Thursday, October 4, 2012

A survey to support evidence-based research into the barriers to exercise for mums

Some of you will know that I'm secretly a science geek. When I first dreamed up Ready Steady Mums I was determined to develop an evidence-based approach to helping mums get active. I researched the medical literature on the subject and consulted with specialists in relevant fields of medicine and fitness.

Since then I have continued to research and analyse the exercise needs of mums and the impact of physical activity on the postpartum body.

The evidence is clear that (a) exercise is good for us pre and postnatal and (b) we don't do enough. We also have quite a good understanding of the barriers to exercise, and later in this blog entry I'm going to share some of what we already know.

First though, a plea. I am committed to improving the amount of real evidence available and used to decide when and how to support mums in getting active. I have recently been worked in support of the Consumers' Forum Committee  at the Royal College of Obstetricians and Gynaecologists on understanding the main issues that prevent mums from getting active and being healthy.

Now Ready Steady Mums has designed a survey to gather personal views on how motherhood and exercise work together... or don't. We're looking for qualitative data. This not a tick-box survey but one where we ask you to write comments and share opinions. You can do it in 5 minutes, or even better you might choose to spend a little longer explaining your thoughts.

If you're a mum, or might one day be a mum, we'd love you to do our survey. And to say thank you, we'll enter you into a prize draw to win a copy of our DVD "Proper Exercise in Pregnancy" for you or a pregnant friend. We'll publish the results on my blog later this year.


Now for what we know already: 

Barriers to exercise for mums

My initial literature review made it clear that significant barriers exist for mum-to-be and new mums to be active. Some papers include quantitative results evidencing this e.g. Owe et al. (2009) 1. Theirs was a very solid study - using data on almost 35k pregnancies from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health - and they found that the proportion of women exercising regularly was 46.4% before pregnancy and decreased to 28.0 and 20.4% in weeks 17 and 30, respectively.

Not a promising statistic!

There is also some excellent research out there on the benefits of physical exercise for new mums. In summary, physical exercise reduces common postnatal health problems such as prolapse and back-pain; and active mums are less likely to suffer from the baby blues or post-natal depression. A list of some key academic references is here.

Various other studies have provided insights into what the barriers are preventing exercise for mums and mums-to-be. I have outlined the findings of some of the most credible, evidence-based studies below.

Sport England (2005) conducted a review of existing qualitative research evidence around understanding participation in sport (with a group at the University of Oxford) 2. Changes in stage of life such as leaving school, having children, children leaving home, retirement and losing a spouse were all identified as crucial points in the maintenance of physical activity. At each stage a shift in social network occurs along with a shift in identity. For women in general (NB they did not look at mothers as a sub-group), they found "challenges to identity" were barriers to participation e.g having to show others an unfit body, appearing incompetent at core skills and, appearing overly masculine. They found that participation was also hampered by difficulty in accessing (and the poor state of) facilities, and concerns with the cost of joining sporting clubs and fitness gyms.

In 2008 the Sport England research team ran their own programme of qualitative research around "understanding participation". Again their work was largely qualitative, with a focus on developing practical ideas to encourage participation. They aimed to help at least two million more people in England to be more active by 2012* as part of the DCMS Legacy Action Plan (2008) 3. A big challenge was identified then and remains: to increase participation amongst those less likely to participate in sport. In Britain male participation in sport is higher, and increasing faster, than it is for women. Therefore, specific emphasis was placed by Sport England on women, especially those caring for children. They articulated a long-term strategy of funding sport in the community through people, organisations and networks that grow and sustain participation in sport (hence their support for Ready Steady Mums). 

*NB A new target for Sport England, set by DCMS to be achieved by March 2013, is increasing by one million the number of adults doing three 30 minute sessions of moderate intensity sport a week.

The Women's Sport and Fitness Foundation (2005) published a study which provided insight to help prioritise the interventions that would get more mothers active 4. This was a landmark study, one of the first to really consider psychological and emotional factors preventing participation.

The WSFF is currently looking further at the barriers to women getting active, and they are due to publish their findings later this year. The scope is broader than just mums, but this will still contribute greatly to the pool of data on this topic. Our shared interest with WSFF is mainly on campaigning - we are both keen to push the debate on women's/mums' sport and fitness - and we are sharing our findings with the WSFF research team.

Lastly, taking a more academic approach, Diane Duncombe et al. (2009) conducted research into exercise in pregnancy 5. Only 158 mothers were sampled but the findings were peer-reviewed and robust.  They found that the amount and intensity of exercise decreased over the course of pregnancy, with main reasons for not exercising including feeling tired or unwell, being too busy, and, particularly in late pregnancy, exercise being uncomfortable. Some women also reported safety concerns.

1. KM Owe, W Nystad, K Bø, 2009, Correlates of regular exercise during pregnancy: the Norwegian Mother and Child Cohort Study, Scan J Med & Sci Sports 19(5), p637–645
2. Charlie Foster, Melvyn Hillsdon, Nick Cavill, Steve Allender, Gill Cowburn, 2005, Understanding Participation in Sport – a Systematic Review, University of Oxford British Heart Foundation Health Promotion Research Group for Sport England
3. Department for Culture, Media and Sports, 2008, Before, during and after: making the most of the London 2012 Games
4. Physical activity and mothers, 2005, Opinion Leader Research (OLR), WSFF Insight
5. Dianne Duncombe, Eleanor H. Wertheim, Helen Skouteris, Susan J. Paxton, Leanne Kelly, 2009, Factors related to exercise over the course of pregnancy including women's beliefs about the safety of exercise during pregnancy,  Midwifery, 25(4), p430-438

If you're willing to help us build a better understanding of exercise and motherhood - so more mums can get the right support to get active - please do our survey and recommend it to any fellow mums/mums-to-be. Thank you!


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