Weir et al. BMC Pregnancy and Childbirth 2010, 10:18http://www.biomedcentral.com/1471-2393/10/18

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Research articlePhysical activity in pregnancy: a qualitative study of the beliefs of overweight and obese pregnant womenZoe Weir1, Judith Bush*1, Stephen C Robson2, Catherine McParlin3, Judith Rankin1 and Ruth Bell1

AbstractBackground: Whilst there has been increasing research interest in interventions which promote physical activity during pregnancy few studies have yielded detailed insights into the views and experiences of overweight and obese pregnant women themselves. The qualitative study described in this paper aimed to: (i) explore the views and experiences of overweight and obese pregnant women; and (ii) inform interventions which could promote the adoption of physical activity during pregnancy.

Methods: The study was framed by a combined Subtle Realism and Theory of Planned Behaviour (TPB) approach. This enabled us to examine the hypothetical pathway between beliefs and physical activity intentions within the context of day to day life. The study sample for the qualitative study was chosen by stratified, purposive sampling from a previous study of physical activity measurements in pregnancy. Research participants for the current study were recruited on the basis of Body Mass Index (BMI) at booking and parity. Semi-structured, in-depth interviews were conducted with 14 overweight and obese pregnant women. Data analysis was undertaken using a Framework Approach and was informed by TPB.

Results: Healthy eating was often viewed as being of greater importance for the health of mother and baby than participation in physical activity. A commonly cited motivator for maintaining physical activity during pregnancy is an aid to reducing pregnancy-related weight gain. However, participants often described how they would wait until the postnatal period to try and lose weight. A wide range of barriers to physical activity during pregnancy were highlighted including both internal (physical and psychological) and external (work, family, time and environmental). The study participants also lacked access to consistent information, advice and support on the benefits of physical activity during pregnancy.

Conclusions: Interventions to encourage recommended levels of physical activity in pregnancy should be accompanied by accessible and consistent information about the positive effects for mother and baby. More research is required to examine how to overcome barriers to physical activity and to understand which interventions could be most effective for overweight/obese pregnant women. Midwives should be encouraged to do more to promote activity in pregnancy.

BackgroundAn increasing proportion of women in the UK are obeseor overweight at the start of their pregnancy [1,2]. Thismay result in adverse consequences for the immediateand longer-term health of the mother and child [3,4]. Inlight of this, pregnancy is emerging as a priority area for

interventions which aim to address the obesity epidemic.Pregnancy is a unique and critical period in the lifecourse for women and, consequently, they may be morereceptive to behaviour change interventions [5]. Physicalactivity promotion is a key component of weight controlinterventions [6] as it has beneficial effects on glucosemetabolism. It has also been suggested that this mayimprove pregnancy outcomes independent of weight [7].National guidance in the UK recommends at least 30

* Correspondence: judith.bush@ncl.ac.uk1 Institute of Health & Society, Newcastle University, Medical Sciences New Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UKFull list of author information is available at the end of the article

BioMed Central© 2010 Weir et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons At-tribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in anymedium, provided the original work is properly cited.

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minutes of moderate intensity activity a day throughoutpregnancy for most women [8,9]. However, research hashighlighted that pregnant women often have low totalphysical activity levels [10] and that these tend to reducefurther in the later stages of pregnancy [11].

There is a dearth of information regarding women'sattitudes to physical activity in pregnancy. A small num-ber of studies have highlighted significant barriers to par-ticipation, including lack of time, lack of facilities(including childcare) and physical barriers [12-15].Indeed it has been found that some women perceivephysical activity to be an unsafe behaviour when pregnant[16,17]. However, few studies have offered detailedinsights into the views and experiences of overweight andobese women themselves. This paper provides qualitativeinsights into how overweight and obese pregnant womenliving in the UK feel about physical activity in pregnancywithin the context of their day to day lives. The findingshighlight the barriers and motivators which surroundphysical activity in pregnancy, the conflicting advice andinformation which women receive during pregnancy, andwhich criteria should be considered when designingeffective interventions for physical activity in pregnancy.

MethodsTheoretical FrameworkThe study was framed by a theoretical approach whichcombined both Subtle Realism [18] and the Theory ofPlanned Behaviour (TPB). This combined approachenabled an examination of the hypothetical pathwaybetween beliefs and physical activity intentions within thecontext of a woman's day to day life. The Subtle Realismapproach [18] stipulates that the social world does existindependently of individual subjective understandings,but is only accessible to us via research participants'interpretations [19]. The TPB is a psychological modelwidely used in the design of behaviour change interven-tions [20]. The TPB approach stipulates that intentionspredict behaviour, and that three sets of beliefs mediatebehavioural intentions in relation to the following crite-ria: (i) behavioural beliefs, i.e. attitudes based on per-ceived benefits and harms, (ii) control beliefs, i.e.perceptions relating to control over necessary resourcesand support to engage in the relevant behaviour; and (iii)normative beliefs i.e. subjective norms, determined byperceptions of the views of others. Using a combined TPBand Subtle Realism approach it was possible to examinewomen's views and experiences within the context oftheir day to day concerns and priorities.

Study participantsEthical approval was given by the Durham and Tees Val-ley 2 Rec (Ref:07/H0908/53), and written informed con-sent was obtained from the study participants. The

sampling frame consisted of 65 women participating in afeasibility study of physical activity measurement meth-ods. Inclusion criteria for the previous study were: (i) anywoman booking with a normal, singleton pregnancy, (ii) ameasured body mass index (BMI) at booking (in the firsttrimester) greater than or equal to 25 kg/m2 (i.e. over-weight or obese), (iii) adequate verbal and written Englishand (iv) older than 16 yrs. Of the women participating inthe measurement study, around 40% were obese, 47%were nulliparous (no previous children), 93% were white,76% were employed at recruitment and 33% were edu-cated to degree level. These women agreed to wear anaccelerometer for seven days at two or three time pointsduring pregnancy and to complete two different physicalactivity questionnaires at each data collection. The mea-surement study was designed to compare self report andobjective measurement methods in pregnant womenduring normal daily activities.

Previous research has highlighted that weight and fam-ily size may influence physical activity participation innon-pregnant women [21,22]. Thus, a stratified purpo-sive sample [19] for the current study was undertakenaccording to BMI and parity. These criteria allowed somediversity in the sample and thus a broad range of women'sexperiences was explored. Of the 22 women invited toparticipate in the study, 14 agreed to be interviewed. Allof the 8 women who declined to be interviewed, or werenot contactable, were in the obese category (BMI 30 kg/m2 or more). Reasons given for non-participationincluded chronic health problems and time constraints.The final sample of 14 interviewees included eight whowere obese and eight who were in their first pregnancy.Thirteen were white, thirteen were employed and fivewere educated to degree level. All women were inter-viewed in late pregnancy.

Data collection and analysisSemi-structured, in-depth interviews based on a topicguide were used to enable a detailed exploration ofwomen's views and experiences using a flexible andresponsive approach [19]. Interviews were audio-recorded at the participant's home, with participant per-mission, and lasted between 45-55 minutes. The topicguide included the following prompts to elicit participantviews and experiences: (i) what a 'healthy lifestyle' meansand its relative relevance for pregnancy; (ii) physicalactivity in pregnancy (the benefits, barriers and influ-ences); (iii) healthy lifestyle interventions in pregnancyand the improvements that could be made.

Data analysis was undertaken using a FrameworkApproach to manage, describe and explore the originaldata in relation to the underlying TPB [19]. The interviewtranscripts were indexed and mapped on the basis ofrecurring themes. The synthesised data were examined to

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identify explanatory accounts, and preliminary typologieswere developed [19].

It is important that researchers reflexively examinetheir research as "knowledge is produced in specific cir-cumstances and that those circumstances shape it insome way" (Rose, 1997, p.305) [23]. For the researchdesign and analysis phases of the study there were threechecks on validity (i) A topic guide was used to ensure asimilar range of topics was discussed with each partici-pant. (ii) In order to ensure the reliability of the study'scoding framework two members of the research team(ZW and JB) read five of the interviews and agreed thecoding framework and (iii) A topic guide was used toensure a similar range of topics was discussed with eachparticipant. Although only a small number of interviewswere conducted, data saturation (i.e. where no newthemes were emerging) was achieved after only 12 inter-views and confirmed with the two final interviews.

ResultsThe findings are presented according to the analyticaltypologies: (i) behavioural beliefs and attitudes, (ii) con-trol beliefs and (iii) normative beliefs. Verbatim quotesfrom the study participants are labelled in terms of theirage, whether they were overweight (BMI 25-30 kg/m2) orobese (BMI over 30 kg/m2) and whether they were nullip-arous (NP) or multiparous (MP).

(i) Behavioural beliefs/attitudesParticipants were aware of, and broadly endorsed, theimportance of a 'healthy diet' and 'being physically active'in pregnancy. The antenatal period was often viewed asan opportunity to make positive lifestyle changes:

"Being pregnant perhaps is a good trigger, a good moti-vational point.....to actually maybe take stock of what youare doing, or what you are not doing. And to start makingchoices which will continue after you're pregnant." (Age 28,overweight, NP)

"This is a time when I'm thinking of health things..."(Age:20, overweight, NP)

However, awareness of needing to adopt a healthy life-style during pregnancy was not always enough to initiatebehavioural change:

"It's not news that you've got to eat well and not smokeand not drink and do activity in pregnancy.....I think peo-ple are aware and choose to ignore it." (Age 31, obese, MP)

"It's all personal choice at the end of the day....all theinformation's there and I think people just deal with thebits they want to deal with." (Age 28, overweight, NP)

A range of perceived benefits of being physically activeduring pregnancy were elicited. Regaining pre-pregnancyweight and body shape were the most commonly citedbenefits:

"It's about myself and about wanting to be able to getback in to a healthy shape once the baby's born, and notbeing fat forever." (Age 20, overweight, NP)

Other perceived physical benefits of being physicallyactive in pregnancy included an easier pregnancy andlabour:

"You just generally feel healthier. You get through yourpregnancy a lot better." (Age 31, obese, MP)

"The fitter you are throughout your pregnancy, the moresupple you are. And you're supposed to have an easiertime giving birth." (Age 30, obese, MP)

The psychological benefits of being physically active inpregnancy were also cited:

"You feel more alive, don't you? The more you do... youdon't feel like a couch potato. You feel better about your-self." (Age 30, obese, MP)

"If your body feels healthier you feel healthier in yourmind.....it all just makes you feel better in yourself...." (Age33, obese, MP)

However, perceived benefits of being physically activein pregnancy were only articulated by our study partici-pants in relation to their own health. Specific benefitsassociated with physical activity for the baby were notmentioned spontaneously (i.e. without prompting) by anyof the study participants. Indeed some women were con-cerned that undertaking physical activity during preg-nancy may have a harmful effect on their baby:

"I don't want to do anything that is going to harm thebaby." (Age 29, obese, NP)

"It was more a case of making sure that the baby wassafe and the baby was all right. That was my main worry."(Age 26, overweight, NP)

All of study participants appeared relatively uncon-cerned about weight gain during pregnancy. Weight gainwas perceived to be a "natural" and "acceptable" part ofbeing pregnant. For many women, any action to addresspregnancy weight gain was deferred to the postnatalperiod:

"I take it for granted that I will put on weight." (Age 37,obese, MP)

"I think like you've got a good excuse to put on weightwhen you're pregnant so I haven't been that bothered."(Age 28, overweight, NP)

"I'm conscious that I'm going to try to do more after thisbaby is born." (Age 31, obese, MP)

Study participants also tended to feel that healthy eat-ing was more important than being physically active inpregnancy. They often cited the baby as being the mainbeneficiary of a healthy diet (which was in marked con-trast to their views on physical activity described earlier):

"Obviously anything you're taking in can sort of make itsway to the baby and will have an effect on the growth ofbaby and things like that." (Age 37, obese, MP)

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"It's just important that you give the baby good nutrientsand good food." (Age 33, obese, MP)

On the basis of the findings, participants may bebroadly classified into three groups: (i) 'diet-emphasisers,'who felt healthy eating had more important beneficialeffects for both mother and baby than physical activity;(ii) 'diet/activity-equalisers' for whom both diet and phys-ical activity were important, and (iii) 'activity-emphasis-ers' who physical activity was more important than diet.Only one participant was classified as an 'activity-empha-siser; she acknowledged the importance of healthy eatingbut felt physical activity could act as an important 'com-pensator' to burn off excess intake.

(ii) Control beliefsThe study participants cited several perceived internaland external barriers to physical activity in pregnancy.Personal health problems associated with pregnancywere the most commonly cited 'internal' barrier to physi-cal activity. Such barriers included sickness, lack ofenergy, and feeling uncomfortable due to size:

"I feel kind of, I suppose, at the mercy of what my body isgoing to do to me. If I feel exhausted I just kind of go with itreally, rather than push myself." (Age 34, overweight, MP)

"You just get heavier and you are bigger and it is harderto move and everything is more uncomfortable." (Age 29,obese, NP)

Other internal barriers associated with physical activityin pregnancy included lack of self-confidence and moti-vation:

"With me being overweight, I'm just too paranoid to goswimming." (Age 30, obese, MP)

"I think some of it is just sheer laziness.... and routinethat stopped me taking that opportunity [to be physicallyactive]." (Age 21, obese, NP)

Work was the most commonly cited external barrier tophysical activity. It was perceived to have a negativeimpact on available time and energy levels, the ability tocommit to a regular exercise class, and also meant havingto prioritise in relation to other day to day life activities:

"Because of the pressures of work...I didn't have timeduring the working week to do it." (Age 28, overweight, NP)

Study participants with children often cited barriers tophysical activity which included lack of time, lack of suit-able childcare, guilt, and wanting to spend time with theirfamily:

"It's difficult with children to fit extra things in." (Age 30,obese, MP)

"I would rather spend time with my daughter ratherthan go off and do a swim because I would feel a bitguilty...." (Age 34, overweight, MP)

"I personally would just prefer to look after [name ofchild].... I don't see it as a great sacrifice" (Age 33, obese,MP)

Some women felt that there was a lack of suitable exer-cise classes for pregnant women:

"If there were more activities offered I would probably domore activities." (Age 29, obese, NP)

"There's a lot of social things but as far as physical stufffor mums...I don't think there's a huge amount offered."(Age 31, obese, MP)

"I know if there was something out there I would useit.....and if there is anything out there, I don't know aboutit.....it's not publicised." (Age 29, obese, NP)

Other perceived barriers to physical activity mentionedby the study participants included not feeling safe whenthey were "out and about" in their local neighbourhood(especially at nights), the weather, and financial con-straints.

(iii) Normative beliefsThe study participants often highlighted how they feltthey had not had adequate levels of information, support,or advice regarding physical activity in pregnancy:

"Other than my midwife just saying, you know, just carryon as normal...(there was) nothing specific from any healthprofessionals." (Age 31, obese, MP)

"I might be doing the midwife, who's lovely, a total injus-tice. But there's nothing that's standing out in my headthat I can think of at the moment that's provided me withthat sort of information or, or that kind of guidance about,about lifestyle or exercise or diet or anything." (Age 28,overweight, NP)

Although study participants felt that all health profes-sionals had a responsibility to provide advice and guid-ance about the benefits or resources available, theygenerally felt that the midwife was the most appropriateperson to provide support and guidance. Typologiesdeveloped around the perceived behavioural expectationsof midwives emphasised how most of the study partici-pants felt that their midwife had assumed a 'non-advisory'role, i.e. they had provided minimal or no activity adviceduring pregnancy. No midwives had been perceived tooffer an 'active advisory' role, i.e. where they wouldactively encourage women to be physically active duringpregnancy.

Whilst study participants had lacked guidance on phys-ical activity during pregnancy from health professionalsthey had often been the recipients of lay knowledge andexpertise from family members and partners. Often suchadvice was conflicting. For example, some participantshad described how their mothers had actively discour-aged physical activity, whereas partners were more likelyto be sources of encouragement:

"My mum has been oh, give up work, cut work down andthat kind of thing...and you know, stop the walking, stopgoing out with the dogs, stop doing this, stop doing that..."(Age 26, overweight, NP)

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"He (husband) is like that,' get up woman, you're justpregnant, you're not ill."' (Age 29, obese, NP)

Most of the study participants had accessed some formof media-based pregnancy information during their preg-nancy (e.g. via TV programmes and pregnancy relatedwebsites such as netmums). Some had also read preg-nancy books. However, the lifestyle in pregnancy infor-mation which had been accessed by the studyparticipants was perceived to be negative, conflicting andimpersonal:

"...its always you shouldn't do this, this and this.... if youlistened and took notice of everything that you heard, youwouldn't know where you were..." (Age 34, overweight, MP)

"You read so much or you get so much off the internet orwhatever that it can be quite overwhelming. And the infor-mation is conflicting..." (Age 28, overweight, NP)

DiscussionThis paper has explored views and experiences of physi-cal activity during pregnancy among overweight andobese women. By adopting a combined Subtle Realismand TPB approach we have been able to highlight a rangeof behavioural, control and normative beliefs whichimpact on women's intentions to being physically activein pregnancy. These views and experiences should betaken into account when designing interventions to pro-mote increased physical activity during pregnancy.

In interpreting the findings of this study, it is importantto acknowledge its limitations. The sample size was smalland derived from women who had already participated ina study of physical activity in pregnancy and thus mayhave already been motivated to maintain a healthy life-style. The participants were also relatively well educatedwith a high level of employment. The findings may there-fore not be generalisable to other settings or to womenfrom black and minority ethnic groups (since there wasonly one non-white participant in the sample).

In order to strive for objectivity and neutrality inresearch it is important to reflect on how bias may creepinto the qualitative research and thus threaten validity[19]. In particular, it is essential to reflect on how theinterviewer was "placed" by participants [23]. The inter-viewer for this study was a health professional, and some-one who was pregnant during the interviews. Whilst theinterviewer distanced herself from the role of the 'expert'at the start of each interview, and stressed she was onlyinterested in participant's own beliefs and attitudes(stressing there were no right or wrong answers), partici-pant 'placing' may still have influenced the interview dia-logue.

In this study validity was maximised by a topic guidebeing used and two researchers deriving a thematicframework from the data (which provided a reliable andtrustworthy context for data interpretation). A number of

further steps were taken to enhance the validity of thestudy. A topic guide was used, and interviewing contin-ued until data saturation was achieved (although achiev-ing data saturation after only 12 interviews is likely tohave been influenced by the homogenous study sample).Also, many of the themes which arise from the study aresimilar to those reported from studies undertaken inother settings. This gives further confidence in the reli-ability of the findings.

The main perceived benefits of being physically activeduring pregnancy highlighted by this study, were (1) tominimise pregnancy-related weight gain and (2) facilitatea return to pre-pregnancy body weight and shape. How-ever, beliefs about the potential harm to the baby fromphysical activity were also evident and specific benefits tothe baby were not elicited by the research participantswithout prompting by the interviewer. The findings alsosuggest that whilst study participants often advocated theimportance of maintaining healthy eating and activitybehaviours during pregnancy, healthy eating was gener-ally perceived to be of greater importance, particularly forthe baby's health, than physical activity. These percep-tions are likely to be influenced by the informationsources that women have access to in pregnancy and theconflicting messages contained within them [24]. Partici-pants were often positively motivated towards eatinghealthily due to the perceived positive effects of a healthydiet on their baby's health and growth. Other studies havealso identified the baby as a primary motivator forenhancing nutrition awareness in pregnancy [25,26].Interventions to promote recommended levels of physicalactivity in pregnancy need to provide specific informa-tion on fetal safety and also stress the potential benefits tothe mother.

It is notable that most of the study participants whowere interviewed were unconcerned about weight gainduring pregnancy. They tended to defer any intention toaddress pregnancy-related weight gain to the postnatalperiod. This attitude may reflect the current absence offormal recommendations for pregnancy weight gain inthe UK. This is in direct contrast to the US [27]. Whilstthere is strong epidemiological evidence which suggestsexcessive pregnancy weight gain is associated withadverse outcomes for mother and infant [28], there isonly limited evidence that weight management interven-tions in pregnancy are effective [29,30]. Thus, there is aneed to develop and evaluate new approaches to diet andactivity interventions in pregnancy. And in particular, toestablish the relative importance of dietary compositionand physical activity levels, as well as weight gain, indetermining pregnancy outcome.

In relation to control beliefs, study participants high-lighted a large number of barriers to participating inphysical activity in pregnancy. These included both inter-

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nal (physical and psychological) and external (work, fam-ily, time and environmental) barriers. These findings arebroadly consistent with other studies [13-17]. Since manyof these barriers were perceived to be outside of awomen's control, any behaviour change interventionsneed to support women to find solutions which effec-tively overcome these barriers. One approach may be toemphasise practical and feasible strategies, such as build-ing in an activity like walking, into a pregnant women'severyday life routines. Encouraging physical activity, par-ticularly during the second trimester (when nausea andfatigue have diminished) and women are not constrainedby physical size, may also be effective.

The exploration of normative beliefs arising from thefindings suggests women are influenced by the attitudesof partners, family members and by sources of informa-tion in the media, books and website. Partners were citedas having positive influences in maintaining activity, incontrast to other family members.

One of the most important issues arising from thisstudy was the perceived lack of accessible informationand advice on the benefits of physical activity duringpregnancy. Midwives were viewed as being ideally placedto advise and support women about physical activity inpregnancy. However, many of the study participantsdescribed how their midwives had not given them anyadvice or guidance on physical activity. It has also beensuggested from the findings of previous research thathealthcare providers are often reluctant to advise on dietand activity changes during pregnancy [31]. Little isknown about why this is the case. Other research hashighlighted how midwives often use language to directmothers to making the best decision around baby feeding[32]. This contrasts sharply with the findings presented inthis paper. The passing on of 'superior knowledge' doesnot appear to take place in relation to physical activity.Whilst it must be acknowledged that the current work-load of midwives is "excessive" due to a shortage of mid-wives,[33] there is a potential role for midwives inoffering advice and support. And interventions to pro-mote activity in pregnancy should involve them. Thefindings also emphasise the potential of using the mediaas a vehicle by which to communicate health informationin pregnancy [28]. However, doing this effectively is chal-lenging.

ConclusionsA healthy lifestyle incorporating recommended levels ofphysical activity during pregnancy may contribute toimproved pregnancy outcomes. By using a combinedSubtle Realism and TPB approach this study has yieldeddetailed insights into a number of behavioural, controland normative beliefs which influence women's behav-ioural intentions. Such insights could be targeted by

interventions to promote physical activity in pregnancy.The findings suggest little awareness of the potential ben-efits of physical activity for the baby. The study also high-lights the significance of perceived barriers toparticipation in physical activity. A focus on benefits forthe baby, and on facilitating return to pre-pregnancyweight and appearance, are specific messages that maymotivate women to be more active during pregnancy.Also provision of personalised support by the midwife islacking. Interventions which harness the media, orinvolve partners, are potential approaches to consider fora proposed intervention in pregnancy. Extending inter-ventions to the postnatal period may also prove fruitful[31].

Competing interestsThe authors declare that they have no competing interests.

Authors' contributionsZW undertook the interviews and analysis and wrote the first draft of the man-uscript. JB contributed to the analysis and writing of the manuscript and tookthe lead in redrafting the script following editorial review. SCR contributed tothe conception and design of the study and reviewed the manuscript. CMcPrecruited the study participants and reviewed the manuscript. JR contributedto the design of the study and reviewed the manuscript. RB contributed toconception and design of the study and writing of the manuscript. All of theauthors have read and approved the final manuscript.

AcknowledgementsWe would like to extend sincere thanks to all those women who gave up their time to take part in this research and to Jean Birtles for transcribing the inter-views.

Author Details1Institute of Health & Society, Newcastle University, Medical Sciences New Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK, 2Institute of Cellular Medicine, William Leech Building, Newcastle University, Newcastle upon Tyne NE2 4HH, UK and 3Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK

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Received: 20 October 2009 Accepted: 28 April 2010 Published: 28 April 2010This article is available from: http://www.biomedcentral.com/1471-2393/10/18© 2010 Weir et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.BMC Pregnancy and Childbirth 2010, 10:18

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Pre-publication historyThe pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/10/18/prepub

doi: 10.1186/1471-2393-10-18Cite this article as: Weir et al., Physical activity in pregnancy: a qualitative study of the beliefs of overweight and obese pregnant women BMC Preg-nancy and Childbirth 2010, 10:18