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American Journal of  Medical 
Science and Innovation (AJMSI) 

Exercise Among Pregnant Females in Antenatal Clinic in Tabuk, Saudi Arabia, 
Prevalence and Barriers

Zinab Alatawi1*, Shumukh Saleem S. Aljohani1, Walaa Fahad Aljuhani1, Nadia Abdualla S. Alomrani1, Ghadah Ali R. Alanazi1, 
Maisaa Mokhtar M. Yousuf1, Nada Saleem S. Alhawiti1, Laila Abdullah S. Alanazi1, Atheer Mansour E. Alatawi1

Volume 4 Issue 1, Year 2025
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v4i1.3125
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: June 07, 2024
Accepted: July 11, 2024
Published: June 26, 2025

Maternal mortality remains a significant global health concern, with physical inactivity being 
the fourth leading risk factor, contributing to 5.3 million premature deaths. This study aimed 
to assess the prevalence and impact of  exercise among females in antenatal clinics and to 
study the barriers to exercise during pregnancy. This cross-sectional survey-based study was 
conducted in antenatal clinics in Tabuk C    ity, Saudi Arabia, among pregnant women from 
September 2022 to December 2022 by using an electronic questionnaire. A total of  168 
participants were included in the study. Ethical approval was obtained from the Institutional 
Review Board, and informed consent was also obtained from participants. The data were 
analysed using descriptive statistics and appropriate statistical tests. The study results 
revealed that the majority of  participants were aged 27-35, with 42% being Saudi Arabian 
citizens. The majority were unemployed, with 43% having a monthly income between 5001 
and 10,000 Saudi Riyals. Out of  168 participants, 70% had multiple children and had no 
abortion history, 51% participated in consistent exercise before pregnancy, and 92% had 
no medical issues. Energy expenditure varied, with mild activity being the most common. 
Household activities contributed the most, followed by sports. Obstacles to physical exercise 
included apprehensions, insufficient energy, fear of  injury, joint or muscular pain, and lack 
of  interest. The study highlighted the importance of  promoting physical activity among 
pregnant women, emphasising the need for tailored interventions to improve maternal and 
fetal well-being.

Keywords
Antenatal Exercise, Barriers to 
Exercise, Energy Expenditure, 
Physical Activity, Pregnancy

1 Faculty of  Medicine, University of  Tabuk, King Faisal road, Tabuk 47512, Saudi Arabia.
* Corresponding author’s e-mail: zinabalatawi569@outlook.com

INTRODUCTION
Physical exercise is a planned and structured physical 
activity that is intended to improve one or more aspects 
of  physical fitness. It is a crucial part of  a healthy lifestyle 
and has a key role in preventing and managing many 
diseases (Ribeiro et al., 2022). Physical inactivity is the 
fourth most important risk factor for mortality worldwide 
among the general population, accounting for about 9% 
or 5.3 million premature mortality worldwide (WHO, 
2019). Considering the growing influence of  inactivity on 
the incidence of  diseases, the World Health Organization 
(WHO) has developed an international action plan with 
the goal of  lowering physical inactivity by at least 10% by 
2025 and 15% by 2030 (Organization, 2019). Pregnancy 
is an ideal time to begin exercising because it is linked to 
a stronger desire to establish a healthy lifestyle (Ribeiro 
et al., 2022). Pregnant women were traditionally advised 
to avoid participating in physical activity because of  
potential health risks. The adverse effects of  physical 
inactivity during pregnancy have become a major concern 
among this group of  individuals (Al-Youbi & Elsaid, 
2020). Among pregnant women, in particular, physical 
inactivity is identified as a distinct risk factor linked to 
a number of  health issues such as immoderate weight 
gain, gestational diabetes,  loss of  voluntary control over 
urination, hypertension,  anxiety and prenatal depression 
(Belachew et al., 2023).
Despite the extensive distribution of  guidelines, a notable 
issue persists: most pregnant women have sedentary lives, 
particularly during the third trimester of  their pregnancy 

(Aljehani et al., 2021). However, contemporary research 
has emphasised several advantages linked to consistent 
physical activity for the health of  the mother and the fetus. 
Numerous guidelines support the integration of  regular, 
moderate-to-intense exercise as a crucial component 
of  preventive care for mothers, providing prescription 
guidelines and highlighting potential contraindications 
(Aljehani et al., 2021). The main health measures specified 
in Healthy People 2010 emphasised the importance 
of  increased physical activity for women’s health, as it 
reduces the risk of  gestational diabetes, pre-eclampsia, 
and excessive weight gain (Yong et al., 2020). 
Further, the American College of  Obstetrics and 
Gynecology (ACOG) recommended continuing exercise 
routines before pregnancy and encouraging previously 
inactive women to engage in physical activity throughout 
pregnancy (Aljehani et al., 2021). One of  these is 
antenatal exercise, which is considered a tailored routine 
of  physical movements designed for pregnant women 
aiming to promote holistic fitness throughout gestation 
(Avignon et al., 2023). Antenatal workouts include 
respiration exercises, aerobic activities, core stability 
training, pelvic floor exercises, spinal care techniques, 
and postural guidance - specifically created to preserve 
cardiovascular capability and physical conditioning in 
expectant mothers. The main objective of  antenatal 
clinics is to increase promotive and preventative health 
measures for expecting mothers (Lattof  et al., 2020). A 
study by Barakat et al. (2019) demonstrated that engaging 
in low-impact exertions of  moderate intensity can prevent 



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overweight, the development of  gestational diabetes, and 
preterm birth (Barakat et al., 2019). Furthermore, these 
physical activities were found to enhance stress coping 
mechanisms, facilitate neurobehavioral relaxation in the 
developing fetus, and aid maternal recovery subsequent 
to parturition (Barakat et al., 2019).
A study in the Aseer region of  Saudi Arabia revealed a 
high prevalence of  obesity among Saudi women (Wahabi 
et al., 2023). Over 52% of  these women were overweight 
or obese, highlighting the need for increased physical 
activity. Consequently, a study in Jeddah, Saudi Arabia, 
found a significant occurrence of  abdominal and general 
obesity and physical inactivity among females in their 
reproductive years (Filfilan & Damanhouri, 2020). A 
study by Dereje et al. (2023) evaluated antenatal physical 
exercise among pregnant women in several regions. The 
results revealed that the ratio of  women engaging in 
adequate physical activity was 39% in Iran (Abedzadeh et 
al., 2022), 14.6% in Norway , 18% in India (Abedzadeh et 
al., 2022), and 10.2% in Nigeria . 
Moreover, in Ethiopia, existing research focused on 
health facilities managed by the government has shown 
that only 8.4% and 11.7% of  pregnant women followed 
the recommendations of  the ACOG (Janakiraman et al., 
2021). Another study by Abeer et al. 2020 examined the 
awareness level among pregnant women in Saudi Arabia 
(Alaglan et al., 2020). The results demonstrated that the 
majority of  women, 86%, believed that participating 
in physical activity during pregnancy is crucial. Of  the 
women surveyed, over half, 75%, stated that they engage 
in physical activity while pregnant. Other studies indicate 
that women are more likely to reduce the duration of  
their activity rather than start exercising during pregnancy 
(Grenier et al., 2021). Consequently, a study by Chen et 
al. (2021) suggested that doctors should be trained to 
manage obesity during pregnancy, promoting a healthy 
lifestyle through regular physical activity. Motivational 
counselling can help overcome apprehensions about 
exercise. Maternal exercise reduces premature birth, 
abnormal fetal growth, type 2 diabetes, and cardiovascular 
disorders post-birth (Chen et al., 2021).
Further, maintaining a healthy Body Mass Index (BMI) 
is beneficial for mothers and babies. In contrast, Barakat 
et al. (2021) demonstrated the link between unhealthy 
lifestyles and negative childbirth outcomes, including 
prolonged labour pain, increased caesarean delivery 
risks, and additional health risks for pregnant women 
and newborns, emphasising the importance of  physical 
activity (Barakat, 2021). Awareness regarding physical 
activity during pregnancy can be raised by mass media 
exposure, sociodemographic distribution of  women 
partners, healthcare practitioner recommendations, 
books, magazines, television, and the availability of  
supportive facilities (Janakiraman et al., 2021). However, 
studies revealed a lack of  research on the percentage of  
pregnant women with awareness and understanding of  
physical activity despite their diverse social, cultural, and 
educational backgrounds, causing them to be reluctant to 

exercise (Kraus, 2023).
 Therefore, the study aimed to assess the prevalence and 
impact of  exercise among females in antenatal clinics and 
to study the barriers to exercise during pregnancy.

MATERIALS AND METHODS
Study Design and Study Population
This cross-sectional survey-based study was conducted in 
Tabuk city, Saudi Arabia, among pregnant women from 
September 2022 to December 2022. The study involved 
a cohort of  168 participants who experienced pregnancy 
and were expecting. 

Ethical Approval 
Ethical approval was obtained and the reference number 
was (NCBE-KACST, KSA: H-07-TU-077). 

Inclusion and Exclusion Criteria
The study included pregnant women of  any age who 
naturally conceived a fetus and with no previous 
miscarriage experience. Conversely, the exclusion 
criteria included pregnant females who had chronic 
systematic illnesses such as cardiorespiratory disease, 
diabetes mellitus, chronic renal disease, and medication-
dependent hypertension. Furthermore, participants 
suffering from the inflammatory joint disorder and 
chronic musculoskeletal problems that hindered their 
capacity to engage in daily physical activity were not 
included in the study. Similarly, the study excluded women 
with contraindications to exercise, such as cervical 
insufficiency, twin or higher pregnancies, placenta previa 
beyond 26 weeks, premature labour, preeclampsia, or 
pregnancy-induced hypertension, as well as those with 
cardiovascular or respiratory diseases and severe anaemia.

Sample Size and Calculation
The sample size was calculated using an online sample 
size calculator, Raosoft (Raosoft, http://www.raosoft.
com/samplesize.html), with a 5% margin error and 95% 
confidence level. Based on an average population size of  
450 and a predicted average response rate of  50% for 
most of  the questions, the sample size was calculated to 
identify an unknown number of  physically active women. 
The sample size was determined to be N= 208 through 
calculation. There was a drop-off  of  40 participants, and 
a total of  168 participants were included in the study.

Data Collection
The study employed a four-part interview questionnaire. 
The first section collected socio-demographic and clinical 
data in order to establish a baseline. Section 2 examined 
the exclusion criteria in order to confirm eligibility. Section 
3 utilised a modified Arabic version of  Lisa Chasan-
Pregnancy Taber’s Physical Activity Questionnaire 
(PPAQ), a validated tool, to evaluate and measure physical 
activity levels among pregnant participants in the Arabic-
speaking community. Furthermore, section 4 analysed 
possible barriers to participation in physical activity. 



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Data Analysis
The collected data were entered into an Excel spreadsheet 
and analysed using the Statistical Package for Social 
Sciences (SPSS Inc., Chicago, IL, USA) version 22.0. 
descriptive statistics were calculated, which included 
frequencies and percentages for categorical variables, 
whereas, mean, standard deviation, median, and 
interquartile ranges for continuous variables. The data 
was analysed using suitable statistical tests, with a p-value 
of  <0.05 considered statistically significant. 

RESULTS AND DISCUSSION
The results section displays data analysis and statistical 
interpretations based on data collection. A total of  168 
participants were included in the study, with the age 
group of  27-35 accounting for 42% of  the majority. 
The majority of  participants were Saudi nationals: 93%, 
62% held a bachelor’s degree, 62% were unemployed, 
and 43% reported a monthly income between 5001 and 
10,000 Saudi Riyals, as shown in Table 1. Moreover, 70% 
of  the participants reported having two or more children. 
Approximately 55% of  participants had not experienced 
any abortions, while 30% were in their first trimester 

and 35% were in the third trimester. Regarding physical 
activity, more than half  51% of  participants reported 
engaging in regular exercise before pregnancy, and a 
significant proportion of  92% stated that they had no 
medical complications that would hinder their ability to 
exercise, as shown in Table 2.
The energy expenditure assessed in MET-h/day for total 
activity ranged from a minimum of  0 to a maximum of  
96.1. The median and mean values were 37.1 and 38.7, 
respectively. When categorising energy expenditure based 
on intensity, mild activity had the highest mean at 17.6 
±8.4, with a median of  16.2, while vigorous exercise 
had the lowest contribution at 3.2±5.5. When classified 
by the type of  activity, household activities showed the 
highest mean at 18.6±8.8, followed by sports at 9.6±9.3. 
In contrast, transportation had the least contribution at 
4.5±4.2, as shown in Table 3. Regarding the barriers to 
exercise, having enough activity (97%), lack of  energy 
(94%), concern about the child (90%), concern about 
pregnancy complications (89%), fear of  injury (86%) 
and muscle contraction with movement (78%), joint or 
muscle pain (67%) and do not like exercise (30%) were 
reported as common barriers, as shown in Figure 1.

Table 1: Demographic Characteristics of  Participants (n = 168)
Characteristics Frequency Percentage
Age
18-26 years 47 28%
27-35 years 71 42%
36 and above 50 30%
Nationality 
Non-Saudi 12 7.1%
Saudi 156 93%
Education Level
No Formal Education 13 7.7%
High School 42 25%
Bachelor 104 62%
Above Bachelors degree 9 5.4%
Employment Status
Employed 54 32%
Un-Employed 104 62%
Student 10 6.0%
Monthly Income
Less than 3000 SAR 17 10%
3001-5000 SAR 41 24%
5001-10000 72 43%
10001-20000 SAR 32 19%
More than 20000 SAR 6 3.6%

Table 1 shows a diverse group of  participants, with (42%) 
aged between 27-35 years and (93%) Saudi nationals. A 
significant proportion had a bachelor’s degree (62%), 
while a smaller fraction had higher education qualifications 
(5.4%). Employment status varied, with (32%) employed, 

(62%) unemployed, and (6%) students. Monthly income 
distribution showed that (43%) had earnings between 
5001-10000 SAR, while (19%) reported incomes between 
10001-20000 SAR. This demographic analysis provides 
an understanding of  the study population.



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Table 2: Obstetric Characteristics of  Participants (n = 168)
Characteristics Frequency Percentage
Number of  Pregnancy
Less than 3 50 30
3 and More 114 68%
Missing 4 2.4%
Number of  Children
Less than 2 48 29%
2 and more 117 70%
Missing 3 1.8%
Abortion
No 93 55%
Yes 69 41%
Missing 6 3.5%
Gestational Age of  the Current Pregnancy
First Trimester 50 30%
Second Trimester 59 35%
Third Trimester 59 35%
Do you have any disease that could affect your 
participation in exercise? 
No 155 92%
Yes 13 7.7%
Were you on regular exercise before becoming 
pregnant?
No 82 49%
Yes 86 51%

Table 2 indicates that the majority of  participants (68%) 
experienced multiple pregnancies, with a significant 
portion (70%) having more than two children. Out of  the 
total 168 participants, (41%) reported having an abortion, 
while (35%) were in their third trimester of  pregnancy. 
Remarkably, (92%) of  the participants did not experience 
any medical complications that hindered their physical 
activity during pregnancy. When examining their activity 
history prior to pregnancy, a nearly equal distribution was 
observed, with 51% of  participants engaging in regular 

exercise and 49% not engaging in regular exercise. These 
findings provide valuable insights into the prenatal health 
and activity patterns of  the participants.
Table 3 presents the distribution of  physical activity 
levels among participants, highlighting an average activity 
level of  38.7 MET-h/day. The range of  total activity 
levels varied from 0 to 96.1 MET-h/day, with 25% of  
participants recording levels below 22.9, 50% below 37.1, 
and 75% below 51.5. Notably, sedentary activity averaged 
1.5 MET-h/day, while light exercise showcased the highest 

Table 3: Energy Expenditure Measured in MET-h/day According to Total Activity, Intensity Level, and Type of  
Activity (n=168)
Percentile
Percentile Percentile Percentile Percentile Percentile Percentile Percentile Percentile
Total Activity 38.7 19.7 0 96.1 22.9 37.1 51.5
By Intensity
Sedentary Activity 1.5 0.95 0 3 0.75 1.5 2.5
Light/Mild 
Activity

17.6 8.4 0 41.5 11.2 16.2 22.9

Moderate Activity 16.4 11.2 0 53.4 8.2 14.7 21.7
Vigorous Activity 3.2 5.5 0 28.8 0 0 3.5
By Type
Househol/
Caregiving

18.6 8.8 0 43.5 12.6 17.6 24



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average at 17.6 MET-h/day. Moderate activity recorded 
an average of  16.4 MET-h/day, whereas vigorous activity 
displayed the lowest average at 3.2 MET-h/day. Home 
and caregiving activities exhibited the highest average at 
18.6 MET-h/day. These findings offer a comprehensive 

Occupation 5.97 6.7 0 28.8 0 4.8 8.9
Sports/Exercise 9.6 9.3 0 42.93 3.9 6.6 13.3
Transportation 4.5 4.2 0 21.3 1.3 4 6.4

analysis of  participants’ daily physical activity patterns, 
illustrating the varying intensity levels and types of  
physical activity engaged in by the participants.
Consequently, barriers to exercise during pregnancy are 
shown in Figure 1. 

Figure 1: Barriers to Exercise during Pregnancy

Figure 1 illustrates the main challenges identified by 
participants regarding their involvement in physical 
activity. These obstacles encompass perceived inadequacy, 
lack of  energy, concerns related to childcare, and fears. 
Additionally, financial considerations, discomfort, and 
adverse weather conditions are among the other barriers 
reported.

Discussion
Maternal mortality is still a major worldwide health issue, 
and the health sector must give this issue immediate 
attention in order to reduce death and morbidity (Group 
& Division, 2019). According to research conducted by 
Wang et al. (2017), it was recommended that pregnant 
women engage in moderate exercise sessions of  at least 
15 minutes in duration undertaken 3-5 times weekly in 
order to maintain a healthy gestation (Wang et al., 2017). 
Such physical activity was posited to aid in preserving 

a favourable body weight and lowering the likelihood 
of  developing gestational diabetes mellitus while also 
enhancing mental and emotional wellness (Janakiraman 
et al., 2021). Prior studies found that these antenatal 
physical exertions yielded significant improvements 
in fetal health parameters and led to expedited labour 
progress marked by shortened delivery times and 
mitigated back discomfort (Jarni et al., 2021). However, 
additional findings revealed that nearly 60% of  pregnant 
individuals reported a sedentary lifestyle, a rate higher 
than the 30% prevalence observed in the general adult 
population. Moreover, antenatal care has been shown to 
be paramount for maximising health outcomes and well-
being amongst expectant mothers and developing fetuses 
(Kaur et al., 2021).
Additionally, engaging in physical activity has been shown 
to be paramount for sustaining complete wellness and 
minimising pregnancy-associated complications (Artal, 



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2016). Notable disagreement persists regarding the 
impact of  physical exertion on expectant individuals 
classified as overweight or obese (Du et al., 2019). These 
mothers demonstrate a reduced incidence of  such 
antenatal physical activity compared to women exhibiting 
healthy body weight, thereby increasing susceptibility to 
adverse consequences (Johansson et al., 2014). Numerous 
studies have conclusively demonstrated the unfavourable 
outcomes associated with maternal obesity and overweight 
during pregnancy, such as an elevated likelihood of  stillbirth 
and neonatal mortality (Du et al., 2019). Furthermore, 
obesity and excessive weight in mothers have been 
linked to physical health issues affecting both mothers 
and neonates, including preeclampsia, macrosomia, and 
gestational diabetes (Du et al., 2019). Studies suggest that 
consistent physical exercise is essential for fostering well-
being among women, particularly throughout the periods 
preceding conception, during pregnancy, and the early 
postpartum stages, with minimal accompanying risks (Du 
et al., 2019). Low-impact home-based physical activity 
undertaken individually may confer greater benefits for 
women struggling with poor body image as compared to 
group exercise programs. However, engaging in exercise 
that does not involve supporting one’s body weight 
is anticipated to reduce strain on ligaments and joints 
(Seneviratne et al., 2016).
Moreover, a recent study conducted in Brazil revealed 
that 23% of  women engage in physical activity when 
pregnant, with half  of  them reducing or quitting their 
exercise routines due to pregnancy (Alaglan et al., 
2020). According to a study conducted in the United 
States, 29% of  women participated in physical activity 
before and during pregnancy, while an additional 4% 
started exercising during pregnancy (Harris et al., 2015). 
Significantly, these percentages are higher in comparison 
to the overall Saudi population, where approximately 12% 
adhered to the recommendations for physical activity, 
as indicated by a nationwide survey (Bcheraoui et al., 
2016). Considering the widespread inactive way of  life, 
it is plausible that women maintain a sedentary lifestyle 
during pregnancy (Nascimento et al., 2012). The need 
of  regular physical activity in maintaining the balance of  
social, emotional, and physical health is becoming more 
widely acknowledged by medical professionals (Al-Youbi 
& Elsaid, 2020). The majority of  people failed to meet 
the recommended levels of  physical activity as outlined 
by established guidelines. Prior studies have indicated a 
significant occurrence of  excessive gestational weight 
gain among pregnant women in Saudi Arabia (Al-Youbi 
& Elsaid, 2020). This condition is believed to be linked 
to a deficiency in understanding the correlated health 
hazards during pregnancy. 
Additionally, a study by Ghadi & Tarek (2020), assessed 
the understanding of  physical activity requirements 
among pregnant women in Saudi Arabia and identified 
factors contributing to their lack of  activity (Al-Youbi 
& Elsaid, 2020). Pregnancy is crucial for managing body 
weight, maximising health outcomes for both mother and 

fetus and developing enduring health habits. Moreover, 
physical activity patterns change during pregnancy, and 
several studies suggest that healthcare practitioners 
should provide comprehensive education on the safety 
and benefits of  engaging in physical activity to promote 
health and weight management (Hayman et al., 2020). 
The study found that 58.4% of  pregnant women lack 
awareness and involvement in physical activity, while 
50.67% understand the requirements. Only 15.8% 
adhere to exercise standards. A US study found that 
32% of  pregnant women met necessary levels during 
early pregnancy but decreased to 12% as the pregnancy 
progressed (Ruifrok et al., 2014). 
The present study examined the exercise among pregnant 
females in antenatal clinics and the prevalence and barriers 
of  physical inactivity. This study aimed to investigate 
and analyze the energy expenditure of  pregnant women 
measured in MET-h/day, considering total activity, 
intensity level, and type of  activity. These findings offer 
valuable insights into the exercise habits of  pregnant 
women within the study population. The obstetric 
characteristics of  the participants provide essential 
insights into their reproductive history and current 
pregnancy status. The majority of  participants had three 
or more pregnancies (68%), and most had two or more 
children (70%). The results align with previous studies in 
Arab countries, indicating a preference for larger families 
demonstrated by  Salam et al. (2023). Notably, a high 
percentage of  women with three or more pregnancies 
suggests a significant presence of  multiparous women 
in the sample, who may have distinct exercise patterns 
compared to primiparous women (Salam & Potty, 2023).
However, the prevalence of  abortion among participants 
was 41%, significantly higher than reported in previous 
studies (Al-Ebadi et al., 2021). This high prevalence 
underscores the importance of  considering the physical 
and emotional aspects of  previous pregnancy losses 
when designing exercise programs for pregnant women 
(Moradinazar et al., 2020). Regarding energy expenditure 
by type of  activity, studies have consistently reported 
higher energy expenditure for physically demanding 
activities such as household chores and sports or 
exercises (Azo & AKBAY, 2016). The present study 
findings align with these previous studies, confirming that 
household and caregiving activities require substantial 
energy expenditure. Also, the mean energy expenditure 
for occupation-related activities in the present study 
was similar to previous literature, which indicates 
that occupational activities fall into the light energy 
expenditure (Newton Jr et al., 2013). 
This difference could be attributed to variations in 
occupational demands or differences in participant 
demographics across studies. The study evaluated energy 
expenditure patterns based on total activity, intensity level, 
and activity type. It revealed significant variability across 
different activities and intensity levels. In contrast, other 
differences may be due to participant characteristics, 
activity protocols, or measurement methods. The 



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findings contribute to the growing knowledge of  
energy expenditure and can inform future research 
and interventions for promoting physical activity and 
maintaining energy balance. Moreover, when comparing 
these findings with the existing literature, several 
consistent barriers to exercise among pregnant women 
were identified as lack of  facilities, financial instability, 
lack of  interest, fear of  harm during pregnancy, muscle 
and joint pain, inability to work, and lack of  awareness 
regarding the importance of  physical activity among 
pregnant women (Rockliffe et al., 2021). Previous studies 
have consistently reported concerns about the safety of  
exercise for the developing fetus and potential pregnancy 
complications as significant barriers to physical activity 
during pregnancy (Ahmadi & Amiri-Farahani, 2021). 
However, the lack of  facilities such as parks or gyms 
(53%) and lack of  a companion to exercise with (53%) 
were reported at higher frequencies in the current study 
compared to previous studies in which it has been 
identified as enabler rather than barrier (Ahmadi & 
Amiri-Farahani, 2021). Furthermore, financial reasons 
(44%) and disliking exercise (30%) emerged as notable 
barriers in the current study. However, physical activities, 
including mandatory exercise sessions, have been proven 
to improve pregnant women’s physical activity levels, 
potentially reducing gestational weight gain, boosting 
self-efficacy in exercise, and reducing pregnancy-related 
discomfort and sadness, as well as mitigating gestational 
weight gain (Lott et al., 2019). 

CONCLUSION                                                                                                                   
In conclusion, this study conducted a thorough 
investigation of  physical activity levels among pregnant 
women in Tabuk, Saudi Arabia. The results of  this 
study contribute to the global conversation surrounding 
the promotion of  physical activity during pregnancy. 
Furthermore, these findings have the potential to 
influence the development of  targeted interventions 
and strategies aimed at fostering a healthier lifestyle for 
pregnant women in the region.

Limitations and Strengths
• The cross-sectional design of  the study and the 

exclusion criteria employed may limit the generalizability 
and applicability of  the findings to pregnant women with 
chronic systemic illnesses. 

• Nevertheless, the study’s notable strengths lie in its 
diverse participant group, meticulous data collection, 
analysis of  energy expenditure, and identification of  
barriers to exercise during pregnancy. 
• This comprehensive study provides valuable insights 
that can inform healthcare practitioners and policymakers 
in their decision-making processes.

REFERENCES
Abedzadeh, M., Taebi, M., Sadat, Z., & Saberi, F. (2022). 

Knowledge and performance of  pregnant women 
referring to Shabihkhani hospital on exercises during 

pregnancy and postpartum periods. Pars Journal of  
Medical Sciences, 8(4), 43-48. 

Ahmadi, K., & Amiri-Farahani, L. (2021). The perceived 
barriers to physical activity in pregnant women: A 
review study. J Client Cent Nurs Care, 7(4), 245-254. 

Al-Ebadi, A., Najem, H., & Abd Ali, I. K. (2021). 
Incidence Rate of  Abortion and its Relationship with 
Sociodemographic Characteristics and Reproductive 
History among Women at Maternal and Pediatric 
Hospital in AL Diwaniyah City. Indian Journal of  
Forensic Medicine & Toxicology, 15(3). 

Al-Youbi, G. M., & Elsaid, T. (2020). Knowledge, attitude, 
and practices on exercise among pregnant females 
attending Al-Wazarat Health Center, Riyadh, Saudi 
Arabia. Journal of  Family Medicine and Primary Care, 9(8), 
3905. 

Alaglan, A. A., Almousa, R. F., Alomirini, A. A., 
Alabdularazaq, E. S., Alkheder, R. S., Alzaben, K. A., 
Alonayzan, G. A., & Saquib, J. (2020). Saudi women’s 
physical activity habits during pregnancy. Women’s 
Health, 16, 1745506520952045. 

Aljehani, M. A., Alghamdi, L. F., Almehwari, O. B., & 
Hassan, A. H. M. (2021). Exercise among pregnant 
females in maternity and children hospital in Jeddah, 
Saudi Arabia, 2019: prevalence and barriers. Journal of  
Family Medicine and Primary Care, 10(6), 2394. 

Artal, R. (2016). Exercise in pregnancy: guidelines. Clinical 
obstetrics and gynecology, 59(3), 639-644. 

Avignon, V., Gaucher, L., Baud, D., Legardeur, H., 
Dupont, C., & Horsch, A. (2023). What do mothers 
think about their antenatal classes? A mixed-method 
study in Switzerland. BMC pregnancy and childbirth, 
23(1), 741. 

Azo, F. M., & Akbay, C. A. (2016). Prevalence and risk 
factors of  abortion among a sample of  married 
women in Kurdistan Region of  Iraq. Zanco Journal of  
Medical Sciences (Zanco J Med Sci), 20(3), 1424_1432-
1424_1432.

Barakat, R. (2021). An exercise program throughout 
pregnancy: Barakat model. Birth Defects Research, 
113(3), 218-226.

Barakat, R., Refoyo, I., Coteron, J., & Franco, E. (2019). 
Exercise during pregnancy has a preventative effect 
on excessive maternal weight gain and gestational 
diabetes. A randomized controlled trial. Brazilian 
journal of  physical therapy, 23(2), 148-155. 

Belachew, D. Z., Melese, T., Negese, K., Abebe, G. F., & 
Kassa, Z. Y. (2023). Antenatal physical exercise level 
and its associated factors among pregnant women in 
Hawassa city, Sidama Region, Ethiopia. Plos one, 18(4), 
e0280220. 

Chen, Y., Ma, G., Hu, Y., Yang, Q., Deavila, J. M., Zhu, 
M. J., & Du, M. (2021). Effects of  maternal exercise 
during pregnancy on perinatal growth and childhood 
obesity outcomes: a meta-analysis and meta-
regression. Sports Medicine, 51(11), 2329-2347. 

Du, M. C., Ouyang, Y. Q., Nie, X. F., Huang, Y., & 
Redding, S. R. (2019). Effects of  physical exercise 



Pa
ge

 
14

2

https://journals.e-palli.com/home/index.php/ajmsi

Am. J. Med. Sci. Innov. 4(1) 135-143, 2025

during pregnancy on maternal and infant outcomes 
in overweight and obese pregnant women: A meta-
analysis. Birth, 46(2), 211-221. 

El Bcheraoui, C., Tuffaha, M., Daoud, F., Kravitz, H., 
Al Mazroa, M. A., Al Saeedi, M., Memish, Z. A., 
Basulaiman, M., Al Rabeeah, A. A., & Mokdad, A. H. 
(2016). On your mark, get set, go: levels of  physical 
activity in the Kingdom of  Saudi Arabia, 2013. Journal 
of  Physical Activity and Health, 13(2), 231-238. 

Kraus E. M., Chavan N. R., Whelan V., Goldkamp J., & 
DuBois J. M. (2023). Reproductive decision making 
in women with medical comorbidities: a qualitative 
study. BMC pregnancy and childbirth, 23(848), 2-14. 
https://doi.org/10.1186/s12884-023-06093-4 

Filfilan, R., & Damanhouri, N. (2020). Prevalence of  
Exercise and its Determinants among Pregnant 
Women Attending Antenatal Care Clinic in Al-
Kaakiah Primary Health Care Center in Makkah: A 
Cross-sectional Study. Annals of  Clinical and Analytical 
Medicine, 9(3). 

Grenier, L. N., Atkinson, S. A., Mottola, M. F., Wahoush, 
O., Thabane, L., Xie, F., Vickers-Manzin, J., Moore, 
C., Hutton, E. K., & Murray-Davis, B. (2021). Be 
healthy in pregnancy: exploring factors that impact 
pregnant women’s nutrition and exercise behaviours. 
Maternal & child nutrition, 17(1), e13068. 

Group, W. B., & Division, t. U. N. P. (2019). Maternal 
mortality: Levels and trends 2000 to 2017. 

Harris, S. T., Liu, J., Wilcox, S., Moran, R., & Gallagher, A. 
(2015). Exercise during pregnancy and its association 
with gestational weight gain. Maternal and child health 
journal, 19, 528-537. 

Hayman, M., Reaburn, P., Alley, S., Cannon, S., & Short, 
C. (2020). What exercise advice are women receiving 
from their healthcare practitioners during pregnancy? 
Women and Birth, 33(4), e357-e362. 

Janakiraman, B., Gebreyesus, T., Yihunie, M., & Genet, 
M. G. (2021). Knowledge, attitude, and practice 
of  antenatal exercises among pregnant women in 
Ethiopia: A cross-sectional study. Plos one, 16(2), 
e0247533. 

Jarni,  M. F., Mohamad, M. Y., & Kamarudzaman, N. 
(2021). Knowledge, attitude, and practice (KAP) 
towards pelvic floor muscle exercise among the 
female population attending the Obstetrics and 
Gynaecology Clinic at Sultan Ahmad Shah Medical 
Centre (SASMEC@ IIUM). International Journal of  
Allied Health Sciences, 5(6), 2521-2529. 

Johansson, S., Villamor, E., Altman, M., Bonamy, A. K. 
E., Granath, F., & Cnattingius, S. (2014). Maternal 
overweight and obesity in early pregnancy and risk of  
infant mortality: a population based cohort study in 
Sweden. BMJ, 349. 

Kaur, R., Taneja, P., & Nandal, I. (2021). A study on 
knowledge, attitude and practices regarding antenatal 
care among pregnant women attending antenatal 
clinic at a tertiary care hospital. International Journal 
of  Reproduction, Contraception, Obstetrics and Gynecology, 

10(4), 1621-1629. 
Lattof, S. R., Moran, A. C., Kidula, N., Moller, A.-B., 

Jayathilaka, C. A., Diaz, T., & Tunçalp, Ö. (2020). 
Implementation of  the new WHO antenatal 
care model for a positive pregnancy experience: 
a monitoring framework. BMJ global health, 5(6), 
e002605. 

Lott, M., Power, M., Reed, E., Schulkin, J., & Mackeen, 
A. (2019). Patient attitudes toward gestational weight 
gain and exercise during pregnancy. Journal of  
pregnancy, 2019. 

Moradinazar, M., Najafi, F., Nazar, Z. M., Hamzeh, B., 
Pasdar, Y., & Shakiba, E. (2020). Lifetime prevalence 
of  abortion and risk factors in women: evidence from 
a cohort study. Journal of  pregnancy, 2020. 

Nascimento, S. L., Surita, F. G., & Cecatti, J. G. (2012). 
Physical exercise during pregnancy: a systematic 
review. Current Opinion in Obstetrics and Gynecology, 
24(6), 387-394. 

Newton Jr, R. L., Han, H., Zderic, T., & Hamilton, 
M. (2013). The energy expenditure of  sedentary 
behavior: a whole room calorimeter study. Plos one, 
8(5), e63171. 

Organization, W. H. (2019). Global action plan on 
physical activity 2018-2030: more active people for a 
healthier world. World Health Organization. 

Ribeiro, M. M., Andrade, A., & Nunes, I. (2022). Physical 
exercise in pregnancy: Benefits, risks and prescription. 
Journal of  perinatal medicine, 50(1), 4-17. 

Rockliffe, L., Peters, S., Heazell, A. E., & Smith, D. M. 
(2021). Factors influencing health behaviour change 
during pregnancy: A systematic review and meta-
synthesis. Health psychology review, 15(4), 613-632. 

Ruifrok, A. E., Althuizen, E., Oostdam, N., Van 
Mechelen, W., Mol, B. W., De Groot, C. J., & Van 
Poppel, M. N. (2014). The relationship of  objectively 
measured physical activity and sedentary behaviour 
with gestational weight gain and birth weight. Journal 
of  pregnancy, 2014. 

Salam, A. A., & Potty, R. S. (2023). Saudi Arabia’s Maternal 
and Child Health Scenario Interpreted. Maternal and 
child health journal, 27(5), 759-765. 

Seneviratne, S., Jiang, Y., Derraik, J., McCowan, L., 
Parry, G., Biggs, J., Craigie, S., Gusso, S., Peres, G., & 
Rodrigues, R. (2016). Effects of  antenatal exercise in 
overweight and obese pregnant women on maternal 
and perinatal outcomes: A randomised controlled 
trial. BJOG: An International Journal of  Obstetrics & 
Gynaecology, 123(4), 588-597. 

Wahabi, H., Fayed, A. A., Shata, Z., Esmaeil, S., Alzeidan, 
R., Saeed, E., Amer, Y., Titi, M., Bahkali, K., & Hneiny, 
L. (2023). The impact of  age, gender, temporality, 
and geographical region on the prevalence of  obesity 
and overweight in Saudi Arabia: scope of  evidence. 
Healthcare, 11(8), 1143. https://doi.org/10.3390/
healthcare11081143

Wang, C., Wei, Y., Zhang, X., Zhang, Y., Xu, Q., Sun, 
Y., Su, S., Zhang, L., Liu, C., & Feng, Y. (2017). A 



Pa
ge

 
14

3

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Am. J. Med. Sci. Innov. 4(1) 135-143, 2025

randomized clinical trial of  exercise during pregnancy 
to prevent gestational diabetes mellitus and improve 
pregnancy outcome in overweight and obese pregnant 
women. American journal of  obstetrics and gynecology, 
216(4), 340-351. 

WHO, U. (2019). Maternal mortality: Levels and trends 
2000 to 2017. Geneva: World Health Organisation. 

Yong, H. Y., Mohd Shariff, Z., Mohd Yusof, B. N., Rejali, 
Z., Bindels, J., Tee, Y. Y. S., & van der Beek, E. M. 
(2020). High physical activity and high sedentary 
behavior increased the risk of  gestational diabetes 
mellitus among women with excessive gestational 
weight gain: a prospective study. BMC pregnancy and 
childbirth, 20, 1-11.


