Assessment of activity levels and perceived barriers or facilitators to physical activity in pregnancy at Aga Khan University Hospital, Nairobi, Kenya

Introduction: Physical activity (PA) during pregnancy significantly reduces the risk of pregnancy related complications and positively influences maternal health and wellbeing. The American College of Obstetricians and Gynaecologists (ACOG) recommends that pregnant women can exercise moderately for 30 minutes on most days of the week, however no study has ever examined the extent to which Kenyan women are meeting these recommendations. Furthermore, attitudes and perceptions of pregnant women towards PA shape their eventual behaviour. Whilst these influencing factors have not been explored, understanding them is essential for implementing effective interventions to improve exercise participation antenatally. Objectives: This study examined the level of PA in pregnant women at Aga Khan University Hospital, Nairobi. The qualitative component of this study explored the attitudes, barriers and facilitators to PA amongst pregnant women using a socio-ecological framework in order to inform interventions to promote PA during pregnancy. Methods: A mixed method study design with a quantitative and qualitative aspect was conducted. Quantitative: A cross-sectional study was used to enrol 233 pregnant women in a hospital setting. Their socio-demographics were recorded and a self-reported Pregnancy Physical Activity Questionnaire (PPAQ) was administered to assess their PA in pregnancy. Using the reported type, frequency and duration of PA along with corresponding metabolic equivalents (METs), the level of PA was assessed using descriptive measures. Women with \u3e7.5 METhr/wk in sports/exercise activities of moderate intensity or greater were considered to have met the ACOG guidelines. Qualitative: Pregnant women’s attitudes, barriers and facilitators to exercise during pregnancy were explored through four focus group discussions comprising of 4-7 women in each group, using a semi-structured interview guide. Women’s responses were coded into categories according to a socio-ecologic framework. Results: Median total energy expenditure (EE) was 169 MET-hr/wk with median EE on sports/exercise of 3.20 MET-hr/wk. Only 74 (32%) of the women met the international guideline for PA in pregnancy. Moderate intensity activity accounted for 27% of total EE. Pregnant women faced significant barriers to PA: safety concerns, fatigue, lack of motivation, time constraints, lack of information, poor access to affordable facilities and deficient pregnancy specific programs. In contrast, enablers such as perceived benefits of an easier labour, better weight management, reduced pregnancy related complications and partner support improved PA and exercise participation. Conclusion: The interaction between individuals, healthcare workers, organisations and policy makers is required to improve PA in pregnant women. Interventions to overcome barriers should focus on antenatal counselling from providers regarding the recommendations of PA during pregnancy, providing written information, provision of specifically tailored PA programs and enhancing social support networks though mothers’ groups and antenatal classes