Associations between the prenatal exercise environment, exercise experience, and adherence: a cross-sectional study...

Prenatal exercise has established health benefits, yet adherence remains low, and the role of the exercise environment in shaping psychological experience during pregnancy is unclear. This study aimed to examine the associations of the prenatal exercise environment with exercise experience and psychological distress, with particular attention to the proposed affective and cognitive pathways within the Prenatal Exercise Environment Dual-pathway framework.

In this cross-sectional study, 361 pregnant women were recruited through multicenter convenience sampling from medical centers in five regions of China. The researcher-developed Prenatal Exercise Environment and Experience Questionnaire underwent preliminary psychometric evaluation in the current sample, followed by structural equation modeling with 5,000 bootstrap resamples and machine-learning analyses.

The prenatal exercise environment was positively associated with positive affective state (β = 0.328, p < 0.001) and exercise enjoyment (β = 0.270, p < 0.001) and negatively associated with repetitive negative thinking (β = -0.297, p < 0.001). Positive affective state was positively associated with exercise enjoyment (β = 0.143, p = 0.007), whereas repetitive negative thinking was negatively associated with exercise enjoyment (β = -0.216, p < 0.001). Exercise enjoyment was inversely associated with psychological distress (β = -0.253, p < 0.001). The model explained 21.8% of the variance in exercise enjoyment but only 6.4% in psychological distress, indicating limited explanatory power for the latter. Exploratory machine learning identified the sensory and physical environment as the strongest predictor of weekly Thermic Effect of Activity.

Prenatal exercise environments influence psychological outcomes through dual affective and cognitive pathways. Improving environmental quality and reducing negative cognition may enhance exercise engagement and mental well-being during pregnancy.