods

Ethics Approval

This study was approved by the human research ethics committee of Nippon Sport Science University, and is consistent with their requirements for human experimentation (approval no. 020-H149). All procedures performed in studies involving human participants were undertaken in accordance with the Declaration of Helsinki and the ethical standards of the institutional and national research committee. A check box for informed consent was provided before proceeding to the response page of the online questionnaire form.

Study Design and Participants

This research was conducted as part of the study mental and physical status, and the partnership of pre/postpartum women in COVID-19 pandemic, a cross-sectional study in Japan. To prevent the spread of COVID-19 through contact, data were collected using a web-based survey. Between March and October 2021, we recruited postpartum women who had given birth after March 2020 (declaration of the COVID-19 pandemic) to participate in a web-based survey. Eligible women were: 1) over 20 years old; 2) living in Japan; 3) without any medical complications; and 4) within the first year after delivery or expecting to give birth after March 2020. The following exclusion criteria were applied: pregnant women (n = 1); consent not entered or declined (n = 12); or missing data from the questionnaire about PA and HRQoL (n = 179). In accordance with the International Physical Activity Questionnaire Short Form (IPAQ-SF) guidelines, we excluded one case with a total weekly activity time ≥ 960 min (Fig. 1). A final total of 590 postpartum women were included in the analysis.

Data Collection

The research guidelines and application were posted to the homepage of a Japanese non-profit organization that provides healthcare information and programs for postpartum women (Madrebonita, Tokyo, Japan) and shared publicly. After receiving an application, the research team sent the prospective participant a personally addressed e-mail with a hyperlink to the questionnaire on the Google platform. In addition, the e-mail explained that the data obtained would be confidential and that the research team was independent of the organization and any other organization.

Questionnaires

The web-based survey comprised 37 questions categorized into 5 main sections: 1) socio-demographic/maternity-related information (Q1–Q8); 2) psychosocial perceptions during the COVID-19 pandemic, in terms of childcare support (Q9, Q10), change in economic status (Q11), increased burdens of housework and childcare (Q12), behavioral restrictions due to the COVID-19 pandemic (Q13), relationship with a partner (Q14); 3), the Whooley Questions [13] as a screening tool for depression (Q15, Q16), and the two-item Generalized Anxiety Disorder scale (GAD-2) [14] as a screening tool for anxiety (Q17, Q18); 4) SF-12v2 as a measure of HRQoL (Q19–30); and 5) PA (Q31–37).

Dependent Variable

Results

Sample characteristics and descriptive statistics

Table 1 shows the characteristics of the participants. The mean age of participants was 34.9 years, and mean period after delivery was 135.4 days. Proportions of participants who > 35 years old (late childbearing), primipara, delivered vaginally, had a nuclear family, had high educational attainment (> 13 years) and were employed workers were 54.1%, 44.7%, 74.7%, 95.4%, 92.0% and 83.7%, respectively. Exercise habits during school days were reported by 34.7% of women. Participants were categorized into an Inactive group (45.9%) and an Active group (54.1%).

Mean and levels of PA are shown in Table 2. Mean MET values for total, vigorous, moderate, and walking activity were 19.3 h/wk (SD 21.8 h/wk), 1.0 h/wk (SD 4.5 h/wk), 4.9 h/wk (SD 12.4 h/wk), and 13.2 h/wk (SD 13.1 h/wk). The prevalence of an inactive lifestyle was 45.9% among postpartum women.

Multivariate analyses to explain PA

Table 3 provides an overview of factors associated with total weekly PA among participants. The most important explanatory factor on PA was anxiety symptoms (β = -0.115, p = 0.021), which were negatively associated with total PA. In comparison to primiparous women, multiparous women appeared to be associated with more active lifestyle (β = 0.101, p = 0.040). Also, greater number of days since the last delivery (β = 0.107, p = 0.017) correlated positively with total PA. In addition, the presence of someone to talk to about childcare and partner during the COVID-19 pandemic (β = 0.093, p = 0.042) was associated with total PA.

PA level and HRQoL

Differences in SF-12v2 between inactive and active levels are shown in Table 4. The Active group showed significantly higher the HRQoL scores than the Inactive group in the following SF-12v2 scales: physical component summary (p < 0.001), mental component summary (p = 0.041), physical function (p < 0.001), role (physical) (p < 0.001), bodily pain (p = 0.001), general health perceptions (p < 0.001), vitality (p < 0.001), role (emotional) (p = 0.005), and mental health (p = 0.024). No significant differences in social functioning were evident between groups (p = 0.107).

Discussion

Postpartum PA under mild lockdown in Japan

The total PA of participants was 19.3 MET h/wk, and the percentage of adults aged 18 to 64 years who achieved the recommended PA of 23 MET h/wk as advocated by the Japanese Ministry of Health, Labor and Welfare was 28.6%. Reportedly, 17.2% of Japanese women in their 30s achieved the recommended PA, lower than in other generations [25], and women in the child-rearing generation tend to show lower PA. In this study, the percentage of low activity level in the IPAQ was 45.9%, indicating that participants in this study was more active compared to a previous study of Japanese postpartum women (92.0%) [26].

Factors influencing PA in postpartum women

This study investigated the relationship between postpartum PA and psychosocial aspects during the COVID-19 pandemic. The results showed that the factors most affecting total PA correspond to anxiety screening with GAD-2 and correlated inversely with total PA. Longer duration after childbirth and multiparity were shown to have positive effects on PA levels. Moreover, women who have someone with whom they can talk to about work and family life had higher total PA.

A new finding from this study was that anxiety symptoms during the COVID-19 pandemic exert negative effects on the PA of the postpartum women. From the time the pandemic was declared in March 2020, activities of daily living were restricted at social and individual levels, representing a source of mental health problems [2, 3, 5]. According to a systematic review of pregnant and postpartum women, the prevalence of mental health disorders after the pandemic started was higher than before the pandemic for both anxiety (40%) and depression (27%), with high prevalence of anxiety both during pregnancy and in the postpartum period [2]. Participants in this study gave birth after March 2020, once the epidemic had been declared a pandemic, and thus were affected by the pandemic during the major life events of pregnancy, childbirth, and early childcare. Increased sedentary time and screen time and physical inactivity during the COVID-19 pandemic represent contributors to worsened mental health [9], suggesting that early detection through screening and intervention are needed.

In the time after delivery, total PA at 12 months postpartum reportedly increased by 1 MET h/wk compared with 3 months postpartum, with a higher percentage of PA from going out in association with childcare and family activities [7]. Opportunities to go out increase as the child grows, which is conjectured to increase PA. In addition, the depressive symptoms that are a factor inhibiting PA decrease with time after childbirth [4] and physical recovery is expected [27], which suggests that activity may be facilitated.

Although a number of studies have examined relationships between parity and PA, no consensus has been obtained [10, 20, 28, 26]. In this study, multiparity showed an association with higher total PA. The latest study using the Pregnancy Physical Activity Questionnaire [28, 29], which includes question items that reflect the lives of women during the child-rearing period, was conducted from December 2019 to September 2021 in Poland [30]. In that study, multiparous women were found to have spent more energy on total PA and household activities, and significantly less on sports and passive rest during the third trimester of pregnancy compared to primiparas. Therefore, multiparous women may engage in higher amounts of PA in association with caring for older children (taking them to and from places, playing in the park, etc.).

In a number of previous studies, childcare support was given as a factor promoting PA, so this study obtained answers for “Number of people who share regular childcare activities” and “Having someone you can talk to with about work and home life?” as childcare support questions. The mean number of persons who shared in childcare duties was 1.3 and 81.2% of respondents had someone with whom they could talk. These women with someone to whom they could talk were found to have higher total PA than women without such a relationship. Previously, a lack of social supports for childcare was indicated to negatively affect PA and mental health [5, 10, 20]. In a survey on social supports and postpartum depression, the incidence of postpartum depression was 7.5% in a group able to consult with a partner or other person, 36.9% in a group unable to consult with their partner but able to consult with another person, and 63.6% in a group unable to consult with anyone, suggesting the importance of emotional support [31]. In the current pandemic, measures were taken to ensure social distancing as a method of infection control. Under such the circumstances, receiving support from relatives and people nearby is likely to be much more difficult compared before the pandemic. Meanwhile, mothers with high social support scores even during the COVID-19 epidemic were reported to exhibit better psychological states than mothers with low scores [32]. As mentioned previously, given the relationship between worsening mental state and physical inactivity, against a backdrop of mental health stressors brought on by a pandemic, the existence of someone with whom to consult provides a support to mothers and is also thought to produce positive effects on PA.

PA level and HRQoL

The Active group showed higher SF-12v2 scores than the Inactive group. This suggests that mothers with a high PA level have higher HRQoL, supporting a review of 55 papers on the relationship between PA and QoL, which concluded that a uniform positive relationship exists between PA level and HRQoL [33]. SF-12v2 standard values for Japanese women in their 30s are as follows: mean PCS, 51.7 (SD 7.7), interquartile range (IQR) 47.1–54.3; mean MCS, 47.4 (SD 9.4), IQR 41.7–48.5. In both groups, PCS was lower than the mean for the general population of the same age and the Inactive group showed a value close to the 25th percentile, suggesting the presence of a certain level of physical discomfort. Moreover, differences in summary score due to activity level were more marked for physical health (3.2 points) than for mental health (1.3 points), representing a similar result to that of a previous study that identified a strong relationship between activity level and physical health. The WHO recommends engaging in moderate PA for ≥ 150 min each week during the postpartum period [34]. In randomized control trials on PA recommended by the WHO, postpartum women who performed continuous PA showed improvements in HRQoL from before to after the interventions [35, 36]. The Active group included women who met one of the following criteria: 1) vigorous PA for ≥ 20 min, ≥ 3 days/week; 2) moderate PA or walking ≥ 30 min, ≥ 5 days/week; or 3) PA on ≥ 5 days/week for total activity of ≥ 10 MET h/wk. Thus, mothers who are able to perform PA continuously throughout the week appear better able to maintain physical and mental health than mothers who are not.

Findings to promote postpartum PA

The perception of anxiety under the COVID-19 pandemic appears to contribute to physical inactivity not only in postpartum women, but also in the general population. Nagata et al. suggested that anxiety about disrupting social harmony by spreading the infection or going out makes Japanese people more inactive [21]. Postpartum women taking care of an infant in such social situations appear likely to experience even more diverse anxieties. The GAD-2 used in screening for anxiety symptoms in this study has been suggested to be related to physical inactivity and may be useful for identifying subjects in need of more support. Continuous examination of factors facilitating PA, with a focus on variables examined in this study, such as primiparity and women with a shorter postpartum period, would help promote postpartum PA.

Limitations

Several limitations need to be taken into consideration. First, this cross-sectional study was limited by not having data from before the pregnancy. Second, recruitment was conducted via the Internet, and many participants lived in urban areas, had a long education history and high employment rate, and did not necessarily reflect the socio-demographically average Japanese women. Postpartum PA has been reported to have stronger negative associations with age and education [26]. None of these factors were significantly associated with PA in this study. Previous research selected users of designated facilities such as medical institutions or subjects residing in the Tohoku region, and lifestyles may also have differed due to differences in participant characteristics. Third, in terms of measuring PA, since the IPAQ-SF evaluates activities lasting ≥ 10 min, evaluating frequently performed activities (such as housework and childcare) as PA is difficult because the activity time per activity is short. Therefore, the PA of mothers may have been underestimated compared to results obtainable from an interview format. In fact, according to an American study that evaluated PA in an interview format, total PA (25.7 MET h/wk) for women 3 months after childbirth was higher than that of participants in the present study [7]. Future research should consider the selection bias, and more detailed examinations should be conducted using multifaceted and longitudinal evaluations of PA appropriate to the lifestyle of women in the child-rearing period.

Conclusions

During the mild COVID-19 lockdown situation in Japan, the half of the postpartum women showed inactive levels of PA. The most influential factor on total PA was the perception of anxiety during the COVID-19 pandemic, which correlated negatively with total PA. Postpartum women who were multiparous with longer duration after delivery led more active lifestyles. The presence of someone with whom can talk to about childcare and partner issues was significantly associated with the maintenance of higher PA among postpartum women, suggesting that factor as a positive influence on PA during the pandemic. Since the impact of mental health and physical inactivity due to COVID-19 outbreak have negative effects on maternal health and QOL, further studies and support focusing on the related factors identified in this study are warranted.

Abbreviations

WHO: World Health Organization

PA: physical activity

QoL: quality of life

COVID-19: coronavirus disease 2019

HRQoL: health-related quality of life

GAD-2: two-item generalized anxiety disorder scale

IPAQ-SF: international physical activity questionnaire, short form

MET: metabolic equivalents

PCS: physical component summary scale

MCS: mental component summary scale

SD: standard deviation

Declarations

Ethics declarations

Ethics approval and consent to participate

This study was approved by the human research ethics committee of Nippon Sport Science University, and is consistent with their requirements for human experimentation (approval no. 020-H149). Informed consent was obtained from all study participants included in this study. A check box for informed consent was provided before proceeding to the response page of the online questionnaire form. Participants were also informed that they could voluntarily end their participation at any time and that non-participation would not result in any disadvantages to them.

Consent for publication

Not applicable.

Availability of data and materials

Due to confidentiality and restrictions being imposed by the research ethics committee of Nippon Sport Science University, the data used in this study have not been deposited in a public repository. The individual responsible for data management is Dr. Yumi Nomura. Data inquiries should be addressed by e-mail ([email protected].).

Competing interests

The authors declare that they have no conflict of interest.

Funding

This study was funded by Nippon Sport Science University and the Nippon Foundation in Japan.

Authors’ contributions

YN developed the research question and contributed to preparing the questionnaire, conducting the literature survey, performing the statistical analyses, interpreting the data, and preparing the manuscript. YN and TA contributed to preparing the questionnaire, creating the data collection plan, and conducting data collection. TA contributed to cleaning the survey data. All authors approved the final manuscript.

Acknowledgement

The authors acknowledge the funding support from Nippon Sport Science University and the Nippon Foundation. We also appreciate the postpartum women who participated in this research and Madrebonita for their assistance.

References

1. Tison GH, Avram R, Kuhar P, Abreau S, Marcus GM, Pletcher MJ, Olgin JE. Worldwide effect of COVID-19 on physical activity: a descriptive study. Ann Intern Med. 2020;173(9):767–770.
2. Shorey SY, Ng ED, Chee CYI. Anxiety and depressive symptoms of women in the perinatal period during the COVID-19 pandemic: a systematic review and meta-analysis. Scand J Public Health. 2021;49(7):730–740.
3. Davenport MH, Meyer S, Meah VL, Strynadka MC, Khurana R. Moms are not OK: COVID-19 and Maternal Mental Health. Front Glob Womens Health. 2020;1.
4. Tokumitsu K, Sugawara N, Maruo K, Suzuki T, Shimoda K, Yasui-Furukori N. Prevalence of perinatal depression among Japanese women: a meta-analysis. Ann Gen Psychiatry. 2020;19(1).
5. Tsuno K, Okawa S, Matsushima M, Nishi D, Arakawa Y, Tabuchi T. The effect of social restrictions, loss of social support, and loss of maternal autonomy on postpartum depression in 1 to 12-months postpartum women during the COVID-19 pandemic. J Affect Disord. 2022;307:206–214.
6. Maugeri G, Castrogiovanni P, Battaglia G, Pippi R, D'Agata V, Palma A, Di Rosa M, Musumeci G. The impact of physical activity on psychological health during Covid-19 pandemic in Italy. Heliyon. 2020;6(6):e04315.
7. Borodulin K, Evenson KR, Herring AH. Physical activity patterns during pregnancy through postpartum. BMC Womens Health. 2009;9(1):32.
8. Stampini V, Monzani A, Caristia S, Ferrante G, Gerbino M, De Pedrini A, Amadori R, Rabbone I, Surico D. The perception of Italian pregnant women and new mothers about their psychological wellbeing, lifestyle, delivery, and neonatal management experience during the COVID-19 pandemic lockdown: a web-based survey. BMC Pregnancy Childbirth. 2021;21(1):473.
9. Knight RL, McNarry MA, Sheeran L, Runacres AW, Thatcher R, Shelley J, Mackintosh KA. Moving forward: understanding correlates of physical activity and sedentary behaviour during COVID-19—an integrative review and socioecological approach. Int J Environ Res Public Health. 2021; 18(20):10910.
10. Pereira MA, Rifas-Shiman SL, Kleinman KP, Rich-Edwards JW, Peterson KE, Gillman MW. Predictors of change in physical activity during and after pregnancy Project Viva. Am J Prev Med. 2007;32(4):312–319.
11. Gaston A, Vamos CA. Leisure-time physical activity patterns and correlates among pregnant women in Ontario, Canada. Matern Child Health J. 2013;17(3):477–484.
12. Coll CVN, Domingues MR, Gonçalves H, Bertoldi AD. Perceived barriers to leisure-time physical activity during pregnancy: a literature review of quantitative and qualitative evidence. J Sci Med Sport. 2017;20(1):17–25.
13. Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. J Gen Intern Med. 1997;12(7):439–445.
14. Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry. 2016;39:24–31.
15. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF et al. International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–1395.
16. The International Physical Activity Questionnaire: IPAQ scoring protocol. https://sites.google.com/site/theipaq/scoring-protocol (2010). Accessed 1 Feb 2021.
17. Ishikawa-Takata K, Tabata I. Exercise and Physical Activity Reference for Health Promotion 2006 (EPAR2006). J Epidemiol. 2007;17(5):177.
18. Shibata Y, Suzuki S. Comparison of the Edinburgh Postnatal Depression Scale and the Whooley questions in screening for postpartum depression in Japan. J Matern Fetal Neonatal Med. 2020;33(16):2785–2788.
19. Evenson KR, Aytur SA, Borodulin K. Physical activity beliefs, barriers, and enablers among postpartum women. J Womens Health. 2009;18(12):1925–1934.
20. Smith BJ, Cheung NW, Bauman AE, Zehle K, McLean M. Postpartum physical activity and related psychosocial factors among women with recent gestational diabetes mellitus. Diabetes Care. 2005;28(11):2650–2654.
21. Nagata S, Adachi HM, Hanibuchi T, Amagasa S, Inoue S, Nakaya T. Relationships among changes in walking and sedentary behaviors, individual attributes, changes in work situation, and anxiety during the COVID-19 pandemic in Japan. Prev Med Rep. 2021;24:101640.
22. Ware JE, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998;51(11):903–912.
23. Mogos MF, August EM, Salinas-Miranda AA, Sultan DH, Salihu HM. A systematic review of quality of life measures in pregnant and postpartum mothers. Appl Res Qual Life. 2013;8(2):219–250.
24. Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K. Translation, adaptation, and validation of the SF-36 health survey for use in Japan. J Clin Epidemiol. 1998;51(11):1037–1044.
25. Shibata A, Oka K, Nakamura Y, Muraoka I. Recommended level of physical activity and health-related quality of life among Japanese adults. Health Qual Life Outcomes. 2007;5(1):64.
26. Yamada A, Momma H, Tatsuta N, Nakai K, Arima T, Yaegashi N, Nagatomi R. Description of maternal physical activity status before and after pregnancy and its predictors among Japanese women: Miyagi regional adjunct study of the Japan Environment and Children’s Study (JECS). Research in Exercise Epidemiology. 2021;23(1):70–83.
27. Treuth MS, Butte NF, Puyau M. Pregnancy-related changes in physical activity, fitness, and strength. Med Sci Sports Exerc. 2005;37(5):832–837.
28. Chasan-Taber L, Schmidt MD, Pekow P, Sternfeld B, Manson J, Markenson G. Correlates of physical activity in pregnancy among Latina women. Matern Child Health J. 2007;11(4):353–363.
29. Matsuzaki M, Haruna M, Nakayama K, Shiraishi M, Ota E, Murayama R, Murashima S, Yeo S. Adapting the Pregnancy Physical Activity Questionnaire for Japanese pregnant women. J Obstet Gynecol Neonatal Nurs. 2014;43(1):107–116.
30. Kołomańska-Bogucka D, Micek A, Mazur-Bialy AI. The COVID-19 pandemic and levels of physical activity in the last trimester, life satisfaction and perceived stress in late pregnancy and in the early puerperium. Int J Environ Res Public Health. 2022;19(5):3066.
31. Yamada Y, Ebara T, Matsuki T, Kano H, Tamada H, Kato S, Sato H, Sugiura-Ogasawara M, Saitoh S, Kamijima M. Relationship between physical activity and physical and mental health status in pregnant women: a prospective cohort study of the Japan Environment and Children’s Study. Int J Environ Res Public Health. 2021;18(21):11373.
32. Terada S, Kinjo K, Fukuda Y. The relationship between postpartum depression and social support during the COVID-19 pandemic: a cross-sectional study. J Obstet Gynaecol Res. 2021;47(10):3524–3531.
33. Bize R, Johnson JA, Plotnikoff RC. Physical activity level and health-related quality of life in the general adult population: a systematic review. Prev Med. 2007;45(6):401–415.
34. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput J-P, Chastin S, Chou R et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–1462.
35. Haruna M, Watanabe E, Matsuzaki M, Ota E, Shiraishi M, Murayama R, Yoshida M, Yeo S. The effects of an exercise program on health-related quality of life in postpartum mothers: a randomized controlled trial. Health. 2013;5(3):432–439.
36. Daley AJ, Blamey RV, Jolly K, Roalfe AK, Turner KM, Coleman S, McGuinness M, Jones I, Sharp DJ, Macarthur C. A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial. Psychol Med. 2015;45(11):2413–2425.

Tables

Table 1. Participant characteristics and descriptive statics.

SD, standard deviation

IQ, interquartile range

BMI, body mass index

Table 2. Mean (SD) and level of self-reported physical activity

MET h/week, metabolic equivalents hours per week

Table 3. Multiple regression of total weekly PA regressed on sociodemographic / COVID-19 related factors and HRQoL.

β, standardized regression coefficient; t, t-value; VIF, variance inflation factor; ΔR², coefficient of determination; *, p < 0.05

Table 4. Health-related quality of life between those who were inactive and active levels of physical activity.

Values are means (SD).

^*, p < 0.05; ^**, p < 0.01; ^***, p < 0.001.