The Journal of Nursing Research h VOL. 22, NO. 4, DECEMBER 2014
ORIGINAL ARTICLE
The Exercise Patterns of Pregnant Women in Taiwan Chen-Ta Tung1 & Ching-Fang Lee2* & Shu-Shan Lin3 & Hsien-Ming Lin4 1
MD, Chief, Section of Obstetrics, Department of Obstetrics and Gynecology, West Garden Hospital & 2 EdD, RN, Associate Professor, Department of Nursing, Oriental Institute of Technology College & 3 MS, RN, Chief, Department of Nursing, West Garden Hospital & 4MD, Chief, Division of Obstetrics, Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital.
ABSTRACT Background: Unless advised otherwise by their doctor, pregnant women should get approximately 30 minutes of moderate exercise on most days. However, most pregnant women do not exercise regularly and do not meet the American College of Obstetricians Gynecology’s standard for the minimum amount of exercise needed to stay healthy during pregnancy. Purpose: We investigate the factors related to regular exercise among pregnant women and describe the type, duration, and change in regular exercise from prepregnancy to pregnancy in Taiwan. Methods: Pregnant women (N = 692) completed a questionnaire on exercise habits and were then grouped into regular exercise (105, 15.2%) and nonregular exercise (587, 84.8%) groups. Demographic and exercise-related variables were then investigated for their association with exercise during pregnancy. Results: Work status, prepregnancy exercise, and trimester were significant predictors of regular exercise during pregnancy. The most commonly reported exercise types were walking, climbing stairs, and yoga. Nearly four fifths (n = 526, 76.0%) of participants did not exercise regularly before pregnancy, whereas 42.9% of participants continued exercising regularly after becoming pregnant. Among those who were inactive before pregnancy, 10.1% began exercising after becoming pregnant. In contrast, 57.1% of participants who had been more active before pregnancy stopped exercising regularly after becoming pregnant. Overall, it was found that participants decreased their amount (minutes times/week) of exercise compared with their prepregnancy amount. Conclusions: Results suggest that walking and climbing stairs, each beneficial to the health of pregnant women, are the most common types of regular exercise engaged in by pregnant women in Taiwan. Regular exercise benefits the health of pregnant women. The findings of this study may be useful to doctors and nurses responsible to counsel pregnant women to exercise regularly and to have a reasonably active lifestyle during pregnancy.
KEY WORDS: regular exercise, pregnancy, active lifestyle.
Introduction Exercise is a structured, planned, and repetitive activity that is performed with fitness in mind (Caspersen, Powell, & Christenson.,
1985). Regular exercise promotes physical and psychological health and increases quality of life (Montoya Arizabaleta, Orozco Buitrago, Aguilar de Plata, Mosquera Escudero, & Ramirez-Velez, 2010; World Health Organization, 2014). During pregnancy, many women believe that they should limit their amount of exercise because their uterus enlarges and their body weight increases. Periods of anxiety and depression often occur during pregnancy (Evans, Heron, Francomb, Oke, & Golding, 2001; Poudevigne & O’Connor, 2006). Therefore, women should be encouraged to exercise and not be restricted by their physical or psychological changes. The American College of Obstetrics and Gynecology (ACOG, 2002) stated that regular exercise is as important during pregnancy as before pregnancy and that regular exercise has many benefits to maternal health, including reduced physical complaints; increased energy, improved mood, posture, muscle tone, strength, and endurance; better sleep; and greater ability to cope with labor pains. The current ACOG guidelines for exercise during pregnancy state that pregnant women without medical or obstetric complications should continue to exercise (ACOG, 2002). Currently, there are no data confirming that exercise during pregnancy either harms or benefits the fetus (de Oliveria Melo et al., 2012; Szymanski & Santin, 2012). According to the ACOG guidelines, pregnant women are encouraged to exercise moderately for a minimum of 30 minutes or more daily (ACOG, 2002). In Taiwan, the recommended amount of regular exercise is 150 minutes per week for all adults. However, no specific figure has been suggested for pregnant women (Health Promotion Administration, 2014). Previous studies have found that most activities during pregnancy are of lower intensity and that fewer modes of physical
Accepted for publication: September 24, 2013 *Address correspondence to: Ching-Fang Lee, No. 58, Sichuan Rd. Sec. 2, Banqiao District, New Taipei City 22061, Taiwan, ROC. Tel: +886 (2) 7738-0145 ext. 6114; Fax: +886 (2) 8966-5400; E-mail: [email protected] Cite this article as: Tung, C. T., Lee, C. F., Lin, S. S., & Lin, H. M. (2014). The exercise patterns of pregnant women in Taiwan. The Journal of Nursing Research, 22(4), 242Y249. doi:10.1097/jnr.0000000000000056
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Pregnant Taiwanese Women’s Exercise Patterns
activity are undertaken during than before pregnancy (Borodulin, Evenson, Wen, Herring, & Benson, 2008; Liu et al., 2011; Tendais, Figueiredo, Mota, & Conde, 2011). Haakstad, Voldner, and Henriksen (2009) reported that only 11% of pregnant women exercised regularly and that most exercised only once a week in the third trimester, significantly less than the recommended guidelines published by the ACOG. Previous studies have also reported a significant association between and among age, occupation, income, prepregnancy exercise, education, prepregnancy body mass index (BMI), parity, health perception, abortion history, gestational weight gain, and exercise during pregnancy (Evenson, Savitz, & Huston, 2004; Haakstad, Voldner, & Henriksen, 2007; Owe, Nystad, & Bø, 2009; Schmidt, Pekow, Freedson, Markenson, & Chasan-Taber, 2006). Therefore, although many pregnant women were relatively inactive (Weiss Kelly, 2005), Gaston, Cramp, and Prapavessis (2012) found that those who exercised regularly led more active lives and seemed to have more energy as well as more positive personalities. However, most women are advised to avoid exercise and even to rest in bed as much as possible during the early stages of pregnancy in Taiwan. Therefore, Taiwanese cultural values may affect the exercise patterns of women during pregnancy. The objectives of this study were to describe the types and durations of Taiwanese women’s regular exercise patterns before pregnancy and then during pregnancy and to investigate the factors associated with these exercise patterns.
Methods Study Participants A purposive sampling technique was used to recruit participants from the prenatal outpatient department of two hospitals and a certified prenatal center in Taipei, Taiwan. All pregnant women who were invited to participate in this project were 20 years or older, were diagnosed as pregnant by their obstetricians, had received the ‘‘Mother’s Manual’’ given to all pregnant women who enter prenatal care, could read and write Chinese, and had completed the written consent form. We excluded women who were at high risk for gestational diabetes, preeclampsia, placenta previa, and other contraindications. We used Power Analysis and Sample Size (version 11.0) to calculate the sample size, assuming a power of 90%, ! = .05, and an odds ratio of 2.0. The sample size estimate was n = 460. The final sample (N = 692) included 105 pregnant women (15.2% of the total) who exercised regularly and 587 pregnant women (84.8%) who did not exercise regularly. The response rate was 86.5%. We divided the participants into two groups based on their responses to the question: ‘‘Have you been exercising regularlyVat least three times per week for at least 30 minutes each time to the point of breathing hard?’’ The regular exercise group was composed of those participants who answered ‘‘yes’’ to this question, had made prenatal visits to one of the two participating hospitals, and had not taken
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prenatal exercise education classes. The nonregular exercise group was composed of those participants who answered ‘‘no’’ to this question and had made prenatal visits to the two participating hospitals.
Data Collection Data were collected from October 2009 to January 2011. Participants who met the inclusion criteria and voluntarily accepted the invitation from researchers to participate in the study received an explanation of the study from the researchers and signed the written consent form. This form included a brief explanation of the research study, an assurance of confidentiality, and the right to withdraw from the study at any time. After completing the questionnaire, all participants received a gift and a verbal expression of thanks from the researchers for their participation.
Measures The researchers used a review of the literature to develop the questionnaire for this study (Evenson et al., 2004; Haakstad et al., 2007; Liu et al., 2011; Schmidt et al., 2006). A committee of five professionals, including an obstetrician, a sports professor, an obstetrical nurse, a nursing professor, and a statistician, then evaluated this questionnaire. Those items receiving low evaluation scores were discussed and modified by the committee. The questionnaire elicited responses from participants in the four categories of sociodemographic characteristics, exercise patterns, perinatal variables, and self-perceived health status during pregnancy. The sociodemographic characteristics included age, education, work status, and individual monthly income. The perinatal characteristics included gestational age, parity, miscarriage history, gestational weight gain, prepregnancy BMI, and prepregnancy health status. The exercise pattern variables included the type, frequency, and duration of prepregnancy and during-pregnancy exercise routines. Self-perceived health status during pregnancy was self-assessed using a 10-point rank scale ranging from 10 (excellent health) to 0 (poor health). The reliability of the Cronbach’s ! value was .87.
Data Analysis Statistical analyses were performed using SPSS for Windows version 19.0 (SPSS, Chicago, IL, USA), and Power Analysis and Sample Size version 11.0 was used to determine sample size. Individual categorical variables were described in terms of frequencies and percentages, whereas continuous variables were described in terms of means and standard deviations. The chi-square test and independent t test were used to compare the individual variables for subjects who did and did not engage in regular exercise. Multivariate logistic regression was used to investigate factors associated with the regular exercise patterns of participants during pregnancy. A twotailed p e .05 was considered statistically significant. 243
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The Journal of Nursing Research
Ethical Considerations The institutional review boards of the two participating hospitals approved this study. Research project personnel contacted the participants after they had provided written consent to participate. As mentioned above, the consent form included a brief description of the study and an assurance of confidentiality.
Results
Chen-Ta Tung et al.
perception. The results of the logistic regression model in Table 4 show that work status, prepregnancy exercise, parity, and trimester were statistically and significantly associated with regular exercise during pregnancy; working full-time and being multiparous were negatively associated with regular exercise during pregnancy; and prepregnancy exercise and being in the third trimester were positively associated with regular exercise during pregnancy. In this model, r2 = .04, the Hosmer and Leweshow goodness-of-fit # 2(8) = 6.66, and p = .57
Overall Characteristics of the Participants Participants ranged in age from 20 to 43.0 years, with a mean (TSD) age of 31.9 (T3.83) years. More than two thirds of the women were over 30 years old. It was found that participants who did not work outside the home or worked parttime, who had no regular prepregnancy exercise, who had no personal income, who were in their third trimester, who were primiparous, or who perceived themselves to be in good health were more likely to report getting regular exercise during pregnancy. The distribution of participant characteristics did not differ significantly between the two groups (p 9 .05), with the exceptions of age, education, prepregnancy health, prepregnancy BMI, miscarriage history, and gestational weight gain (Table 1).
Exercise Patterns in Relation to Pregnancy Five hundred twenty-six (70.0%) participants reported getting no regular exercise both during and before pregnancy (Table 1). Of the 585 participants who reported not exercising before pregnancy, only 59 (10.1%) started to exercise after becoming pregnant. Of the 107 participants who reported exercising before pregnancy, 46 (42.9%) reported continuing with regular exercise and remaining active after becoming pregnant, and 61 (57.1%) reported stopping their regular exercises after becoming pregnant. For the subgroup of participants who exercised only during pregnancy, the number of times they exercised each week was greater and the number of minutes spent exercising each time was lower than for women who had exercised before pregnancy and continued to exercise while pregnant (144.92 T 65.98 and 171.30 T 93.94 minutes/week, respectively). However, when the comparison was made between women who only exercised before pregnancy and those who had exercised before and continued exercising during pregnancy, the figures for times per week and minutes per time were 149.18 T 71.87 and 168.26 T 67.14 minutes/week, respectively (Table 2). Participants did a wider variety of exercise activities before becoming pregnant than during pregnancy. The most common type of regular exercise was walking in only and continuing pregnancy group, followed by climbing stairs and yoga (Table 3).
Factors Related to Regular Exercise During Pregnancy The factors examined included work status, personal income, prepregnancy exercise, current trimester, parity, and health
Discussion In this study of pregnant women in Taiwan, participants in their third trimester tended to have more regular exercise routines during pregnancy than those in their first trimester. Although the results of previous studies monitoring pregnant women in various countries are inconsistent with regard to exercise, most have indicated that women exercise less in their third trimester and that the amount of exercise decreases with each trimester (Domingues & Barros, 2007; Evenson et al., 2004; Haakstad et al., 2007, 2009; Juhl, Madsen, Andersen, Andersen, & Olsen, 2012; Liu et al., 2011; Schmidt et al., 2006). Conversely, our study shows that pregnant women in Taiwan tend to engage in regular exercise late in their pregnancy. Thus, our results highlight a trend toward increased levels of exercise as labor nears. This may reflect the influence of the traditional cultural belief that climbing stairs makes labor and delivery easier (Hsu & Ko., 2006; Lee, Chiang, Lin, Lin, & Hsu, 2012). Our study is consistent with the findings of previous studies that multiparous women and women working full-time are significantly less likely to exercise regularly than women who are primiparous and either do not work or work part-time (Juhl et al., 2012; Liu et al., 2011; Schmidt et al., 2006). Other studies (Lee et al., 2012; Zhang & Savitz, 1996) have also found that women who have not yet had a baby are likely to exercise more than multiparous women. In addition, other studies have strongly associated regular exercise before pregnancy with regular exercise during pregnancy (Haakstad et al., 2009; Owe et al., 2009) and indicated that pregnant women who regularly exercise before becoming pregnant tend to maintain an active lifestyle during pregnancy (Owe et al., 2009). Still, other studies have suggested that sedentary habits before pregnancy are very difficult to modify during pregnancy (Haakstad et al., 2009). Amount of exercise has previously been associated with women’s concerns about safety (Lee, Chiang, Lin, & Hsu, 2011; Sung, 1996, 2000; Symons Downs & Hausenblas, 2004). The Taiwanese folk belief in a ‘‘fetal sedative’’ (an-t’ai) promotes the avoidance of exercise during pregnancy, particularly during the first trimester. This fetal sedative is a complex of practices intended to calm the fetus and prevent a miscarriage. Fetus calming refers to the ritual of ‘‘propitiating the fetus god.’’ This ritual is traditionally performed if the fetus god has been offended, prompting to god to ‘‘move the fetus.’’ Another
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Pregnant Taiwanese Women’s Exercise Patterns
VOL. 22, NO. 4, DECEMBER 2014
TABLE 1.
Characteristics of Women in the Nonregular Exercise and Regular Exercise Groups (N = 692)
All (N = 692)
Nonregular Exercise Group (n = 587)
Regular Exercise Group (n = 105)
N
%
n
%
n
%
Age (years) G29 30Y35 Q36
210 380 102
30.3 54.9 14.7
172 322 93
29.3 54.9 15.8
38 58 9
36.2 55.2 8.6
Education High school or less University Graduate
111 490 91
16.0 70.8 13.2
88 423 76
15.0 72.1 12.9
23 67 15
21.9 63.8 14.3
Working status Full-time None or part-time
420 272
60.7 39.3
371 216
63.2 36.8
49 56
46.7 53.3
Personal income (NT$/month) e20,000 20,001Y50,000 Q50,001
206 389 95
29.8 56.4 13.8
158 343 84
27.0 58.6 14.4
48 46 11
45.7 43.8 10.5
Prepregnancy health Normal Abnormal
668 24
96.5 3.5
565 22
96.3 3.7
103 2
98.1 1.9
Prepregnancy BMI Underweight Normal Overweight or obese
89 488 113
12.9 70.7 16.4
72 413 100
12.3 70.6 17.1
17 75 13
16.2 71.4 12.4
Prepregnancy exercise No Yes
585 107
84.5 15.5
526 61
89.6 10.4
59 46
56.2 43.8
Trimester First Second Third
73 220 399
10.5 31.8 57.7
69 193 325
11.8 32.9 55.4
4 27 74
3.8 25.7 70.5
Miscarriages No Yes
534 158
77.2 22.8
450 137
76.7 23.3
84 21
80 20
Parity 1 91
406 286
58.7 41.3
329 258
56.0 44.0
77 28
73.3 26.7
Mean
SD
Mean
SD
Variable
Mean
SD
Gestational weight gain
8.52
5.72
8.38
5.01
9.27
8.62
Health status perception
3.69
0.79
3.66
0.80
3.84
0.72
Chi-Square Test #2
p
4.59
.101
3.63
.163
10.21*
.002
14.88**
.001
0.90
.342
2.26
.324
76.09***
.000
10.295**
.006
0.56
.528
10.98**
.001
t
p
j1.47 2.08*
.141 .038
*p G .05. **p G .01. ***p G .001.
important Taiwanese folk belief regarding pregnancy (Sung, 1996, 2000) is that a pregnant mother may have a miscarriage if she is overly tired or falls because of carelessness (Sung, 2011). Therefore, in Taiwan, many women will tend to avoid strenuous or even any form of exercise to protect the fetus. Pregnant women commonly decrease the amount of time
they spend working outside the home upon learning they are pregnant, with some even quitting their job (Lee et al., 2012; Schmidt et al., 2006). Studies have found that pregnant women in the United States have a lower rate of discontinuous exercise (13%) than Taiwanese (57.1%) as well as greater rates of regular exercise (20.4%Y65.6%) 245
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Chen-Ta Tung et al.
TABLE 2.
Exercise Patterns and Modal Means for Pregnant Taiwanese Women
Item
Exercise Before Pregnancy Only (n = 61)
Exercise During Pregnancy Only (n = 59)
Mean
Mean
Times/week
SD
4.31
Prepregnancy Mean
2.80
1.17
61.23
38.52
35.76
16.71
52.28
149.18
71.87
144.92
65.98
168.26
Minutes/time Times/week minutes/time
SD
Exercise Continued After Becoming Pregnant (n = 46)
1.49
Pregnancy
SD
3.61
Mean
1.48
SD
4.15
1.70
24.53
42.50
15.12
67.14
171.30
93.94
TABLE 3.
Types of Regular Exercise for Pregnant Women Before and During Pregnancy Exercise Before Pregnancy Only (n = 61) Item
Exercise During Pregnancy Only (n = 59)
Exercise Continued After Becoming Pregnant (n = 46) Prepregnancy
Pregnancy
Frequency
%
Frequency
%
Frequency
%
Frequency
%
Walking
33
29.7
55
70.5
32
40.5
42
70.0
Yoga
24
21.6
4
5.1
9
11.4
8
13.3
Biking
16
14.4
2
2.6
9
11.4
1
1.7
7
6.3
17
21.8
7
8.9
8
13.3
13
11.7
0
0
8
10.1
0
0
Climbing stairs Aerobics Jogging
8
7.2
0
0
4
5.1
0
0
Swimming
3
2.7
0
0
3
3.8
0
0
Mountain climbing
3
2.7
0
0
3
3.8
0
0
Others
4
3.6a
0
0
4
4.1b
1
1.7c
Note. aOthers include badminton (n = 2) and calisthenics (n = 2). bOthers include calisthenics (n = 3) and table tennis (n = 1). cOthers include calisthenics (n = 1).
and a greater propensity for maintaining exercise routines (61.2%) than both Taiwanese and Brazilian women (Evenson et al., 2004; Owe et al., 2009; Zhang & Savitz, 1996). The major reasons for discontinuing regular exercise routines included women’s perceptions of the limited or questionable benefits of exercise TABLE 4.
Logistic Regression Model for Women who Exercised Regularly (N = 105) Variable
OR
95% CI
p
Constant
0.04***
Full-time work
0.51**
[0.32, 0.81]
.000
Multiparous
0.47**
[0.29, 0.78]
.003
Prepregnancy exercise
7.00***
[4.26, 11.50]
.000
Third trimester
3.10*
[1.04, 9.24]
.043
Note. Data presented as odds ratios (OR) and 95% confidence intervals (CI). The reference group had no job or part-time job, had no prepregnancy exercise, and was primiparous and in the first trimester. *p G .05. **p G .01. ***p G .001.
during pregnancy, tiredness, and medical advice (Domingues & Barros, 2007). Overall, it seems that Taiwanese women tend to decrease their amount of regular exercise during pregnancy more than their American and Brazilian counterparts (Evenson et al., 2004; Zhang & Savitz, 1996). On the other hand, the number of participants who started exercising after becoming pregnant was greater in our study (10.1%) than the numbers found in previous studies (3.4%Y7%; Domingues & Barros, 2007; Evenson et al., 2004; Haakstad et al., 2009). Our higher results may be attributable to the Taiwanese folk belief that exercise may make labor easier, prompting Taiwanese women to start exercising more regularly during pregnancy. As for the Taiwanese women who exercised during pregnancy, in general, the duration of their regular exercise decreased in terms of minutes per week over the course of their pregnancy. However, these women also exercised more frequently during their pregnancy than before their pregnancy. Nevertheless, three fourths of the women in this study did not exercise regularly before becoming pregnant, and most were not sufficiently active and did not change their exercise pattern after becoming pregnant. The ACOG (2002)
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Pregnant Taiwanese Women’s Exercise Patterns
recommends that pregnant women who did not exercise regularly before pregnancy should start exercising once they became pregnant in accordance with the ACOG guidelines for exercise type, duration, and intensity. Furthermore, the ACOG recommends that those who had been exercising regularly should continue exercising regularly during pregnancy. We found that, in general, our prepregnancy exercisers continued to exercise regularly during pregnancy, which is consistent with the literature (Haakstad et al., 2009). Walking was the type of exercise most commonly reported by the Taiwanese women overall, regardless of whether they were pregnant. Previous studies found walking, swimming, cycling, and aerobic exercise to be the most common types of exercise during pregnancy in Western countries (Evenson et al., 2004; Liu et al., 2011; Poudevigne & O’Connor, 2006; Schmidt et al., 2006). By comparison, the women in our study exercised conservatively. Walking and climbing stairs fit easily into their daily routines, as these are simple and easily available modes of exercise for most pregnant women as well as conform with the aforementioned folk belief that regularly climbing stairs makes labor and delivery easier.
Limitations This study has several limitations. First, the study population consisted of mostly older, better-educated pregnant women in urban areas. This may limit the degree to which our findings may be generalized. Wider-population-based samples as well as longer periods of follow-up may be needed to gain a richer understanding of the overall exercise patterns of pregnant women in Taiwan. The second limitation relates to the assessment of the degree of regular exercise, which relied on self-reporting and on self-recall of prepregnancy exercise duration and frequency. Other factors that may influence exercise beliefs such as Taiwanese folk beliefs and the attitudes of family/partners should be considered in future studies of the nature and role of Taiwanese women’s exercise patterns before and during pregnancy,
Implications for Nursing Our findings provide insights into the design of programs aimed at promoting regular exercise for pregnant women. Healthcare providers should promote the types of regular exercise that healthy pregnant women prefer in Taiwan such as walking, climbing stairs, and antenatal yoga classes. In general, healthcare providers should help make pregnant women aware that a moderate amount of exercise may be achieved in a variety of ways and that they should select activities that are enjoyable, simple, and readily available for most pregnant women. Health workers and institutions should be made aware of our finding that multiparous women are less likely than primiparous women to exercise regularly and that the constraints of child care appear to be a major factor influencing the ability of women of childbearing age to engage in regular exercise routines.
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As our culture becomes increasingly globalized and as increasing numbers of Taiwanese women live and work outside Taiwan, the Taiwanese belief in a fetal sedative (an-t’ai) may become more widespread or may also be increasingly replaced by more modern, Western scientific views. In any case, health professionals in other countries will likely be dealing with greater numbers of pregnant Taiwanese women and thus should be aware of possible cultural differences when promoting and educating women about the need for exercise during pregnancy.
Conclusions This study examined the exercise patterns of pregnant women in northern Taiwan. Prepregnancy exercise habits, parity, work status, and current trimester were all found to be significantly associated with regular exercise during pregnancy. The most commonly reported types of exercise were walking, climbing stairs, and yoga. However, most of the women in our study were not sufficiently active and did not meet the current ACOG exercise-during-pregnancy standards. Furthermore, they tended to exercise less rather than more after becoming pregnant. Assessing these factors may assist clinicians in Taiwan to counsel pregnant women and to promote regular exercise during pregnancy.
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Haakstad, L. A. H., Voldner, N., & Henriksen, T. (2009). Why do pregnant women stop exercising in the third trimester? Acta Obstetricia Et Gynecologica Scandinavica, 88(11), 1267Y1275. doi:10.3109/ 00016340903284901 Haakstad, L. A. H., Voldner, N., Henriksen, T., & Bø K. (2007). Physical activity level and weight gain in a cohort of pregnant Norwegian women. Acta Obstetricia Et Gynecologica Scandinavica, 86(5), 559Y564. doi:10.1080/00016340601185301 Health Promotion Administration. (2014). Enough exercise. Retrieved from http://www.hpa.gov.tw/BHPNet/Web/HealthTopic/ TopicArticle.aspx?id=201405260007&Class=2&parentid= 201405260002 Hsu, C. Y., & Ko, P. C. (2006). Pregnant woman’s exercise habits and related factors. Chung Shan Medicine Journal, 17(2), 187Y199. Juhl, M., Madsen, M., Andersen, A. M., Andersen, P. K., & Olsen, J. (2012). Distribution and predictors of exercise habits among pregnant women in the Danish National Birth Cohort. Scandinavian Journal of Medicine & Science in Sports, 22(1), 128Y138. doi:10 .1111/j.1600-0838.2010.01125.x Lee, C. F., Chiang, I. C., Lin, H. M., & Hsu, C. J. (2011). Exercise beliefs during pregnancy. Formosan Journal of Medicine, 11(5), 449Y455. (Original work published in Chinese) Lee, C. F., Chiang, I. C., Lin, S. S., Lin, H. M., & Hsu, C. J. (2012). Physical activity pattern and related factors among women during pregnancy. Formosan Journal of Medicine, 16(2), 103Y111. (Original work published in Chinese) Liu, J., Blair, S. N., Teng, Y., Ness, A. R., Lawlor, D. A., & Riddoch, C. (2011). Physical activity during pregnancy in a prospective cohort of British women: Results from the Avon longitudinal study of parents and children. European Journal of Epidemiology, 26(3), 237Y247. doi:10.1007/s10654-010-9538-1 Montoya Arizabaleta, A., Orozco Buitrago, L., Aguilar de Plata, A., Mosquera Escudero, M., & Ramirez-Velez, R. (2010). Aerobic exercise during pregnancy improves health-related quality of life: A randomized trial. Journal of Physiotherapy, 56(4), 253Y258. doi:10.1016/S1836-9553(10)70008-4 Owe, K. M., Nystad, W., & Bø, K. (2009). Correlates of regular exercise during pregnancy: The Norwegian mother and child cohort
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study. Scandinavian Journal of Medicine & Science in Sports, 19(5), 637Y645. doi:10.1111/j.1600-0838.2008.00840.x Poudevigne, M. S., & O’Connor, P. J. (2006). A review of physical activity patterns in pregnant women and their relationship to psychological health. Sports Medicine, 36(1), 19Y38. doi:10.2165/ 00007256-200636010-00003 Schmidt, M. D., Pekow, P., Freedson, P. S., Markenson, G., & Chasan-Taber, L. (2006). Physical activity patterns during pregnancy in a diverse population of women. Journal of Women’s Health, 15(8), 909Y918. doi:10.1089/jwh.2006.15.909 Sung, J. S. (1996). The fetal sedative and the perception of ‘‘tai shen’’ in the traditional Taiwan. Taiwan Historical Research, 3(2), 143Y193. (Original work published in Chinese) Sung, J. S. (2000). The concept of pregnancy, fetal sedative, and the traditional cosmology: A perspective from gender and culture. Taiwan Historical Research, 7(2), 117Y162. (Original work published in Chinese) Sung J. S. (2011). Fetus calming. Encyclopedia of Taiwan Retrieved from http://taiwanpedia.culture.tw/en/content?ID=2090 Symons Downs, D., & Hausenblas, H. (2004). Women’s exercise beliefs and behaviors during their pregnancy and postpartum. Journal of Midwifery Women’s Health, 49(2), 138Y144. doi:10.1016/j.jmwh.2003.11.009 Szymanski, L. M., & Satin, A. (2012). Exercise during pregnancy: Fetal response to current public health guidelines. Obstetrics & Gynecology, 119(3), 603Y610. doi:10.1097/AOG.0b013e31824760b5 Tendais, I., Figueiredo, B., Mota, J., & Conde, A. (2011). Physical activity, health-related quality of life and depression during pregnancy. Cadernos de Sau´de Pu´blica, 27(2), 219Y228. Weiss Kelly, A. (2005). Practical exercise advice during pregnancy: Guidelines for active and inactive women. The Physician and Sports medicine, 33(6), 24Y30. doi:10.3810/psm.2005.06.104 World Health Organization. (2014). Physical activity. Retrieved from http://www.who.int/mediacentre/factsheets/fs385/en/ Zhang, J., & Savitz, D. (1996). Exercise during pregnancy among US women. Annals of Epidemiology, 6, 53Y59. doi:10.1016/10472797(95)00093-3
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The Journal of Nursing Research
懷孕婦女規律運動
VOL. 22, NO. 4, DECEMBER 2014
婦女於懷孕期間規律運動型態及其相關因素 董政達1 李靜芳2* 林淑珊3 林顯明4 1
西園醫院婦產部主任 2亞東技術學院護理系副教授 3 西園醫院護理部主任 4亞東醫院產科主任
背 景
沒有內外科疾病的孕婦 ，應每天至少有 30 分鐘以上的中等強度之運動 ，但大多數的孕 婦並未達到建議。
目 的
欲瞭解孕婦規律運動之相關因素 ，及從懷孕前至懷孕期間運動型態及持續時間的改變。
方 法
共有692 位孕婦完成問卷調查 ，分為規律運動組（105 位 ，15.2％）及未規律運動組（587 位 ，84.8%）共兩組。瞭解社會人口學 、運動有關變項與孕期運動的關係。
結 果
孕期規律運動的顯著預測因子為工作狀態 、懷孕前運動 、妊娠階段。孕婦常見的運動 型態為走路 、爬樓梯及瑜珈。近八成（526 位佔 76%）的婦女於懷孕前未規律運動。有 42.9% 的婦女會從孕前持續運動至懷孕；有 10.1% 者於孕前無運動 ，但懷孕後才開始運 動；有 57.1% 於懷孕後停止運動。整體而言 ，婦女於懷孕後會減少每週運動的時間。
結 論
走路和爬樓梯為台灣孕婦最常見的規律運動型態 ，規律運動有益懷孕婦女的健康。應 該鼓勵婦女於懷孕期間積極的生活型態。本研究結果可提供醫護人員於促進孕婦規律運 動和採取主動生活型態之參考。
關鍵詞：規律運動、懷孕、主動生活型態。
接受刊載：102年9月24日 *通訊作者地址：李靜芳 22061新北市板橋區四川路二段58號 電話：（02）77380145－6114 E-mail: [email protected]
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ORIGINAL ARTICLE
The Exercise Patterns of Pregnant Women in Taiwan Chen-Ta Tung1 & Ching-Fang Lee2* & Shu-Shan Lin3 & Hsien-Ming Lin4 1
MD, Chief, Section of Obstetrics, Department of Obstetrics and Gynecology, West Garden Hospital & 2 EdD, RN, Associate Professor, Department of Nursing, Oriental Institute of Technology College & 3 MS, RN, Chief, Department of Nursing, West Garden Hospital & 4MD, Chief, Division of Obstetrics, Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital.
ABSTRACT Background: Unless advised otherwise by their doctor, pregnant women should get approximately 30 minutes of moderate exercise on most days. However, most pregnant women do not exercise regularly and do not meet the American College of Obstetricians Gynecology’s standard for the minimum amount of exercise needed to stay healthy during pregnancy. Purpose: We investigate the factors related to regular exercise among pregnant women and describe the type, duration, and change in regular exercise from prepregnancy to pregnancy in Taiwan. Methods: Pregnant women (N = 692) completed a questionnaire on exercise habits and were then grouped into regular exercise (105, 15.2%) and nonregular exercise (587, 84.8%) groups. Demographic and exercise-related variables were then investigated for their association with exercise during pregnancy. Results: Work status, prepregnancy exercise, and trimester were significant predictors of regular exercise during pregnancy. The most commonly reported exercise types were walking, climbing stairs, and yoga. Nearly four fifths (n = 526, 76.0%) of participants did not exercise regularly before pregnancy, whereas 42.9% of participants continued exercising regularly after becoming pregnant. Among those who were inactive before pregnancy, 10.1% began exercising after becoming pregnant. In contrast, 57.1% of participants who had been more active before pregnancy stopped exercising regularly after becoming pregnant. Overall, it was found that participants decreased their amount (minutes times/week) of exercise compared with their prepregnancy amount. Conclusions: Results suggest that walking and climbing stairs, each beneficial to the health of pregnant women, are the most common types of regular exercise engaged in by pregnant women in Taiwan. Regular exercise benefits the health of pregnant women. The findings of this study may be useful to doctors and nurses responsible to counsel pregnant women to exercise regularly and to have a reasonably active lifestyle during pregnancy.
KEY WORDS: regular exercise, pregnancy, active lifestyle.
Introduction Exercise is a structured, planned, and repetitive activity that is performed with fitness in mind (Caspersen, Powell, & Christenson.,
1985). Regular exercise promotes physical and psychological health and increases quality of life (Montoya Arizabaleta, Orozco Buitrago, Aguilar de Plata, Mosquera Escudero, & Ramirez-Velez, 2010; World Health Organization, 2014). During pregnancy, many women believe that they should limit their amount of exercise because their uterus enlarges and their body weight increases. Periods of anxiety and depression often occur during pregnancy (Evans, Heron, Francomb, Oke, & Golding, 2001; Poudevigne & O’Connor, 2006). Therefore, women should be encouraged to exercise and not be restricted by their physical or psychological changes. The American College of Obstetrics and Gynecology (ACOG, 2002) stated that regular exercise is as important during pregnancy as before pregnancy and that regular exercise has many benefits to maternal health, including reduced physical complaints; increased energy, improved mood, posture, muscle tone, strength, and endurance; better sleep; and greater ability to cope with labor pains. The current ACOG guidelines for exercise during pregnancy state that pregnant women without medical or obstetric complications should continue to exercise (ACOG, 2002). Currently, there are no data confirming that exercise during pregnancy either harms or benefits the fetus (de Oliveria Melo et al., 2012; Szymanski & Santin, 2012). According to the ACOG guidelines, pregnant women are encouraged to exercise moderately for a minimum of 30 minutes or more daily (ACOG, 2002). In Taiwan, the recommended amount of regular exercise is 150 minutes per week for all adults. However, no specific figure has been suggested for pregnant women (Health Promotion Administration, 2014). Previous studies have found that most activities during pregnancy are of lower intensity and that fewer modes of physical
Accepted for publication: September 24, 2013 *Address correspondence to: Ching-Fang Lee, No. 58, Sichuan Rd. Sec. 2, Banqiao District, New Taipei City 22061, Taiwan, ROC. Tel: +886 (2) 7738-0145 ext. 6114; Fax: +886 (2) 8966-5400; E-mail: [email protected] Cite this article as: Tung, C. T., Lee, C. F., Lin, S. S., & Lin, H. M. (2014). The exercise patterns of pregnant women in Taiwan. The Journal of Nursing Research, 22(4), 242Y249. doi:10.1097/jnr.0000000000000056
242 Copyright © 2014 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
Pregnant Taiwanese Women’s Exercise Patterns
activity are undertaken during than before pregnancy (Borodulin, Evenson, Wen, Herring, & Benson, 2008; Liu et al., 2011; Tendais, Figueiredo, Mota, & Conde, 2011). Haakstad, Voldner, and Henriksen (2009) reported that only 11% of pregnant women exercised regularly and that most exercised only once a week in the third trimester, significantly less than the recommended guidelines published by the ACOG. Previous studies have also reported a significant association between and among age, occupation, income, prepregnancy exercise, education, prepregnancy body mass index (BMI), parity, health perception, abortion history, gestational weight gain, and exercise during pregnancy (Evenson, Savitz, & Huston, 2004; Haakstad, Voldner, & Henriksen, 2007; Owe, Nystad, & Bø, 2009; Schmidt, Pekow, Freedson, Markenson, & Chasan-Taber, 2006). Therefore, although many pregnant women were relatively inactive (Weiss Kelly, 2005), Gaston, Cramp, and Prapavessis (2012) found that those who exercised regularly led more active lives and seemed to have more energy as well as more positive personalities. However, most women are advised to avoid exercise and even to rest in bed as much as possible during the early stages of pregnancy in Taiwan. Therefore, Taiwanese cultural values may affect the exercise patterns of women during pregnancy. The objectives of this study were to describe the types and durations of Taiwanese women’s regular exercise patterns before pregnancy and then during pregnancy and to investigate the factors associated with these exercise patterns.
Methods Study Participants A purposive sampling technique was used to recruit participants from the prenatal outpatient department of two hospitals and a certified prenatal center in Taipei, Taiwan. All pregnant women who were invited to participate in this project were 20 years or older, were diagnosed as pregnant by their obstetricians, had received the ‘‘Mother’s Manual’’ given to all pregnant women who enter prenatal care, could read and write Chinese, and had completed the written consent form. We excluded women who were at high risk for gestational diabetes, preeclampsia, placenta previa, and other contraindications. We used Power Analysis and Sample Size (version 11.0) to calculate the sample size, assuming a power of 90%, ! = .05, and an odds ratio of 2.0. The sample size estimate was n = 460. The final sample (N = 692) included 105 pregnant women (15.2% of the total) who exercised regularly and 587 pregnant women (84.8%) who did not exercise regularly. The response rate was 86.5%. We divided the participants into two groups based on their responses to the question: ‘‘Have you been exercising regularlyVat least three times per week for at least 30 minutes each time to the point of breathing hard?’’ The regular exercise group was composed of those participants who answered ‘‘yes’’ to this question, had made prenatal visits to one of the two participating hospitals, and had not taken
VOL. 22, NO. 4, DECEMBER 2014
prenatal exercise education classes. The nonregular exercise group was composed of those participants who answered ‘‘no’’ to this question and had made prenatal visits to the two participating hospitals.
Data Collection Data were collected from October 2009 to January 2011. Participants who met the inclusion criteria and voluntarily accepted the invitation from researchers to participate in the study received an explanation of the study from the researchers and signed the written consent form. This form included a brief explanation of the research study, an assurance of confidentiality, and the right to withdraw from the study at any time. After completing the questionnaire, all participants received a gift and a verbal expression of thanks from the researchers for their participation.
Measures The researchers used a review of the literature to develop the questionnaire for this study (Evenson et al., 2004; Haakstad et al., 2007; Liu et al., 2011; Schmidt et al., 2006). A committee of five professionals, including an obstetrician, a sports professor, an obstetrical nurse, a nursing professor, and a statistician, then evaluated this questionnaire. Those items receiving low evaluation scores were discussed and modified by the committee. The questionnaire elicited responses from participants in the four categories of sociodemographic characteristics, exercise patterns, perinatal variables, and self-perceived health status during pregnancy. The sociodemographic characteristics included age, education, work status, and individual monthly income. The perinatal characteristics included gestational age, parity, miscarriage history, gestational weight gain, prepregnancy BMI, and prepregnancy health status. The exercise pattern variables included the type, frequency, and duration of prepregnancy and during-pregnancy exercise routines. Self-perceived health status during pregnancy was self-assessed using a 10-point rank scale ranging from 10 (excellent health) to 0 (poor health). The reliability of the Cronbach’s ! value was .87.
Data Analysis Statistical analyses were performed using SPSS for Windows version 19.0 (SPSS, Chicago, IL, USA), and Power Analysis and Sample Size version 11.0 was used to determine sample size. Individual categorical variables were described in terms of frequencies and percentages, whereas continuous variables were described in terms of means and standard deviations. The chi-square test and independent t test were used to compare the individual variables for subjects who did and did not engage in regular exercise. Multivariate logistic regression was used to investigate factors associated with the regular exercise patterns of participants during pregnancy. A twotailed p e .05 was considered statistically significant. 243
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The Journal of Nursing Research
Ethical Considerations The institutional review boards of the two participating hospitals approved this study. Research project personnel contacted the participants after they had provided written consent to participate. As mentioned above, the consent form included a brief description of the study and an assurance of confidentiality.
Results
Chen-Ta Tung et al.
perception. The results of the logistic regression model in Table 4 show that work status, prepregnancy exercise, parity, and trimester were statistically and significantly associated with regular exercise during pregnancy; working full-time and being multiparous were negatively associated with regular exercise during pregnancy; and prepregnancy exercise and being in the third trimester were positively associated with regular exercise during pregnancy. In this model, r2 = .04, the Hosmer and Leweshow goodness-of-fit # 2(8) = 6.66, and p = .57
Overall Characteristics of the Participants Participants ranged in age from 20 to 43.0 years, with a mean (TSD) age of 31.9 (T3.83) years. More than two thirds of the women were over 30 years old. It was found that participants who did not work outside the home or worked parttime, who had no regular prepregnancy exercise, who had no personal income, who were in their third trimester, who were primiparous, or who perceived themselves to be in good health were more likely to report getting regular exercise during pregnancy. The distribution of participant characteristics did not differ significantly between the two groups (p 9 .05), with the exceptions of age, education, prepregnancy health, prepregnancy BMI, miscarriage history, and gestational weight gain (Table 1).
Exercise Patterns in Relation to Pregnancy Five hundred twenty-six (70.0%) participants reported getting no regular exercise both during and before pregnancy (Table 1). Of the 585 participants who reported not exercising before pregnancy, only 59 (10.1%) started to exercise after becoming pregnant. Of the 107 participants who reported exercising before pregnancy, 46 (42.9%) reported continuing with regular exercise and remaining active after becoming pregnant, and 61 (57.1%) reported stopping their regular exercises after becoming pregnant. For the subgroup of participants who exercised only during pregnancy, the number of times they exercised each week was greater and the number of minutes spent exercising each time was lower than for women who had exercised before pregnancy and continued to exercise while pregnant (144.92 T 65.98 and 171.30 T 93.94 minutes/week, respectively). However, when the comparison was made between women who only exercised before pregnancy and those who had exercised before and continued exercising during pregnancy, the figures for times per week and minutes per time were 149.18 T 71.87 and 168.26 T 67.14 minutes/week, respectively (Table 2). Participants did a wider variety of exercise activities before becoming pregnant than during pregnancy. The most common type of regular exercise was walking in only and continuing pregnancy group, followed by climbing stairs and yoga (Table 3).
Factors Related to Regular Exercise During Pregnancy The factors examined included work status, personal income, prepregnancy exercise, current trimester, parity, and health
Discussion In this study of pregnant women in Taiwan, participants in their third trimester tended to have more regular exercise routines during pregnancy than those in their first trimester. Although the results of previous studies monitoring pregnant women in various countries are inconsistent with regard to exercise, most have indicated that women exercise less in their third trimester and that the amount of exercise decreases with each trimester (Domingues & Barros, 2007; Evenson et al., 2004; Haakstad et al., 2007, 2009; Juhl, Madsen, Andersen, Andersen, & Olsen, 2012; Liu et al., 2011; Schmidt et al., 2006). Conversely, our study shows that pregnant women in Taiwan tend to engage in regular exercise late in their pregnancy. Thus, our results highlight a trend toward increased levels of exercise as labor nears. This may reflect the influence of the traditional cultural belief that climbing stairs makes labor and delivery easier (Hsu & Ko., 2006; Lee, Chiang, Lin, Lin, & Hsu, 2012). Our study is consistent with the findings of previous studies that multiparous women and women working full-time are significantly less likely to exercise regularly than women who are primiparous and either do not work or work part-time (Juhl et al., 2012; Liu et al., 2011; Schmidt et al., 2006). Other studies (Lee et al., 2012; Zhang & Savitz, 1996) have also found that women who have not yet had a baby are likely to exercise more than multiparous women. In addition, other studies have strongly associated regular exercise before pregnancy with regular exercise during pregnancy (Haakstad et al., 2009; Owe et al., 2009) and indicated that pregnant women who regularly exercise before becoming pregnant tend to maintain an active lifestyle during pregnancy (Owe et al., 2009). Still, other studies have suggested that sedentary habits before pregnancy are very difficult to modify during pregnancy (Haakstad et al., 2009). Amount of exercise has previously been associated with women’s concerns about safety (Lee, Chiang, Lin, & Hsu, 2011; Sung, 1996, 2000; Symons Downs & Hausenblas, 2004). The Taiwanese folk belief in a ‘‘fetal sedative’’ (an-t’ai) promotes the avoidance of exercise during pregnancy, particularly during the first trimester. This fetal sedative is a complex of practices intended to calm the fetus and prevent a miscarriage. Fetus calming refers to the ritual of ‘‘propitiating the fetus god.’’ This ritual is traditionally performed if the fetus god has been offended, prompting to god to ‘‘move the fetus.’’ Another
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Pregnant Taiwanese Women’s Exercise Patterns
VOL. 22, NO. 4, DECEMBER 2014
TABLE 1.
Characteristics of Women in the Nonregular Exercise and Regular Exercise Groups (N = 692)
All (N = 692)
Nonregular Exercise Group (n = 587)
Regular Exercise Group (n = 105)
N
%
n
%
n
%
Age (years) G29 30Y35 Q36
210 380 102
30.3 54.9 14.7
172 322 93
29.3 54.9 15.8
38 58 9
36.2 55.2 8.6
Education High school or less University Graduate
111 490 91
16.0 70.8 13.2
88 423 76
15.0 72.1 12.9
23 67 15
21.9 63.8 14.3
Working status Full-time None or part-time
420 272
60.7 39.3
371 216
63.2 36.8
49 56
46.7 53.3
Personal income (NT$/month) e20,000 20,001Y50,000 Q50,001
206 389 95
29.8 56.4 13.8
158 343 84
27.0 58.6 14.4
48 46 11
45.7 43.8 10.5
Prepregnancy health Normal Abnormal
668 24
96.5 3.5
565 22
96.3 3.7
103 2
98.1 1.9
Prepregnancy BMI Underweight Normal Overweight or obese
89 488 113
12.9 70.7 16.4
72 413 100
12.3 70.6 17.1
17 75 13
16.2 71.4 12.4
Prepregnancy exercise No Yes
585 107
84.5 15.5
526 61
89.6 10.4
59 46
56.2 43.8
Trimester First Second Third
73 220 399
10.5 31.8 57.7
69 193 325
11.8 32.9 55.4
4 27 74
3.8 25.7 70.5
Miscarriages No Yes
534 158
77.2 22.8
450 137
76.7 23.3
84 21
80 20
Parity 1 91
406 286
58.7 41.3
329 258
56.0 44.0
77 28
73.3 26.7
Mean
SD
Mean
SD
Variable
Mean
SD
Gestational weight gain
8.52
5.72
8.38
5.01
9.27
8.62
Health status perception
3.69
0.79
3.66
0.80
3.84
0.72
Chi-Square Test #2
p
4.59
.101
3.63
.163
10.21*
.002
14.88**
.001
0.90
.342
2.26
.324
76.09***
.000
10.295**
.006
0.56
.528
10.98**
.001
t
p
j1.47 2.08*
.141 .038
*p G .05. **p G .01. ***p G .001.
important Taiwanese folk belief regarding pregnancy (Sung, 1996, 2000) is that a pregnant mother may have a miscarriage if she is overly tired or falls because of carelessness (Sung, 2011). Therefore, in Taiwan, many women will tend to avoid strenuous or even any form of exercise to protect the fetus. Pregnant women commonly decrease the amount of time
they spend working outside the home upon learning they are pregnant, with some even quitting their job (Lee et al., 2012; Schmidt et al., 2006). Studies have found that pregnant women in the United States have a lower rate of discontinuous exercise (13%) than Taiwanese (57.1%) as well as greater rates of regular exercise (20.4%Y65.6%) 245
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The Journal of Nursing Research
Chen-Ta Tung et al.
TABLE 2.
Exercise Patterns and Modal Means for Pregnant Taiwanese Women
Item
Exercise Before Pregnancy Only (n = 61)
Exercise During Pregnancy Only (n = 59)
Mean
Mean
Times/week
SD
4.31
Prepregnancy Mean
2.80
1.17
61.23
38.52
35.76
16.71
52.28
149.18
71.87
144.92
65.98
168.26
Minutes/time Times/week minutes/time
SD
Exercise Continued After Becoming Pregnant (n = 46)
1.49
Pregnancy
SD
3.61
Mean
1.48
SD
4.15
1.70
24.53
42.50
15.12
67.14
171.30
93.94
TABLE 3.
Types of Regular Exercise for Pregnant Women Before and During Pregnancy Exercise Before Pregnancy Only (n = 61) Item
Exercise During Pregnancy Only (n = 59)
Exercise Continued After Becoming Pregnant (n = 46) Prepregnancy
Pregnancy
Frequency
%
Frequency
%
Frequency
%
Frequency
%
Walking
33
29.7
55
70.5
32
40.5
42
70.0
Yoga
24
21.6
4
5.1
9
11.4
8
13.3
Biking
16
14.4
2
2.6
9
11.4
1
1.7
7
6.3
17
21.8
7
8.9
8
13.3
13
11.7
0
0
8
10.1
0
0
Climbing stairs Aerobics Jogging
8
7.2
0
0
4
5.1
0
0
Swimming
3
2.7
0
0
3
3.8
0
0
Mountain climbing
3
2.7
0
0
3
3.8
0
0
Others
4
3.6a
0
0
4
4.1b
1
1.7c
Note. aOthers include badminton (n = 2) and calisthenics (n = 2). bOthers include calisthenics (n = 3) and table tennis (n = 1). cOthers include calisthenics (n = 1).
and a greater propensity for maintaining exercise routines (61.2%) than both Taiwanese and Brazilian women (Evenson et al., 2004; Owe et al., 2009; Zhang & Savitz, 1996). The major reasons for discontinuing regular exercise routines included women’s perceptions of the limited or questionable benefits of exercise TABLE 4.
Logistic Regression Model for Women who Exercised Regularly (N = 105) Variable
OR
95% CI
p
Constant
0.04***
Full-time work
0.51**
[0.32, 0.81]
.000
Multiparous
0.47**
[0.29, 0.78]
.003
Prepregnancy exercise
7.00***
[4.26, 11.50]
.000
Third trimester
3.10*
[1.04, 9.24]
.043
Note. Data presented as odds ratios (OR) and 95% confidence intervals (CI). The reference group had no job or part-time job, had no prepregnancy exercise, and was primiparous and in the first trimester. *p G .05. **p G .01. ***p G .001.
during pregnancy, tiredness, and medical advice (Domingues & Barros, 2007). Overall, it seems that Taiwanese women tend to decrease their amount of regular exercise during pregnancy more than their American and Brazilian counterparts (Evenson et al., 2004; Zhang & Savitz, 1996). On the other hand, the number of participants who started exercising after becoming pregnant was greater in our study (10.1%) than the numbers found in previous studies (3.4%Y7%; Domingues & Barros, 2007; Evenson et al., 2004; Haakstad et al., 2009). Our higher results may be attributable to the Taiwanese folk belief that exercise may make labor easier, prompting Taiwanese women to start exercising more regularly during pregnancy. As for the Taiwanese women who exercised during pregnancy, in general, the duration of their regular exercise decreased in terms of minutes per week over the course of their pregnancy. However, these women also exercised more frequently during their pregnancy than before their pregnancy. Nevertheless, three fourths of the women in this study did not exercise regularly before becoming pregnant, and most were not sufficiently active and did not change their exercise pattern after becoming pregnant. The ACOG (2002)
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Pregnant Taiwanese Women’s Exercise Patterns
recommends that pregnant women who did not exercise regularly before pregnancy should start exercising once they became pregnant in accordance with the ACOG guidelines for exercise type, duration, and intensity. Furthermore, the ACOG recommends that those who had been exercising regularly should continue exercising regularly during pregnancy. We found that, in general, our prepregnancy exercisers continued to exercise regularly during pregnancy, which is consistent with the literature (Haakstad et al., 2009). Walking was the type of exercise most commonly reported by the Taiwanese women overall, regardless of whether they were pregnant. Previous studies found walking, swimming, cycling, and aerobic exercise to be the most common types of exercise during pregnancy in Western countries (Evenson et al., 2004; Liu et al., 2011; Poudevigne & O’Connor, 2006; Schmidt et al., 2006). By comparison, the women in our study exercised conservatively. Walking and climbing stairs fit easily into their daily routines, as these are simple and easily available modes of exercise for most pregnant women as well as conform with the aforementioned folk belief that regularly climbing stairs makes labor and delivery easier.
Limitations This study has several limitations. First, the study population consisted of mostly older, better-educated pregnant women in urban areas. This may limit the degree to which our findings may be generalized. Wider-population-based samples as well as longer periods of follow-up may be needed to gain a richer understanding of the overall exercise patterns of pregnant women in Taiwan. The second limitation relates to the assessment of the degree of regular exercise, which relied on self-reporting and on self-recall of prepregnancy exercise duration and frequency. Other factors that may influence exercise beliefs such as Taiwanese folk beliefs and the attitudes of family/partners should be considered in future studies of the nature and role of Taiwanese women’s exercise patterns before and during pregnancy,
Implications for Nursing Our findings provide insights into the design of programs aimed at promoting regular exercise for pregnant women. Healthcare providers should promote the types of regular exercise that healthy pregnant women prefer in Taiwan such as walking, climbing stairs, and antenatal yoga classes. In general, healthcare providers should help make pregnant women aware that a moderate amount of exercise may be achieved in a variety of ways and that they should select activities that are enjoyable, simple, and readily available for most pregnant women. Health workers and institutions should be made aware of our finding that multiparous women are less likely than primiparous women to exercise regularly and that the constraints of child care appear to be a major factor influencing the ability of women of childbearing age to engage in regular exercise routines.
VOL. 22, NO. 4, DECEMBER 2014
As our culture becomes increasingly globalized and as increasing numbers of Taiwanese women live and work outside Taiwan, the Taiwanese belief in a fetal sedative (an-t’ai) may become more widespread or may also be increasingly replaced by more modern, Western scientific views. In any case, health professionals in other countries will likely be dealing with greater numbers of pregnant Taiwanese women and thus should be aware of possible cultural differences when promoting and educating women about the need for exercise during pregnancy.
Conclusions This study examined the exercise patterns of pregnant women in northern Taiwan. Prepregnancy exercise habits, parity, work status, and current trimester were all found to be significantly associated with regular exercise during pregnancy. The most commonly reported types of exercise were walking, climbing stairs, and yoga. However, most of the women in our study were not sufficiently active and did not meet the current ACOG exercise-during-pregnancy standards. Furthermore, they tended to exercise less rather than more after becoming pregnant. Assessing these factors may assist clinicians in Taiwan to counsel pregnant women and to promote regular exercise during pregnancy.
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Haakstad, L. A. H., Voldner, N., & Henriksen, T. (2009). Why do pregnant women stop exercising in the third trimester? Acta Obstetricia Et Gynecologica Scandinavica, 88(11), 1267Y1275. doi:10.3109/ 00016340903284901 Haakstad, L. A. H., Voldner, N., Henriksen, T., & Bø K. (2007). Physical activity level and weight gain in a cohort of pregnant Norwegian women. Acta Obstetricia Et Gynecologica Scandinavica, 86(5), 559Y564. doi:10.1080/00016340601185301 Health Promotion Administration. (2014). Enough exercise. Retrieved from http://www.hpa.gov.tw/BHPNet/Web/HealthTopic/ TopicArticle.aspx?id=201405260007&Class=2&parentid= 201405260002 Hsu, C. Y., & Ko, P. C. (2006). Pregnant woman’s exercise habits and related factors. Chung Shan Medicine Journal, 17(2), 187Y199. Juhl, M., Madsen, M., Andersen, A. M., Andersen, P. K., & Olsen, J. (2012). Distribution and predictors of exercise habits among pregnant women in the Danish National Birth Cohort. Scandinavian Journal of Medicine & Science in Sports, 22(1), 128Y138. doi:10 .1111/j.1600-0838.2010.01125.x Lee, C. F., Chiang, I. C., Lin, H. M., & Hsu, C. J. (2011). Exercise beliefs during pregnancy. Formosan Journal of Medicine, 11(5), 449Y455. (Original work published in Chinese) Lee, C. F., Chiang, I. C., Lin, S. S., Lin, H. M., & Hsu, C. J. (2012). Physical activity pattern and related factors among women during pregnancy. Formosan Journal of Medicine, 16(2), 103Y111. (Original work published in Chinese) Liu, J., Blair, S. N., Teng, Y., Ness, A. R., Lawlor, D. A., & Riddoch, C. (2011). Physical activity during pregnancy in a prospective cohort of British women: Results from the Avon longitudinal study of parents and children. European Journal of Epidemiology, 26(3), 237Y247. doi:10.1007/s10654-010-9538-1 Montoya Arizabaleta, A., Orozco Buitrago, L., Aguilar de Plata, A., Mosquera Escudero, M., & Ramirez-Velez, R. (2010). Aerobic exercise during pregnancy improves health-related quality of life: A randomized trial. Journal of Physiotherapy, 56(4), 253Y258. doi:10.1016/S1836-9553(10)70008-4 Owe, K. M., Nystad, W., & Bø, K. (2009). Correlates of regular exercise during pregnancy: The Norwegian mother and child cohort
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The Journal of Nursing Research
懷孕婦女規律運動
VOL. 22, NO. 4, DECEMBER 2014
婦女於懷孕期間規律運動型態及其相關因素 董政達1 李靜芳2* 林淑珊3 林顯明4 1
西園醫院婦產部主任 2亞東技術學院護理系副教授 3 西園醫院護理部主任 4亞東醫院產科主任
背 景
沒有內外科疾病的孕婦 ，應每天至少有 30 分鐘以上的中等強度之運動 ，但大多數的孕 婦並未達到建議。
目 的
欲瞭解孕婦規律運動之相關因素 ，及從懷孕前至懷孕期間運動型態及持續時間的改變。
方 法
共有692 位孕婦完成問卷調查 ，分為規律運動組（105 位 ，15.2％）及未規律運動組（587 位 ，84.8%）共兩組。瞭解社會人口學 、運動有關變項與孕期運動的關係。
結 果
孕期規律運動的顯著預測因子為工作狀態 、懷孕前運動 、妊娠階段。孕婦常見的運動 型態為走路 、爬樓梯及瑜珈。近八成（526 位佔 76%）的婦女於懷孕前未規律運動。有 42.9% 的婦女會從孕前持續運動至懷孕；有 10.1% 者於孕前無運動 ，但懷孕後才開始運 動；有 57.1% 於懷孕後停止運動。整體而言 ，婦女於懷孕後會減少每週運動的時間。
結 論
走路和爬樓梯為台灣孕婦最常見的規律運動型態 ，規律運動有益懷孕婦女的健康。應 該鼓勵婦女於懷孕期間積極的生活型態。本研究結果可提供醫護人員於促進孕婦規律運 動和採取主動生活型態之參考。
關鍵詞：規律運動、懷孕、主動生活型態。
接受刊載：102年9月24日 *通訊作者地址：李靜芳 22061新北市板橋區四川路二段58號 電話：（02）77380145－6114 E-mail: [email protected]
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