UNIVERSITY OF GHANA-LEGON

COLLEGE OF HEALTH SCIENCES

SCHOOL OF PHARMACY

DEPARTMENT OF CLINICAL AND PHARMACY PRACTICE

THE RECREATIONAL HEALTH PRACTICES BY PREGNANT WOMEN IN

ANTENATAL CLINICS

BY

MONA ABDULLAI

(22012111)

THIS DISSERTATION IS SUBMITTED TO THE SCHOOL OF PHARMACY,

UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILLMENT OF THE

REQUIREMENT FOR THE AWARD OF DOCTOR OF PHARMACY.

DECEMBER, 2024
 DECLARATION

I, Samuel Kwasi, Apedo in full knowledge of my liability, hereby declare that all the texts,

diagrams and tables in this Project Work are based solely on my own individual work and is

not based on work published in another document or by another contributor. Where I have

drawn on the work of others, this has been appropriately and fully acknowledged in the

form of citation and references as set out in the Student Handbook.

………………………………….

Mona Abdullai
(Student)

…………………………
Dr. Paul Owusu Donkor
(Supervisor)

i
 DEDICATION

I dedicate this dissertation to my lovely parents.

ii
 ACKNOWLEDGEMENT

My outmost gratitude first to Allah the Almighty for the life, strength, knowledge and

wisdom given me during this study. My special thanks also go to my supervisor, Dr. Paul

Owusu Donkor who despite his busy schedules has painstakingly offered me complete

guidance, constructive criticisms and most importantly exercised the greatest patience for

me. Completing this project under your guidance has been an inspiring and enriching

experience. Your leadership, vision, and clear direction played a pivotal role in ensuring its

success. The way you empowered the team, encouraged innovative ideas, and handled

challenges with calm and confidence is truly admirable. You consistently fostered a

collaborative environment, where everyone felt valued and motivated to give their best.

Thank you for your unwavering support and for being a supervisor who truly leads by

example. It’s been a privilege to learn from you, and this project’s success is a testament to

your exceptional leadership.

Further, I would like to thank my family for their love, patience, understanding and

financial support throughout this study. To all my colleagues and friends who in one way or

the other assisted me to make this study a success, I am grateful for all the support given

me.

iii
 TABLE OF CONTNET

DECLARATION............................................................................................................................i

DEDICATION...............................................................................................................................ii

ACKNOWLEDGEMENT...........................................................................................................iii

TABLE OF CONTNET...............................................................................................................iv

LIST OF FIGURES.......................................................................................................................v

LIST OF ABBREVIATIONS.....................................................................................................vii

ABSTRACT................................................................................................................................viii

CHAPTER ONE............................................................................................................................1

INTRODUCTION.........................................................................................................................1

1.1 Background............................................................................................................................1

1.2 Statement of the Problem.......................................................................................................3

1.3 Study Objectives....................................................................................................................5

1.3.1 General Objectives..........................................................................................................5

1.3.2 Specific Objectives.........................................................................................................5

1.4 Rationale for the study...........................................................................................................5

CHAPTER TWO...........................................................................................................................7

LITERATURE REVIEW.............................................................................................................7

2.1 Introduction............................................................................................................................7

2.2 Overview of Recreational Health Practices...........................................................................7

2.2.1 Definition of Recreational Health Practices...................................................................7

2.2.2 Examples of Recreational Health Practices....................................................................9

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 2.2.3 Benefits of Recreational Health Practices.....................................................................10

2.2.4 Challenges associated with Recreational Health Practices...........................................12

2.2.5 Gallery of types of Exercises........................................................................................15

2.3. Empirical Reviews..............................................................................................................17

2.3.1 Knowledge of pregnant women attending Antenatal Clinics regarding physical activity

...............................................................................................................................................17

2.3.2 Level of participation in physical activity among pregnant women attending Antenatal

Clinics....................................................................................................................................18

2.3.3 Factors associated with low levels of participation in physical activity among pregnant

women attending Antenatal Clinics.......................................................................................19

REFERENCES............................................................................................................................20

v
 LIST OF FIGURES

Figure 2.1 Squat.............................................................................................................................15

Figure 2.2 Kegels ..........................................................................................................................15

Figure 2.3 The Standing Crunch....................................................................................................16

Figure 2.4 The Seated Stability Hold.............................................................................................16

vi
 LIST OF ABBREVIATIONS

Abbreviation Full Meaning

ACOG American College of Obstetricians and Gynaecologists

ANC Antenatal Clinic

PA Physical Activity

ABSTRACT

Introduction: Pregnancy is a significant life event characterized by various physical and

emotional changes, making a healthy lifestyle essential for maternal and fetal well-being. Despite

vii
the recognized benefits of prenatal exercise, many women struggle to engage in physical activity

during this period due to hormonal changes and misconceptions about its safety. This inactivity

increases the risk of chronic diseases and adverse pregnancy outcomes.

Aim: This study aims to assess the knowledge and participation levels of physical activity

among pregnant women attending antenatal clinics in Ghana, as well as to identify the factors

contributing to low participation rates.

viii
 CHAPTER ONE

INTRODUCTION

1.1 Background

Pregnancy is a significant life event that brings about various physical and emotional changes in

women. During this period, maintaining a healthy lifestyle is crucial for both maternal and fetal

well-being. Pregnancy is a specific period that most women find it difficult to engage in some

recreational health practices such as exercise as a result of hormonal changes. This often

decreased their physical activity, thereby placing this special population at risk of several chronic

diseases and sometimes premature mortality. This is natural as recreational health practices helps

the body to remain healthy (Perales et al., 2016; Gregg et al., 2017; Schafer et al., 2019).

Pregnant women are encouraged to engage in regular physical activities known as “prenatal

exercise” (Fraser et al., 2014). This type of exercise is any physical effort aimed at enhancing the

health of both the mother and the fetus before delivery. The benefits of prenatal exercise are

significant and well-documented (da Silva et al., 2017). For instance, it promotes blood

circulation to vital organs of the developing fetus and the mother (Fraser et al., 2014). Prenatal

exercises can also reduce the risk of pregnancy-related disorders, improve muscle tone, and

facilitate safe deliveries (May et al., 2017; Perales et al., 2017). Additionally, regular exercise

helps prevent gestational diabetes and lowers the risk of preterm labor, especially among first-

time mothers (Markinde et al., 2014). Women who engage in multiple sports types experience a

24% reduced risk of preterm delivery. Furthermore, babies born to active mothers tend to exhibit

better neurological development and adaptability (Labonte-Lemoyne et al., 2017).

While personal and cultural values are thought to impact a woman's physical activities, there is

limited understanding of how to encourage exercise during pregnancy (Nkhata et al., 2015).
1
Markinde et al., (2014) emphasized that prenatal exercise programs should be thoughtfully

designed to help pregnant women maintain their health throughout pregnancy. Various exercise

options are available, including aerobics like dancing, walking, and swimming, as well as Kegel

exercises, which involve tightening pelvic muscles to manage urine flow (Santos-Rocha et al.,

2019). These activities aim to engage all muscle groups during childbirth, enhance postpartum

recovery, maintain muscle tone especially in the pelvic area and improve circulation, and support

the uterus and other organs effectively (da Silva et al., 2017; May et al., 2017; Schafer et al.,

2019).

Furthermore, Jackson et al., (1995) report that exercise is an activity requiring physical effort

done to improve health. Exercise is a physical or mental activity that is done to stay healthy or

become stronger (Richards et al., 2015). Therefore, exercise sessions in antenatal clinic should

be designed to stimulate interest in the physical changes occurring to promote body awareness

and to facilitate physical and mental relaxation (Tunkara-Bah, 2016). Proper introduction of

exercise during pregnancy influences the perception of exercise during pregnancy (Ferrari et al.,

2013). However, many factors may influence the perception of pregnant women such as age,

level of education and culture (Thompson et al., 2017; Harrison et al., 2018). Historically, there

have been concerns about the adverse effects of prenatal exercise on pregnancy outcome but

recent studies have found no adverse effects of regular, moderate-intensity prenatal exercise

(Markinde et al., 2014).

Ogodo and colleagues (2016) documented that despite the clear benefits of adequate physical

activity and significant risks to sedentary behaviour, only about 15% of pregnant women achieve

recommended levels of physical activity weekly during pregnancy. Common misconceptions

include beliefs that physical activity may cause miscarriage, restrict fetal growth, cause preterm

2
birth, and lead to musculoskeletal injury (Garland, 2017). Others common reason for pregnant

women not exercising while pregnant is cultural belief; physical changes during pregnancy; not

knowing how to exercise and being unsure why they should exercise (David, 2016; Schafer et

al., 2019). Some of the barriers to physical activity during pregnancy are depression, anxiety and

fatigue; which have been shown to be attenuated by regular exercise performed by non-pregnant

samples (American College of Obstetricians and Gynaecologists, 2015; Coll et al., 2017).

Consequently, the adverse consequences of inactivity may be life-threatening problems among

pregnant women about 60% are inactive during pregnancy.

Exercise during pregnancy is of utmost concern for most health care providers, educators, the

general public as well as pregnant women and their families (Rajabi et al., 2018; van Poppel et

al., 2019). Regular and moderate exercise in early pregnancy is healthy for mothers and their

babies. Studies have reported that many expectant mothers still remain inactive and do not meet

sufficient exercise recommendations (Nkhata et al., 2015; Choi et al., 2016; Cid et al., 2016).

There is inadequate information on prenatal exercises and their outcome among pregnant. Hence,

this study seeks to assess the perception of prenatal exercise and its outcome among pregnant

women attending ante-natal clinics in Ghana.

1.2 Statement of the Problem

Physical Activity (PA) in the general population is considered too low and this is reflected in

pregnant women as well (Lindqvist et al., 2016; Bouchard et al., 2012). The American College of

Obstetricians and Gynecologists (ACOG) has suggested that healthy pregnant women should

engage in 150 min of moderate PA per week (Birsner et al., 2020; Yang et al., 2022). Despite

this, there have been some misconceptions associated with PA and exercises during pregnancy

including miscarriage, low birth weight, and early delivery (Brown et al., 2022; Mbada et al.,

3
2014). In Ghana, pregnant women (mostly in rural areas and underdeveloped regions), believe

the myth that exercising in the first trimester might lead to miscarriage (Moses et al., 2015).

Interestingly, barriers to the participation of exercise among pregnant women have been reported

and these barriers are a combination of physical, psychological, and social factors (Kandel et al.,

2021; Leiferman et al., 2011). Whilst some pregnant women reported embarrassment about their

body appearance, others also reported that the lack of social support from loved ones, and the

fear of danger of exercise to themselves and the growing fetus are some of the reasons for which

they would rather not participate in exercise or PA (Leiferman et al., 2011; Thornton et al., 2006;

Clarke et al., 2004; Kieffer et al., 2002). Some studies (Leiferman et al., 2011; Clarke et al.,

2004) reported a lack of education and knowledge of safe ways to exercise during pregnancy. It

is said that women who exercise regularly before pregnancy are more likely to keep this attitude

during pregnancy than those who were sedentary before becoming pregnant (Shum et al., 2022;

Gaston et al., 2011). Thus, education and health promotion programs targeting women in their

reproductive years are of vital importance for achieving sustainable health practices.

Moreover, a study conducted in South Africa reported that (70.2%) pregnant women received

PA information from television, the radio, and other media sources (Okafor et al., 2021).

However, a study conducted in Nigeria on the knowledge and attitude of pregnant Nigerian

women toward antenatal exercise reported that (15.8%) of the respondents had a negative

attitude toward antenatal exercise due to limited information on exercise (83.3%) and tiredness

(70.0%) as another factor (Mbada et al., 2014). In Ghana, Moses et al. (2015) reported that

(71.5%) pregnant women were aware of the importance of PA in the Kumasi metropolis but

concluded that pregnant women do not spend more time performing PA. Additionally, Asante et

4
al., (2022) reported a high (74%) level of knowledge of PA among pregnant women in Ho,

Ghana. However, most pregnant women rather engage in PA as their gestational age increases.

Existing literature on the association between knowledge of PA and participation in PA among

pregnant women are limited especially in sub-Sahara Africa (Okafor et al., 2021; Mbada et al.,

2014). Only two studies (Asante et al., 2022; Moses et al., 2015) has been conducted and

published in Ghana. Thus, understanding the knowledge and participation levels in PA of

pregnant women in Ghana is of clinical relevance to foster education and promotion of PA.

1.3 Study Objectives

1.3.1 General Objectives

This study generally seeks to investigate the extent of knowledge and participation levels of PA

among pregnant women in Ghana

1.3.2 Specific Objectives

This study specifically seeks;

1. To investigate the knowledge of pregnant women attending Antenatal Clinics regarding

physical activity,

2. To determine the level of participation in physical activity among pregnant women

attending Antenatal Clinics, and;

3. To determine the factors associated with low levels of participation in physical activity

among pregnant women attending Antenatal Clinics.

1.4 Rationale for the study

Despite the recognized benefits of recreational activities during pregnancy, there is a lack of

comprehensive research focusing on the specific types of activities that pregnant women engage

in while receiving antenatal care. This gap presents a significant research problem, as

5
understanding the preferences and barriers faced by this population is essential for developing

effective interventions and support systems.

The study will be used to inform health workers about the severity, benefits, barriers, and

susceptibility of the various practices, thereby affecting their perceptions and practices.

Furthermore, the findings from the study will be used to develop interventions to improve health

workers’ and communities’ knowledge, as well as interventions for awareness campaigns to

overcome stigma, resulting in improved community attitudes and practices toward recreational

health practices during pregnancy. Data on recreational health practices would also be used to

enhanced future research, adding to the country's limited physical activity in pregnancy data.

6
 CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

2.2 Overview of Recreational Health Practices

Recreational health practices encompass a variety of activities that promote physical, mental, and

emotional well-being during pregnancy. These practices are particularly important for pregnant

women attending antenatal care (ANC) as they contribute to a healthy pregnancy and prepare

women for childbirth. Engaging in recreational activities can help alleviate common pregnancy-

related discomforts, enhance mood, and foster social connections. It is essential for healthcare

providers to encourage these practices as part of comprehensive prenatal care.

2.2.1 Definition of Recreational Health Practices

Recreational health practices can be defined as activities that individuals engage in during their

leisure time to promote health and well-being. For pregnant women, these practices encompass

both physical and non-physical activities specifically tailored to meet their unique needs during

this transformative period. The importance of defining these practices lies in understanding how

they contribute to the overall health of both the mother and the developing fetus.

Physical activities are a significant component of recreational health practices for pregnant

women. These activities include exercises that are safe and beneficial during pregnancy, such as

walking, swimming, prenatal yoga, and low-impact aerobics. Engaging in regular physical

activity helps maintain cardiovascular health, improves muscle strength, and enhances flexibility.

These exercises also promote healthy weight gain, which is crucial for both maternal and fetal

health. Healthcare professionals often recommend that pregnant women engage in at least 150

7
minutes of moderate-intensity exercise each week, as it has been shown to reduce the risk of

gestational diabetes, hypertension, and other complications.

In addition to physical activities, non-physical recreational practices play a crucial role in

promoting emotional and mental well-being. Creative pursuits, such as art, music, and writing,

provide pregnant women with opportunities for self-expression and relaxation. These activities

can serve as therapeutic outlets, allowing women to process their feelings and experiences during

pregnancy. For instance, journaling can help women reflect on their thoughts and emotions,

providing clarity and reducing anxiety. Similarly, engaging in art or music can foster a sense of

accomplishment and joy, contributing positively to mental health.

Relaxation techniques are another essential aspect of recreational health practices. Pregnancy can

be a time of heightened stress and anxiety, making it important for women to find effective ways

to manage these feelings. Practices such as meditation, deep breathing, and prenatal massage can

promote relaxation and mindfulness, helping women connect with their bodies and their babies.

These techniques not only reduce stress but also improve overall emotional resilience, enabling

women to navigate the challenges of pregnancy with greater ease.

Social engagement is a vital component of recreational health practices that should not be

overlooked. Many pregnant women experience feelings of isolation, particularly if they are first-

time mothers or lack a supportive network. Participating in group activities, such as prenatal

classes or support groups, can provide a sense of community and belonging. These interactions

allow women to share their experiences, learn from one another, and build lasting friendships.

The social support gained through these connections can significantly enhance emotional well-

being, providing a network of encouragement and understanding.

8
2.2.2 Examples of Recreational Health Practices

Pregnant women have access to a diverse array of recreational health practices that can

significantly enhance their physical and emotional well-being. These practices encompass

various activities, each tailored to meet the unique needs and preferences of expectant mothers.

2.2.2.1 Physical Exercises

Physical exercise is one of the most common recreational health practices among pregnant

women. Activities such as walking, swimming, and prenatal yoga are particularly beneficial.

Walking is a low-impact exercise that can be easily incorporated into daily routines. It promotes

cardiovascular health, helps maintain a healthy weight, and can alleviate common pregnancy

discomforts, such as back pain and swelling. Swimming, with its buoyancy, provides a full-body

workout while minimizing strain on joints, making it an excellent option for pregnant women.

Prenatal yoga focuses on gentle stretching, breathing techniques, and relaxation, helping to

improve flexibility and reduce stress. Many women find that these physical activities not only

enhance their fitness levels but also boost their mood and energy.

2.2.2.2 Relaxation Techniques

In addition to physical exercise, relaxation techniques are crucial for managing stress and anxiety

during pregnancy. Practices such as meditation, deep breathing exercises, and prenatal massage

can help women cultivate a sense of calm and well-being. Meditation encourages mindfulness,

allowing women to focus on their breath and connect with their bodies. This practice can reduce

anxiety and promote emotional resilience. Deep breathing exercises, which can be done

anywhere, help improve oxygen flow and reduce tension. Prenatal massage, performed by

trained professionals, can alleviate muscle tension and promote relaxation, providing both

physical and emotional benefits.

9
2.2.2.3 Creative Hobbies

Creative hobbies also play a significant role in recreational health practices for pregnant women.

Engaging in activities such as painting, crafting, or writing can serve as therapeutic outlets,

allowing women to express their feelings and thoughts during this transformative time. Creative

pursuits can foster a sense of accomplishment and joy, contributing positively to mental health.

For example, journaling can help women reflect on their experiences, providing clarity and

reducing anxiety. Art and music can also serve as powerful forms of expression, allowing

women to connect with their emotions and enhance their overall well-being.

2.2.2.4 Social Activities

Social activities are another essential component of recreational health practices. Many pregnant

women experience feelings of isolation, particularly if they are first-time mothers or have

recently moved to a new area. Participating in group activities, such as prenatal classes or

support groups, can create a sense of community and provide valuable emotional support. These

interactions allow women to share their experiences, learn from one another, and build lasting

friendships. The social support gained through these connections can significantly enhance

emotional well-being, providing a network of encouragement and understanding.

2.2.3 Benefits of Recreational Health Practices

Engaging in recreational health practices during pregnancy offers a myriad of benefits that

significantly enhance the overall well-being of expectant mothers. These benefits encompass

physical, mental, and emotional health, contributing to a healthier pregnancy experience and

better outcomes for both mothers and their babies.

10
2.2.3.1 Physical Health Benefits

One of the primary benefits of recreational health practices is improved physical health. Regular

physical activity during pregnancy helps manage weight gain, reduces the risk of gestational

diabetes, and improves cardiovascular fitness. Engaging in moderate-intensity exercises, such as

walking, swimming, or prenatal yoga, can enhance muscle strength and flexibility, making it

easier for women to cope with the physical demands of pregnancy and childbirth. Additionally,

exercise has been shown to alleviate common pregnancy discomforts, such as back pain,

swelling, and fatigue. Maintaining a healthy level of physical fitness, pregnant women can

experience a more comfortable pregnancy and prepare their bodies for labor.

2.2.3.2 Better Mental Health Benefits

Another significant benefit of recreational health practices is the positive impact on mental

health. Pregnancy can be a time of heightened emotional fluctuations due to hormonal changes,

leading to increased stress and anxiety. Engaging in recreational activities that promote

relaxation, such as meditation and deep breathing exercises, can help women manage these

feelings effectively. These practices foster mindfulness and promote a sense of calm, allowing

women to connect with their bodies and their babies on a deeper level. Furthermore, regular

physical activity releases endorphins, which are natural mood enhancers, helping to combat

feelings of depression and anxiety. Prioritizing mental health, pregnant women can navigate the

challenges of pregnancy with greater resilience and positivity.

2.2.3.3 Improvement in Social Connection

Social connections gained through recreational health practices are another critical benefit. Many

pregnant women experience feelings of isolation, especially if they are first-time mothers or lack

a supportive network. Participating in group activities, such as prenatal classes or support groups,

11
fosters a sense of community and belonging. These interactions provide opportunities to share

experiences, learn from one another, and build lasting friendships. The emotional support gained

through these connections can significantly enhance well-being, reducing feelings of loneliness

and providing a network of encouragement. Social engagement also promotes positive mental

health, as women feel understood and supported during this transformative time.

2.2.3.4 Benefits for motherhood

Additionally, recreational health practices contribute to better preparation for motherhood.

Engaging in prenatal classes equips women with essential knowledge and skills related to

childbirth, breastfeeding, and newborn care. This preparation can alleviate fears and increase

confidence as they approach labor and delivery. Being informed and prepared can lead to a more

positive birthing experience, reducing anxiety and promoting a sense of control. Moreover, the

social interactions fostered through these classes can create a support network that extends

beyond pregnancy, providing ongoing encouragement and camaraderie as women transition into

motherhood.

2.2.4 Challenges associated with Recreational Health Practices

Despite the numerous benefits of recreational health practices, various challenges can impede

pregnant women from fully engaging in these activities. Understanding these challenges is

essential for healthcare providers and support networks to create effective strategies that

encourage participation in recreational practices during pregnancy.

2.2.4.1 Physical Limitations

One significant challenge is the physical limitations that many pregnant women experience.

Pregnancy can bring about a range of discomforts, including fatigue, nausea, and

musculoskeletal pain, which may deter women from engaging in physical activities. For

12
instance, some women may find it difficult to maintain an exercise routine due to morning

sickness or extreme tiredness, especially during the first and third trimesters. Additionally,

physical changes, such as weight gain and changes in balance, can make certain activities feel

more challenging or uncomfortable. These limitations can lead to a decrease in motivation to

participate in recreational health practices, ultimately affecting overall well-being.

2.2.4.2 Lack of access to safe environments for exercise and recreational activities

Another challenge is the lack of access to safe environments for exercise and recreational

activities. In some areas, particularly in underserved communities, there may be limited access to

parks, gyms, or community centers where women can engage in physical activities. Safety

concerns, such as inadequate facilities or high crime rates, can further discourage women from

participating in outdoor activities. Additionally, the availability of prenatal classes or support

groups may be limited, making it difficult for women to find opportunities for social engagement

and education. This lack of access can lead to feelings of isolation and hinder the ability to

connect with others during pregnancy.

2.2.4.3 Time Constraints

Time constraints also pose a significant challenge for pregnant women seeking to engage in

recreational health practices. Many women juggle multiple responsibilities, including work,

household duties, and caring for other children. As a result, finding time to prioritize recreational

activities can be difficult. The demands of daily life may lead women to prioritize other

obligations over self-care, ultimately impacting their physical and mental health. This challenge

highlights the importance of creating flexible and accessible recreational opportunities that can

easily fit into busy schedules.

13
2.2.4.4 Issues of Social Stigma

Furthermore, some women may face social stigma or lack of encouragement from partners or

families regarding their engagement in recreational health practices. Cultural beliefs and societal

expectations can influence perceptions of pregnancy and exercise, leading to misconceptions

about what is safe or appropriate for expectant mothers. For example, some individuals may

believe that pregnant women should avoid physical activity altogether, which can discourage

women from participating in beneficial exercises. Additionally, a lack of support from partners

or family members can lead to feelings of guilt or inadequacy when prioritizing self-care, further

complicating the pursuit of recreational activities.

14
2.2.5 Gallery of types of Exercises

15
Figure 2.1 Squat Figure 2.2 Kegels

16
 Figure 2.4 The Seated Stability Hold

Figure 2.3 The Standing Crunch

17
2.3. Empirical Reviews

2.3.1 Knowledge of pregnant women attending Antenatal Clinics regarding physical activity

The knowledge of pregnant women attending antenatal clinics regarding physical activity varies

significantly across different regions and cultural contexts, revealing a complex landscape of

awareness and practice. While many women demonstrate a positive attitude towards exercise

during pregnancy, actual knowledge and engagement often fall short. For instance, a study in

Ethiopia found that 53.1% of pregnant women had good knowledge about physical activity

during pregnancy (Hailu et al., 2024). Similarly, in Nigeria, 53% of participants exhibited

adequate knowledge, indicating a moderate level of awareness (Godsday et al., 2022).

While many women recognize the benefits of physical activity during pregnancy, practical

participation remains low. For instance, a study in Nigeria indicated that awareness of physical

activity was higher among women attending tertiary health facilities (60.7%) compared to those

at primary healthcare centers (34.4%) (Emmanuel et al., 2024). In South Africa, 62.4% of

pregnant women reported high knowledge regarding prenatal physical activity (Okafor & Goon,

2022). Despite this awareness and generally positive attitudes, actual engagement in physical

activity is low, with a meta-analysis revealing that only 34.5% of pregnant women in Africa

participate in antenatal exercise (Geda et al., 2023). Common activities include walking and

housework, while structured exercises are practiced less frequently (Nkhata et al., 2024).

In terms of attitudes toward exercise, many studies highlight a generally positive sentiment

among pregnant women; for example, 113 out of 120 women in India expressed a favorable

attitude towards physical activity (Abhilasha et al., 2024), while 52.6% of respondents in

Ethiopia shared this positive outlook (Hailu et al., 2024). Positive attitudes towards physical

18
activity were also noted, with 88.2% of South African women affirming its safety and 79.6%

recognizing its benefits for the baby; however, negative attitudes, such as feelings of tiredness

and lack of interest, were cited as barriers (Okafor & Goon, 2022).

The knowledge of pregnant women attending antenatal clinics in Ghana regarding physical

activity (PA) highlights a complex interplay of awareness, beliefs, and participation levels. A

study conducted in Ho found that 74% of pregnant women possessed high knowledge about PA,

with 62.3% recognizing its role in promoting a healthy pregnancy (Asante et al., 2022).

2.3.2 Level of participation in physical activity among pregnant women attending Antenatal

Clinics

The level of participation in physical activity among pregnant women attending antenatal clinics

globally varies significantly, with many women exhibiting low engagement in exercise despite

its recognized benefits. Knowledge and attitudes towards physical activity are crucial in

determining participation levels, which remain suboptimal across different regions.

In Nigeria, only 10% of women reported good practice levels regarding physical activity

(Godsday et al., 2022), whereas 52.2% of women in Ethiopia engaged in physical activity, which

is notably higher than the national average (Hailu et al., 2024). Moreover, a significant

proportion of women are sedentary, with 75.2% of high-risk pregnant women classified as

sedentary or little active (Miranda et al., 2022), and only 25.5% of pregnant women in Ethiopia

practicing adequate antenatal physical exercise (Belachew et al., 2023).

Despite the benefits of physical activity during pregnancy, many women remain inactive,

underscoring the need for targeted educational interventions. Additionally, cultural and

individual factors may contribute to low participation rates, suggesting a more nuanced approach

to understanding this issue.

19
2.3.3 Factors associated with low levels of participation in physical activity among pregnant

women attending Antenatal Clinics

However, despite this awareness, many women harbor misconceptions, particularly the fear that

exercising in early pregnancy could lead to miscarriage. Common barriers to participation

include a lack of prior exercise habits (66.2%), time constraints (22.1%), and fear of miscarriage

(11.7%) (Asante et al., 2022). Additionally, personal and environmental factors, such as

inadequate information from healthcare providers and feelings of tiredness, further contribute to

low participation rates (Okafor et al., 2021).

Research indicates that women who receive comprehensive information about the benefits and

risks of PA are more likely to engage in physical activities (Cannella et al., 2010). However,

many women, especially those who are younger or less educated, report receiving insufficient

information about prenatal PA.

Moreover, common barriers to participation include feelings of tiredness, lack of interest, and

inadequate information about physical activity, alongside factors such as education level and

support systems that significantly influence exercise practices (Belachew et al., 2023; Okafor et

al., 2021). This discrepancy between high knowledge levels and low participation rates

underscores the need for targeted educational interventions to address misconceptions and

promote active lifestyles among pregnant women in Ghana.

20
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