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Psychology, Society & Education
versión On-line ISSN 1989-709X
Psychology, Society & Education vol.15 no.2 Córdoba may./ago. 2023 Epub 18-Mar-2024
https://dx.doi.org/10.21071/psye.v15i2.15817
Articles
Physical activity association with body image in postpartum women
1 Universidad de Huelva, Huelva (Spain)
2 Universidad de Granada, Granada (Spain)
The perception of body image is usually affected in the different stages of a woman’s life. The practice of physical exercise would be related to an improvement in the perception of body image, so it is important to investigate how the practice of physical exercise affects body image in the postpartum stage, since at this stage the perception is usually more negative . For this purpose, an online questionnaire was designed, consisting of socio-demographic questions, the International Physical Activity Questionnaire and the Body Shape Questionnaire. The sample consisted of 80 Spanish women, aged between 23 and 42 years, who were mothers in 2020 and 2021. The results show that the Body Mass Index is positively and significantly associated with body dissatisfaction. However, in relation to physical exercise, the results showed an inverse relationship. The women with the highest body dissatisfaction were those with the highest Body Mass Index and the highest level of physical activity, with Body Mass Index being the variable that most explained body dissatisfaction.
Keywords: Body image; Postpartum; Body Mass Index; Exercise; Women
Pregnancy and the postpartum period are characterized by major physiognomic, psychosocial, and hormonal alterations that lead to changes in the physical appearance, differences in the way of interaction with the environment, and, among many other issues, adjustment processes to a new role and a different life situation (Gross & Marcussen, 2017). Moreover, the fast physics changes which originate in the body and its image in a relatively short period (40 weeks), make the pregnancy an ideal time to assess the body image prospectively (Skouteris, 2011).
During the pregnancy, important psychological and emotional sequels can happen as a result to these changes. The concern of body image is one of these sequels (Kiani-Sheikhabadi et al., 2019). It is probably that women reassess her body image, since the body’s size and image change, and the related physical symptoms with the pregnancy are more pronounced. This potentially allows for a possible consequence of factors that drive to the lack of body satisfaction with other women’s life moments, in which the body shape remains relatively stable (Kiani-Sheikhabadi et al., 2019).
During the postpartum period, women can have a deep pressure for “recovery” and lose weight rapidly (Montgomery et al., 2013). The “perfect body” stereotypes sold by the media emphasize the importance of achieving an unrealistically slim and toned postpartum body (Lovering et al., 2018). As a result, the concern related to the body can be high, especially because body changes after the pregnancy are often unexpected and out of hand (Borrelli et al., 2016; Skouteris, 2005).
Different investigations (Clark et al., 2009; Gjerdingen et al., 2009) have shown that body dissatisfaction increases in a significant way after childbirth until 12 months, which is of concern as it is associated with poorer mental health and the acquisition of eating disorders. For Carter-Edwards (2010) there are substantial changes during pregnancy related to weight gain, leading on multiple occasions to situations of overweight and obesity during pregnancy and after childbirth. Women who gain weight during pregnancy have more chances to keep more weight during postpartum period than women with a moderate weight gain (Rooney et al., 2002), being the Body Mass Index (BMI) a variable that can influence the body image. In addition to changes in body image, many women in postpartum period report a decrease in physical exercise (Walker et al., 2016). A systematic review by Engberg et al. (2012) identifies different studies in which physical exercise decrease significantly before pregnancy until postpartum period. Systematic physical exercise has a positive impact on women’s physical health during pregnancy and postpartum (Bull et al., 2020). However, despite scientific evidence to this effect, there is little empirical evidence on this issue. Body image changes and alterations in physical exercise behaviour are two important areas of change that have a strong capacity to influence welfare (Downs et al., 2008). Nevertheless, the complexities and interrelationships between body image and exercise at this stage are not well understood. In this sense, the relationship is complex and bidirectional.
On the one hand, there is evidence that women who follow the physical exercise guidelines have better body satisfaction (Boscaglia et al., 2003; Hilton & Olson, 2001). In a cross-sectional study of 440 women, body satisfaction was significantly higher in those who engaged in systematic physical exercise (Erbil et al., 2012). In addition, there is evidence that body image dissatisfaction in the early postpartum period is a strong determinant of body image dissatisfaction one year later (Rallis et al., 2007). Similarly, women who are active before pregnancy may enjoy better health during pregnancy and postpartum period (Abraham et al., 2001). However, these findings are based in a small number of studies with little samples. On the other hand, there are studies which have shown significantly negative associations between body dissatisfaction and physical exercise (Walkert et al., 2016). Likewise, there are studies that could not find any association between body image and physical exercise (Collings et al., 2018). A qualitative study reveals that the relation between physical exercise and body image is complex, individualistic, dynamic, and context-dependent (Raspovic et al., 2020). Most of the women who participated in the study stated that they exercised or did not exercise largely because of body dissatisfaction and that this led to negative situations related to their body. On the contrary, moms who showed more body satisfaction described more adaptative exercise behaviours.
A problem that may be hampering research evidence in this area is the difficulty in measuring exercise behaviour, specifically the prevalence rate of physical activity level during this stage. Some 70% of pregnant women are inactive (Evenson et al., 2004), and null and low rates persist postpartum (Pereira et al., 2007). Therefore, there is a need for research examining the influence of physical exercise behaviour and its contribution to explain women’s body image in postpartum period. Considering the contradictory results of the scientific evidence in relation to the practice of physical activity and changes in body image, the aim of this job is to know to what extent physical exercise gives benefits to women in postpartum period in relation to their body image taking into account their body composition.
Method
Design and participants
This study is part of a cross-sectional and observational research with a retrospective cohort focused on before, during, and after pregnancy stages. The sample consisted of 80 Spanish women, aged between 23 to 42 years (M = 33.94; SD = 4.26) who were mothers in 2020 and 2021. Inclusion criteria were as follows: (1) the voluntary participation in the study, (2) having a healthy baby, (3) being in the postpartum stage from 0 to 12 months, and (4) being over 18 years of age. Participants were informed about the study design and their consent was requested prior to participation. During data collection, current ethical and legal standards for research involving human subjects and data protection were respected.
Instruments
General sociodemographic information was collected on each participant, including age, employment status, number of children, months of breastfeeding, and physical activity before, during, and after pregnancy. Body composition was assessed by BMI. The BMI was calculated with the following formula: BMI = weight / height2 (kg/m2). For the BMI coding, the WHO classification was taken into account, in which a BMI equal to or greater than 30 kg/m2 was considered as obesity.
To assess physical activity, the International Physical Activity Questionnaire (IPAQ) (Craig et al., 2003) was used. The IPAQ consists of seven questions about the frequency, duration, and intensity of activity (low, moderate, and intense) performed in the last seven days, as well as walking and sitting time in a working day. On the basis of the results, three levels of physical activity were proposed: Light physical activity, with no activity or some activity, but not enough to be included in the following categories; Moderate physical activity, with three or more days of vigorous activity with an intensity of at least 20 minutes per day, five or more days of moderate intensity and/or walking at least 30 minutes per day, or five or more days of any combination of walking, moderate intensity activity, and vigorous activity, adding up to a minimum total physical activity of at least 600 MET-minutes/week; and Intense physical activity, with vigorous intensity activities at least three days achieving a minimum total physical activity of at least 1,500 MET-minutes/week or seven or more days of any combination of walking, moderate intensity, or vigorous intensity activities, achieving a minimum total physical activity of at least 3,000 MET-minutes/week (Delgado, Tercedor & Soto, 2005).
The Body Shape Questionnaire (BSQ), developed by Cooper and colleagues in 1987 and adapted to the Spanish population by Raich et al. (1996), was used to measure body image. The instrument measures concern about weight and dissatisfaction with body image. It consists of 34 items (“Has worrying about your figure made you go on a diet?”) with a Likert-type scale with the following values: 1 = never; 2 = rarely; 3 = sometimes; 4 = often; 5 = very often; 6 = always. The questionnaire has a total score in which all partial scores for each item have to be added together. The Cronbach’s alpha was 0.92.
Procedure
An online survey was completed and sent by email to exercise professionals at sports centres specializing in pregnancy and postpartum for distribution. Participants signed a statement giving their consent to collect personal information, as well as to submit to the questionnaires comprising this research, all of which were detailed in the initial pre-questionnaire information.
Data analysis
A descriptive analysis of the study variables was performed, using the mean and standard deviation to explain the quantitative characteristics of the sample and the number and percentage for the qualitative characteristics. The normality of the distributions and the homogeneity of the variables were tested with the Kolmogorov-Smirnov test. The Wilcoxon test and Mann-Whitney U test were used to study the relationship between physical activity before during and after pregnancy and body composition. To analyse whether the level of physical activity was related to body image, the Kruskall Wallis test was used, using a post hoc test to establish differences between levels of physical activity (light, moderate, or vigorous). An analysis of variance was performed to jointly assess the effects of BMI and physical activity level on body dissatisfaction. The Spearman correlation was used to quantitatively relate body image and physical activity. Finally, a multivariate linear regression analysis was performed to estimate the predictive power of body dissatisfaction as the dependent variable and age, BMI, months postpartum, and total physical activity as independent variables. The significance level was set at .05. The statistical package SPSS 22.0 for Windows was used to create the database and subsequent statistical analysis.
Results
Table 1 shows the descriptive results of the participants. It was observed a higher physical activity rate during pregnancy, it was also noted that more than a half of these women have an active job. The practice of physical activity is more important at all the stages -before, during, and after pregnancy-, being fewer the number of women who did not practice it. Finally, it is noted that, in all stages previous mentioned, the predominant type of physical activity among these women is strength training, gymnasiums, and fitness.
Table 1. Descriptive characteristics of the participants
| Variables | M (SD) |
|---|---|
| Age (years) | 33.9 (4.25) |
| Breastfeeding (months) | 132.2 (96.6) |
| Pregnancy weight (kg) | 11.9 (7.2) |
| PA before pregnancy (days/week) | 3.78 (1.83) |
| PA during pregnancy (days/week) | 4.20 (2.17) |
| PA after pregnancy (days/week) | 3.59 (2.14) |
| N (%) | |
| Occupation | |
| Housewife | 6 (7.5) |
| Active work | 45 (56.3) |
| Non-active work | 29 (36.3) |
| Physical activity before | |
| Yes | 72 (90) |
| No | 8 (10) |
| Physical activity during | |
| Sí | 70 (87.5) |
| No | 10 (12.5) |
| Physical activity after | |
| Sí | 68 (85) |
| No | 12 (15) |
| BMI (kg/m 2 ) | |
| Underweight | 6 (7.5) |
| Normal weight | 58 (72.5) |
| Overweight | 14 (17.5) |
| Obesity | 2 (2.5) |
Table 2 analyses the relationship between physical activity before, during, and after pregnancy and the BMI of the polled people. Significantly statistically differences were observed in the BMI between women who practiced physical activity after pregnancy (U = 286.5; W = 2632.5; p = .05), being the BMI higher in those women who did not practice physical activity during postpartum. On the contrary, no differences were observed in the BMI of those who practiced physical activity before and during pregnancy (U = 226.5; W = 262.5; p = .166 y U = 321.5; W = 286.5; p = .343, respectively).
Table 2. Relationship of physical activity to BMI before, during and after pregnancy
| PA | BMI (kg/m2) | p Valor | |
|---|---|---|---|
| Before pregnancy | Yes | 41.3 | .166 |
| No | 32.8 | ||
| During pregnancy | Yes | 40.1 | .343 |
| No | 43.3 | ||
| After pregnancy | Yes | 38.7 | .051 |
| No | 50.6 |
Figure 1 shows the association between the physical activity level and body image. It was observed that those women who were more physically active were more dissatisfied with their body image. In a post hoc test, it was stablished that the only significant differences are between the moderate physical activity group (average range BSQ = 47.64; p = .023) and the high-level group of physical activity (average range BSQ = 34.66).
Figure 2 shows the comparative analysis between the categorised BMI and body image dissatisfaction. Sadistically significant differences were observed between the different BMI groups and body image dissatisfaction (χ2 kw (2) = 12.4; p = .006; n = 80), in other words, the higher the BMI, the higher the dissatisfaction with body image. In particular, we find differences when we compare the underweight group with the overweight one (p = .005) and the underweight group with the obesity one (p = .004), being the average ranges in the underweight category 19.6, in the overweight category 51.3, and in the obesity category 74.5.
An analysis of variance was conducted to jointly assess the BMI and physical exercise level about body dissatisfaction (Table 3). The results of this analysis show the existence of significant differences according to BMI (p = .031) and not according to the level of physical activity. The interaction between the two was not statistically significant. The variance percentage of BMI was 11.7%.
Table 3. Test of inter-subject effects between BMI and level of physical activity
| Type III sum of squares | gl | Quadratic mean | F | p Valor | Eta2 | |
|---|---|---|---|---|---|---|
| BMI | 4351.6 | 3 | 1450.5 | 3.14 | .031 | 0.117 |
| PA | 2013.8 | 2 | 1006.9 | 2.18 | .12 | 0.058 |
| BMI*PA | 1538.2 | 3 | 512.7 | 1.11 | .351 | 0.045 |
Note. PA = Physical Activity; BMI = Body Mass Index.
Table 4 shows the analysed correlations between body dissatisfaction, body mass index, and physical activity according to time and typology. A positive association existed between body dissatisfaction and BMI (p < .01), the weekly frequency of physical activity practice after pregnancy, as well as the practice typology, mainly through reported light PA (p < .05).
Table 4. Bivariate correlation analysis between BSQ, Body Mass Index, and physical activity according to time and typology
| BMI | Days PA before | Days PA during | Days PA after | METs Total | METs light PA | METs PA moderate | METs PA intense | |
|---|---|---|---|---|---|---|---|---|
| BSQ | 0.468** | 0.19 | 0.174 | 0.235* | 0.206 | 0.259* | 0.143 | 0.115 |
**p < .01; *p < .05.
Table 5 shows multivariate linear regression analysis between body dissatisfaction as a dependent variable and age, BMI, months postpartum, and total physical activity as independent variables. Overall, it was observed that both BMI (β = 0.40; p < .001) and overall physical activity (β = 0.35; p < .001) of the participants were predictors of their body image, being explained in 31.8% of them. On the contrary, age in last month of pregnancy did not prove to be predictor of body image when these variables were introduced into the model.
Table 5. Multivariate linear regression analysis between body image and age, body mass index, last month of pregnancy and overall physical activity
| Model | B | SE | β | t | p Valor | R2 | R2 Ajustado | |
|---|---|---|---|---|---|---|---|---|
| 1 | (Interception) | 78.7 | 2.89 | − | 27.2 | < .001 | 0.000 | 0.000 |
| 2 | (Interception) | -7.2 | 18.1 | − | -0.4 | .692 | 0.564 | 0.318 |
| Age (years) | 0.42 | 0.59 | 0.07 | 0.7 | .483 | |||
| BMI (kg/m2) | 3.32 | 0.8 | 0.4 | 4.14 | < .001 | |||
| Last pregnancy (months) | 0.37 | 0.83 | 0.04 | 0.45 | .652 | |||
| PA (Mets) | 0.01 | 0.01 | 0.35 | 3.76 | < .001 | |||
Note. SE = Standard Error; PA = Physical Activity; BMI = Body Mass Index.
Discusion
The aim of the study was to determine to what extent engaging in physical exercise provides benefits to women during the postpartum stage in terms of their body image, taking into account their body composition.
Consistent with previous research (Clark et al., 2009; Skouteris, 2005), the results demonstrate that women with higher BMI exhibited greater body dissatisfaction during the postpartum stage. We observed a significant and positive association between body image dissatisfaction and BMI. Similar findings were reported by Ballester et al. (2008), who found that women with higher BMI had greater dissatisfaction with their body image. The study by Sarwer et al. (2011) further emphasizes that body dissatisfaction is more significant when there is gestational weight gain, that is, when BMI is higher.
Although our sample consists of Spanish postpartum women, this relationship can be found in several studies from different countries. While it is true that body image varies according to ethnicity and country of residence, this study indicates that regardless of these factors, individuals with higher BMI experience greater body dissatisfaction (Casillas-Estrella et al., 2006). However, there are articles that reach opposite conclusions (Carter-Edwards et al., 2010). In this regard, the literature demonstrates that there are racial differences in postpartum weight, ideal body images, and body satisfaction. Body discrepancy among African American women was significantly lower than that of white women, indicating greater body satisfaction among African American women.
Regarding physical exercise, we obtained results showing an inverse relationship with body image. We already know all the benefits of physical exercise on health, including that of pregnant and postpartum women. We found physiological benefits, physical exercise is protective and positively associated with physical fitness. It also has significant psychological benefits such as reducing depression, improving quality of life, and enhancing perceived health (Nygaard et al., 2013). However, in our study, when measuring the effects of physical activity on body image, the relationship was inverse. This means that higher body dissatisfaction was associated with greater engagement in physical exercise. This could be because women with poorer body composition or higher BMI, when dissatisfied with their physical condition, decide to engage in more physical exercise or increase its intensity as a means to modify their bodies.
In the present study, it was observed that individuals who consider physical activity as a fundamental aspect of their lives exhibited greater body dissatisfaction. One possible explanation could be the fear of gaining weight as it could be a motivating factor for engaging in physical activity, and this fear of weight gain would be related to body image (Arbinaga et al., 2011).
Although our sample may not be similar to the one in the previous article, we can observe that a relationship could be established between the fear of gaining weight or increasing BMI and an increase in physical exercise. Gaining weight or increasing BMI in these women would increase the likelihood of engaging in more physical exercise, which aligns with the results of our sample.
All this concern about body image during the postpartum period could be explained by the literature suggesting that women perceive sociocultural pressures to achieve ideal but unrealistic perfect bodies during this stage, which contributes to their body image concerns (Faleschini et al., 2019; Lovering et al., 2018; Riesco-González et al., 2022).
The level of physical exercise performed by these women before, during, and after pregnancy has been studied, with a particular focus on the physical exercise conducted after childbirth. Women who did not engage in any form of exercise during their postpartum period had higher BMI. In this study, body image was statistically explained to a greater extent by BMI than by level of physical exercise practiced, which is consistent with the following study that solely examines the BMI of women without measuring their physical exercise in relation to body image (Walker et al., 2004).
It is important to note some limitations that should be taken into account. The data were collected remotely due to the COVID-19 pandemic, which led us to conduct this research entirely online. The data obtained came from a convenience sample and non-probabilistic sampling, since we only included women who were within one year postpartum, resulting in a sample composed of women who were in the postpartum stage for one year or less.
However, the data from this study have provided valuable insights and have allowed us to increase knowledge about how different factors, such as BMI and physical exercise, affect the body image of postpartum women. In conclusion, further research is necessary, and new studies with larger samples should be conducted, incorporating different exercise interventions aimed at improving the body image of these women. Additionally, objective assessments of physical activity should be incorporated, as the IPAQ is a self-reported questionnaire and the results are subject to the accuracy and honesty of the responses.
Conclusions
The findings of this study reveal that higher BMI values are associated with greater body dissatisfaction during the postpartum period. Furthermore, women who engaged in more physical activity during this stage experienced more issues with their body image and provide women with the necessary tools to improve their body image during the postpartum period.
Further large-scale and long-term research is needed to explore the relationship between body image and exercise, as well as to develop interventions aimed at enhancing body appreciation and reducing body dissatisfaction.
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Received: March 05, 2023; Revised: June 13, 2023; Accepted: July 07, 2023
Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons
