Journal of Behavioral Medicine

, Volume 41, Issue 5, pp 668–679 | Cite as

Psychosocial and demographic predictors of postpartum physical activity

  • Christine M. GuardinoEmail author
  • Calvin J. Hobel
  • Madeleine U. Shalowitz
  • Sharon L. Ramey
  • Christine Dunkel Schetter
  • Community Child Health Network (CCHN)


Physical activity promotes better health outcomes across the lifespan, and provides physical and mental health benefits for women who have recently given birth. However, research has not adequately characterized physical activity levels or risk factors for inadequate physical activity during the postpartum period. The objective of the present study was to describe levels and correlates of physical activity at 6 months postpartum in mothers of diverse race/ethnicity (55% African American, 23% White, 22% Hispanic/Latina), with the majority living in or near poverty. We analyzed data collected by the five-site Community Child Health Network study. Women (n = 1581) were recruited shortly after the birth of a child. Multinomial logistic regression models tested associations of demographic factors and self-reported stress in several life domains with total physical activity levels at 6–9 months postpartum, including activities done at work, at home, for transportation, and leisure. Thirty-five percent of participants in this sample reported low levels of physical activity. African American race, Latina ethnicity, and living in a rural area were associated with low levels of physical activity, whereas working outside the home was associated with high physical activity. Contrary to hypotheses, chronic stress was not associated with physical activity with the exception of financial stress, which predicted greater likelihood of being highly physically active. These findings suggest that optimal postpartum care should integrate physical activity promotion, and that African American, Latina, and rural-dwelling women may benefit most from efforts to promote activity following birth.


Physical activity Postpartum Health behaviors 



The CCHN was supported through cooperative agreements with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U HD44207, U HD44219, U HD44226, U HD44245, U HD44253, U HD54791, U HD54019, U HD44226-05S1, U HD44245-06S1, R03 HD59584) and the National Institute for Nursing Research (U NR008929).

Compliance with ethical standards

Conflict of interest

Christine M. Guardino, Calvin J. Hobel, Madeleine U. Shalowitz, Sharon L. Ramey and Christine Dunkel Schetter, on behalf of Community Child Health Network (CCHN) declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures performed in this study were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


  1. Adler, N. E., & Snibbe, A. C. (2003). The role of psychosocial processes in explaining the gradient between socioeconomic status and health. Current Directions in Psychological Science, 12(4), 119–123. CrossRefGoogle Scholar
  2. Ainsworth, B. E., Bassett, D. R., Jr., Strath, S. J., Swartz, A. M., O’Brien, W. L., Thompson, R. W., et al. (2000). Comparison of three methods for measuring the time spent in physical activity. Medicine and Science in Sports and Exercise, 32, S457–S464.CrossRefGoogle Scholar
  3. Ainsworth, B. E., Macera, C., Jones, D., Reis, J. P., Addy, C. L., Bowles, H. R., et al. (2006). Comparison of the 2001 BRFSS and the IPAQ Physical Activity Questionnaires. Medicine and Science in Sports and Exercise, 38, 1584–1592. CrossRefPubMedGoogle Scholar
  4. American College of Obstetrics and Gyencology. (2015). Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650.Google Scholar
  5. Armstrong, K., & Edwards, H. (2003). The effects of exercise and social support on mothers reporting depressive symptoms: A pilot randomized controlled trial. International Journal of Mental Health Nursing, 12, 130–138.CrossRefGoogle Scholar
  6. Baruth, M., Sharpe, P. A., Parra-Medina, D., & Wilcox, S. (2014). Perceived barriers to exercise and healthy eating among women from disadvantaged neighborhoods: Results from a focus groups assessment. Women & Health. CrossRefGoogle Scholar
  7. Bauman, A. E. (2004). Updating the evidence that physical activity is good for health: An epidemiological review 2000–2003. Journal of Science and Medicine in Sport, 7, 6–19.CrossRefGoogle Scholar
  8. Boulé, N. G., Haddad, E., Kenny, G. P., Wells, G. A., & Sigal, R. J. (2001). Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus. JAMA, 286, 1218–1227.CrossRefGoogle Scholar
  9. Brown, W. J., Heesch, K. C., & Miller, Y. D. (2009). Life events and changing physical activity patterns in women at different life stages. Annals of Behavioral Medicine, 37, 294–305.CrossRefGoogle Scholar
  10. Brownson, R. C., Baker, E. A., Housemann, R. A., Brennan, L. K., & Bacak, S. J. (2001). Environmental and policy determinants of physical activity in the United States. American Journal of Public Health, 91, 1995–2003.CrossRefGoogle Scholar
  11. Carlson, S. A., Fulton, J. E., Schoenborn, C. A., & Loustalot, F. (2010). Trend and prevalence estimates based on the 2008 Physical Activity Guidelines for Americans. American Journal of Preventive Medicine, 39, 305–313.CrossRefGoogle Scholar
  12. Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Reports, 100(2), 126–131.PubMedPubMedCentralGoogle Scholar
  13. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.CrossRefGoogle Scholar
  14. Cooney, G. M., Dwan, K., Greig, C. A., Lawlor, D. A., Rimer, J., Waugh, F. R., et al. (2013). Exercise for depression. Cochrane Database of Systematic Reviews. CrossRefPubMedGoogle Scholar
  15. Crespo, C. J., Smit, E., Andersen, R. E., Carter-Pokras, O., & Ainsworth, B. E. (2000). Race/ethnicity, social class and their relation to physical inactivity during leisure time: Results from the Third National Health and Nutrition Examination Survey, 1988–1994. American Journal of Preventive Medicine, 18, 46–53.CrossRefGoogle Scholar
  16. Daley, A. J., MacArthur, C., & Winter, H. (2007). The role of exercise in treating postpartum depression: A review of the literature. Journal of Midwifery & Women’s Health, 52, 56–62.CrossRefGoogle Scholar
  17. Davis, K., & Dimidjian, S. (2012). The relationship between physical activity and mood across the perinatal period: A review of naturalistic and clinical research to guide future investigation of physical activity-based interventions for perinatal depression. Clinical Psychology: Science and Practice, 19, 27–48. CrossRefGoogle Scholar
  18. Dunkel Schetter, C., Schafer, P., Lanzi, R. G., Clark-Kauffman, E., Raju, T. N. K., & Hillemeier, M. M. (2013). Shedding light on the mechanisms underlying health disparities through community participatory methods: the stress pathway. Perspectives on Psychological Science, 8, 613–633. CrossRefPubMedGoogle Scholar
  19. Evenson, K. R., Aytur, S. A., & Borodulin, K. (2009). Physical activity beliefs, barriers, and enablers among postpartum women. Journal of Women’s Health, 18, 1925–1934. CrossRefPubMedPubMedCentralGoogle Scholar
  20. Eyler, A. A., Baker, E., Cromer, L. C., King, A. C., Brownson, R. C., & Donatelle, R. J. (1998). Physical activity and minority women: A qualitative study. Health Education & Behavior, 25, 640–652.CrossRefGoogle Scholar
  21. Fishman, E. I., Steeves, J. A., Zipunnikov, V., Koster, A., Berrigan, D., Harris, T. A., et al. (2016). Association between objectively measured physical activity and mortality in NHANES. Medicine and Science in Sports and Exercise, 48, 1303–1311. CrossRefPubMedPubMedCentralGoogle Scholar
  22. Fleury, J., & Lee, S. M. (2006). The social ecological model and physical activity in African American women. American Journal of Community Psychology, 37, 129–140. CrossRefPubMedGoogle Scholar
  23. Fox, K. R. (1999). The influence of physical activity on mental well-being. Public Health Nutrition, 2, 411–418.CrossRefGoogle Scholar
  24. Hagberg, J. M., Park, J.-J., & Brown, M. D. (2000). The role of exercise training in the treatment of hypertension: An update. Sports Medicine, 30, 193–206.CrossRefGoogle Scholar
  25. Hagstromer, M., Oja, P., & Sjostrom, M. (2006). The International Physical Activity Questionnaire (IPAQ): A study of concurrent and construct validity. Public Health Nutrition, 9, 755–762.CrossRefGoogle Scholar
  26. Hamer, M., Endrighi, R., & Poole, L. (2012). Physical activity, stress reduction, and mood: Insight into immunological mechanisms. Methods in Molecular Biology, 934, 89–102. CrossRefPubMedGoogle Scholar
  27. Hellerstedt, W. L., & Jeffery, R. W. (1997). The association of job strain and health behaviours in men and women. International Journal of Epidemiology, 26, 575–583.CrossRefGoogle Scholar
  28. Hinkley, T., Crawford, D., Salmon, J., Okely, A. D., & Hesketh, K. (2008). Preschool children and physical activity. American Journal of Preventive Medicine, 34(5), 435–441. CrossRefPubMedGoogle Scholar
  29. Im, E.-O., Lee, B., Hwang, H., Yoo, K. H., Chee, W., Stuifbergen, A., et al. (2010). “A waste of time”: Hispanic women’s attitudes toward physical activity. Women and Health, 50, 563–579. CrossRefPubMedGoogle Scholar
  30. Jackson, J. S., Knight, K. M., & Rafferty, J. A. (2010). Race and unhealthy behaviors: Chronic stress, the HPA axis, and physical and mental health disparities over the life course. American Journal of Public Health, 100, 933–939. CrossRefPubMedPubMedCentralGoogle Scholar
  31. James, P., Troped, P. J., Hart, J. E., Joshu, C. E., Colditz, G. A., Brownson, R. C., et al. (2013). Urban sprawl, physical activity, and body mass index: Nurses’ health study and nurses’ health study II. American Journal of Public Health, 103(2), 369–375.CrossRefGoogle Scholar
  32. Johnson, K., Posner, S. F., Biermann, J., Cordero, J. F., Atrash, H. K., Parker, C. S., et al. (2006). Recommendations to improve preconception health and health care—United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR. Recommendations and Reports: Morbidity and Mortality Weekly Report. Recommendations and Reports/Centers for Disease Control, 55, 1–23.Google Scholar
  33. Jolliffe, J. A., Rees, K., Taylor, R. S., Thompson, D., Oldridge, N., & Ebrahim, S. (2001). Exercise-based rehabilitation for coronary heart disease. Cochrane Database Systematic Review, 1, CD001800.Google Scholar
  34. Juarbe, T. C. (1998). Cardiovascular disease-related diet and exercise experiences of immigrant Mexican women. Western Journal of Nursing Research, 20, 765–782.CrossRefGoogle Scholar
  35. Kershaw, K. N., Mezuk, B., Abdou, C. M., Rafferty, J. A., & Jackson, J. S. (2010). Socioeconomic position, health behaviors, and C-reactive protein: a moderated-mediation analysis. Health Psychology, 29, 307–316. CrossRefPubMedPubMedCentralGoogle Scholar
  36. King, A. C., Castro, C., Wilcox, S., Eyler, A. A., Sallis, J. F., & Brownson, R. C. (2000). Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women. Health Psychology, 19, 354–364.CrossRefGoogle Scholar
  37. Lu, M. (2007). Recommendations for preconception care. American Family Physician, 76, 397–400.PubMedGoogle Scholar
  38. Mama, S. K., Quill, B. E., Fernandez-Esquer, M. E., Reese-Smith, J. Y., Banda, J. A., & Lee, R. E. (2011). Body image and physical activity among Latina and African American women. Ethnicity and Disease, 21(3), 281–287.PubMedGoogle Scholar
  39. Mathieu, R. A., Powell-Wiley, T. M., Ayers, C. R., McGuire, D. K., Khera, A., Das, S. R., et al. (2012). Physical activity participation, health perceptions, and cardiovascular disease mortality in a multiethnic population: The Dallas Heart Study. American Heart Journal, 163, 1037–1040. CrossRefPubMedPubMedCentralGoogle Scholar
  40. Mezuk, B., Abdou, C. M., Hudson, D., Kershaw, K. N., Rafferty, J. A., Lee, H., et al. (2013). “White Box” epidemiology and the social neuroscience of health behaviors. Society and Mental Health, 3, 79–95. CrossRefGoogle Scholar
  41. Mezuk, B., Rafferty, J. A., Kershaw, K. N., Hudson, D., Abdou, C. M., Lee, H., et al. (2010). Reconsidering the role of social disadvantage in physical and mental health: stressful life events, health behaviors, race, and depression. American Journal of Epidemiology, 172, 1238–1249. CrossRefPubMedPubMedCentralGoogle Scholar
  42. Moraska, A., & Fleshner, M. (2001). Voluntary physical activity prevents stress-induced behavioral depression and anti-KLH antibody suppression. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 281, R484–R489. CrossRefPubMedGoogle Scholar
  43. Moore, L. L., Lombardi, D. A., White, M. J., Campbell, J. L., Oliveria, S. A., & Ellison, R. C. (1991). Influence of parents’ physical activity levels on activity levels of young children. The Journal of Pediatrics, 118(2), 215–219. CrossRefPubMedGoogle Scholar
  44. Myers, H. F. (2009). Ethnicity- and socio-economic status-related stresses in context: An integrative review and conceptual model. Journal of Behavioral Medicine, 32, 9–19. CrossRefPubMedGoogle Scholar
  45. Ng, D. M., & Jeffery, R. W. (2003). Relationships between perceived stress and health behaviors in a sample of working adults. Health Psychology, 22, 638–642. CrossRefPubMedGoogle Scholar
  46. O’Campo, P., Schetter, C. D., Guardino, C. M., Vance, M. R., Hobel, C. J., Ramey, S. L., et al. (2016). Explaining racial and ethnic inequalities in postpartum allostatic load: Results from a multisite study of low to middle income woment. SSM-Population Health. CrossRefPubMedPubMedCentralGoogle Scholar
  47. O’Toole, M. L., Sawicki, M. A., & Artal, R. (2003). Structured diet and physical activity prevent postpartum weight retention. Journal of Women’s Health, 12, 991–998. CrossRefPubMedGoogle Scholar
  48. Olson, C. M., Strawderman, M. S., Hinton, P. S., & Pearson, T. A. (2003). Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum. International Journal of Obesity, 27, 117–127.CrossRefGoogle Scholar
  49. Orchard, T. J., Temprosa, M., Goldberg, R., Haffner, S., Ratner, R., Marcovina, S., et al. (2005). The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: The Diabetes Prevention Program randomized trial. Annals of Internal Medicine, 142, 611.CrossRefGoogle Scholar
  50. Parks, S. E., Housemann, R. A., & Brownson, R. C. (2003). Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States. Journal of Epidemiology and Community Health, 57, 29–35.CrossRefGoogle Scholar
  51. Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Current Opinion in Psychiatry, 18, 189. CrossRefPubMedGoogle Scholar
  52. Pereira, M. A., Rifas-Shiman, S. L., Kleinman, K. P., Rich-Edwards, J. W., Peterson, K. E., & Gillman, M. W. (2007). Predictors of change in physical activity during and after pregnancy: Project Viva. American Journal of Preventive Medicine, 32, 312–319.CrossRefGoogle Scholar
  53. Perng, W., Stuart, J., Rifas-Shiman, S. L., Rich-Edwards, J. W., Stuebe, A., & Oken, E. (2015). Preterm birth and long-term maternal cardiovascular health. Annals of Epidemiology, 25, 40–45. CrossRefPubMedGoogle Scholar
  54. Ramey, S. L., Schafer, P., Declerque, J. L., Lanzi, R. G., Hobel, C., Shalowitz, M., et al. (2015). The Preconception Stress and Resiliency Pathways model: A multi-level framework on maternal, paternal, and child health disparities derived by Community-Based Participatory Research. Maternal and Child Health Journal, 19, 707–719. CrossRefGoogle Scholar
  55. Rebar, A. L., Stanton, R., Geard, D., Short, C., Duncan, M. J., & Vandelanotte, C. (2015). A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations. Health Psychology Review, 9, 366–378. CrossRefPubMedGoogle Scholar
  56. Sallis, J. F., Prochaska, J. J., & Taylor, W. C. (2000). A review of correlates of physical activity of children and adolescents. Medicine and Science in Sports and Exercise, 32, 963–975.CrossRefGoogle Scholar
  57. Sampselle, C. M., Seng, J., Yeo, S., Killion, C., & Oakley, D. (1999). Physical activity and postpartum well-being. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 28, 41–49. CrossRefPubMedGoogle Scholar
  58. Schiller, J. S., Lucas, J. W., Ward, B. W., & Peregoy, J. A. (2012). Summary health statistics for U.S. adults: National Health Interview Survey, 2010. Vital and Health Statistics, 10, 1–207.Google Scholar
  59. Stephens, T. (1988). Physical activity and mental health in the United States and Canada: Evidence from four population surveys. Preventive Medicine, 17(1), 35–47.CrossRefGoogle Scholar
  60. Stults-Kolehmainen, M. A., & Sinha, R. (2014). The effects of stress on physical activity and exercise. Sports Medicine, 44, 81–121. CrossRefPubMedGoogle Scholar
  61. Tanner Stapleton, L. R., Dooley, L., Guardino, C. M., Paek, C., Huynh, J., & Dunkel Schetter, C. (2015). The Community child health network life stress interview: A brief chronic stress measure for community health research. Anxiety, Stress & Coping, 29(4), 352–366.CrossRefGoogle Scholar
  62. Thompson, P. D., Buchner, D., Piña, I. L., Balady, G. J., Williams, M. A., Marcus, B. H., et al. (2003). Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Arteriosclerosis, Thrombosis, and Vascular Biology, 23(8), e42–e49.Google Scholar
  63. Trost, S. G., Owen, N., Bauman, A. E., Sallis, J. F., & Brown, W. (2002). Correlates of adults’ participation in physical activity: Review and update. Medicine and Science in Sports and Exercise, 34, 1996–2001. CrossRefPubMedGoogle Scholar
  64. U.S. Department of Health and Human Services. (2008). Physical Activity Guidelines for Americans. Washington, DC.Google Scholar
  65. Viladrich, A., Yeh, M.-C., Bruning, N., & Weiss, R. (2009). “Do Real Women Have Curves?” Paradoxical body images among Latinas in New York City. Journal of Immigrant and Minority Health, 11, 20–28. CrossRefPubMedGoogle Scholar
  66. Vogel, T., Brechat, P., Leprêtre, P., Kaltenbach, G., Berthel, M., & Lonsdorfer, J. (2009). Health benefits of physical activity in older patients: A review. International Journal of Clinical Practice, 63, 303–320.CrossRefGoogle Scholar
  67. Warburton, D. E. R., Nicol, C. W., & Bredin, S. S. D. (2006). Health benefits of physical activity: The evidence. Canadian Medical Association Journal, 174, 801–809.CrossRefGoogle Scholar
  68. Wilcox, S., Castro, C., King, A., Housemann, R., & Brownson, R. C. (2000). Determinants of leisure time physical activity in rural compared with urban older and ethnically diverse women in the United States. Journal of Epidemiology and Community Health, 54, 667–672.CrossRefGoogle Scholar
  69. Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of Health Psychology, 2(3), 335–351.CrossRefGoogle Scholar
  70. Wolfe, W. A. (2000). Obesity and the African–American woman: A cultural tolerance of fatness or other neglected factors. Ethnicity and Disease, 10, 446–453.PubMedGoogle Scholar
  71. Wu, P., Kwok, C. S., Haththotuwa, R., Kotronias, R. A., Babu, A., Fryer, A. A., et al. (2016). Pre-eclampsia is associated with a twofold increase in diabetes: A systematic review and meta-analysis. Diabetologia, 59, 2518–2526. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychologyDickinson CollegeCarlisleUSA
  2. 2.Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, The Burns and Allen Research InstituteCedars-Sinai Medical CenterLos AngelesUSA
  3. 3.North Shore University Health System Research Institute and Department of PediatricsUniversity of ChicagoEvanstonUSA
  4. 4.Virginia Tech Carilion Research InstituteVirginia TechRoanokeUSA
  5. 5.Department of PsychologyUniversity of California, Los AngelesLos AngelesUSA
  6. 6.Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentRockvilleUSA

Personalised recommendations