# Exercise as it relates to Disease/Exercising during pregnancy: Comparing attitudes between Australian and Chinese pregnant women

This is an article critique of; A comparison of beliefs about exercise during pregnancy between Chinese and Australian pregnant women - Kym J Guelfi , Chen Wang , James A Dimmock , Ben Jackson , John P Newnham , Huixia Yang (2015)

## What is the background to this research?[edit | edit source]

Through all areas and stages of life it is very important to maintain a healthy lifestyle, especially when pregnant. The health of the mother directly affects the health of the foetus making a clean, active lifestyle. Maintaining health during pregnancy has been shown to improve gestational diabetes, deter excessive foetal growth, and decrease excessive weight gain. Overall it appears there is some evidence to suggest that pregnant women engaging in frequent exercise tend to have lighter babies; however this does not seem to predispose to low-birth weight babies Exercise guidelines around the world recommend that pregnant women complete 60-150 minutes per week, to a maximum of 30 minutes per day. Despite these recommendations it remains that many women do not follow these guidelines and remain inactive during pregnancy. The Theory of Planned Behaviour (TPB) is a model used since 1998 looking at attitude-behaviour relationships to predict a wide variety of behaviours, one of which being exercise adherence, Attitudes towards behaviours, subjective norms and perceived behavioural control are factor in predicting these behaviours. A study done found that the TPB was able to explain 59% of the variation from the norm in intentions to exercise regularly it also reported that the strongest factor is subjective norms. That itself is strongly influenced by cultural beliefs and with the benefits of maintaining the health guidelines during pregnancy being many, it is important to understand differences in communities.

## Where is the research from?[edit | edit source]

Kym J. Guelfi, Chen Wang , James A. Dimmock, Ben Jackson , John P. Newnham and Huixia Yang conducted a international questionnaire in Perth, Australia and Beijing, China. The survey results were gather in 2014 from April to May. Research was carried out in Peking University First Hospital (Beijing, China) or King Edward Memorial Hospital (Perth, Australia). The study was approved by the Institutional Ethics Committees (Ethics Committee of Peking University First Hospital; Western Australian Women and Newborn Heath Service Ethics Committee and The University of Western Australia Human Ethics Committee).

## What kind of research was this?[edit | edit source]

The study is in the form of an observational design and the research participants were selected from a pre-existing database from both hospitals and some surrounding local community forums. Participants were asked to respond with a form completed in waiting rooms and a sample of the Australian participants were asked to complete online forms if not attending the main hospital.

## What did the research involve?[edit | edit source]

A total of 455 women, 240 from Beijing 215 from Perth, were asked to fill out a questionnaire. The Questionnaire assessed attitudes, subjective norms, perceived behavioural control and intentions toward exercise during pregnancy, together with the participants current levels of physical activity. Other components involved were a) an assessment of maternal beliefs regarding the importance of exercise in relation to other health behaviours, b) an assessment of attitudes, subjective norms, perceived behavioural control and intentions toward exercise during pregnancy, and c) an assessment of current levels of physical activity.
The demographic variables assessed in the questionnaire were;
· Age
· Height
· Body mass
· Health status
· Household income
· Country of birth
· And finally, duration of time living in either China or Australia
Data from participants were excluded if; They had been living in the country of study for less that 2.5 years (n = 22 for Australia), or if they had reported any significant health conditions that were associated with their pregnancy (n = 13 for China; n = 7 for Australia). In the end the study used the data from 187 in Australia and 225 women in China.
It should be noted that due to the much more diverse population in Australia compared to China, all women in the Chinese sample were born in China and of Asian ethnicity. In contrast, 40 % of the Australian sample was born in a country outside of Australia, with 76 % identifying themselves as Caucasian, 16 % of Asian ethnicity, 1 % Indigenous Australian and 7 % as other ethnicities.

## What were the basic results?[edit | edit source]

With overall current fitness, Australian woman had reported higher levels in both moderate and vigorous exercise. The results showed that the Australian women showed higher levels of current exercise and also intentions to exercise in the following 4 weeks after pregnancy. The paper did associate these changes with higher instrumental attitudes, ratings of subjective norm, and perceived behavioural control toward exercise within the Australian set of participants. On the other hand perceived behavioural control was the only predictor of intentions to exercise with the Chinese participants. When it came to the attitudes towards health behaviours during pregnancy the data was significantly different between populations.
Chinese women viewed behaviours like getting a good night’s sleep, not drinking alcohol, eating healthy foods, not drinking coffee, resting and relaxing, not worrying too much, stopping work and having an active lifestyle during pregnancy as more important when compared with the Australian women. These attitudes were much more lax when compared to the Australian women. When asked what they rated as their biggest barrier to exercising was, Australian women on average rated lack of time higher while the other group rated concerns about the safety of exercising highest on average. This is very likely attributed to the cultural beliefs and attitudes towards exercise in pregnancy.
A study that focused on the cultural attitudes and beliefs towards exercise and their barriers towards it (for patients undergoing dialysis) showed the cultural belief that tiredness caused by overwork can be detrimental to the body has strongly influenced perceptions about exercise. The patients showed aversion towards any type of exercise more strenuous than walking . They also found that cold or evil wind in traditional Chinese culture also affected patients’ perception in the way that sweating caused by exercise may make them more vulnerable to diseases. Chinese patients undergoing HD were still concerned that cold wind was something that may deteriorate their health.
Due to the self-reporting style of the data there is always a degree of bias that could be influencing the participant's reporting. Self-report surveys have its limitations, Mainly with over-reporting, under-reporting and self-serving biases. Self-reporting questionnaires do have their strengths, they are a great affordable option that can reach a wide set of participants, and the data is easily comparable. On the other hand it would be much better to include the added measure of portable activity monitors such as a pedometer, accelerometer, or fit watch.

## What conclusions can we take from this research?[edit | edit source]

The Theory of Planned Behaviour, though an older model of predicting behaviour is still very applicable today, it is still extremely valid and quite reliable. But being as varied as we all are it is still highly appropriate to make sure every pregnant woman is educated on physical activity recommendations, and then do a proper medical check to .The theory of planned behaviour is still a useful model to study intentions to exercise in certain populations, though it does not tell necessarily give you the “Why” behind it.
Beliefs, attitudes, barriers and intentions towards exercise during pregnancy differ between cultures. Understanding these differences may assist in the design of exercise interventions to maximise exercise adherence and lifelong physical activity patterns.
Women around the world need to be better educated on pre-natal health and up to date information should be far more readily available. This is very practical seeing as already, health guidelines around the world all advocate for the similar levels of exercise in pregnant women’s life unless medically unable. I agree with the conclusion that they have come up with, this area deserves more research towards cultural views, especially in the current times. Medical knowledge is getting more advanced by the day however this research shows that still, things like superstition and cultural bias is breeding misinformation to populations of people.

## Practical advice[edit | edit source]

This study has shown that there is a clear difference in continents in attitudes towards exercise and health behaviours. If this questionnaire is taken earlier in pregnancy it could inform medical professionals of the health of their clients and alert them to intervene with extra education in that area. More research should be done to compare different cultures attitudes and cultures and how they affect exercise and health behaviours.
With the knowledge behind this, women would be more likely to take up better health behaviours Using the questionnaire across a larger sample size of healthy pregnant women from all over the world we could get a large scale view of exercise adherence and attitudes.

## Further information/resources[edit | edit source]

https://www.whattoexpect.com/
https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-exercise

## References[edit | edit source

* 1 2 3 OLSON, D., R.S. SIKKA, J. HAYMAN, M. NOVAK, and C. STAVIG. Exercise in pregnancy. Curr. Sports Med. Rep., Vol. 8, No. 3, pp. 147-153, 2009
* 1 2 3 4 5 6 7 Guelfi et al. BMC Pregnancy and Childbirth (2015) 15:345
* 1 2 3 Savvaki D, Taousani E, Goulis DG, Tsirou E, Voziki E, Douda H, Nikolettos N, Tokmakidis SP. Guidelines for exercise during normal pregnancy and gestational diabetes: a review of international recommendations. Hormones (Athens). 2018 Dec;17(4):521-529.
* ↑ HAAKSTAD, L.A., VOLDNER, N., HENRIKSEN, T. and BØ, K. (2009), Why do pregnant women stop exercising in the third trimester?. Acta Obstetricia et Gynecologica Scandinavica, 88: 1267-1275
* ↑ Conner, M. and Armitage, C.J. (1998), Extending the Theory of Planned Behavior: A Review and Avenues for Further Research. Journal of Applied Social Psychology, 28: 1429-1464.
* 1 2 Ching-Fang Lee, I-Chyun Chiang, Fang-Ming Hwang, Li-Kang Chi, Hsien-Ming Lin, Using the Theory of Planned Behavior to predict pregnant women's intention to engage in regular exercise, Midwifery, Volume 42, 2016, Pages 80-86, ISSN 0266-6138
* 1 2 Yan Song, MSN, RN, Jing Wang, MSN, RN,, Xiaolan Chen, MD , Yujie Guo, PhD, RN , Xinmei Wang, RN, and Wen Liang, RN, Journal of Transcultural Nursing 2019, Vol. 30(6) 558–568
* ↑ Lene A.H. Haakstad, Ingvild Gundersen & Kari Bø (2010) Self-reporting compared to motion monitor in the measurement of physical activity during pregnancy, Acta Obstetricia et Gynecologica Scandinavica, 89:6, 749-756
* ↑ Ribeiro, Maria Margarida, Andrade, Ana and Nunes, Inês. "Physical exercise in pregnancy: benefits, risks and prescription" Journal of Perinatal Medicine, vol. 50, no. 1, 2022, pp. 4-17
* ↑ Richard, M., Christina, M. F., Deborah, L. S., Rubio, N., & Kennon, M. S. (1997). Intrinsic motivation and exercise adherence. Int J Sport Psychol, 28(4), 335-354.