Physical activity (PA) during pregnancy in Greece

Objective: To evaluate the amount and types of physical activity (PA) performed by Greek women during pregnancy and assess the validity and reliability of the Greek version of the Pregnancy Physical Activity Questionnaire (PPAQ). Study design: This prospective study comprised two stages. The first stage was the completion of the PPAQ Greek version twice, with a one-week interval between the two rounds, to assess internal consistency and reproductivity. The validity was evaluated by comparing the PPAQ results with data from smartwatches that recorded step counts and metabolic equivalent tasks (METs). The second stage included pregnant women from various regions of Greece that completed the PPAQ once during their pregnancy. The level of PA during pregnancy and consistency with the international PA recommendations was evaluated with the use of METs. Results: A total of 1058 pregnant women filled the PPAQ Greek version, while eighteen women randomly participated in the reliability and validity analyses of the PPAQ. Results from the PPAQ completed one week apart showed strong agreement (Intraclass Correlation Coefficient [ICC]: 0.82-0.96). A comparison between the PPAQ results and smartwatch data revealed no significant differences in PA levels (correlation coefficient: 0.542; p = 0.022). The median total PA for all the participants was 142.1 MET-hours/week (interquartile range: 106.04 MET-hours/week). PA levels increased with advancing gestation in sports/exercise (1st vs. 2nd trimester, p = 0.048; 2nd vs. 3rd trimester, p G 0.001), occupational activities (1st vs. 3rd trimester, p G 0.001; 2nd vs. 3rd trimester, p = 0.024), and transportation activities (1st vs. 3rd trimester, p G 0.001; 2nd vs. 3rd trimester, p G 0.001). Moderate-to-vigorous intensity activities also increased with gestational age (p = 0.023, 95 % confidence interval [CI]: 0.1-1.4; p = 0.045, 95 % CI: 0-0.08, respectively). Women were more active in household/ caregiving activities across all trimesters (p = 0.017; 95 % CI: 0.09-0.95). Women with higher educational levels were more likely to engage in sports/exercise (p = 0.039, 95 % CI: -3.3 to -0.08) and had higher overall PA levels (p = 0.029, 95 % CI: 0.37-6.3). However, only 14.8 % of the participants met the international PA recommendations for pregnancy. Conclusion: The Greek version of the PPAQ is a reliable tool for assessing PA in pregnant Greek women. Higher educational levels and advanced gestational age were found to be associated with increased PA levels. However, only a small proportion of pregnant Greek women met the international PA recommendations, highlighting the need for targeted interventions.