The five focus group discussions (n=19) were conducted between December 2018 and January 2019. Out of the 19 participants, four were postpartum, and 15 were pregnant. Mean age of the pregnant and postpartum participants was 28.4 ±3.17 years and 28.8 ±2.04 years, respectively. All participants were White, British and spoke English as their first language. The mean gestational age among pregnant participants was 26.8 ±4.49 weeks, and the mean age of the children from the postpartum women was 5 ±1.41 months. Physical activities undertaken by the participants included cycling, swimming, football and circuit training. Eight overarching themes were identified from the transcripts of the five focus groups, of which six themes directly related to already active women’s perceptions of barriers and facilitators of physical activity during pregnancy, and two themes related to the women’s requirements for a physical activity intervention.
Cognizant of Physical Activity Benefits
Almost all the participants were aware of the current guidelines that are available for physical activity in adults (25). However, the women were not aware of a separate guideline for physical activity during pregnancy.
…I think it’s only for England that the government’s recommendations are 150 minutes of physical activity…[P1]
…should include every type of activity, and can’t restrict with just aerobics or muscle training…[P18]
…do they have something specific for us? I don’t think, there is…..[P7]
While the women participated in the focus groups were aware of the recommendations and guidelines, they were also appreciative of the health benefits that an active lifestyle offers, including mental wellbeing.
…I know that there a lot of advantages and perks that it has and it brings to you…[P3]
…it gave me a sense of well being so I felt good doing physical activity…[P7]
Other benefits of physical activity, such as having fun, were also highlighted. A couple of participants commented on the benefits of joint physical activity with their partners, which helped in strengthening the relationships and bonds between them.
…keep myself healthy so and it just so much fun you see…[P2]
… really boosts the bond between me and my partner and it’s also really helpful for us to keep keep ourselves fit…[P4]
Sources of Advice
Almost all the study participants credited midwives as their source of advice when it came to doing physical activity during and after pregnancy. They had regular conversations regarding the amount, mode and safety of exercise in and around pregnancy, and found the resources that were given to them by their midwives, to be valuable. Another important source of information were websites and online forums, where women receive peer support and advice from other women who had real-time experiences that they share in the discussion forums.
… My midwife has a lot of handouts or pamphlets which also gives loads of info…[P12]
… [mentioned website] is one source that that’s where we could find many online forums for physical activity and pregnant women…[P3]
Reasons to be active during pregnancy
During the focus group discussions, the study participants were encouraged to share their own reasons to be active during pregnancy. Women felt that doing exercise was “not going to harm” and thought that they should continue to receive the benefits for themselves and the baby.
…I felt I should be physically active and keep myself and the growing baby healthy, and it’s not gonna cause any harm…[P2]
Although they feel that exercise and physical activity during pregnancy is safe, most of the study participants were of the opinion that there is a “safe level” which differs from person to person. They tend to avoid the same intensity and level of activities that they were doing before pregnancy.
… I did reduced it to half mainly because I was very concerned about the safety of myself and the kid or the baby…[P1]
Barriers to Physical Activity During pregnancy
All of the study participants who were pregnant believed that their “growing tummy” is a substantial barrier for being active during pregnancy. As pregnancy progresses, the size of their growing abdomen poses difficulties in carrying out certain activities such as running, thereby they should reduce the amount and type of exercise during advanced pregnancies.
… I felt my bump, my tummy is getting bigger and I thought I should reduce it as it is hard…[P1]
Another key barrier that was highlighted by the study participants was that they felt short of breath when they tried to do the same amount of activities as earlier, and they use this as a marker or cut-off point for stopping their exercise. The participants perceived higher intensity exercise as unsafe for the baby. Therefore, shortness of breath which occurs at more intense exercise, was perceived as unsafe.
… I eventually I could not do a lot as I become breathless at times, so I stick onto…[P16]
… At times I may stop my exercise panting heavily, and know that’s when I should stop….[P7]
…I know when to stop, when I start panting, I know its not good for the baby and I stop…[P11]
Barriers to physical activity after pregnancy
Postpartum women in the study had a different set of barriers, with childcare at the top of the list. They felt that arranging childcare was difficult, expensive and nonessential, especially when they are spending for both the childcare and their exercise or activity. The study participants obviously believe that it is essential to be physically active, but consider that in balancing childcare costs and difficulty, it would make exercising not a priority.
…I have to take care of my boy and childcare is not too easy these days…[P16]
…nothing can stop me, but I fear the costs of childcare will cause big troubles…[P17]
…I agree, spending money on childcare, and again spend some money to swim is definitely not in my court…[P16]
Another related barrier highlighted by the study participants is that they “do not want to spend any time away from baby”. They consider that it is the time to stay with the newborn and develop their bond rather than spending time away from the baby for exercise and physical activity.
…is the time to cherish, I don’t want to lose those precious time with my baby…[P17]
…have been told it’s the time to bond with my baby, and I don’t want to give it away…[P18]
Fatigue seems to be another key barrier in postpartum women, preventing them from being active. The study participants cited getting tired quickly, especially with the baby around as a barrier for resuming their pre-pregnancy activities.
…my lack of energy makes me think I won’t be fit anytime soon to come back to my previous levels…[P19]
…I get tired easily, and I think because I feed my baby I become weak…[P18]
Facilitators of physical activity during and after pregnancy
Access to activities and facilities that are exclusively available for already active women during pregnancy is often highlighted as an essential facilitator to maintain their activity levels during and after pregnancy. Participants also felt that, although such activities may exist, they are not available everywhere, and the participants were not aware of them.
…however, don’t think I can do the same exercise and activities that I did earlier, I need something specific that can be done in pregnancy…[P6]
...my mom always use to say, don’t do the same when you are pregnant. But, I didn’t know anything else…[P14]
…it is a shame, that this part of the country is always neglected, I know many places in the south that has a lot of gyms and studios exclusive to pregnant women. [P12]
The study participants considered it helpful to have group activities for women who are either pregnant or have a newborn. They felt the opportunity to share their experiences and receive peer support would encourage attendance.
…it will be fun if you can do it as a group where we can share our experiences…[P5]
...it would definitely motivate and encourage when we do it as a big group of women who are pregnant or have babies…[P11]
The participants also highlighted that they feel safe and comfortable to do an activity that has already been carried out by other pregnant and postpartum women and found to be safe.
…it is better to do what you and others were already doing especially when you know they are safe and time tested…[P13]
Ideal Physical Activity intervention
The study participants came up with a number of suggestions when the discussion focused on the prerequisites of a physical activity intervention that would be designed to assist already active women and help them maintain or increase their activity levels during and after pregnancy. There was a mixed response as to whether the intervention must have the usual activities that they already do or could include new activities for them to try.
…it gives you confidence to do when you do something you are already used to…[P15]
…when you know it’s done by many, I do not see any issues trying out new activities…[P10]
…at times I am bored…why not try to do some exciting new stuff…[P19]
Though there is a difference of opinion as to whether to use the same or new activities in the programme, there was consensus among the participants that, any activity should provide the same amount of social and activity-wise ‘satisfaction and fun’ as the previous activities offer.
…need something that when done gives me the sense of satisfaction…[P3]
…usually feel so happy after swimming, and would like to feel the same or even more after any new thing I do…[P14]
Study participants suggest that the activity must be offered near their residences, as they feel it will be a “hassle” for them to travel, especially when it is a new venue.
…definitely will be a hassle to drive even if it is just a few miles…[P8]
…can’t trust it when the place is new and far…[P13]
Participants did not want to wear any type of activity tracking device in order to monitor their activity levels. They felt that such wearable devices would make the activity inconvenient and less fun. However, the participants also commented that if the devices are smaller and fashionable like wristwatches, they would be happy to use them.
…it will be inconvenient, and defeats the sense of joy I get from exercise…[P5]
…if it is like Fitbit or something like that, it is alright with me…[P13]
Although they were not comfortable about wearing activity tracking devices, almost all the study participants were happy about filling out brief questionnaires in order to help the evaluation.
…don’t mind filling out forms…[P4]
…they should be brief though… [P6]