UCSF

The benefits of physical activity are wide ranging and substantial. Yet the majority of US adults do not meet the recommended minimum guidelines of activity. Mothers, in particular, experience a decline in physical activity after having children. In the transition to having children, the facilitators and barriers to being active change. Though inactivity after having children poses a significant risk, there is insufficient research on the patterns, barriers and facilitators, and potential pathways for intervention.

The first chapter of my dissertation explores patterns of physical activity and the association with having a child. The literature suggests that women experience a decline after birth but no studies examined more than 2 time points and thus we do not have sufficient insight into longtime patterns. We used a mixed model to estimate the percent change in physical activity with the event of birth, and for pre-specified times since birth. We found that there was a significant decrease in leisure time physical activity at birth and it persists through 5 years, however, by 10 years, women experience a rebound.

The second chapter of my dissertation examines more closely the experience of pregnancy and postpartum and how that affects women’s’ abilities to stay active. We examined data from low-income Latina pregnant and postpartum women affected by gestational diabetes in San Francisco and Sonoma counties. Using a mixed methods design, we collected quantitative survey data and qualitative data from 3 focus groups. We used descriptive statistics to analyze the quantitative survey data, and grounded theory and the Capability, Opportunity, Motivation Behavior (COM-B) framework to code and identify themes from the focus groups. Our samples of pregnant and postpartum Latina women affected by GDM were predominately Spanish speaking, low-income, and born outside the US. In the transition from pregnancy to postpartum, women noted a shift from a focus on self-care in order to maintain a healthy GDM pregnancy to caring primarily for their children. Two strategies that helped postpartum women stay active were setting proximal and family-centered goals and engaging their families in providing instrumental support. Family-centered goals included modeling healthy behaviors for their children and staying healthy in order to support their families.

The last chapter of my dissertation was an 8-week arm, randomized trial comparing the effectiveness of a virtual exercise and mobile apps intervention to a waitlist control. Using Google Hangouts, mothers in the intervention exercised together in real time guided by a mobile exercise app of their choosing. We found that a web and mobile app group exercise intervention was a feasible and acceptable way to deliver a physical activity intervention to mothers with young children. The intervention significantly increased physical activity in inactive mothers.

As a body of work, my three dissertation papers add a significant contribution to our understanding of the impact of becoming a mother on physical activity level patterns and associated barriers and facilitators. My work also suggests a potential path forward to increasing activity levels for women with children.