The relationship between physical activity and sleep among pregnant women
Highlights
► This study used a national sample of pregnant women. ► Physical activity was measured objectively using accelerometry. ► Active pregnant women were less likely to have difficulty finishing a meal because of being tired or sleepy.
Introduction
Although exercising during pregnancy was once thought to be deleterious to the fetus through hypothetical risks such as acute fetal hypoxia and hyperthermia (Wolfe et al., 1989), empirical evidence suggests otherwise during uncomplicated pregnancies (Zeanah & Schlosser, 1993). For example, Brenner, Wolfe, Monga, and McGrath (1999) showed that a brief progressive exercise test terminated at a maternal heart rate of 170 beats per min did not induce fetal distress during a healthy pregnancy. With respect to maternal health, Lotgering, Spinnewijn, Struijk, Boomsma, and Wallenburg (1998) evaluated respiratory and metabolic responses to endurance cycling exercises among pregnant and postpartum women and showed that pregnant women were equally capable as postpartum women to safely perform approximately 40 min of cycling at 70–75% VO2 peak.
Furthermore, appropriate levels of exercise during pregnancy can result in positive health outcomes for the mother and the baby (Artal and O’Toole, 2003, Ji and Han, 2010, SMA, 2002). Maternal benefits to exercise include both physical and psychological changes, such as reduced fatigue and swelling of the lower extremities (Wallace, Boyer, Dan, & Holm, 1986), and less insomnia, stress, anxiety, and depression (Clapp et al., 1992). Although limited, there is some evidence to suggest that regular exercise during pregnancy may reduce the length of labor and decrease complications during delivery (Bungum et al., 2000, Sternfeld, 1997). Regular exercise may also help prevent some of the negative health outcomes that often occur from living a sedentary lifestyle during pregnancy, such as decreased cardiovascular fitness, excessive weight gain, increased risk of gestational diabetes mellitus (Bung, Artal, Khodiguian, & Kjos, 1991), pre-eclampsia (Sorensen et al., 2003), and difficulty psychologically coping with the concomitant physical changes during pregnancy (Wolfe & Mottola, 2000). Beyond this, physical activity during pregnancy may result in physical and psychological benefits in the post-partum period (Sampselle, Seng, Yeo, Killion, & Oakley, 1999). Lastly, given that women who engage in exercise during pregnancy tend to continue their exercise regimens postpartum, the beneficial effects of exercise are likely to continue long past pregnancy (Clapp, 1990). Consequently, it is advisable that pregnant women, assuming an uncomplicated pregnancy, engage in 30 min or more of moderate-intensity exercise a day on most, if not all, days of the week (ACOG, 2002).
Pregnant women encounter many discomforts during pregnancy (Davis, 1996), including restless sleep, shorter sleep duration, and difficulty falling asleep (Mindell & Jacobson, 2000). Inadequate or disturbed sleep is associated with numerous negative biopsychosocial and biophysical health outcomes among adults, including clinical depression, cardiovascular disease, type-2 diabetes, obesity, and all-cause mortality (Sigurdson & Ayas, 2007). Impaired sleep during pregnancy can also affect maternal well-being (Lee & Kimble, 2009). Additionally, maternal work schedules during pregnancy may also influence sleep, with work shift-induced sleep deprivation possibly leading to fetal growth impairment or other pregnancy-related complications (Bonzini, Palmer, Coggon, Cromi, & Ferrario, 2011). Clearly, there are numerous benefits associated with physical activity participation during pregnancy, with empirical evidence further indicating that it may help improve some of the discomforts associated with pregnancy (Horns et al., 1996, Smith and Michel, 2006); however, we currently have a limited understanding of the influence of physical activity on sleep during pregnancy.
To provide insight into the potential sleep-enhancing benefit of physical activity among pregnant women and to therefore see if physical activity may serve as a non-pharmacological treatment for sleep disorders during pregnancy, we reviewed the extant literature. In a large, population-based epidemiological study in the general population, Loprinzi and Cardinal (2011) reported that, after controlling for important confounding variables, participants meeting physical activity guidelines, compared to those not meeting guidelines, were less likely to feel overly sleepy during the day, have leg cramps while sleeping and have difficulty concentrating when tired. Although few studies have examined whether gender differences occur, a meta-analysis of acute and chronic exercise demonstrated a larger influence on sleep in women, compared to men (Kubitz, Landers, Petruzello, & Han, 1996). With respect to the link between physical activity and sleep among pregnant women, we found only one empirical study examining this association. Borodulin et al. (2010) examined the cross-sectional association of self-reported physical activity and self-reported sleep quality and duration among 1259 pregnant women 24–29 weeks’ gestation. Overall, they found that self-reported physical activity was not strongly associated with sleep quality or duration. Importantly, though, their study employed a subjective measure of physical activity that may have attenuated the relationship between physical activity and sleep through its widely established potential measurement error, including recall, misclassification bias, and social desirability effects.
To overcome this limitation and to expand upon our knowledge base regarding the association between physical activity and sleep among pregnant women, the present study sought to examine this relationship using an objective measure of physical activity (i.e., accelerometry). Accelerometry provides important objectively-measured information on the frequency, intensity, and duration of physical activity. Also, to increase the generalizability of our findings to more diverse samples of pregnant women, we conducted this study using a nationally representative sample of pregnant women. Therefore, the purpose of the present study was to examine the association between objectively-measured physical activity and sleep in a nationally representative sample of U.S. pregnant women. We hypothesized that objectively-measured physical activity would be positively associated with a variety of self-reported sleeping-related parameters among pregnant women.
Section snippets
Design and participants
For this study we used data from the National Health and Nutrition Examination Survey (NHANES) 2005–2006 cycle. Briefly, NHANES employs a representative sample of non-institutionalized U.S. civilians, selected by a complex, multistage probability design. Participants were interviewed in their homes and subsequently examined in mobile examination centers (MEC) across numerous U.S. geographic locations. The study was approved by the National Center for Health Statistics ethics review board, with
Results
Descriptive characteristics of the analyzed sample are presented in Table 1. The time spent in moderate-intensity, vigorous-intensity, and moderate-to-vigorous physical activity per day, as well as the prevalence of meeting physical activity guidelines (i.e., 150 min of moderate-intensity or 75 min of vigorous-intensity, or a combination of the two) (USDHHS, 2008), are shown in Table 2.
With respect to the amount of time (mean minutes ± standard error) it took to fall asleep at night, there was
Discussion
The present study examined the association between objectively-measured physical activity and a range of self-reported sleeping parameters using a nationally representative sample of 138 pregnant women between 18 and 43 years of age. Overall, we found that objectively-measured physical activity was not strongly associated with various sleeping parameters among U.S. pregnant women.
However, our findings did show that pregnant women who engage in higher amounts of physical activity were less
References (36)
- et al.
Exercise during pregnancy and type of delivery in nulliparae
Journal of Obstetric, Gynecologic, and Neonatal Nursing
(2000) The course of labor after endurance exercise during pregnancy
American Journal of Obstetrics & Gynecology
(1990)The discomforts of pregnancy
Journal of Obstetric, Gynecologic, and Neonatal Nursing
(1996)- et al.
Exercise and sleep
Sleep Medicine Reviews
(2000) Leg cramps and restless legs syndrome during pregnancy
Journal of Midwifery & Women’s Health
(2009)- et al.
Pregnancy outcomes among active and sedentary primiparous women
Journal of Obstetric, Gynecologic, and Neonatal Nursing
(1996) - et al.
The effects of qi exercise on maternal/fetal interaction and maternal well-being during pregnancy
Journal of Obstetric, Gynecologic, and Neonatal Nursing
(2010) - et al.
Impaired sleep and well-being in mothers with low-birth-weight infants
Journal of Obstetric, Gynecologic, and Neonatal Nursing
(2009) - et al.
Association between objectively-measured physical activity and sleep, NHANES 2005–2006
Mental Health and Physical Activity
(2011) - et al.
Sleep disturbances during pregnancy
Journal of Obstetric, Gynecologic, and Neonatal Nursing
(2000)
Nutrition for the childbearing years
Journal of Obstetric, Gynecologic, and Neonatal Nursing
Physical activity and postpartum well-being
Journal of Obstetric, Gynecologic, and Neonatal Nursing
A pilot study on the effects of aquatic exercises on discomforts of pregnancy
Journal of Obstetric, Gynecologic, and Neonatal Nursing
Aerobic exercise, maternal self-esteem, and physical discomforts during pregnancy
Journal of Nurse-Midwifery
Adherence to ACOG guidelines on exercise during pregnancy: effect on pregnancy outcome
Journal of Obstetric, Gynecologic, and Neonatal Nursing
Exercise during pregnancy and the postpartum period
Obstetrics and Gynecology
Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period
British Journal of Sports Medicine
Shift work and pregnancy outcomes: a systematic review with meta-analysis of currently available epidemiological evidence
BJOG: An International Journal of Obstetrics and Gynaecology
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