Postpartum exercise and food intake: the importance of behavior-specific self-efficacy

Objective: To examine the relationships between psychosocial characteristics and change in exercise and food intake of women during the first year postpartum. Design: A prospective cohort study following women from pregnancy until 1 year postpartum. Psychosocial variables, change in food intake, and exercise frequency were assessed using anonymous mailed questionnaires during pregnancy and at 1 year postpartum. Sociodemographic and anthropometric information was obtained from the medical record. Subjects/setting: Six hundred twenty-two women who enrolled for prenatal care in the Bassett Healthcare system between November 7, 1994, and November 15, 1996, and who met the eligibility criteria. The attrition rate for completing the questionnaire at 1 year postpartum was 20%. Statistical analyses performed: Multivariate linear regression with exercise frequency at 1 year postpartum and change in food intake during the second 6 months postpartum as the dependent variables and psychosocial factors assessed at 1 year postpartum as the independent variables, controlling for sociodemographic variables, body mass index, and gestational weight gain. Results: Higher exercise self-efficacy and having the intention to exercise were associated with more frequent exercise at 1 year postpartum in the multivariate regression analysis (r2=20%). Food intake self-efficacy, body satisfaction, weight gain acceptance, and drive for thinness were all significant in the multivariate analysis (r2=7%) and higher scores on these variables were associated with reductions in food intake. Applications/conclusions: Interventions that aim to help women get regular exercise and make appropriate reductions in food intake during the postpartum period should focus on self-efficacy specific to the targeted behaviors. For example, dietitians may strengthen exercise self-efficacy by providing postpartum women with mastery experiences of setting realistic exercise goals. Likewise, dietitians can focus on food intake self-efficacy by modeling strategies that women can use to avoid overeating in stressful situations.