Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis (Preprint)

Background:
Guidelines on physical activity/exercise during pregnancy recommend all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity/exercise during this life-stage and are increasingly using mobile applications (apps) to access health-related information. However, the extent to which apps provide physical activity/exercise advice aligns with current evidence-based pregnancy recommendations is currently unclear.

Objective:
The aim of this study was to conduct a systematic search and content analysis of apps that promote physical activity/exercise in pregnancy to examine: (1) alignment of the content with current evidence-based recommendations (2) delivery, format and features of physical activity/exercise instruction; and (3) credentials of app developers.

Methods:
Systematic searches were conducted in the Australian AppStore and GooglePlay stores in October 2020. Apps were identified using combinations of search terms relevant to pregnancy, and exercise or physical activity and screened for inclusion (primary focus on physical activity/exercise during pregnancy, free to download or did not require immediate paid subscription and an average user rating of 4+ out of 5). Each app was then independently reviewed using an author-designed extraction tool. Data were exported, collated, and reported using descriptive statistics.

Results:
Twenty-seven apps were included in this review (GooglePlay: n=16 and AppStore: n=11). All were exercise-based apps that predominately recommended structured and purposeful activity. Two thirds provided some information relating to the FITT principles (Frequency, intensity, time and type) of exercise; however only three provided this information in-line with current evidence-based guidelines. Just over one third of apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. No apps actively engaged in screening for potential contraindications. Only four apps collected information about the user’s current exercise behaviours, three apps allowed users to personalise features relating to their exercise preferences and just over one third provided information about developer credentials.

Conclusions:
Our findings showed that few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. No apps screened users for contraindications to physical activity/exercise during pregnancy and most lacked appropriate personalisation features to account for an individual’s characteristics. Few involved qualified experts during the development of the app. As such, there is a need to improve the quality of apps that promote exercise in pregnancy, to ensure women are (1) appropriately supported to engage in exercise, and (2) the potential risk of injury, complications and/or adverse pregnancy outcomes for both mother and child is minimised. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalisation and tailoring to individual users, or by developing a recognised system for regulating apps. Clinical Trial: Not applicable