Table 1 Included studies for literature review

South

Africa

[55]

Soweto (Urban)

13 purposively selected participants aged 19–41 years

3rd (29–33 weeks)

Qualitative

Indirect measure:

Semi-structured interviews

• Demonstrated positive beliefs about PA, but participants remained inactive during the prenatal period.

• PA limitations included lack of time, lack of finances and inadequate information from healthcare providers.

• There was also an absence of social support network to facilitate PA participation.

• Findings suggested a holistic approach to improve PA compliance during pregnancy, inclusive of PA education and exercise opportunities within a community setting.

South Africa

[56]

Vanguard, Western Cape (Urban)

34 stratified randomly selected participants, aged 17–36 years

All

Qualitative exploratory study

Indirect measure:

Interview

• Pregnant women showed an interest in participating in PA during pregnancy and requested more information and a possible intervention programme.

• Participants were aware of the benefits of being physically active during pregnancy, but knowledge levels varied.

• Participants were unsure of the types of PA recommended for safe practice in pregnancy.

• Participants said that they did not receive PA-related advice and information from health care providers.

• Participants expressed interest in PA clubs or antenatal PA classes for accessibility to safe and regular PA.

Ethiopia [58]

Mekelle

299 (16–36 years)

All

Cross-sectional

Indirect measure:

PPAQ

• Only 8.4% women met the international recommended guideline for PA during pregnancy.

• Age group of 26–35 years (AOR: 2.69, 95% CI: 1.07–6.78), attending non-formal education (AOR: 13.50, 95% CI: 2.65–68.91), and unemployment (AOR: 5.23, 95% CI: 1.34–20.38) were significantly associated with a higher risk of sedentary activity status.

• Being married (AOR: 0.26, 95% CI: 0.09–0.73), having two children (AOR: 0.13, 95% CI: 0.03–0.59), and traveling an hour or more to health facilities (AOR: 0.31, 95% CI: 0.11–0.89) were significant positive predictors of physical activity participation.

• Majority (70.6%) received advice about PA from health professionals

• Most common reported reason for not exercising during pregnancy was fear of miscarriage.

• Walking was the most commonly reported mode of exercise (86.3%).

Ethiopia

[59]

Tigray

442 (18–38 years)

Not stated

Cross-sectional

Self-administered questionnaire

• Majority (78.1%) of the women were physically active

• Generally, expended less total energy during pregnancy 141.23 MET-h/week

• Expended highest amount of energy (69.4 MET-h/weeks) on household activities

• Primiparous women were 7.68 times more likely to be inactive as compared to multiparous women

• Education level of mothers had significant association with women’s level of physical activity during pregnancy

• Women with history of miscarriage had 8.05 times higher odds of becoming physically inactive during pregnancy as compared to those without history of miscarriage [AOR = 8.045; 95% CI (3.325, 19.465)).

Nigeria

[86]

Ibadan (Urban)

453 conveniently selected participants (mean age: 30.89 ± 4.44 years)

2nd & 3rd

Cross-sectional

Indirect measure:

PPAQ

• Half the participants were sedentary.

• Most of the energy expended by the pregnant women was on household chores.

• Number of children, stage of pregnancy, gravidity and employment status had a significant influence on the physical activity levels of the pregnant women.

• Increased number of children and gravidity, and advanced stage of pregnancy, significantly predicted increased likelihood of being sedentary.

Nigeria

[87]

Ile-Ife (Urban)

189 consecutively selected (mean age: 28.9 ± 4.63 years)

All

Cross-sectional

Indirect measure: Self-administered questionnaire

• Most women had knowledge of pelvic floor muscle strengthening, back care, relaxation and breathing exercises from antenatal exercises.

• Swimming and cycling were not known as antenatal exercises.

• Most women affirmed antenatal exercises reduced back pain, promoted ability to cope with labour and delivery, and prevented excessive weight gain.

• Knowledge about the benefits of antenatal exercises was not influenced by maternal sociodemographic characteristics, but age was found to significantly influence knowledge about contraindications to antenatal exercises.

• Knowledge of exercise during pregnancy was influenced mostly by tiredness, lack of will to exercise, and insufficient information on exercise.

• The majority of pregnant women demonstrated inadequate knowledge about antenatal exercises. However, the women had positive attitudes towards exercise.

Ethiopia

[88]

Jimma (Urban)

304 conveniently selected participants aged 20–27 years

All

Cross-sectional

Direct measure:

Combined Uniaxial Accelerometer and Heart Rate Sensor

• Overall level of PA was low-AEE (kJ/kg/day) and PAL

• Most women spent most of their time in sedentary and light intensity activities, with small amounts of moderate to vigorous activity.

• Gestational age and degree of adiposity were both independently associated with lower activity and fitness levels, while muscle mass was independently associated with higher activity and muscular fitness levels.

Burundi

[91]

Rural/Urban

150 conveniently selected participants aged 18–40 years

All

Quantitative

Indirect measure:

Self-administered questionnaire

• Most participants adopted sedentary lifestyles during pregnancy (88.0%), and had a negative view of exercise and PA during pregnancy (84.6%).

Egypt

[92]

Kafrelsheikh (Urban)

20 healthy pregnant women aged 20–25 years

2nd & 3rd (20–36 weeks’ gestation)

Randomised, controlled trial (RCT)

Direct measure: Pelvic floor muscle (PFM) using Peritron® to measure vaginal squeeze pressure

• Significant differences between both groups in mean PFM at 36 weeks gestation (WG); and a significant correlation between PFM strength at 36 WG and mode of delivery (vaginal delivery; r = 0.58, p < 0.05; caesarean delivery; r = -0.49, p < 0.05).

• Recommended pelvic floor muscle exercises for health during pregnancy as a safe and inexpensive strategy for increasing the vaginal delivery rate.

Egypt

[93]

Cairo (Urban)

100 (50 control group; 50 intervention group). Age: 20–35 years

Not stated

Prospective, interventional and controlled

Direct measure:

Supervised exercises (aerobic, stationary cycling, treadmill walking, stretching, pelvic curls, tailor press back bridge, crunches)

• Exercise group exhibited significant improvement in depressive symptoms after the aerobic exercise programme compared to baseline (p < 0.001), while the control group demonstrated no significant change over time.

• Supervised exercise during pregnancy has a positive effect on antenatal depression as a primary and secondary preventive strategy.

Egypt

[94]

Aswan (Urban)

360 (Mean age: 25.± 2.4 years)

10–39 weeks gestation

Prospective Cohort

Direct measure:

Supervised regular walking 5 times per week for 30 minutes

• Regular walking significantly reduced the occurrence of preeclampsia (OR = 0.120, 95% CI; 0.015–0.970; p = 0.037), postdate pregnancy (OR = 0.274; 95% CI = 0.099–0.759; p = 0.008), excessive weight gain (OR = 0.220; 95% CI = 0.114–0.424; p = 0.000) and caesarean delivery (OR = 0.519; 95% CI = 0.316–0.841; p = 0.007).

• Only a small proportion of pregnant women engaged in moderate to high (1.2%) PA during pregnancy.

Egypt

[95]

Urban

60 participants, randomly assigned to 30 in the control group and 30 in the intervention group

2nd and 3rd (≥ 14 weeks gestation)

Clinical control trial

Direct measure: Supervised antenatal exercises

• Exercises had no effect on the mode of delivery and maternal activity during gestation in both groups.

• Antenatal exercise is very effective in decreasing adverse effects in older primigravida and their offspring.

Egypt

[96]

Cairo (Urban)

40 (Age: 25–35 years)

2nd (20–24 weeks)

Prospective, interventional and controlled

Direct measure: Walking on treadmill

• Moderate intensity aerobic exercises were effective in reducing fasting blood glucose and fasting insulin levels in pregnant women at risk of gestational diabetes mellitus in both interventional and control groups.

Egypt

[97]

Urban

64

Quasi-experimental prospective study

Indirect measures:

Structured interviewing, questionnaire

• Stretching and physical exercise in women with mild preeclampsia promoted positive foetomaternal outcomes and did not pose greater maternal or neonatal risks than among those who did not practice.

Kenya

[98]

Kakamega County

306 conveniently selected participants aged 15–40 years

All

Descriptive survey

Indirect measure:

Self-administered questionnaire

• About 17% did not know that exercise is useful in pregnancy.

• Participants indicated exercise prevented incontinence (80.4%), decreased risk of preeclampsia (71.6%), and decreased risk of gestational diabetes (65.7%) and hypertension (68.6%)

• Strong association between the level of education and knowledge on the role of exercise during pregnancy (X² = df; 3 = 39.109;p = 0.02)

Kenya

[99]

Rongo (Rural)

100 (Age: ≤19–45 ≥ years)

2nd & 3rd

Longitudinal

Indirect measure:

International Physical Activity Questionnaire

• Women dedicated 78% of their time to physical work and only 22% to leisure activities per day.

• On average, women were active in their 2nd trimester as well as their 3rd trimester of pregnancy.

• Habitual PA of pregnant women in the setting included domestic, productive and leisure activities.

• Daily energy expenditure was relatively high

Nigeria

[100]

Maiduguri (Urban)

398 randomly selected participants 18->30 years

All

Analytic cross-sectional survey

Indirect measure:

Pregnancy Physical Activity Questionnaire (PPAQ)

• Most (86.4%) pregnant women did not participate in PA, and only 14.6% achieved the recommended levels of PA.

• PA significantly decreased from 1st trimesters to 2nd and 3rd trimesters.

• Sport/exercise was associated with enhanced physical health and health-related quality of life (HQoL) (r = 0.142,p < 0.01).

• Pregnant women with sufficient PA were four times more likely to report a high quality of life, physically (OR: 4.33, 95%, CI: 1.36–13.80)

• The study recommended sports/exercise as an important aspect of PA to prevent delivery interventions and improve the physical wellbeing of pregnant women, at least in that setting.

Nigeria

[101]

Osun State, south west (Urban)

289 purposively selected participants (mean age: 29.8 ± 5.11 years)

All

Cross-sectional

Indirect measure:

PPAQ

• Most participants were involved in light intensity and household PA (1263.6 ± 633.4) and low levels of vigorous intensity PA (6.4 ± 6.8)

• Both the mean of participation and the occupational PA were highest in the 2nd trimester.

• The 3rd trimester had the highest mean fatigue score.

• There was a significant relationship between pregnancy-related fatigue and physical activity.

Nigeria

[102]

Enugu (Urban)

350 purposively selected participants

All

Longitudinal cohort

Indirect measure:

Self-administered questionnaire

• The majority (82.9%) of the participants practised antenatal exercise, particularly aerobic exercises (76.2%).

• The majority exercised less than five days a week (70.0%) and ≥ 30 minutes daily (63.4%).

• Most exercised based on self-prescription (39.0%).

• Antenatal exercise practice and patterns did not improve postpartum health-related quality of life.

• The study recommended improved education and supervision of antenatal exercise for better postpartum health outcomes.

Nigeria

[103]

Owerri (Urban)

70 (simple random assignment into exercise and control groups)

2nd (20 weeks gestation)

Randomised, controlled trial

Direct measure:

Borge Rating of Perceived Exertion (RPE)

• Exercise in pregnancy significantly lengthened period of gestation.

• Exercising women were more likely to carry their pregnancies to full term than those who did not exercise.

• Exercise could serve as a means of preventing preterm births.

Nigeria

[104]

Urban/Rural

361

Cross-sectional

Indirect measure:

Questionnaire

• Pregnant and nursing women demonstrated high engagement in physical exercise, which was undertaken by self-prescription.

• Higher education is a significant determinant of exercise participation during pregnancy in Nigeria.

Nigeria

[105]

Urban

30 (n = 16 control group; n = 14 intervention group) randomly selected participants aged 18–45 years

Not stated

Intervention study

Direct measure: Supervised aerobic exercises

• The study showed that aerobic exercises combined with education on sleep hygiene significantly reduced levels of insomnia and fatigue in pregnant women, which was not possible with the use of education only.

South Africa

[106]

Soweto (Urban)

332 (Mean age: 29.5 ± 5.8 years)

2nd & 3rd (14–33 weeks gestation)

Longitudinal cohort

Indirect Measure: Global Physical Activity Questionnaire (GPAQ)

• Half of the women were classified as being active in the 2nd trimester, however, significantly fewer women participated in PA in the 3rd trimester

• Total PA decreased significantly as the pregnancy progressed.

• Walking for transport constitutes 80% of the total MVPA.

• The study showed that pregnant women spent an average of five hours per day sitting.

South Africa

[107]

Soweto (Urban)

210 (Mean age: 30.4 ± 5.8 years)

2nd & 3rd (14–33 weeks)

Observational, longitudinal study

Direct measure:

Hip-worn triaxial accelerometer (ActiGraph GT3X+, ActiGraph, Pensacola, FL)

• Significant decline in PA from 2nd to 3rd trimester (12.8 ± 4.1 mg vs. 9.7 ± 3.6 mg, p < 0.01) with a high prevalence of overweight/obesity and HIV.

• PA at 29–33 weeks and changes in PA were inversely associated with weight change at 29–33 weeks (β = 0.24; 95% CI-0.49; -0.00; p = 0.05 and β = -0.36; 95% CI-0.62; -0.10; p = 0.01, respectively)

• No significant associations between PA and birth outcomes.

South Africa

[108]

Vhembe, Ngovhela (Rural)

59 randomly selected participants aged < 18->30 years

2nd & 3rd

Cross-sectional

Indirect measure:

Self-administered questionnaire

• Women demonstrated an average knowledge of types of antenatal exercises, their benefits and contraindications.

• Women had no knowledge of pelvic floor exercises.

• Antenatal exercise participation was low.

Zambia

[109]

Lusaka (Urban)

300 (Mean age: 29.4 years)

All

Cross-sectional survey

Indirect measure:

Self-administered questionnaire

• Exercise practice was significantly associated with level of education.

• Most of the participants exhibited inadequate levels of knowledge on ideal exercises during pregnancy.

• Most reported a lack of knowledge on how to perform antenatal exercises, feelings of fatigue and general discomfort as barriers to exercises participation.

• Walking was identified as the most common type of exercise performed by the women.

• Participants did not know any specific antenatal exercises; consequently, they were not able to practise correct exercises during pregnancy.

Ethiopia [110]

Butajira

247 (15–45 years)

3rd (31–34 weeks

Community-based prospective cohort study

Indirect measure: Global Physical Activity Questionnaire

• About 47.2% women engaged in vigorous physical activities

• Low birthweight at term was significantly associated with vigorous physical activity (AOR = 2.48; CI: 1.01–6.09), prolonged standing (AOR = 3.37; CI: 1.14–9.93), and squatting (AOR = 2.61; CI: 1.04–6.54)