Environmental Supports, Expectations, and Barriers to Leisure-Time Physical Activity During Pregnancy: A Rural-Urban...

Physical activity (PA) during pregnancy has well-documented benefits, yet pregnant rural residents may face additional barriers to PA.

To examine whether leisure-time physical activity (LTPA) and correlates of LTPA, including exercise outcome expectations, barriers, and environmental supports for PA, differ by rurality, and explore whether rurality moderates the associations between these correlates and LTPA during pregnancy.

Pregnant individuals from Iowa and West Virginia (n = 374) completed questionnaires assessing LTPA, exercise outcome expectations and barriers during each trimester, and environmental supports for PA at the first trimester. Rurality status was categorized as urban, micropolitan, or small town rural using Rural-Urban Commuting Area codes. Robust linear mixed effects models included trimester as a fixed effect and a random intercept for participant. Environmental supports were analyzed using a robust linear model restricted to first-trimester data. Models were adjusted for site, age, pre-pregnancy body mass index, education, parity, and minority status.

In unadjusted models, small-town rural participants engaged in less LTPA than urban participants (9.02 vs. 12.14 MET-h/week, p = 0.021), though this was not significant after adjustment. Small-town rural participants reported fewer environmental supports for PA than urban participants (β = -0.42 SD, p = 0.002). Rurality did not moderate the associations between examined correlates and LTPA.

Rurality was not associated with LTPA, exercise expectations, or barriers after adjustment. Although small-town rural participants reported fewer environmental supports for PA, this was not associated with LTPA, warranting further investigation in larger samples to determine whether improving environmental supports would translate into increased LTPA during pregnancy.