Journal of Physical Activity and Health, 2015, 12, 782 -788 http://dx.doi.org/10.1123/jpah.2013-0412 © 2015 Human Kinetics, Inc.
ORIGINAL RESEARCH
Parenthood and Physical Activity in Young Adults: A Qualitative Study Ethan E. Hull, Jeannette M. Garcia, Angela M. Kolen, and Robert J. Robertson Background: New parents have to adjust to less sleep, less free time, and more responsibility as a result of having a child. The purpose of this study was to examine how having a child impacts the physical activity (PA) beliefs and behaviors of new parents over a 2- to 3-year time period. Methods: Participants included 49 men and women (31% men, 96% white) who did not have a child at baseline (26.3 ± 1.1 years old) but did have a child at the time of follow-up (28.9 ± 1.7 years old). The child’s mean age at follow-up was 12 ± 7 months old. PA was measured via questionnaire at baseline and again at follow-up. Interviews regarding PA occurred at follow-up. Results: PA significantly decreased in parents across the time period (P < .001), and parents attributed this decrease to having a child and being pregnant. Parents mentioned they lack time, energy, and motivation for PA as a result of caring for a new child. Parents who maintained their activity level stated they prioritized PA and chose activities they enjoyed. Conclusions: These results show that although activity levels decrease in individuals who have a child, PA in new parents may be a function of priority, intensity, and enjoyment. Keywords: life transition, parent, child, longitudinal
Physical activity (PA) has numerous health benefits, reduces the risk of disease, and has been recommended at reasonable levels of 150 minutes of weekly PA for adults.1 Unfortunately, large percentages of the population are not meeting these levels2,3 and thereby do not derive the health benefits of regular activity. Given the known health benefits of regular PA, it is important to understand why some individuals choose not to engage in it and what factors may prevent them from being active. The most common reasons reported for a low level of PA are lack of time, the inconvenience of exercise, and lack of self-motivation.4 Studies have shown that individuals who report having less time for PA are less active and more likely to be classified as obese.5 However, focusing on eliminating a barrier may not necessarily target deeper, more specific issues since it has been suggested that removing previously reported barriers does not always increase PA levels.6 Some practices that appear to contribute to an active lifestyle include having the determination to prioritize and schedule PA into one’s lifestyle,7 choosing enjoyable activities, and having increased self-efficacy for PA.8 Thus, attitudes and beliefs are important in adhering to a physically active lifestyle. Even among those individuals who are physically active and value the benefits of PA, common life occurrences such as starting or stopping school, starting or changing employment, moving into a new residence, becoming married, or having children can impede the continuity of PA and create new barriers to participation.9–12 Two life transitions that have been shown to have an impact on PA and exercise are pregnancy and parenthood.13–15 Studies have shown that women who are pregnant tend to have reduced levels of PA.16,17 There is evidence that maintaining an activity program during pregnancy is associated with increased body image, selfesteem, and the general health and well-being of the mother and
child.18–20 Wallace et al20 examined pregnant women participating in an aerobic activity program and found that they had significantly higher self-esteem and energy levels compared with their sedentary peers. In addition, women who remain active throughout and after their pregnancy have significantly better mood, and a reduced risk of postpartum depression, which affects 10% to 15% of pregnant women.18 This suggests that there is a need to encourage women who are pregnant to adopt and maintain a physically active lifestyle. Barriers that limited PA participation during pregnancy may persist after having a child. New parents report increased stress and responsibility, as well as decreased leisure time and sleep quality after having a child.21,22 Additionally, both men and women show large reductions in PA after becoming a parent.13,14 Given the increased responsibility and stress that new parents may experience, regular PA could mediate the stress response associated with having and raising a child.15 In addition, PA not only will have health benefits for the parents, but through active role-modeling, may encourage the child to be active as well. The vast majority of studies that have examined the link between parent and child activity levels have shown that parents who are active also have children who are active.23,24 Thus, there is a need to identify possible coping mechanisms or motivations that will enable new parents to continue to be physically active. The overall purpose of this study was to compare the PA change of new parents across a 2- to 3-year period and to query these parents as to how and why their PA levels may have changed. In addition, we examined barriers to activity, how new parents perceived their activity level, their future plans regarding activity, and how they were able to maintain or increase their activity level. An added dimension of this research was that we compared the parents’ statements regarding their PA level with what they reported on a PA questionnaire.
Hull ([email protected]) is with the Physical and Health Education Dept, Slippery Rock University, Slippery Rock, PA. Garcia is with the Curry School of Education, University of Virginia, Charlottesville, VA. Kolen is with the Dept of Human Kinetics, St. Francis Xavier University, Antigonish, NS, Canada. Robertson is with the Health and Physical Activity Dept, University of Pittsburgh, Pittsburgh, PA.
Methods
782
Study Design and Participants Forty-nine individuals (31% men, 96% white, 65% holders of at least a bachelor’s degree) were identified from a longitudinal study
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of PA from adolescence through adulthood conducted at the University of Pittsburgh. This study was approved by the University of Pittsburgh Institutional Review Board, and informed consent was obtained from all participants. Participants in this analysis were selected if they had no child at baseline and had a child who was ≤ 24 months old at follow-up (mean child age at follow-up was 12 ± 7 mo old). PA was measured at baseline (mean participant age was 26.3 ± 1.1 yr old in 2005) and again at follow-up (mean age was 28.9 ± 1.7 yr old in 2007/2008) using a validated past-year questionnaire.25 At follow-up, participants were invited to talk about their PA in a 20- to 30-minute semistructured interview with a trained interviewer. (A brief sample of the questions from the semistructured interview is shown in Table 1.) Participants were provided with a small snack and a bottle of water, and the interview was conducted in a one-on-one session in a quiet room. Interviews were recorded from 49 participants, and PA data were calculated, in hours per week, for 48 of these participants.
Measurements Participant demographics, such as age, sex, race, education, employment status, and whether the participant had children, and if so their ages, were collected at baseline and follow-up (Table 2). The Past Year Leisure Time Physical Activity Questionnaire, developed by Aaron et al,25 was used at baseline and follow-up. The PA questionnaire asked participants to report all leisure-time PA in which they participated at least 10 times during the past year. The questionnaire asked participants to choose from a list of 26 common activities (eg, tennis, outdoor bicycling, gardening, walking for exercise), and participants were able to add additional activities that were not listed on the questionnaire. For each activity indicated, participants were asked how many months per year they participated in this
activity, how many days per week, and how many minutes per day. A mean PA score was calculated in hours per week for each activity. Summing all activities yielded the total mean hours per week of activity. The test–retest reproducibility for 1 month was shown to be r = .79, and for 1 year it was r = .66, suggesting that this questionnaire yields a reasonable estimate of short-term and long-term PA recall.25 Validity of this questionnaire was assessed by comparing the average of four 1-week questionnaires with the past-year questionnaire that was completed before and after the study. The correlation between questionnaires was r = .80, which, according to Willet,26 provides a conservative estimate of the validity of this measure. To further examine differences in barriers and coping mechanisms, participant PA was categorized into tertiles of PA change: least decreased, moderately decreased, and most decreased. A thematic comparison was made between the statements of parents from different PA categories, with a focus on strategies and coping mechanisms for PA, especially between parents of the least decreased and most decreased categories. From baseline to follow-up, interviews regarding PA beliefs and behaviors were recorded from 49 participants, and changes in the pattern or amount of PA between the 2 time points (ie, baseline and follow-up) were discussed in a semistructured interview with the purpose of identifying factors that contributed to a change in activity. A phenomenological framework was followed in which the lived experiences of the participants were examined. The trained interviewers were not privy to the participant’s demographics or any information that would inject bias into the interview.
Data Management and Analysis All interviews were coded using NVivo 8.0 employing a combined free and tree node design. A “code” was used to describe a specific reference or response made by a participant. For example, when the
Table 1 Guiding and Probing Questions Guiding questions
Probing questions
Over the past two years, do you consider yourself to have been physically active?
Do you think you do enough physical activity to be healthy?
What are the challenges of being active, and what has helped you stay active?
How does [insert challenge] keep you from being active?
Who or what supports your physical activity?
How does your [friend, coworker, spouse, work shift] support your activity?
Do you feel your physical activity level has changed over the two-year period?
What has contributed to the change?
What are some reasons that you have [increased, decreased, started, stopped] [insert activity]?
Do you have any plans to increase your physical activity, and if so, how?
What would you say are your barriers to being physically active?
In what ways does [insert barrier] become a barrier to you? How do you overcome [insert barrier]?
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interviewer asked about barriers to PA, the participant’s responses were coded according to theme, such as “barriers to PA.” Likewise, if a participant mentioned a barrier to PA during their interview at any time, that section of text was thematically coded as “barriers to PA.” Using the NVivo software, a search or query could be run for the “barriers to PA” code, which would compile all those specific sections of text that were highlighted as “barriers to PA” from every participant into one document. Codes were determined separately by 2 coders based on interview questions and responses. The 2 coders then discussed and agreed upon a single set of codes. Using the agreed upon set of codes, 20% of the interviews were coded separately by each coder. Comparison of the 20% of coded interviews was performed manually, without the use of a software program, with an 88% consistency between coders. Further discussion between the 2 coders resolved any remaining discrepancies, and the remaining interviews were coded using the newly agreed upon set of codes. Differences between baseline and follow-up levels of PA and differences between the least and most decreased PA groups were examined with t tests using SPSS 18.0 with an alpha level of .05.
Results The participants in this study were in their mid to late 20s; their children were approximately 1 year old; and most of the participants were women, were white, held at least a bachelor’s degree, and
worked full time. Table 2 compares PA levels across participant demographics, such as age, sex, race, education, child’s age, and employment status of the participants. PA decreased by nearly 3 hours per week from baseline to follow-up (P < .001), with a median follow-up PA of 2.6 hr/wk, or approximately 22 minutes per day for new parents. The PA data showed that new fathers were more active than new mothers at both time points (P < .05). No other differences in PA level were found for race, education, employment, or the child’s age. The first question that all participants were asked was whether they considered themselves to have been physically active over the past 2 to 3 years. The majority of responses were “yes” for reasons related to health, routine, and enjoyment, with less frequent responses of having a child and a fear of being overweight. About one-third of the participants indicated they did not feel they were physically active owing to factors related to having a child, experiencing a pregnancy, lacking time, and having insufficient motivation to be active. Even though most participants stated they felt they were physically active, most participants (42 of 49) said their PA had decreased over the time period. Before the interviewer told the participant whether his or her PA level had increased or decreased according to the questionnaire results, the interviewer asked the participant whether his or her PA had changed over the 2- to 3-year period, and how it may have changed. Of the individuals who stated they thought their PA had declined (42 of 49), nearly all of those individuals
Table 2 Demographics and Physical Activity (PA) Levels of Participants Participant demographics (n = 49)
Baseline PA (median hr/wk)
Follow-up PA (median hr/wk)
Age at baseline, mean (SD), y
26.3 (0.9)
5.5
—
Age at follow-up, mean (SD), y
28.9 (1.7)
—
2.6**
Child age mean (SD), mo
a
12 (7.2)
Sex Male
31%
6.9*
5.1*
Female
69%
5.4*
3.3*
White
96%
5.5
2.7
African American (minority)
4%
5.9
2.7
Less than a college (BS) degree
35%
6.2
3.1
At least a college (BS) degree
65%
4.8
2.4
69%
5.5
2.7
31%
4.8
1.4
Less than or equal to 12 mo
63%
4.8
2.0
Between 13 and 24 mo
37%
6.1
3.1
b
Race b
Education status b
Employment status Working full time for pay Not working full
timec
b
Child age b
* P < .05; ** P < .001. Abbreviations: BS, bachelor of science. a Paired sample t-test compared baseline PA with follow-up PA in all subjects. b Independent sample t-tests (physical activity was normalized through a natural log transformation). c Includes working part-time for pay, being a full-time homemaker, being a full-time student, and being unemployed. JPAH Vol. 12, No. 6, 2015
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reported answers that matched their responses to the PA questionnaire. On the other hand, of those participants who stated they felt their PA had increased over the time period (7 of 49), all had PA data from their questionnaires that showed their PA had decreased from baseline to follow-up. A follow-up question asked participants if they presently did enough PA to be healthy. Over half the participants felt they did enough PA to be healthy while a third (16 of 49) felt they did not, and only a few (6 of 49) felt their activity level was “somewhat” healthy. Participants were then asked to elaborate on their responses. More than half of the 16 participants who did not feel they were active enough to be healthy responded that having a child and their pregnancy were the main reasons for not being sufficiently active. Other responses in this category included feeling lazy and not having adequate time for activity. Participants who felt they were active enough to be considered healthy cited wanting to stay in shape, be without disease, lower their stress level, and enjoy activity as their reasons for staying active. When both mothers and fathers were asked why their PA had changed, the overwhelming theme was either child and/or pregnancy related. The vast majority of parents stated they felt that having a child and becoming pregnant had decreased their PA. One participant who had decreased his PA by 22 hours per week stated “definitely decreased because my wife was pregnant and we had a child.” Less common factors for why participants felt their PA had decreased included having less motivation and time to participate, as well as feeling far busier than they used to, which appeared to be mostly child related: “I had a baby seven months ago and just my interest in exercise is not there” (PA decreased 3.8 hr/wk); “I had a baby; I don’t have that much time” (PA decreased 2.3 hr/ wk). Some parents indicated that they are less active because their children cannot participate in adult sports or recreational activities: “We don’t play tennis as much and we used to go snow skiing, but we don’t do those types of activities because she [daughter] is not able to” (PA decreased 2.7 hr/wk). Even though most parents indicated that their PA had decreased because of having a child, they also reported that they were active with their child through active play, walking, or running or because they involved their child in their own activities. Although the PA of this mother decreased by nearly 11 hr/wk over the 2-year time period, she states, “I try and take her with me as much as possible on my walks, [and I] try to involve her while I’m doing my [exercise] tapes. [I] just involve her in what I am doing so I can get my exercise in.” A small number of parents stated they are more active now because they are actively raising their child. Before they had a child, they thought of exercise as a structured activity that occurred within the confines of a class or exercise session, but now they feel they are more active even without doing those structured activities: “I am more active than I was before because of my son. Whereas before I only felt like I was being active if I was going to yoga or actually doing something . . . now I feel like I am always active” (PA decreased 1.2 hr/wk). “Sure he is not the kind of baby you can plop down and entertains himself. He constantly needs entertained. He pulled himself up early and [is] crawling early so somebody always needs to have an eye on him. He is constantly on the move” (PA decreased 2.1 hr/wk). The parents who stated they were more active now because of their child (n = 6) decreased their PA by 1.3 hr/wk across the time period. Parents who did not make this statement (n = 43) collectively decreased their PA by 2.9 hr/wk. These between-groups differences were not significant (P = .11) but showed that some parents mitigated a decrease in their own PA as they tried to model an active
lifestyle with their child: “Going to the park more often with my daughter and chasing her and walking more because where we live it’s a main street and it’s just straight flat so we just walk as far as we can walk and then turn around” (PA decreased 1.5 hr/wk). “[I am] probably more [active] because I feel the need to get my son outdoors and three years ago I didn’t have a son and so it was just about me and if I was feeling tired I would just stop and settle in, but I feel like he needs to be outside—he needs to be taught how to be active” (PA decreased 1.2 hr/wk). An underlying theme in the majority of parent responses regarding behavior change was that their children were nearly always included in their answers in some form. When asked how their child has changed their activity level, some parents stated that their child has changed their perspective: “Time and lack of childcare and a different focus on life—it’s not [exercise is not] as important right now” (PA decreased 3.7 hr/wk). “I have someone else to think of; someone else’s needs to think of and address” (PA increased 14 hr/wk). This previous participant attributed her large increase in activity level to her involvement in many more activities as a result of having a child. A major theme in many parent responses was that they felt tired all the time. Parents indicated that because they were constantly moving, their young children made them feel exhausted at the end of the day. Even though some parents stated they know and have heard that being active can increase their energy level, many felt they were too tired to be physically active. When asked why their PA decreased, a participant who decreased 3.8 hr/wk of PA stated, “I really can’t explain [it]. I don’t know, my energy is not there. They say if you exercise the energy goes up but if you don’t have the energy in the first place—I’m tired from working and taking care of the baby.” As shown in Table 2, nearly 70% of participants reported working full time. A similar response from full-time working mothers and fathers was that they were tired after work and by the time they have put their children to bed, there is no longer energy or motivation for PA: “I am working full time and when I’m not working I am with my son and getting dinner ready. I don’t have a chance to do anything for myself until 8:30 at night—at that point I don’t have the energy to go to the gym” (PA increased by 45 min/ wk). One parent stated that after a long day and then being with her child, she wants to unwind: “I can’t get anything done until she goes to bed at night. I come home and she wants all the attention and I don’t see her all day so of course I want to give it to her. You are just tired most of the time . . . and by 9 o’clock you just want to roll into bed and relax for awhile—you just don’t get a moment to yourself” (PA decreased 3.8 hr/wk). Even the parents who were not working full time revealed similar sentiments of fatigue and a lack of time for activity. Though parents appear to understand there are benefits from being physically active, many parents state that their chronic tiredness and additional responsibilities have caused them to make PA less of a priority: “A lot of times I am just tired; physical activity seems like a good idea but I am just tired a great deal of time” (PA decreased by 2.8 hr/ wk). “I was on a pretty good routine when I first moved to the area: I went [inline skating] every day, I exercised, and I did all kind of active things. Even while I was pregnant I walked and exercised every day, but after she was born there was just no time and a lot of times I’m just tired” (PA decreased by 4.2 hr/wk). Even though many parents state that their PA has declined, the results indicated that some parents managed to maintain or even increase their activity level across the time period. To examine whether differences existed between parents who maintained their PA level and parents who decreased their PA level, parents were
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categorized into equal tertiles of PA change across the 2- to 3-year time period: least decreased, moderately decreased, and most decreased. The “least decreased” group showed a change of +0.3 median hours of PA per week across the time period, which would translate to an overall minimal change of +2.5 minutes of PA per day. The “moderately decreased” group changed their PA by –2.7 median hours per week, or a decrease of about 23 minutes per day. The “most decreased” group showed a change of –6.8 median hours of PA per week, or a decrease of about 58 minutes per day across the time period. When the “most decreased” category of parents were asked if they considered themselves to be physically active, 33% indicated No because of time and the baby while 66% indicated they felt they were active because they wanted to stay in shape and maintain their weight and because they enjoyed the activity. On the other hand, only 15% of the “least decreased” individuals felt they were not active, and about 85% of this group felt that they were physically active because they enjoyed PA, wanted to maintain their weight and maintain a routine, and have a baby. When follow-up and baseline PA questionnaires were compared to determine activities that were either started, increased, maintained, decreased, or stopped, the “most decreased” group appeared to stop about 3 times as many activities compared with the “least decreased” group (P < .001). Table 3 shows this comparison along with the number of activities that were started, increased, decreased, and maintained. Frequent reasons for stopping an activity from both groups included lacking time as a result of caring for the baby, being employed, and experiencing pregnancy. Less common responses for stopping an activity included lack of proximity to a facility, few social connections, and expense. Examining the responses of the 2 groups separately showed that parents from the “most decreased” group overwhelmingly said there was no time for the activities and they now lacked interest, enjoyment, desire, and motivation for the specific activities they once performed. Parents from the “least decreased” group did not mention that they lacked interest or motivation. When parents from the “least decreased” group stopped an activity, they added a new activity or increased the time they spent in their other activities. When participants were asked what factors kept them active, the “least decreased” group mentioned more often that they enjoyed the activities and liked the results of the activity, such as increased health, better physical shape, lower stress, and greater strength compared with the “most decreased” group. In addition, when the metabolic equivalent levels of the activities were compared, parents from “least decreased” group participated in activities of a higher
intensity level (basketball, running, biking, weight lifting) compared with parents from the “most decreased” group (walking for exercise, aerobics, gardening). As for barriers to PA, these 2 groups gave similar responses with time and lack of childcare at the top of the list. When asked how they overcame barriers to PA participation, more individuals in the “most decreased” category stated they were not able to overcome their barriers to being active whereas the vast majority of participants in the “least decreased” group stated that they overcame their barriers because they made time for activity early in the day, over lunch, on weekends, and during any other available time. Secondary analyses found no significant differences between these 2 groups on any of the demographic measures shown in Table 2. In a follow-up question, all parents were asked what would motivate or encourage them to become more active. The 3 main themes were having childcare, more free time in the day, and more flexibility in their job. Participants also reported social support as an important factor in becoming more active. Several participants responded that having friends who are active or an exercise partner would motivate them to be active. Others mentioned that they would need family that would be willing to watch their child while they exercised. Only 2 participants responded that nothing would motivate them or encourage them to become more physically active. A summary of the major themes from the qualitative interviews are shown in Table 4.
Discussion In this study we examined changes in PA in new parents and their beliefs, barriers, and coping mechanisms with regard to staying active. Collectively, PA significantly decreased across the 2- to 3-year time period, and fathers were more active than mothers at baseline and follow-up. This result was expected since PA tends to decrease over time,9 especially in new parents,14 and because men tend to be more active than women.2 Even though PA decreased in nearly all participants, most parents stated that they felt they were physically active enough to be considered healthy. Given that this was a young cohort of parents, they may have considered themselves healthy because their activity level was not zero and they were without physical symptoms of disease, which is a primary way individuals assess their state of health.27 When parents were asked how their PA had changed across the time period, most stated that it had decreased, and nearly all of those individuals showed a decline in PA on their questionnaire. This is an alarming trend because with most parents showing a decrease
Table 3 Type of Change in Activity Status From Baseline to Follow-up
a
Parents whose PA decreased the least
Parents whose PA decreased the most
Pa
Number of new activities (mean ± SD)
0.8 ± 0.9
0.3 ± 0.6
.17
Number of activities increased (mean ± SD)
0.4 ± 0.5
0.2 ± 0.4
.25
Number of activities maintained (mean ± SD)
1.3 ± 1.5
0.8 ± 1.2
.25
Number of activities decreased (mean ± SD)
0.6 ± 0.6
0.7 ± 0.8
.81
Number of activities stopped (mean ± SD)
0.9 ± 0.8
3.1 ± 1.3
< .001
Independent sample t-tests.
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Table 4 Summary of Main Themes From Qualitative Interviews Themes The vast majority of parents stated that having a child and becoming pregnant decreased their PA. Most all parents stated that they were exhausted, were far busier, and had less free time for PA after having a child. Most parents indicated that they played with and were active with their child. Many parents appeared to decrease the priority they placed on PA as a result of having a child. Parents whose PA decreased the most overwhelmingly stated that they lacked time, interest, enjoyment, and motivation for the PA that they once had. They also stated that they were not able to overcome barriers to PA. Parents whose PA decreased the least did not mention that they lacked interest or motivation and stated that they enjoyed PA. They also made time for PA in their schedule and chose activities of higher intensity for reasons related to health, physical shape, and lower stress.
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Overall, parents said they would be more active if they had childcare, more free time, and more flexibility in their job.
in PA, it could be expected that the health of those parents might also be at risk for declining since PA is one of the most important factors in maintaining overall health.1 Further, the parents in this study overwhelmingly reported that the arrival of the child drastically reduced their time for PA and increased their responsibilities. Other studies support this finding and have shown that new parents have far less leisure time and increased stress levels.21,22 Since time is often the number one factor reported for not being active,4 and has been repeatedly shown to be negatively associated with activity level,5 it is not surprising why parents’ PA levels have decreased after having a child. As a result, many parents stated that the little time and energy they did have, they gave to their child instead of being physically active for their own health or enjoyment. Although it may be hard to find fault with parents who want to spend time with their child, we wonder if parents are aware of the trade-off they might be making with their own health as they decrease their PA level for their child. Future interventions could help parents strike a balance between spending time with their child and being physically active so they can maintain their health and be an active role model for their child. Some parents indicated that they attempt to be active with their child by playing with and raising the child, but more needs to be known about whether raising and playing with a young child occurs at an intensity level that maintains or improves health in the short or long term. While most parents in this study, and elsewhere,22 stated they were tired and exhausted from caring for their child, especially at the end of the day, some parents in this study managed to maintain their PA levels better than others. These parents from the “least decreased” PA group were different in 3 main ways from the parents from the “most decreased” group. First, the more active parents prioritized PA in their life such that it was planned and structured into their daily routine; next, they engaged in activities that they enjoyed; and last, they participated in activities of a higher intensity level. These parents appeared more determined to make PA a part of their life compared with the “most decreased” parents. Fortier et al7 have shown that self-determination is a powerful predictor of PA participation and is a characteristic that can be promoted in individuals to increase PA participation and maintenance. Previous research has also shown that enjoyment is predictive of PA participation,8
and even the expectation of enjoyment can help individuals maintain their activity level.28 The parents in this study who maintained their PA level commented that they liked being active because it was fun and it made them feel healthy. In addition, they may have been motivated by the greater health and fitness benefits that higher intensity activities tend to promote.1 These parents also made specific statements that may resonate with parents who still want to be active but have found it difficult. The more active parents from this study said they take their child with them when they exercise and use a bicycle seat or jogging stroller. They also stated that they exercise with their child so that they could be active role models, something that was important to most parents. Conversely, those parents from the “most decreased” group appeared to have fewer coping skills by which they could stay active and often sounded defeated when it came to finding solutions to their low PA level. They stated there was no time, they were tired, and they lacked the desire and motivation to be active, which were very similar to the top reasons why people do not engage in PA in the first place.4 Even though this group had not given up on activity altogether at follow-up, their decreasing PA trend did not bode well for their future activity levels or health. Unfortunately, we have found no other longitudinal studies that have examined PA before and after having a young child coupled with interviews regarding activity beliefs and behaviors. Given the lack of data, future research in this area is sorely needed. The strengths of this research include the large sample for a qualitative study (n = 49), the use of longitudinal PA data that were compared with interviews, and the inclusion of the participants’ lived experiences. Another strength of this study was that data were collected soon before and after participants had a first child, which is a life-changing transition that is often difficult to measure in the general population. The study’s limitations included the use of a self-report PA questionnaire that asked participants to indicate the activities in which they were involved but did not specifically ask about everyday life PA, which may have provided an indication of the amount of time parents spent playing or being active with their child. In addition, questionnaires are prone to bias, and an objective measure of PA such as accelerometry might have provided a
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more accurate measure of PA associated with playing and caring for a young child. The main conclusion of this research was that parents struggle to stay active with a new child, and parents are aware of this. Almost all parents mention that they have less energy, motivation, and time for PA as a result of caring for a new child. However, parents who prioritized their health and PA, and who chose higher intensity activities that they enjoyed, appeared to be at a lower risk of decreased PA. Parents who do not mention coping mechanisms for staying active appear to be at the greatest risk of declining PA. This research offers insight into the coping strategies some parents use for staying active, as well as the common reasons parents give for not being active. Future programming and intervention efforts could use this information to encourage new parents, and all individuals, to choose activities they enjoy, prioritize activity into their daily routine, and choose activities of a higher intensity level. Specific attention should be paid to educating new parents that their health is strongly linked with their PA level, and that higher intensity activities confer greater health benefits that can reciprocally reinforce motivation for being active. Future research should employ objective measures of PA across this life transition and examine whether the PA associated with raising and playing with a child is sufficient for maintaining and improving health. Acknowledgments This research was supported by National Institutes of Health Grants RO1HD35607 and RO1CA109895.
References 1. Centers for Disease Control and Prevention. 2008 physical activity guidelines for Americans. Atlanta, GA: U.S. Department of Health and Human Services; 2008. 2. Centers for Disease Control and Prevention. Physical activity and health: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services; 1996. 3. National Center for Health Statistics. Health, United States, 2012: with special feature on emergency care. Hyattsville, MD: U.S. Department of Health and Human Services; 2013. 4. Sallis JF, Hovell MF. Determinants of exercise behavior. Exerc Sport Sci Rev. 1990;18:307–330. PubMed doi:10.1249/00003677199001000-00014 5. Trost SG, Owen N, Bauman AE, Sallis JF, Brown W. Correlates of adults’ participation in physical activity: review and update. Med Sci Sports Exerc. 2002;34:1996–2001. PubMed doi:10.1097/00005768200212000-00020 6. Withall J, Jago R, Fox KR. Why some do but most don’t. Barriers and enablers to engaging low-income groups in physical activity programs: a mixed method study. BMC Public Health. 2011;11:507. PubMed doi:10.1186/1471-2458-11-507 7. Fortier MS, Duda JL, Guerin E, Teixeira PJ. Promoting physical activity: development and testing of self-determination theory– based interventions. Int J Behav Nutr Phys Act. 2012;9:20. PubMed doi:10.1186/1479-5868-9-20 8. McArthur LH, Raedeke TD. Race and sex difference in college student physical activity correlates. Am J Health Behav. 2009;33:80–90. PubMed doi:10.5993/AJHB.33.1.8
9. Aaron DJ, Jekal Y-S, LaPorte RE. Epidemiology of physical activity from adolescence to young adulthood. World Rev Nutr Diet. 2005;94:36–41. PubMed doi:10.1159/000088204 10. Malina RM. Tracking of physical activity and physical fitness across the lifespan. Res Q Exerc Sport. 1996;67(3, Suppl):S48–S57. PubMed 11. Telama R, Yang X, Viikari J, et al. Physical activity from childhood to adulthood: a 21-year tracking study. Am J Prev Med. 2005;28(3):267– 273. PubMed doi:10.1016/j.amepre.2004.12.003 12. Trudeau F, Laurencelle L, Shephard RJ. Tracking of physical activity from childhood to adulthood. Med Sci Sports Exerc. 2004;36(11):1937– 1943. PubMed doi:10.1249/01.MSS.0000145525.29140.3B 13. Brown WJ, Trost SG. Life transitions and changing physical activity patterns in young women. Am J Prev Med. 2003;25(2):140–143. PubMed doi:10.1016/S0749-3797(03)00119-3 14. Hull EE, Rofey DL, Robertson RJ, Nagle EF, Otto AD, Aaron DJ. Influence of marriage and parenthood on physical activity: a 2-year prospective analysis. J Phys Act Health. 2010;7(5):577–583. PubMed 15. Sjögren K, Hansson EE, Stjernberg L. Parenthood and factors that influence outdoor recreational physical activity from a gender perspective. BMC Public Health. 2011;11:93–102. PubMed doi:10.1186/1471-2458-11-93 16. Da Costa D, Rippen N, Dritsa M, Ring A. Self-reported leisure time physical activity during pregnancy and relationship to psychological well-being. J Psychosom Obstet Gynaecol. 2003;24(2):111–119. PubMed doi:10.3109/01674820309042808 17. Fell DB, Joseph KS, Adamson BA, Dodds L. The impact of pregnancy on physical activity level. Matern Child Health J. 2009;13(5):597–603. PubMed doi:10.1007/s10995-008-0404-7 18. Evans J, Heron J, Francomb H, Oke J, Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323:257–260. PubMed doi:10.1136/bmj.323.7307.257 19. Goodwin A, Astbury J, McMecken J. Body image and psychological well-being in pregnancy: a comparison of exercisers and non-exercisers. Aust N Z J Obstet Gynaecol. 2000;40(4):442–447. PubMed doi:10.1111/j.1479-828X.2000.tb01178.x 20. Wallace AM, Bayer DB, Dan A, Holm K. Aerobic exercise, maternal self-esteem, and physical discomforts during pregnancy. J Nurse Midwifery. 1986;31(6):255–262. PubMed doi:10.1016/00912182(86)90034-0 21. Woollett A, Parr M. Psychological tasks for women and men in the postpartum. J Reprod Infant Psychol. 1997;15:159–183. doi:10.1080/02646839708404541 22. Gay CL, Lee KA, Lee S. Sleep patterns and fatigue in new mothers and fathers. Biol Res Nurs. 2004;5:311–318. PubMed doi:10.1177/1099800403262142 23. Loprinzi PD, Trost SG. Parental influences on physical activity behavior in pre-school children. Prev Med. 2010;50(3):129–133. PubMed doi:10.1016/j.ypmed.2009.11.010 24. Zecevic CA, Tremblay L, Lovsin T, Michel L. Parental influence on young children’s physical activity. Int J Pediatr. 2010;2010:1–9. PubMed doi:10.1155/2010/468526 25. Aaron DJ, Kriska AM, Dearwater SR, Cauley JA, Metz KF, LaPorte RE. Reproducibility and validity of an epidemiologic questionnaire to assess past year physical activity in adolescents. Am J Epidemiol. 1995;142(2):191–201. PubMed 26. Willet W. Nutritional epidemiology. New York: Oxford University Press; 1990. 27. Krause NM, Jay GM. What do global self-related health items measure? Med Care. 1994;32(9):930–942. PubMed doi:10.1097/00005650199409000-00004 28. Dunton GF, Vaughan E. Anticipated affective consequences of physical activity adoption and maintenance. Health Psychol. 2008;27:703–710. PubMed doi:10.1037/0278-6133.27.6.703
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ORIGINAL RESEARCH
Parenthood and Physical Activity in Young Adults: A Qualitative Study Ethan E. Hull, Jeannette M. Garcia, Angela M. Kolen, and Robert J. Robertson Background: New parents have to adjust to less sleep, less free time, and more responsibility as a result of having a child. The purpose of this study was to examine how having a child impacts the physical activity (PA) beliefs and behaviors of new parents over a 2- to 3-year time period. Methods: Participants included 49 men and women (31% men, 96% white) who did not have a child at baseline (26.3 ± 1.1 years old) but did have a child at the time of follow-up (28.9 ± 1.7 years old). The child’s mean age at follow-up was 12 ± 7 months old. PA was measured via questionnaire at baseline and again at follow-up. Interviews regarding PA occurred at follow-up. Results: PA significantly decreased in parents across the time period (P < .001), and parents attributed this decrease to having a child and being pregnant. Parents mentioned they lack time, energy, and motivation for PA as a result of caring for a new child. Parents who maintained their activity level stated they prioritized PA and chose activities they enjoyed. Conclusions: These results show that although activity levels decrease in individuals who have a child, PA in new parents may be a function of priority, intensity, and enjoyment. Keywords: life transition, parent, child, longitudinal
Physical activity (PA) has numerous health benefits, reduces the risk of disease, and has been recommended at reasonable levels of 150 minutes of weekly PA for adults.1 Unfortunately, large percentages of the population are not meeting these levels2,3 and thereby do not derive the health benefits of regular activity. Given the known health benefits of regular PA, it is important to understand why some individuals choose not to engage in it and what factors may prevent them from being active. The most common reasons reported for a low level of PA are lack of time, the inconvenience of exercise, and lack of self-motivation.4 Studies have shown that individuals who report having less time for PA are less active and more likely to be classified as obese.5 However, focusing on eliminating a barrier may not necessarily target deeper, more specific issues since it has been suggested that removing previously reported barriers does not always increase PA levels.6 Some practices that appear to contribute to an active lifestyle include having the determination to prioritize and schedule PA into one’s lifestyle,7 choosing enjoyable activities, and having increased self-efficacy for PA.8 Thus, attitudes and beliefs are important in adhering to a physically active lifestyle. Even among those individuals who are physically active and value the benefits of PA, common life occurrences such as starting or stopping school, starting or changing employment, moving into a new residence, becoming married, or having children can impede the continuity of PA and create new barriers to participation.9–12 Two life transitions that have been shown to have an impact on PA and exercise are pregnancy and parenthood.13–15 Studies have shown that women who are pregnant tend to have reduced levels of PA.16,17 There is evidence that maintaining an activity program during pregnancy is associated with increased body image, selfesteem, and the general health and well-being of the mother and
child.18–20 Wallace et al20 examined pregnant women participating in an aerobic activity program and found that they had significantly higher self-esteem and energy levels compared with their sedentary peers. In addition, women who remain active throughout and after their pregnancy have significantly better mood, and a reduced risk of postpartum depression, which affects 10% to 15% of pregnant women.18 This suggests that there is a need to encourage women who are pregnant to adopt and maintain a physically active lifestyle. Barriers that limited PA participation during pregnancy may persist after having a child. New parents report increased stress and responsibility, as well as decreased leisure time and sleep quality after having a child.21,22 Additionally, both men and women show large reductions in PA after becoming a parent.13,14 Given the increased responsibility and stress that new parents may experience, regular PA could mediate the stress response associated with having and raising a child.15 In addition, PA not only will have health benefits for the parents, but through active role-modeling, may encourage the child to be active as well. The vast majority of studies that have examined the link between parent and child activity levels have shown that parents who are active also have children who are active.23,24 Thus, there is a need to identify possible coping mechanisms or motivations that will enable new parents to continue to be physically active. The overall purpose of this study was to compare the PA change of new parents across a 2- to 3-year period and to query these parents as to how and why their PA levels may have changed. In addition, we examined barriers to activity, how new parents perceived their activity level, their future plans regarding activity, and how they were able to maintain or increase their activity level. An added dimension of this research was that we compared the parents’ statements regarding their PA level with what they reported on a PA questionnaire.
Hull ([email protected]) is with the Physical and Health Education Dept, Slippery Rock University, Slippery Rock, PA. Garcia is with the Curry School of Education, University of Virginia, Charlottesville, VA. Kolen is with the Dept of Human Kinetics, St. Francis Xavier University, Antigonish, NS, Canada. Robertson is with the Health and Physical Activity Dept, University of Pittsburgh, Pittsburgh, PA.
Methods
782
Study Design and Participants Forty-nine individuals (31% men, 96% white, 65% holders of at least a bachelor’s degree) were identified from a longitudinal study
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of PA from adolescence through adulthood conducted at the University of Pittsburgh. This study was approved by the University of Pittsburgh Institutional Review Board, and informed consent was obtained from all participants. Participants in this analysis were selected if they had no child at baseline and had a child who was ≤ 24 months old at follow-up (mean child age at follow-up was 12 ± 7 mo old). PA was measured at baseline (mean participant age was 26.3 ± 1.1 yr old in 2005) and again at follow-up (mean age was 28.9 ± 1.7 yr old in 2007/2008) using a validated past-year questionnaire.25 At follow-up, participants were invited to talk about their PA in a 20- to 30-minute semistructured interview with a trained interviewer. (A brief sample of the questions from the semistructured interview is shown in Table 1.) Participants were provided with a small snack and a bottle of water, and the interview was conducted in a one-on-one session in a quiet room. Interviews were recorded from 49 participants, and PA data were calculated, in hours per week, for 48 of these participants.
Measurements Participant demographics, such as age, sex, race, education, employment status, and whether the participant had children, and if so their ages, were collected at baseline and follow-up (Table 2). The Past Year Leisure Time Physical Activity Questionnaire, developed by Aaron et al,25 was used at baseline and follow-up. The PA questionnaire asked participants to report all leisure-time PA in which they participated at least 10 times during the past year. The questionnaire asked participants to choose from a list of 26 common activities (eg, tennis, outdoor bicycling, gardening, walking for exercise), and participants were able to add additional activities that were not listed on the questionnaire. For each activity indicated, participants were asked how many months per year they participated in this
activity, how many days per week, and how many minutes per day. A mean PA score was calculated in hours per week for each activity. Summing all activities yielded the total mean hours per week of activity. The test–retest reproducibility for 1 month was shown to be r = .79, and for 1 year it was r = .66, suggesting that this questionnaire yields a reasonable estimate of short-term and long-term PA recall.25 Validity of this questionnaire was assessed by comparing the average of four 1-week questionnaires with the past-year questionnaire that was completed before and after the study. The correlation between questionnaires was r = .80, which, according to Willet,26 provides a conservative estimate of the validity of this measure. To further examine differences in barriers and coping mechanisms, participant PA was categorized into tertiles of PA change: least decreased, moderately decreased, and most decreased. A thematic comparison was made between the statements of parents from different PA categories, with a focus on strategies and coping mechanisms for PA, especially between parents of the least decreased and most decreased categories. From baseline to follow-up, interviews regarding PA beliefs and behaviors were recorded from 49 participants, and changes in the pattern or amount of PA between the 2 time points (ie, baseline and follow-up) were discussed in a semistructured interview with the purpose of identifying factors that contributed to a change in activity. A phenomenological framework was followed in which the lived experiences of the participants were examined. The trained interviewers were not privy to the participant’s demographics or any information that would inject bias into the interview.
Data Management and Analysis All interviews were coded using NVivo 8.0 employing a combined free and tree node design. A “code” was used to describe a specific reference or response made by a participant. For example, when the
Table 1 Guiding and Probing Questions Guiding questions
Probing questions
Over the past two years, do you consider yourself to have been physically active?
Do you think you do enough physical activity to be healthy?
What are the challenges of being active, and what has helped you stay active?
How does [insert challenge] keep you from being active?
Who or what supports your physical activity?
How does your [friend, coworker, spouse, work shift] support your activity?
Do you feel your physical activity level has changed over the two-year period?
What has contributed to the change?
What are some reasons that you have [increased, decreased, started, stopped] [insert activity]?
Do you have any plans to increase your physical activity, and if so, how?
What would you say are your barriers to being physically active?
In what ways does [insert barrier] become a barrier to you? How do you overcome [insert barrier]?
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interviewer asked about barriers to PA, the participant’s responses were coded according to theme, such as “barriers to PA.” Likewise, if a participant mentioned a barrier to PA during their interview at any time, that section of text was thematically coded as “barriers to PA.” Using the NVivo software, a search or query could be run for the “barriers to PA” code, which would compile all those specific sections of text that were highlighted as “barriers to PA” from every participant into one document. Codes were determined separately by 2 coders based on interview questions and responses. The 2 coders then discussed and agreed upon a single set of codes. Using the agreed upon set of codes, 20% of the interviews were coded separately by each coder. Comparison of the 20% of coded interviews was performed manually, without the use of a software program, with an 88% consistency between coders. Further discussion between the 2 coders resolved any remaining discrepancies, and the remaining interviews were coded using the newly agreed upon set of codes. Differences between baseline and follow-up levels of PA and differences between the least and most decreased PA groups were examined with t tests using SPSS 18.0 with an alpha level of .05.
Results The participants in this study were in their mid to late 20s; their children were approximately 1 year old; and most of the participants were women, were white, held at least a bachelor’s degree, and
worked full time. Table 2 compares PA levels across participant demographics, such as age, sex, race, education, child’s age, and employment status of the participants. PA decreased by nearly 3 hours per week from baseline to follow-up (P < .001), with a median follow-up PA of 2.6 hr/wk, or approximately 22 minutes per day for new parents. The PA data showed that new fathers were more active than new mothers at both time points (P < .05). No other differences in PA level were found for race, education, employment, or the child’s age. The first question that all participants were asked was whether they considered themselves to have been physically active over the past 2 to 3 years. The majority of responses were “yes” for reasons related to health, routine, and enjoyment, with less frequent responses of having a child and a fear of being overweight. About one-third of the participants indicated they did not feel they were physically active owing to factors related to having a child, experiencing a pregnancy, lacking time, and having insufficient motivation to be active. Even though most participants stated they felt they were physically active, most participants (42 of 49) said their PA had decreased over the time period. Before the interviewer told the participant whether his or her PA level had increased or decreased according to the questionnaire results, the interviewer asked the participant whether his or her PA had changed over the 2- to 3-year period, and how it may have changed. Of the individuals who stated they thought their PA had declined (42 of 49), nearly all of those individuals
Table 2 Demographics and Physical Activity (PA) Levels of Participants Participant demographics (n = 49)
Baseline PA (median hr/wk)
Follow-up PA (median hr/wk)
Age at baseline, mean (SD), y
26.3 (0.9)
5.5
—
Age at follow-up, mean (SD), y
28.9 (1.7)
—
2.6**
Child age mean (SD), mo
a
12 (7.2)
Sex Male
31%
6.9*
5.1*
Female
69%
5.4*
3.3*
White
96%
5.5
2.7
African American (minority)
4%
5.9
2.7
Less than a college (BS) degree
35%
6.2
3.1
At least a college (BS) degree
65%
4.8
2.4
69%
5.5
2.7
31%
4.8
1.4
Less than or equal to 12 mo
63%
4.8
2.0
Between 13 and 24 mo
37%
6.1
3.1
b
Race b
Education status b
Employment status Working full time for pay Not working full
timec
b
Child age b
* P < .05; ** P < .001. Abbreviations: BS, bachelor of science. a Paired sample t-test compared baseline PA with follow-up PA in all subjects. b Independent sample t-tests (physical activity was normalized through a natural log transformation). c Includes working part-time for pay, being a full-time homemaker, being a full-time student, and being unemployed. JPAH Vol. 12, No. 6, 2015
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reported answers that matched their responses to the PA questionnaire. On the other hand, of those participants who stated they felt their PA had increased over the time period (7 of 49), all had PA data from their questionnaires that showed their PA had decreased from baseline to follow-up. A follow-up question asked participants if they presently did enough PA to be healthy. Over half the participants felt they did enough PA to be healthy while a third (16 of 49) felt they did not, and only a few (6 of 49) felt their activity level was “somewhat” healthy. Participants were then asked to elaborate on their responses. More than half of the 16 participants who did not feel they were active enough to be healthy responded that having a child and their pregnancy were the main reasons for not being sufficiently active. Other responses in this category included feeling lazy and not having adequate time for activity. Participants who felt they were active enough to be considered healthy cited wanting to stay in shape, be without disease, lower their stress level, and enjoy activity as their reasons for staying active. When both mothers and fathers were asked why their PA had changed, the overwhelming theme was either child and/or pregnancy related. The vast majority of parents stated they felt that having a child and becoming pregnant had decreased their PA. One participant who had decreased his PA by 22 hours per week stated “definitely decreased because my wife was pregnant and we had a child.” Less common factors for why participants felt their PA had decreased included having less motivation and time to participate, as well as feeling far busier than they used to, which appeared to be mostly child related: “I had a baby seven months ago and just my interest in exercise is not there” (PA decreased 3.8 hr/wk); “I had a baby; I don’t have that much time” (PA decreased 2.3 hr/ wk). Some parents indicated that they are less active because their children cannot participate in adult sports or recreational activities: “We don’t play tennis as much and we used to go snow skiing, but we don’t do those types of activities because she [daughter] is not able to” (PA decreased 2.7 hr/wk). Even though most parents indicated that their PA had decreased because of having a child, they also reported that they were active with their child through active play, walking, or running or because they involved their child in their own activities. Although the PA of this mother decreased by nearly 11 hr/wk over the 2-year time period, she states, “I try and take her with me as much as possible on my walks, [and I] try to involve her while I’m doing my [exercise] tapes. [I] just involve her in what I am doing so I can get my exercise in.” A small number of parents stated they are more active now because they are actively raising their child. Before they had a child, they thought of exercise as a structured activity that occurred within the confines of a class or exercise session, but now they feel they are more active even without doing those structured activities: “I am more active than I was before because of my son. Whereas before I only felt like I was being active if I was going to yoga or actually doing something . . . now I feel like I am always active” (PA decreased 1.2 hr/wk). “Sure he is not the kind of baby you can plop down and entertains himself. He constantly needs entertained. He pulled himself up early and [is] crawling early so somebody always needs to have an eye on him. He is constantly on the move” (PA decreased 2.1 hr/wk). The parents who stated they were more active now because of their child (n = 6) decreased their PA by 1.3 hr/wk across the time period. Parents who did not make this statement (n = 43) collectively decreased their PA by 2.9 hr/wk. These between-groups differences were not significant (P = .11) but showed that some parents mitigated a decrease in their own PA as they tried to model an active
lifestyle with their child: “Going to the park more often with my daughter and chasing her and walking more because where we live it’s a main street and it’s just straight flat so we just walk as far as we can walk and then turn around” (PA decreased 1.5 hr/wk). “[I am] probably more [active] because I feel the need to get my son outdoors and three years ago I didn’t have a son and so it was just about me and if I was feeling tired I would just stop and settle in, but I feel like he needs to be outside—he needs to be taught how to be active” (PA decreased 1.2 hr/wk). An underlying theme in the majority of parent responses regarding behavior change was that their children were nearly always included in their answers in some form. When asked how their child has changed their activity level, some parents stated that their child has changed their perspective: “Time and lack of childcare and a different focus on life—it’s not [exercise is not] as important right now” (PA decreased 3.7 hr/wk). “I have someone else to think of; someone else’s needs to think of and address” (PA increased 14 hr/wk). This previous participant attributed her large increase in activity level to her involvement in many more activities as a result of having a child. A major theme in many parent responses was that they felt tired all the time. Parents indicated that because they were constantly moving, their young children made them feel exhausted at the end of the day. Even though some parents stated they know and have heard that being active can increase their energy level, many felt they were too tired to be physically active. When asked why their PA decreased, a participant who decreased 3.8 hr/wk of PA stated, “I really can’t explain [it]. I don’t know, my energy is not there. They say if you exercise the energy goes up but if you don’t have the energy in the first place—I’m tired from working and taking care of the baby.” As shown in Table 2, nearly 70% of participants reported working full time. A similar response from full-time working mothers and fathers was that they were tired after work and by the time they have put their children to bed, there is no longer energy or motivation for PA: “I am working full time and when I’m not working I am with my son and getting dinner ready. I don’t have a chance to do anything for myself until 8:30 at night—at that point I don’t have the energy to go to the gym” (PA increased by 45 min/ wk). One parent stated that after a long day and then being with her child, she wants to unwind: “I can’t get anything done until she goes to bed at night. I come home and she wants all the attention and I don’t see her all day so of course I want to give it to her. You are just tired most of the time . . . and by 9 o’clock you just want to roll into bed and relax for awhile—you just don’t get a moment to yourself” (PA decreased 3.8 hr/wk). Even the parents who were not working full time revealed similar sentiments of fatigue and a lack of time for activity. Though parents appear to understand there are benefits from being physically active, many parents state that their chronic tiredness and additional responsibilities have caused them to make PA less of a priority: “A lot of times I am just tired; physical activity seems like a good idea but I am just tired a great deal of time” (PA decreased by 2.8 hr/ wk). “I was on a pretty good routine when I first moved to the area: I went [inline skating] every day, I exercised, and I did all kind of active things. Even while I was pregnant I walked and exercised every day, but after she was born there was just no time and a lot of times I’m just tired” (PA decreased by 4.2 hr/wk). Even though many parents state that their PA has declined, the results indicated that some parents managed to maintain or even increase their activity level across the time period. To examine whether differences existed between parents who maintained their PA level and parents who decreased their PA level, parents were
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categorized into equal tertiles of PA change across the 2- to 3-year time period: least decreased, moderately decreased, and most decreased. The “least decreased” group showed a change of +0.3 median hours of PA per week across the time period, which would translate to an overall minimal change of +2.5 minutes of PA per day. The “moderately decreased” group changed their PA by –2.7 median hours per week, or a decrease of about 23 minutes per day. The “most decreased” group showed a change of –6.8 median hours of PA per week, or a decrease of about 58 minutes per day across the time period. When the “most decreased” category of parents were asked if they considered themselves to be physically active, 33% indicated No because of time and the baby while 66% indicated they felt they were active because they wanted to stay in shape and maintain their weight and because they enjoyed the activity. On the other hand, only 15% of the “least decreased” individuals felt they were not active, and about 85% of this group felt that they were physically active because they enjoyed PA, wanted to maintain their weight and maintain a routine, and have a baby. When follow-up and baseline PA questionnaires were compared to determine activities that were either started, increased, maintained, decreased, or stopped, the “most decreased” group appeared to stop about 3 times as many activities compared with the “least decreased” group (P < .001). Table 3 shows this comparison along with the number of activities that were started, increased, decreased, and maintained. Frequent reasons for stopping an activity from both groups included lacking time as a result of caring for the baby, being employed, and experiencing pregnancy. Less common responses for stopping an activity included lack of proximity to a facility, few social connections, and expense. Examining the responses of the 2 groups separately showed that parents from the “most decreased” group overwhelmingly said there was no time for the activities and they now lacked interest, enjoyment, desire, and motivation for the specific activities they once performed. Parents from the “least decreased” group did not mention that they lacked interest or motivation. When parents from the “least decreased” group stopped an activity, they added a new activity or increased the time they spent in their other activities. When participants were asked what factors kept them active, the “least decreased” group mentioned more often that they enjoyed the activities and liked the results of the activity, such as increased health, better physical shape, lower stress, and greater strength compared with the “most decreased” group. In addition, when the metabolic equivalent levels of the activities were compared, parents from “least decreased” group participated in activities of a higher
intensity level (basketball, running, biking, weight lifting) compared with parents from the “most decreased” group (walking for exercise, aerobics, gardening). As for barriers to PA, these 2 groups gave similar responses with time and lack of childcare at the top of the list. When asked how they overcame barriers to PA participation, more individuals in the “most decreased” category stated they were not able to overcome their barriers to being active whereas the vast majority of participants in the “least decreased” group stated that they overcame their barriers because they made time for activity early in the day, over lunch, on weekends, and during any other available time. Secondary analyses found no significant differences between these 2 groups on any of the demographic measures shown in Table 2. In a follow-up question, all parents were asked what would motivate or encourage them to become more active. The 3 main themes were having childcare, more free time in the day, and more flexibility in their job. Participants also reported social support as an important factor in becoming more active. Several participants responded that having friends who are active or an exercise partner would motivate them to be active. Others mentioned that they would need family that would be willing to watch their child while they exercised. Only 2 participants responded that nothing would motivate them or encourage them to become more physically active. A summary of the major themes from the qualitative interviews are shown in Table 4.
Discussion In this study we examined changes in PA in new parents and their beliefs, barriers, and coping mechanisms with regard to staying active. Collectively, PA significantly decreased across the 2- to 3-year time period, and fathers were more active than mothers at baseline and follow-up. This result was expected since PA tends to decrease over time,9 especially in new parents,14 and because men tend to be more active than women.2 Even though PA decreased in nearly all participants, most parents stated that they felt they were physically active enough to be considered healthy. Given that this was a young cohort of parents, they may have considered themselves healthy because their activity level was not zero and they were without physical symptoms of disease, which is a primary way individuals assess their state of health.27 When parents were asked how their PA had changed across the time period, most stated that it had decreased, and nearly all of those individuals showed a decline in PA on their questionnaire. This is an alarming trend because with most parents showing a decrease
Table 3 Type of Change in Activity Status From Baseline to Follow-up
a
Parents whose PA decreased the least
Parents whose PA decreased the most
Pa
Number of new activities (mean ± SD)
0.8 ± 0.9
0.3 ± 0.6
.17
Number of activities increased (mean ± SD)
0.4 ± 0.5
0.2 ± 0.4
.25
Number of activities maintained (mean ± SD)
1.3 ± 1.5
0.8 ± 1.2
.25
Number of activities decreased (mean ± SD)
0.6 ± 0.6
0.7 ± 0.8
.81
Number of activities stopped (mean ± SD)
0.9 ± 0.8
3.1 ± 1.3
< .001
Independent sample t-tests.
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Table 4 Summary of Main Themes From Qualitative Interviews Themes The vast majority of parents stated that having a child and becoming pregnant decreased their PA. Most all parents stated that they were exhausted, were far busier, and had less free time for PA after having a child. Most parents indicated that they played with and were active with their child. Many parents appeared to decrease the priority they placed on PA as a result of having a child. Parents whose PA decreased the most overwhelmingly stated that they lacked time, interest, enjoyment, and motivation for the PA that they once had. They also stated that they were not able to overcome barriers to PA. Parents whose PA decreased the least did not mention that they lacked interest or motivation and stated that they enjoyed PA. They also made time for PA in their schedule and chose activities of higher intensity for reasons related to health, physical shape, and lower stress.
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Overall, parents said they would be more active if they had childcare, more free time, and more flexibility in their job.
in PA, it could be expected that the health of those parents might also be at risk for declining since PA is one of the most important factors in maintaining overall health.1 Further, the parents in this study overwhelmingly reported that the arrival of the child drastically reduced their time for PA and increased their responsibilities. Other studies support this finding and have shown that new parents have far less leisure time and increased stress levels.21,22 Since time is often the number one factor reported for not being active,4 and has been repeatedly shown to be negatively associated with activity level,5 it is not surprising why parents’ PA levels have decreased after having a child. As a result, many parents stated that the little time and energy they did have, they gave to their child instead of being physically active for their own health or enjoyment. Although it may be hard to find fault with parents who want to spend time with their child, we wonder if parents are aware of the trade-off they might be making with their own health as they decrease their PA level for their child. Future interventions could help parents strike a balance between spending time with their child and being physically active so they can maintain their health and be an active role model for their child. Some parents indicated that they attempt to be active with their child by playing with and raising the child, but more needs to be known about whether raising and playing with a young child occurs at an intensity level that maintains or improves health in the short or long term. While most parents in this study, and elsewhere,22 stated they were tired and exhausted from caring for their child, especially at the end of the day, some parents in this study managed to maintain their PA levels better than others. These parents from the “least decreased” PA group were different in 3 main ways from the parents from the “most decreased” group. First, the more active parents prioritized PA in their life such that it was planned and structured into their daily routine; next, they engaged in activities that they enjoyed; and last, they participated in activities of a higher intensity level. These parents appeared more determined to make PA a part of their life compared with the “most decreased” parents. Fortier et al7 have shown that self-determination is a powerful predictor of PA participation and is a characteristic that can be promoted in individuals to increase PA participation and maintenance. Previous research has also shown that enjoyment is predictive of PA participation,8
and even the expectation of enjoyment can help individuals maintain their activity level.28 The parents in this study who maintained their PA level commented that they liked being active because it was fun and it made them feel healthy. In addition, they may have been motivated by the greater health and fitness benefits that higher intensity activities tend to promote.1 These parents also made specific statements that may resonate with parents who still want to be active but have found it difficult. The more active parents from this study said they take their child with them when they exercise and use a bicycle seat or jogging stroller. They also stated that they exercise with their child so that they could be active role models, something that was important to most parents. Conversely, those parents from the “most decreased” group appeared to have fewer coping skills by which they could stay active and often sounded defeated when it came to finding solutions to their low PA level. They stated there was no time, they were tired, and they lacked the desire and motivation to be active, which were very similar to the top reasons why people do not engage in PA in the first place.4 Even though this group had not given up on activity altogether at follow-up, their decreasing PA trend did not bode well for their future activity levels or health. Unfortunately, we have found no other longitudinal studies that have examined PA before and after having a young child coupled with interviews regarding activity beliefs and behaviors. Given the lack of data, future research in this area is sorely needed. The strengths of this research include the large sample for a qualitative study (n = 49), the use of longitudinal PA data that were compared with interviews, and the inclusion of the participants’ lived experiences. Another strength of this study was that data were collected soon before and after participants had a first child, which is a life-changing transition that is often difficult to measure in the general population. The study’s limitations included the use of a self-report PA questionnaire that asked participants to indicate the activities in which they were involved but did not specifically ask about everyday life PA, which may have provided an indication of the amount of time parents spent playing or being active with their child. In addition, questionnaires are prone to bias, and an objective measure of PA such as accelerometry might have provided a
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788 Hull et al
more accurate measure of PA associated with playing and caring for a young child. The main conclusion of this research was that parents struggle to stay active with a new child, and parents are aware of this. Almost all parents mention that they have less energy, motivation, and time for PA as a result of caring for a new child. However, parents who prioritized their health and PA, and who chose higher intensity activities that they enjoyed, appeared to be at a lower risk of decreased PA. Parents who do not mention coping mechanisms for staying active appear to be at the greatest risk of declining PA. This research offers insight into the coping strategies some parents use for staying active, as well as the common reasons parents give for not being active. Future programming and intervention efforts could use this information to encourage new parents, and all individuals, to choose activities they enjoy, prioritize activity into their daily routine, and choose activities of a higher intensity level. Specific attention should be paid to educating new parents that their health is strongly linked with their PA level, and that higher intensity activities confer greater health benefits that can reciprocally reinforce motivation for being active. Future research should employ objective measures of PA across this life transition and examine whether the PA associated with raising and playing with a child is sufficient for maintaining and improving health. Acknowledgments This research was supported by National Institutes of Health Grants RO1HD35607 and RO1CA109895.
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