Physical activity (PA) during pregnancy has been widely recognized as beneficial for maternal and fetal health [1]. Regular PA contributes to improved cardiovascular fitness, reduced gestational diabetes risk, and better psychological wellbeing among pregnant women [2]. Conversely, pregnancy is a period often associated with reduced PA [3] and more sedentary lifestyles [4]. Furthermore, women tend to decline PA level as the pregnancy progresses in later trimesters due to physical discomfort, fatigue, and sociocultural barriers [5].

The American College of Obstetricians and Gynecologists (ACOG) has recommended that healthy pregnant women should engage in moderate intensity PA at least 30 minutes a day on most days of the week [6]. Numerous quantitative research found that majority of pregnant women do not perform even least amount of PA as per the international recommendations [7–10]. Even though numerical findings broadly available on PA, the nature of PA changes during pregnancy with its influencing factors yet to be explored through qualitative trials. Also, it is important to distinguish & understand the aspect of PA changes (how these changes happen when pregnant) with pregnant women’s views prior to implementing any healthcare intervention.

In Sri Lanka, cultural beliefs and family norms often influence women’s activity patterns during pregnancy [11]. Traditional expectations may discourage moderate activity due to perceived risks to the fetus [12]. However, national antenatal guidelines encourage safe, moderate-intensity exercise similarly to international recommendation [13]. But there is scarcity of qualitative research evidence that explore how Sri Lankan primigravid women perceive and adapt their physical activity behaviors throughout pregnancy. Understanding these experiences is essential to inform culturally sensitive antenatal education and promote maternal health. Therefore, this study aimed to explore changes in physical activity during pregnancy among Sri Lankan primigravid women and to identify the social and cultural factors influencing these changes.

A phenomenological qualitative design was used to explore primigravid women’s experiences of PA during pregnancy. The study was conducted at Teaching hospital, Peradeniya, a one of the tertiary hospitals in Sri Lanka. Participants were primigravid women attending antenatal clinics between January to May 2021. Purposive sampling was used to recruit women to enroll mothers from different ethnic groups.

After providing detailed explanations about the study, participants’ written informed consent was obtained prior to the data collection. Principal investigator who followed a training on qualitative survey carried out all the sessions in a quiet area at the clinic setting. Sociodemographic data was obtained using pre-designed self-administered data sheets. Qualitative data was collected through in-depth interviews using a pre-designed semi-structured interview guide to explore their experiences on ante-natal PA changes during the pregnancy period. Interview guide consists of a set of questions mainly focused on how mother’s PA status changes in the pregnancy and leading factors to those PA changes.

Interviews were conducted with 19 Sinhala speaking primiparous pregnant women using one-to-one interview method until theme saturation reaches. Each interview session approximately lasted 45–60 minutes. All interview sessions were audio tape recorded. Data collection process was carried out along with the thematic analysis until theme saturation was accomplished.

Collected data were transcribed, examined and organized according to the recurrent themes. Data analysis was done using thematic analysis method by two assessors independently (principal investigator and another investigator) through inductive approach. Then results were examined for similarities and differences. Some different themes were identified. Discussions were carried out regarding these facts by assessors and then final themes were confirmed. Representative participant quotations were used to illustrate themes.

According to the collected sociodemographic data, majority of the participants were Buddhist (74%) & Sinhala (84%) whereas few women were present from other religions (Catholic-13%, Christian − 13%) and ethnicities (Tamil − 5.5%, Burger − 10.5%). Among them 58% (11) of pregnant women in age range 20–25 years while others’ age higher than 25 years (42%). From the total study sample 37% women studied up to Advanced level and most of them were unoccupied (66%). Also 16% (3) women had low monthly household income below Rs. 40000, whereas 21% (4) women were in high income range (> Rs. 100000). 53% of women presented from extended families and majority of participants (47%) were living in semi-urban areas.

Based on the qualitative data, predominantly all women in the study sample expressed that their physical activities differ with the pregnancy. In diverse ways their normal PA patterns have been transformed, influenced by wide range of physical, psychological, emotional and spiritual factors. None of them stated about continuing usual day-to-day PA as in the pre-pregnancy period or trying to achieve pregnancy PA requirement. Basically, five themes were derived through their experiences and presented along with the sub themes in Table 1.

Among the study sample, majority of women (14) verbalized about changes in their household chorus and how they perform daily living activities with some selected light-intensity PA. Accordingly, engagement in normal household tasks with light activities was elicited as first sub theme and can be evidenced by, a woman said, “I do most of the normal day-to-day activities as previous like cooking, sweeping home and garden, light cleaning activities specially in the kitchen, but prevent doing any of heavy activities, even washing heavy clothes, lifting weighted things from the floor like”. (Woman No.4, first trimester).

Also, they expressed some limited activities due to pregnancy highlighting limitations of bending, stretching and weightlifting activities while performing usual daily PA. This sub-theme can be comprehend according to, a woman told, “I do usual works in home and office, but difficult to do some bending/stretching activities, when cleaning floor, removing spider nets on roof, then others supports, also prevent from washing huge, weighted bed sheets, but washing light clothes, hmm, prevent from lifting rice bag or other heavy things, because they are not good, may harmful to baby” (Woman No.7, second trimester).

Some of pregnant women mentioned about complete prevention from certain PA, One of them said “I don’t do any heavy works since I was pregnant, previously did everything in home & surrounding, so, stopped slicing firewood with saw, gardening, raking, sewing dress with machine such heavy activities, mother & husband also said to stop these things because, heavy works badly influence to developing fetus, but, doing my other daily routine activities” (Woman No.12, second trimester). Upon this clarification, avoidance of heavy activities is clearly recognized as another sub-theme.

According to the stated sub themes which were identified over their explanations, “modification of PA with some activity restrictions” was drawn as the first main theme. Family beliefs, women’s knowledge and social norms were obvious factors affecting to vary pregnant women’s PA. It is apparent that pregnant women were being aware of fetal growth and tend to do their daily living PA regardless of gestational week. Furthermore, pregnant women select PA not only based on health education which is provided by midwives and/or other primary health care professionals but also depend on widespread socio-cultural norms.

Few pregnant mothers expressed that they prevent or restrict even common household tasks/day -to-day PA in their pregnancy period due to various reasons.

Through their explanations, it can be derived as difficulties while PA with increased body weight and low back pain a sub theme. As an example, one of them verbalized “once I became pregnant, most of daily activities were reduced, and now do not engage in any physical activity other than my personal care, because, difficult to do those activities with increased body weight. Actually, ms do not cooking, even washing clothes, sweeping in home. Mother and my sister are there to support me. Also, if I do some activity like cleaning dishes, plates in standing feel back pain. Therefore, trying to be prevent activities always” (Woman No.15, third trimester)

Further, some mothers reported inactivity due to fear which was identified through the conversations like, a mother told “Since this is my first experience, I am very careful when doing any activity. Although midwife ms said to do some, fell much fear, thinking it causes harm to my baby, so, do not performing even daily activities” (Woman No.03, first trimester)

Lack of physical fitness & lethargy was detected as another sub category under this major theme as evidenced by one mother explained “Usually I do my works by own, but when I pregnant, it is totally changed, because, it is new and much different experience, specially feel like no physical fitness as previous to do work, although having no any pain yet, therefore, not performing household or other activities. Sometimes, feeling lazy to start tasks” (Woman No.10, second trimester)

Some of the study participants verbalized that they prevent even daily routines because of tiredness. As an example, “It is feeling much exhausted if I do small activity like sweeping home even. So, do not try to do physical activities, always try to be relax and comfortable without any work. Also, difficult to managing with body weight” (Woman No.8, second trimester). So, “exhaustion minimizes physical activity” was specified as sub-theme of main category.

In accordance with stated sub themes, “Avoidance PA other than self-care activities” was formulated as second main theme. Changing body texture with physiological parameters, lack of knowledge on appropriate PAs, common discomfort and psychological imbalance were well notified concerns in preventing even daily living PA forms. But they tried to keep self-care activities at a satisfactory stating that self-care and hygiene directly affect fetal health.

Based on their perception “Increased sitting period” elicited as another sub theme. One of them stated that, “most of the times, I need to be seated comfortably, feels more difficulties when standing or walking. So, I am trying to do most of the works with sitting” (Woman No.11, second trimester).

Increased time duration on bed rest was derived as another sub theme and can be verified by, a mother said, “When I do some activities feeling more tired, so, I used to rest on bed most of the times after doing my household works, specially, after finishing morning workload” (Woman No.5, first trimester).

Sleeping on daytime is also recognized as a sub theme, as one of expectant mother mentioned that “After, finishing my household routines, I sleep about 2 hours after lunch.it good for me to reduce tiredness” (Woman No.9, second trimester).

Most of the expectant mothers (12) described their experiences related to converting active lifestyle gradually to a partially sedentary life. So, “Increasing sedentary period” was illustrated as third main theme. It is well detected that pregnancy induced physical discomfort urged more sedentary PA rather than moderate/light intensity PA as a relief technique. So, some extra PA which not consuming energy were added to their daily routine in order to get adequate break during the work.

Considerable number of participants (7) also well focused on more religious activities when pregnant and it can be evidenced that, one of them expressed “I often used to go to the temple at evening, also before sleeping everyday hearing pirith, it will make my mind calm and relax” (Woman No.12, second trimester). Upon this verbalized point it can be recognized involvement in more religious activities as a sub theme.

Sub theme attention to mental relaxation is presented by few numbers of women (3) and mentioned that they allocate some time duration for make their minds free and reduce stress due to pregnancy related worries. This theme can be evidenced by, one of mother voiced “Mother always advice to do meditation, so I do sometimes, she said it is good for mental development of my baby. I also like to engage this activity, because it offers lot of benefits for mind to free, decrease stress, also helps to sleep better” (Woman No.16, third trimester).

Accordingly, “Focusing on Psychological relaxation” was extracted as a main theme. Spiritual beliefs have influenced mothers’ PA in various ways. Basically, pregnant mothers believe that peaceful mindset positively impacts on fetal psychological development other than reducing tension. So, they preferred to allocate some hours to calm their mind as well as to receive blessings for growing fetus by adding selected reassuring spiritual activities.

“Time allocation for leisure activities” was generated as last theme under the changes in PA during pregnancy, only 4 women pointed out that they assign some extra time for fun & leisure activities compared with pre-pregnancy. This can be well defined through such examples which are presented below.

One of them said “Often we two going places for leisure to specially walking path or garden, or musical programs, drama. Husband helps more to enjoy ignoring difficulties” (Woman No.10, second trimester).

Another women said “when pregnant, I needed more time to rest and relaxation, so, reading books is improved especially about pregnancy, fetus development like, usually I prefer to read books, additionally also doing internet searching for listen music, sometimes hear slow classical music, these activities are interested and offer relaxation to mind” (Woman No.18, third trimester).

Few pregnant mothers preferred to include some time for leisure activities as they consider it gives psychological relaxation and one way of distracting pregnancy-related difficulties. Also, they think that calm mind is helpful to achieve desired fetal growth.

Overall women’s experiences revealed that changing PA pattern, type and amount is significant and common from the beginning of pregnancy period. It was basically formed by socio-cultural norms, family influences, pregnancy-related discomfort and women’s safety perception. Even though all women showed some considerable modifications and adaptations in PA, they did not have clear idea about required amount of PA in pregnancy and how to perform PA for being healthy during pregnancy. Knowledge deficit on PA is apparent since they expressed general idea regarding PA benefits rather than presenting health related advantages with background knowledge. Negativity towards PA was reflected through their experiences highlighting the necessity of tailored ante-natal PA interventional program with sufficient education.

This study explored experiences in physical activity during pregnancy among Sri Lankan primigravid women. Identified main themes reflect pregnant women usually lessen PA due to their undesirable inference which is predisposed by risk perception, fear of safety, cultural factors and family inspirations. Also, they did not verbalize on any PA recommendations or appropriate activity types in pregnancy due to inadequate knowledge.

Participants in the present study expressed concerns about miscarriage, abdominal pain, or fetal harm. Similar findings have been reported in other Asian contexts, where cultural restrictions and fear of miscarriage reduce activity levels in China and Bangladesh [17, 18].

Findings revealed a shift from active to sedentary lifestyles, mainly influenced by cultural beliefs and family expectations. Such cultural orientations differ from Western contexts, where prenatal exercise is strongly promoted as part of healthy pregnancy management [14, 15]. In many Asian societies, rest is traditionally associated with fetal protection, and physical effort is perceived as potentially harmful [16]. These cultural beliefs often dominate and result in continued sedentary practices, even though evidence supports the safety and benefits of moderate-intensity exercise during pregnancy.

As this study found, pregnant women’s chief concern towards fetal well-being and refrain from risk activities were substantial factors for reducing PA, similar results presented through research which was done in Scotland [19]. Lack of focusing on PA in primary health care setting may be the reason for this situation.

Furthermore, psychological factors such as fear, uncertainty, and lack of confidence also contributed to reduced PA according to this study. Fear-avoidance behaviors, commonly reported among pregnant women with discomfort or low back pain, appeared to influence decisions to limit some tasks [20]. Participants’ preference for relaxation practices, including religious activities, indicates an emphasis on psychological well-being rather than physical fitness. This aligns with research showing that pregnant women often prioritize emotional and spiritual coping strategies over physical exertion [21, 22].

However, unlike Western populations, where exercise is encouraged, Sri Lankan women prioritize rest as a sign of care. Even though Sri Lankan ministry of Health introduced PA national guideline including pregnancy PA recommendations [13] which aligns with evidence suggesting that Asian women generally possess limited understanding of exercise recommendations during pregnancy [23, 24]. Poor dissemination of health information within primary health care settings may partly explain this gap. Studies conducted in both developing and developed settings have similarly documented inadequate emphasis on PA counselling during routine antenatal visits [25, 26].

The findings highlight the need for antenatal education programs addressing misconceptions about PA. Nurses and midwives should provide culturally sensitive guidance to promote safe exercise routines. This study provides context-specific insights into Sri Lankan primigravida experiences, based on an understudied group through qualitative approach allowing in-depth exploration of cultural and familial influences. However, the study was limited to a selected ante natal clinic in a major tertiary care hospital in country and included a small sample, which may reduce generalizability. Further studies involving multiparous women, different geographic settings, and quantitative assessments are recommended to strengthen evidence and support national policy development.

Sri Lankan primigravid women exhibit substantial reductions in PA during pregnancy, shaped by cultural norms, safety concerns, inadequate knowledge, and strong influence from family members. Despite national guidelines, awareness of appropriate activity levels remains limited. The findings highlight the need for enhanced antenatal counselling, improved health education strategies, and culturally sensitive interventions that address misconceptions surrounding PA in pregnancy. Strengthening the role of nurses, midwives, and primary health care providers could promote healthier, more active pregnancies, ultimately improving maternal and fetal outcomes. So, community health sector organized tailored ante-natal education programs are well recommended.