Physical Activity and its Associated Factors in Pregnant Women in Khoy City in 2024: A Cross-Sectional Study

Extended Abstract

Background

Physical activity during pregnancy is increasingly recognized as a key determinant of maternal and fetal health. Regular activity is associated with a reduced risk of gestational diabetes, preeclampsia, excessive weight gain, and adverse delivery outcomes, while also supporting psychological well-being, mood stability, and sleep quality. International guidelines recommend at least 150 minutes of moderate-intensity aerobic activity per week for healthy pregnant women. Nevertheless, evidence suggests that many pregnant women worldwide often do not meet these recommendations, with activity often limited to low-intensity or household-based activities. In Iran, physical activity behaviors during pregnancy are strongly influenced by cultural norms and sociocultural expectations. This study aimed to assess physical activity levels and associated factors among pregnant women in Khoy, West Azerbaijan, Iran, in 2024, to inform future health promotion strategies.

Methods

This cross-sectional study was conducted among pregnant women beyond the 12th gestational week in Khoy, Iran. The sample size of 226 was determined using Cochran’s formula, based on an accessible population of approximately 600 women, and adjusted for design effect. Participants were recruited from seven urban health centers using multistage sampling with probability proportional to size (PPS). Eligibility criteria included women aged 18–44 years, with at least three months of residency in Khoy and no medical contraindications to physical activity. Data were collected using a demographic questionnaire (age, education, employment, socioeconomic status, obstetric history) and the validated Persian version of the Pregnancy Physical Activity Questionnaire (PPAQ). The PPAQ assesses weekly duration of 36 activities across five domains: household/caregiving, occupational, transportation, sports/exercise, and leisure. Activity intensity was classified as sedentary (<1.5 METs), light (1.5–2.9 METs), moderate (3–6 METs), or vigorous (>6 METs). Weekly energy expenditure (MET-hours/week) was calculated by multiplying duration by corresponding MET values. Descriptive statistics were used to summarize participant characteristics and physical activity levels. Normality was assessed using the Shapiro–Wilk test. Associations between physical activity and independent variables were examined using univariate linear regression (demographics, socioeconomic status, and obstetric characteristics). Variables with P<0.20 were entered into multivariate regression models. Statistical analyses were performed using SPSS v24, with significance set at P<0.05. Ethical approval was obtained from the Research Ethics Committee of Khoy University of Medical Sciences (IR.KHOY.REC.1403.031), and informed consent was obtained from all participants.

Results

Of 226 invited women, 196 participated (response rate 86%). The mean (SD) age was 28.06±6.23 years, and the mean gestational age was 23.18±9.59 weeks. Most participants were housewives (83.9%), reported average socioeconomic status (58.2%), and had completed secondary school or a diploma (44.4%) with 28.1% reporting university education. A history of miscarriage was reported by 17.9%. The mean total physical activity was 43.68±17.54 MET-hours/week. Domestic and caregiving activities accounted for the largest proportion of energy expenditure (31.85±14.09 MET-hours/week), followed by leisure/sports (5.67±6.96), transportation (4.25±3.44), and occupational activities (1.49±4.93). Light-intensity activity constituted the largest share of total activity (21.62±1.33 MET-hours/week), while vigorous activity was minimal (2.99±4.69 MET-hours/week). Sedentary behaviours accounted for 5.91±3.06 MET-hours/week. Overall, 71.5% of participants engaged primarily in light-intensity and household-based activities. Regression analyses revealed no statistically significant associations between physical activity and maternal age, gestational age, parity, previous miscarriage, or education level (P>0.05). Socioeconomic status and occupation were also not significantly associated with total physical activity, though women reporting “much higher than average” socioeconomic status demonstrated lower activity compared to others; however, this association did not retain significance in multivariate models (P=0.20).

Conclusions

Pregnant women in this study predominantly engaged in light-intensity and household-based activities, with low levels of moderate-to-vigorous physical activity. Cultural beliefs emphasizing rest during pregnancy, lack of structured exercise opportunities, insufficient encouragement from healthcare providers, and family restrictions were identified in related literature as likely contributors. These barriers appear to limit participation in structured exercise, despite growing recognition of the safety and benefits of prenatal physical activity. The study highlights a marked insufficiency in moderate-to-vigorous activity levels among pregnant women in Khoy, with household activities dominating daily energy expenditure. The absence of significant associations with socio-demographic variables suggests that low physical activity is widespread across population subgroups. These findings are consistent with prior research indicating insufficient engagement in recommended prenatal exercise levels.

Practical Implications of Research

This findings highlight the need for culturally appropriate interventions to promote safe, moderate-intensity physical activity during pregnancy. Incorporating simple exercises such as walking or stretching into routine antenatal care, training healthcare providers to deliver consistent counselling, and involving family members in educational programs may help improve physical activity levels among pregnant women and reduce the risk of pregnancy-related complications.