Three simple evidence-based infographics have been developed to support healthcare professionals (HCPs) in the implementation of the 2011 UK Chief Medical Officers’ (CMOs) physical activity (PA) recommendations.1 They are designed to empower HCPs to promote PA behaviour change across the life course. They address birth to 5 years, children and young people (5–18 years), and adults and older people.
However, no recommendations were made specifically for perinatal PA in the CMOs’ 2011 report.1 This is perhaps reflected in the NICE guidelines for antenatal care in the uncomplicated pregnancy whereby the guidance regarding PA is vague.2 Nevertheless, pregnancy provides a unique opportunity to promote PA behaviour change, as women are highly motivated to optimise their lifestyle and there is an increased contact with HCPs. However, HCPs can lack confidence, knowledge, and resources to deliver appropriate PA advice to pregnant women. They feel under-resourced, uncertain regarding safety concerns, and inadequately trained.3 Consequently, despite being receptive to PA advice, pregnant women receive inconsistent, vague, and conflicting guidance.4
In response to the need for clear evidence and resources for HCPs, the four UK CMOs commissioned the Physical Activity and Pregnancy Study, led by a group based at the University of Oxford, to review the available evidence and, if sufficient, provide evidence- based recommendations in the form of an additional infographic.
DESIGNING THE INFOGRAPHIC
The group reviewed a variety of evidence sources. It conducted a systematic review of reviews of the epidemiological evidence related to PA and pregnancy outcomes, followed by a structured review of key qualitative studies, current grey literature, and relevant existing infographics. Finally, expert opinions were sought using the FUSE Network (Centre for Translational Research in Public Health) to explore the experiences of both HCPs and pregnant women. The group produced an infographic that was field- tested with over 250 HCPs. The final draft was subsequently submitted to the CMOs for final editing and approval.
The evidence review found that the benefits of being active during pregnancy were reducing the risk of gestational diabetes, hypertensive disorders, and excessive gestational weight gain, and improving cardiovascular fitness.5 These benefits are in addition to those gained by following the adult recommendations (reduced risk of type 2 diabetes, cardiovascular disease, falls, depression and dementia, joint and back pain, and cancer of the colon and breast). No evidence of adverse maternal or infant outcomes were identified from the systematic reviews, suggesting that physical activity is safe in pregnancy. This is a key message for giving HCPs the confidence required to make PA recommendations to women.
The infographic is the final product of this process and was launched in June 2017 (image above). It aims to provide simple, clear, and consistent messages about PA for HCPs to deliver evidence-based recommendations to pregnant women. It provides objective details regarding intensity, time, and frequency, and aims to convey the positive message of encouraging women to incorporate PA into their daily routines with specific examples of suitable activity underpinned by key primary safety messages. Similar to the other CMO PA infographics, this resource has been designed to help HCPs to facilitate effective PA counselling and aid consultations. In addition, there is a link providing HCPs with further supporting evidence and guidance.6
USING AND SHARING THE INFOGRAPHIC
This infographic can be shared across professional networks, including social media. It should be available widely on surgery information boards and websites, antenatal classes, on the NHS Choices website, and anywhere that pregnant women may meet. If we can encourage physical activity during pregnancy this could provide evidence-based benefits that may lead to an active springboard for families to sustain healthy behaviours beyond childbirth.
- © British Journal of General Practice 2017