Matern Child Health J (2011) 15:806–813
DOI 10.1007/s10995-010-0647-y
Sports and Leisure Time Physical Activity During Pregnancy in
Nulliparous Women
Hanne Kristine Hegaard • Peter Damm •
Morten Hedegaard • Tine Brink Henriksen •
Bent Ottesen • Anna-Karin Dykes • Hanne Kjaergaard
Published online: 1 August 2010
Springer Science+Business Media, LLC 2010
Abstract To describe patterns of leisure time physical
activity during pregnancy in relation to pre-pregnancy
leisure time physical activity, socio-demographic charac-
teristics, fertility history, and lifestyle factors. 4,718
nulliparous with singleton pregnancy and intended spon-
taneous vaginal delivery were included in the study at
gestational week 33 from May 2004 to July 2005.
Information was provided by self-administered question-
naires. Leisure time physical activity was categorised into
four categories: competitive sport, moderate-to-heavy,
light or sedentary. In this population of nulliparous
women, 4% participated in competitive sport, 25% in
H. K. Hegaard A.-K. Dykes
Department of Health Sciences, Faculty of Medicine, Lund
University, Lund, Sweden
H. K. Hegaard (&) B. Ottesen H. Kjaergaard
Panum Research-Section, Juliane Marie Centre, Copenhagen
University Hospital, Rigshospitalet, Blegdamsvej 9, 2200
Copenhagen, Denmark
e-mail: hkhegaard@hotmail.com;
Hanne.Hegaard@rh.regionh.dk
P. Damm M. Hedegaard
Department of Obstetrics, Juliane Marie Centre, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
P. Damm B. Ottesen H. Kjaergaard
Faculty of Health Sciences, Copenhagen University Hospital,
Copenhagen, Denmark
T. B. Henriksen
Perinatal Epidemiology Research Unit, Departments
of Obstetrics and Paediatrics, Aarhus University Hospital,
Skejby, Denmark
A.-K. Dykes
Faculty of Health and Society, Malmo University, Malmo,
Sweden
123
moderate-to-heavy activities, 66% in light activities, and
5% in sedentary activities in the year prior to pregnancy.
Physical activity before pregnancy was statistically sig-
nificantly associated with age, pre-pregnancy BMI, chronic
diseases, number of years at school, and smoking habits.
The proportion of women who took part in com-petitive
sports, and moderate-to-heavy activities decreased over the
three trimesters of pregnancy. The proportion of women
with light physical activity was stable during pregnancy
while the proportion of women with sedentary activity
increased from 6% to 29%. During the third tri-mester
women performing competitive sports or moder-ate-to-
heavy activities before pregnancy continued to have a
higher level of physical activity than women with light
activities or sedentary activities before pregnancy. In
general the intensity and time spent on exercise decreased
during pregnancy. Women with the highest level of
exercise prior to pregnancy continued to be the most active
during pregnancy. Among women with sedentary activities
before pregnancy one-fourth changed to light activity
during pregnancy.
Keywords Prepregnancy Exercise Sociodemographic
Lifestyle
Introduction
Physical activity in general is associated with lower mor-tality
and morbidity and psychological well-being [1–13]. Physical
activity during pregnancy has been associated with reduced
risk for complications, such as preterm delivery, gestational
diabetes, pre-eclampsia, low back pain and excessive maternal
gestational weight gain [4, 9, 14–19]. Also, physical activity
during pregnancy appears to
Matern Child Health J (2011) 15:806–813
have a positive impact on health later in life for both
women [20] and their offspring [3, 21].
Therefore, it is worrying to find that most women
appear to reduce their leisure time physical activities when
they become pregnant [5, 10, 12, 22]. A decline in the
intensity of physical activity is observed, as many women
cease vigorous sports activities when pregnant [12, 23–25].
Contrary to this, some women are inactive prior to preg-
nancy but start exercising during pregnancy [5, 22, 26].
Pregnancy related discomfort, feelings of discomfort with
exercise, and fear of doing harm to the fetus are all stated
as reasons for reducing physical activity [8, 11]. A history
of miscarriage or infertility treatment also appear to affect
the level of activity [22]. Up to now the relationship
between socio-demographic characteristics, lifestyle fac-
tors, and exercise before pregnancy and the changes in
exercise during pregnancy have only been sparsely studied
[26], although knowledge of this could be very useful in
targeting health promotion and disease prevention in
specific groups of pregnant women.
The purpose of our study was to describe patterns of
leisure time physical activity during pregnancy in relation
to pre-pregnancy leisure time physical activity, socio-
demographic characteristics, fertility history, and lifestyle
factors.
Methods
Data stem from a multi-centre cohort study of nulliparous
women who attended the antental clinics of nine obstetric
departments from May 2004 to July 2005. Inclusion criteria
were: age C 18 years, Danish speaking, singleton preg-nancy,
intended spontaneous vaginal delivery. Seventy-nine per cent
of the eligible women were consecutively invited to
participate in the study at gestational week 33, however,
13.7% of those invited declined. A total of 4,718 out of 5,282
filled in a self-administered questionnaire at gesta-tional week
37 providing information on socio-demographic
characteristics, chronic disease, infertility treatment, and life
style factors, including questions related to leisure time
physical activity before and during pregnancy.
In the questionnaire, the women were asked: When you
look back on the year before you became pregnant, which
would you say is the most appropriate description of your
activities?
1. Hard training and competing in sports regularly and
several times a week.
2. Sports or heavy gardening for at least 4 h a week.
3. Walking, cycling, or other light exercise for at least 4
h a week (including Sunday walks, light gardening,
and cycling or walking to work).
807
4. Reading, watching television, or pursuing some other
sedentary occupation.
Leisure time physical activity was categorised as com-
petitive sports, moderate-to-heavy, light, or sedentary. The
items of leisure time activities with the four categories
were originally developed and validated by Saltin [27, 28],
and has been applied in many studies [14, 29–32]. Pre-
pregnancy BMI was calculated as kg/m2 and catego-rised
as shown in Table 1. Underweight (body mass index
(BMI) less than 18.5 kg/m2), normal weight (BMI 18.5–
24.99 kg/m2), overweight (BMI 25–29.99 kg/m2), and
obese (BMI greater than 30.0 kg/m2).
Since no invasive procedures were applied in the study,
Danish law required no Ethics Committee System
approval. The policy of the Helsinki Declaration was fol-
lowed throughout the data collection and analyses. Written
informed consent was obtained. Permission to establish the
database was obtained from the Danish Data Protection
Agency j. no. 2004-41-3995.
Statistical Analysis
Chi-square test for independence within contingency tables
was used. Statistical significance was defined as a two-
sided P value \0.05 and analyses were performed in SPSS
15.0 (SPSS Inc., Chicago, Ill).
Results
In this study population of 4,718 nulliparous women, 4%
participated in competitive sports, 25% in moderate-to-
heavy exercise, 66% in light exercise, and 5% in sedentary
activities in the year before pregnancy. The level of leisure
time physical activity the year before pregnancy according
to fertility history, socio-demographic- and lifestyle char-
acteristics is shown in Table 1 and significant associations
with maternal age, maternal pre-pregnancy BMI, chronic
diseases, number of years at school, and smoking habit
status were found.
Women with light and sedentary activity prior to preg-
nancy were likely to be young (\20 years old) and obese
(pre-pregnancy BMI C 30 kg/m2). Women, who took part
in competitive sports and moderate-to-heavy physical
activities, were more likely to be without a chronic disease,
to have a higher education (12 years at school) and to be
non-smokers.
The pattern of leisure time physical activity before and
during pregnancy is given in Fig. 1. This shows a decrease
from prior to pregnancy to the third trimester in the number of
women who practice competitive sports (4.0–0.1%) and those
who practice moderate-to-heavy activities (25–2.4%).
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Table 1 Level of leisure time physical activity in the year before pregnancy in nulliparous women according to socio-demographic, infertility
history, and lifestyle factors (n = 4,718)
Characteristic Population Level of leisure time physical activity the year before pregnancy P value
distribution (n) v2-test
Competitive Moderate-to-heavy Light Sedentary
(n = 190) % (n = 1,171) % (n = 3,099) % (n = 258) %

Total population N 4,718 4.0 24.8 65.7 5.5 –

Maternal age (year)
\20 48 2.1 8.3 79.2 10.4
20–24 619 3.9 17.9 72.1 6.0
25–29 2,217 4.5 25.9 64.1 5.4
30–34 1,434 3.9 26.7 64.0 5.4 \0.001
35?
Pre-pregnancy BMI (kg/m2)
\18.5 189 2.1 22.8 73.8 1.6
18.5–24.99 3,214 4.8 28.2 62.6 4.4
25–29.99 757 3.2 20.5 70.7 5.7
[ 30 339 1.2 8.6 74.1 15.9 \0.001
Years at school (year)
7–9 259 3.8 17.4 70.7 8.1
10–11 811 4.1 15.8 72.5 7.6
C12 3,307 4.2 27.8 63.4 4.7
Other 331 2.1 23.9 67.7 6.3 \0.001
Chronic disease
Yes 419 2.6 20.4 71.9 5.1
No 4,217 4.2 25.4 64.9 5.5 0.015
Infertility treatment
Yes 354 2.8 23.2 67.5 6.5
No 4,338 4.1 25.0 65.4 5.4 0.43
Smoking status before pregnancy
Smoker 1,162 3.4 17.3 70.6 8.8
Non-smoker 3,577 4.2 27.3 64.0 4.4 \0.001
* Values vary due to missing values

The proportion of women with light activities was stable
from 65% before pregnancy to 67% in the third trimester
while in the same period the proportion of women with
sedentary activity increased from 6 to 29%.
The level of leisure time physical activity during the
first, second, and third trimesters by pre-pregnancy levels
of physical activity is illustrated in Fig. 2a–d.
Women who took part in competitive sports before
pregnancy (n = 190) gradually reduced their activity dur-
ing pregnancy and the majority reduced it during their first
trimester (Fig. 2a). In their third trimester only 2% (n = 3)
of these women still took part in competitive sports, 14%
(n = 28) in moderate-to-heavy activities, 71% (n = 135) in
light activities, and 12% (n = 24) were sedentary (Fig. 2a).
A similar tendency was seen in pregnant women with
moderate-to-heavy activity (n = 1,171) before preg-nancy
(Fig. 2b). In their third trimester only 9% (n = 101) took
part in moderate-to-heavy activities, 73% (n = 835)
in light activities, while 18% (n = 215) were sedentary
(Fig. 2b). Of the women with light activities (n = 3,099)
before pregnancy, the majority continued at this level
during pregnancy, but 1% (n = 26) switched to moderate-
to-heavy physical activity and 30% (n = 919) were sed-
entary in their third trimester (Fig. 2c). Among the women
with sedentary activities (n = 258) before pregnancy, some
increased their activities during pregnancy. Thus, 25% (n =
64) took part in light activities and 2% (n = 5) in moderate-
to-heavy activities in their third trimester (Fig. 2d).
Changes in leisure time physical activity from prior to
pregnancy through the first trimester in relation to socio-
demographic characteristics, infertility treatment and life-
style factors is shown in Table 2. Women with normal
weight (BMI 18.5–24.99 kg/m2) continued more frequent
moderate-to- heavy leisure time physical activity from
prior to pregnancy through the first trimester than those

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Matern Child Health J (2011) 15:806–813 809

Fig. 1 The level of leisure time physical activity the year before and
during pregnancy in nulliparous women (n = 4,718)

with a higher pre-pregnancy BMI or lower pre-pregnancy

BMI (P = 0.02). Women who had received infertility
treatment were less likely to continue their moderate-to-
heavy leisure time physical activity (P = 0.01) (Table 2).
Among women with light leisure time activities before
pregnancy, those who conceived following infertility
treatment more often reduced their level of activity from
prior to pregnancy through the first trimester than those
who had not (P = 0.003); non-smokers reduced light
activity more often than did smokers (P \ 0.0001).

Discussion

In this population of 4,718 nulliparous women, two-thirds

participated in light physical activities and one-fourth in
moderate-to-heavy leisure time physical activity before
pregnancy while only a few women participated in com-
petitive sports or had sedentary activities in the year before
pregnancy. Clear associations were found between age,
pre-pregnancy BMI, presence of chronic diseases, number
of years at school, smoking habit status and level of leisure
time physical activity before pregnancy. A relatively high
prevalence of inactivity among the youngest women and
higher activity in women with a higher education were
found in this, and other studies [5, 7, 33].
As reported by Donahue [7] women who were obese or
smokers were more inactive the year before pregnancy than
women with normal weight and those who were non-smokers.
As in other studies [12, 23, 34] we found an overall
decline in the intensity and duration of leisure time phys-
ical activity during pregnancy; pregnant women changed
Fig. 2 Level of physical activity during pregnancy illustrated by
different levels of pre-pregnancy physical activity. a Pre-pregnancy
level: Competetitive sport (n = 190). b Pre-pregnancy level: Mod-
erate-heavy (n = 1,171). c Pre-pregnancy level: Light (n = 3,099). d
Pre-pregnancy level: Sedentary (n = 261)
from sports activities to lighter exercise, a change that is
also mentioned in other studies [12, 24].
We also confirmed previous findings that leisure time
physical activity during pregnancy depended on pre-preg-
nancy exercise level [22]. Although we described a decline
in intensity during pregnancy in women with the highest

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810
Table 2 Pregnancy-related change in leisure time physical activity in the first trimester according to baseline characteristics
Change in physical activity level in 1. Level of leisure time physical activity the year before pregnancy
trimester
Competitive Moderate-to-heavy Light Sedentary
Continue Reduce P Continue Reduce P Increase Continue Reduce P Increase Continue P
(n = 82) (n = 108) value (n = 574) (n = 595) value (n = 58) (n = 2,725) (n = 316) value (n = 82) (n = 176) value
% % % % % % % % %

Maternal age (year)

\20 0 100 0.4 50 50 0.3 3 84 13 0.7 60 40
20–24 44 56 41 59 3 87 10 29 71
25–29 42 58 51 49 2 88 10 28 72
30–34 41 59 48 52 2 88 11 33 67
C 35 75 25 52 48 1 88 11 47 53 0.3
2
Pre-pregnancy BMI (Kg/m )
\18.5 75 25 0.2 33 67 0.02 1 85 14 0.2 67 33
18.5–24.99 45 55 51 49 2 88 10 32 68
25–29.99 25 75 46 54 2 86 12 35 65
C 30 50 50 31 69 1 91 8 24 76 0.3
Chronic disease
Yes 54 46 0.3 40 60 0.06 2 86 12 0.3 12 88
No 43 57 50 50 2 88 10 34 66 0.03
Infertility treatment
Yes 70 42 0.08 35 65 0.01 0.4 84 16 0.003 30 70
No 42 58 50 50 2.0 88 10 32 68 1.0
Years at school (year)
7–9 40 60 0.8 51 49 0.7 3 87 10 0.4 38 62

Matern Child Health J (2011) 15:806–813

10–11 47 53 52 48 2 90 8 23 77
C12 43 57 49 51 2 88 10 33 67
Other 29 71 44 56 3 86 11 48 52 0.2
Smoking before pregnancy
Daily smoking 62 38 0.4 47 53 0.3 2 91 3 0.001 19 81
Current smoking 75 25 64 36 1 94 5 43 57
Quit smoking in pregnancy 43 43 54 463 4 89 7 43 57
Quit smoking before pregnancy 37 63 51 49 2 88 10 27 73
Never smoking 42 58 48 52 2 87 12 31 69 0.1
Matern Child Health J (2011) 15:806–813
level of activity before pregnancy these women were still
more physically active and at a higher intensity level than
those with light or sedentary activities prior to pregnancy.
Women with a BMI of more than 25 kg/m2 ceased mod-
erate-to-heavy physical activity during pregnancy more
often than did women with a normal weight (BMI 18.5–
24.99 kg/m2. Decreasing the activity in these women
might result in even higher risk of gestational diabetes,
pre-eclampsia or preterm delivery than if these women had
continued their level of physical activity [4, 14, 15, 19].
Some studies even suggest that the protective effect from
exercise is most pronounced in obese pregnant women [9,
35]. However, a reduction in the most intensive leisure
time physical activities from prior to pregnancy through
the first trimester might also be associated with some
benefits. A recent Danish study indicates an association
between frequent high impact exercise during pregnancy
and an increased risk of abortion [36]. Women, who
conceived by infertility treatment, were more likely to cut
down mod-erate-to-heavy exercise. The explanation for
this could be the fear that physical activity could harm
their unborn child [2, 8, 11].
Among women with sedentary activity before preg-
nancy, one-forth practised light exercise during their third
trimester. Other studies similarly show that some women,
who were formerly inactive, start exercising when they
become pregnant [5, 22, 26]. This could indicate that these
women consider their pregnancy to be a chance to change
their lifestyle; in Denmark the national guidelines recom-
mend inactive women to start physical exercise during
pregnancy and this message may have reached this group
of women [34]. The guidelines, which recommend 30 min
per day of moderate physical exercise for all healthy
pregnant women, were issued prior to this study [34].
Another interesting point was that of the women who
practised competitive sports, moderate or light exercises
before pregnancy, around 70% practised only light exer-
cises in their third trimester. This may be due to physical
activity being uncomfortable towards the end of pregnancy
and difficult to perform at a more intensive level [2, 8].
This study shows that by far the greater number of
women who were physically active before pregnancy
remained or reduced their activities to a level corre-
sponding to light physical exercise.
Whether this light leisure time physical activity level is
sufficient to improve the health of a mother and fetus
during pregnancy or whether it would be better for the
women to exercise at a higher level corresponding to
moderate-to-heavy physical activity remains to be shown.
Several studies show that women who during their preg-
nancy have exercised at a level comparable to moderate-to-
heavy in our study have a lower risk of preterm delivery,
pre-eclampsia, and gestational diabetes [4, 14, 15, 19].
811
Strengths and Weaknesses of Our Study
The population studied was large and comprised only
nulliparous women. Several studies have demonstrated that
parity influences the level of physical activity during
pregnancy [22, 24, 37]. Restriction to nulliparous women
will therefore create a homogeneous population and the
change in their level of physical activity will not be
influenced by care for other children [38], or previous
pregnancy experience. The assessment of physical activity
relied on self-reporting and retrospective recall of pre-
pregnancy activities and this may induce some bias. Also,
although the questions on activity deal with leisure time
physical activities the term ‘‘leisure time’’ is not specifi-
cally defined. Thus, there is a risk that some women
included their work-related activities. Furthermore, the
external validity of our study is hampered by the fact that
only nulliparous women with no planned elective caesar-
ean section, or induction of labour, were studied. Com-
parison with other studies should be restricted to a similar
group.
Conclusion
Overall, this study showed that the intensity and time spent
on physical activity decreased during pregnancy. Women
who were most active prior to pregnancy reduced their
exercise level, but continued to be the most active during
pregnancy. However, some sedentary pregnant women
increased their exercise level, indicating that it is possible
to change behaviour during pregnancy. Women who were
underweight, obese or pregnant following infertility treat-
ment tended to reduce their physical activity most. Thus
based on our findings it is likely that these women together
with sedentary pregnant women might benefit from inten-
sified antenatal advice concerning physical activity during
pregnancy, but this has to be investigated in future studies.
Acknowledgments The study was supported by grants from the
Research Committee of the Copenhagen Hospital Corporation, The
0
Danish Association of Midwives, Aase and Ejnar Danielsen s Foun-
dation, Sophus Jacobsen and wife Astrid Jacobsen Foundation; The
Augustinus Foundation, and Else and Mogens Wedell-Wedellsborg
0
s Found.
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Tugas Mata Kuliah Pendidikan Jasmani dan Olahraga

Soal:
 Cari sebuah jurnal/artikel mengenai pendidikan jasmani dan olahraga lalu buat resume atau
kesimpulan dari jurnal/artikel tersebut!

Jawaban:
 Kesimpulan:
Penelitian ini mengenai bagaimana intensitas kegiatan olahraga wanita hamil secara
keseluruhan, penelitian ini menunjukkan bahwa intensitas dan waktu yang dihabiskan untuk
aktivitas fisik/olahraga menurun selama kehamilan. Wanita sebelum kehamilan mengurangi
tingkat olahraga mereka, tetapi terus berusaha olahraga selama kehamilan. Namun, beberapa
wanita hamil meningkatkan tingkat olahraga mereka, yang menunjukkan bahwa ada
kemungkinan untuk mengubah perilaku selama kehamilan. Wanita yang kekurangan berat
badan, obesitas atau hamil setelah perawatan infertilitas cenderung mengurangi aktivitas fisik
mereka. Dengan demikian ada kemungkinan bahwa wanita-wanita hamil perlu didampingi dan
diberi saran untuk menjaga kehamilan lebih baik.