Experiences of healthcare professionals providing physical activity advice to pregnant and postpartum women: a systematic review of qualitative evidence.

Objective: To synthesise global qualitative evidence on healthcare professionals' (HCPs) experiences, barriers and enablers in delivering physical activity (PA) advice to pregnant and postpartum women. Design: Systematic review of qualitative, mixed-methods and multimethod studies, using thematic synthesis. Study quality was assessed using the National Institute for Health and Care Excellence critical appraisal checklist. Data sources: Three electronic databases were searched up to 31 July 2024. Eligibility criteria for selecting studies: Studies published after 2010 with a qualitative component exploring HCPs' perspectives on providing PA advice in maternity care. Only qualitative data were extracted and synthesised. Results: Twenty-six studies from 10 countries were included, involving midwives, obstetricians, physiotherapists and other HCPs (sample sizes: 7-192), with experience ranging from 0.5 to 41 years. All studies were qualitative, with four using a multimethod study design. 18 studies focused on pregnancy, 3 on postpartum and 5 on both. Seven themes and 24 subthemes were identified. These included HCPs' attitudes toward PA, variability in advice provision and systemic and individual level barriers (eg, time constraints, lack of training, limited confidence). Proposed solutions included formal PA education, institutional support and improved resources. Fifteen studies were rated high quality and 11 moderate. Conclusion: Most studies were from high-income countries, limiting generalisability to low-resource settings. The evidence base was predominantly focused on pregnancy, with limited data on postpartum PA advice. Across settings, HCPs face persistent barriers to delivering effective PA advice. Addressing these challenges through structured training and systemic support is essential to empower HCPs and promote maternal PA engagement. PROSPERO registration number: CRD42023483377.