RIAF Journal ISSN: 2953-6693 Vol – 4 No. 2, July 2026
114
Articles
Jhonny Vidal Corpus
Universidad Adventista de Bolivia, Bolivia
jhonny.vidal@uab.edu.bo
ORCID https://orcid.org/0009-0008-6781-8866
Dora Abigail Chura Ruiz
Universidad Adventista de Bolivia, Bolivia
abigail.chura@uab.edu.bo
ORCID https://orcid.org/0009-0000-6428-0919
Abstract: The present research, titled "Influence
of Physical Activity on Anxiety During Pregnancy
in a 21-Year-Old Woman: Case Study," aimed to
determine the influence of a physical activity
program on the anxiety levels of a pregnant
woman. A mixed-methods nested design
(quantitative dominant) was employed during the
participant's third trimester of pregnancy.
In the initial evaluation (pre-test), the woman
presented with a very severe anxiety level with a
mean score of 3.5 on the Hamilton Anxiety Rating
Scale (HAM-A), and a low level of physical activity,
measured at 438 MET-min/week by the IPAQ.
Following the implementation of an adapted eight-
week physical activity program, the intervention
demonstrated a positive bifocal change. Anxiety
was reduced by 45.7%, moving from a "very
severe" level to a moderate level (mean score of
1.9). Simultaneously, the level of physical activity
increased by 36.5%, reaching 598 MET-min/week,
which corresponds to the moderate level. The
triangulation of this data, along with qualitative
perceptions of well-being and effort self-regulation
(Borg Scale), confirmed the program's efficacy.
It is concluded that supervised physical activity is
an effective, safe, and non-pharmacological
strategy to significantly reduce gestational anxiety,
improving the emotional and physical well-being
of the participant.
Keywords: Physical activity; gestational anxiety;
pregnancy; non-pharmacological strategy; clinical
case.
Influence of Physical Activity on Anxiety During Pregnancy in a 21-Year-Old
Woman
Jhonny Vidal Corpus
1
& Dora Abigail Chura Ruiz
2
RIAF. Revista Internacional de Actividad Física
Universidad de Guayaquil, Ecuador
Periodicidad: Semestral
Vol. 4, núm. 2, 2026
revista.riaf@ug.edu.ec
Received: June 1
st
, 2026
Approved: July 1
st
, 2026
Published: July 25
th
, 2025
URL: https://revistas.ug.edu.ec/index.php/riaf
DOI: https://doi.org/10.53591/riaf.v4i2.3346
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RIAF Journal ISSN: 2953-6693 Vol – 4 No. 2, July 2026
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RIAF Journal ISSN: 2953-6693 Vol – 4 No. 2, July 2026
116
anxiety is understood as the feeling of restlessness
or nervousness in the face of difficult or uncertain
situations. During this period, physical activity
presents itself as an effective non-
pharmacological method for managing anxiety
during gestation, offering benefits without the
risks associated with medications. From this
perspective, Rodríguez-Blanque et al. (2020) state
that regular practice of adapted exercise for
pregnant women significantly contributes to
reducing anxiety levels and improving the
emotional well-being of women during
pregnancy.
The World Health Organization (2022)
recommends that pregnant women engage in
regular physical activity, always under medical
supervision, due to its multiple physical and
emotional benefits. Physical activity not only
favors bodily health but also contributes to
psychological well-being and the reduction of
anxiety levels during gestation. Recent research,
such as that by Sánchez-Polán et al. (2021), has
shown that pregnant women who maintain a
moderate physical activity routine present
significantly lower levels of anxiety compared to
those with sedentary habits, highlighting the
importance of promoting physical activity as a
non-pharmacological strategy to improve
emotional state and quality of life during
pregnancy.
Numerous studies have demonstrated that
physical activity has a positive impact on reducing
anxiety during pregnancy. For example, Smith et
al. (2020) showed that pregnant women who
engage in moderate physical activity experienced
a 30% reduction in anxiety levels.
Within the framework of this research, various
sources from indexed journals, Scielo, Dialnet,
and Google Scholar are incorporated. The most
relevant studies related to the topic are presented
below.
In Canada, Mottola (2021), in his research on
"Effects of Physical Activity on Anxiety During
Pregnancy," conducted an experimental study
involving 120 participants. Standardized tests
were applied, including the Beck Depression
Inventory (BDI) and the Hamilton Anxiety Scale
(HAM-A). The results indicate that pregnant
women who practice physical activity reduce
anxiety symptoms by 30%. According to Mottola,
moderate physical activity significantly reduces
anxiety symptoms in pregnant women.
Similarly, in the United Kingdom, Wilson and
Carter (2019), in a study on "Physical Activity and
Depression During Pregnancy," conducted a
randomized controlled trial involving 120
participants. Standardized tests were applied,
including the EPDS and the Physical Activity
Questionnaire. The results indicate that women
who practice physical activity during the
gestational stage reduce depression symptoms by
30%. According to Wilson and Carter, regular
physical activity helps mitigate depression
symptoms during pregnancy.
Likewise, in the United States, Smith et al.
(2020) analyzed the "Effects of Moderate
Physical Activity on Reducing Anxiety During
Pregnancy." Smith conducted a longitudinal study
including 150 pregnant women in their second
trimester. Standardized tests such as the
Hamilton Anxiety Scale (HAM-A) and physical
activity records were applied. The findings
showed that women who engaged in moderate
physical activity experienced a 30% reduction in
anxiety levels. According to Smith, moderate
physical activity is an effective tool for managing
anxiety during pregnancy.
Similarly, in South Korea, Lee et al. (2022), in
a study on the "Influence of Physical Activity on
Anxiety and Stress in Pregnant Women,"
conducted a longitudinal study involving 250
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117
pregnant women. Standardized tests were
applied, including the General Health
Questionnaire (GHQ-28) and the physical
activity questionnaire (IPAQ). The results
indicate that pregnant women who practice
moderate physical activity reduce anxiety and
stress levels by 40%. According to Lee, physical
activity is an effective strategy for improving
mental health during pregnancy.
Finally, in Brazil, Silva et al. (2019) analyzed
the "Impact of Physical Activity on Anxiety and
Self-Esteem in Pregnant Women." Silva
conducted a cross-sectional study involving 20
pregnant women. Standardized tests were
applied, including the Hamilton Anxiety Scale
and self-esteem questionnaires. The results
indicate that women who practice regular physical
activity have lower levels of anxiety and higher
self-esteem. According to Silva, physical activity
has a positive impact on mental and emotional
health during pregnancy.
Pregnancy is a complex biological and
psychological process spanning approximately
forty weeks, during which women experience
significant physiological, hormonal, and
emotional transformations necessary for proper
fetal development. According to Cunningham et
al. (2022), this process is divided into three
trimesters, each with particular characteristics
that influence both the physical and mental health
of the pregnant woman. The first trimester
comprises weeks 1 through 13 and involves the
greatest hormonal changes, generating symptoms
such as nausea, emotional sensitivity, and fatigue.
The second trimester, spanning from week 14 to
week 27, is usually characterized by greater
physical and emotional stability, being considered
the period of greatest well-being during gestation.
In turn, the third trimester, "from week 28
until the end of pregnancy, is associated with a
significant increase in physical discomfort,
increased abdominal load, sleep alterations, and
concern about childbirth and the baby's health"
(p.145). Recent research indicates that this last
trimester is when higher levels of gestational
anxiety are reported, due to factors such as fear
of childbirth, uncertainty about fetal well-being,
and the proximity of the delivery process.
Venkatesh et al. (2021) point out that, as the
time of delivery approaches, anxiety levels tend to
increase, which can modify how the pregnant
woman experiences and perceives pain during
birth. During the third trimester of pregnancy, the
main hormones that present significant changes
are estrogens, progesterone, prolactin, oxytocin,
relaxin, and cortisol, all essential for maternal
adaptation and fetal development (Dukic &
Ehlert, 2023).
Estrogens and progesterone increase
progressively, favoring uterine growth, muscle
relaxation, and breast preparation, although they
can generate fluid retention, fatigue, and
emotional changes.
Prolactin elevates milk production, oxytocin
facilitates uterine contractions, and relaxin
contributes to joint flexibility, while cortisol plays
a fundamental role in regulating maternal
metabolism, fetal maturation, and preparation for
childbirth, although elevated or dysregulated
levels can be associated with stress, sleep
alterations, and risk of complications such as
preterm birth or low birth weight. These
hormonal changes are reflected in common
pregnancy symptoms such as anxiety, heartburn,
constipation, low back pain, and fatigue, making
prenatal care and professional follow-up essential
to guarantee maternal-fetal health and adequate
physiological adaptation during this critical stage.
Anxiety during pregnancy is defined as an
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118
emotional response marked by excessive and
persistent worry related to aspects of fetal
development, childbirth, and maternal health,
which can manifest through physical and
cognitive symptoms. Fallon et al. (2020) indicate
that anxiety during pregnancy represents a
significant risk for both mother and baby, as it can
be related to complications such as preterm birth,
low birth weight, and an increased likelihood of
postpartum depression. This emotional state is
influenced by endocrine changes, increasing
physical demands, and psychosocial factors,
making its identification and proper management
essential. According to Venkatesh et al. (2021),
anxiety during pregnancy tends to be more
intense in the third trimester, mainly due to fears
associated with the upcoming birth and the
protection and well-being of the newborn.
In this context, physical activity is positioned
as a key tool for promoting comprehensive health
during pregnancy. The World Health
Organization (2020) describes physical activity as
any body movement generated by skeletal
muscles that involves energy expenditure,
highlighting its relevance both for disease
prevention and mental well-being. It is classified
according to intensity as light, moderate, and
vigorous. Light activity comprises gentle
movements or mobility exercises without a
considerable increase in heart rate; moderate
activity produces moderate increases in heart and
respiratory rate, such as brisk walking or gentle
aerobics; while vigorous activity causes greater
cardiovascular demand, including activities such
as running or functional training. Furthermore,
Tremblay et al. (2017) emphasize that maintaining
an active lifestyle is essential, as sedentary
behavior characterized by low-energy-demand
activities performed in a seated or reclined
position constitutes a risk factor for health during
pregnancy, and its presence is associated with
increased risks of obesity, gestational diabetes,
and metabolic complications.
The benefits of physical activity during
pregnancy have been extensively documented by
recent research. In particular, Nascimento et al.
(2021) highlight that performing moderate-
intensity exercises regularly contributes to
reducing anxiety and stress, in addition to
improving sleep quality and emotional regulation.
Complementarily, Davenport et al. (2020)
indicate that exercise during pregnancy helps
reduce risks such as gestational diabetes,
pregnancy-induced hypertension, and excessive
weight gain, while also improving
cardiorespiratory condition. In this context, the
World Health Organization (WHO, 2020)
recommends that pregnant women engage in at
least 150 minutes of moderate physical activity
per week, while Souza et al. (2022) highlight that
structured programs supervised by professionals
present greater adherence and better results,
facilitating progression toward adequate levels of
physical activity.
To measure the level of physical activity in
research and clinical contexts, the International
Physical Activity Questionnaire (IPAQ) is used,
which allows quantifying the weekly time
dedicated to light, moderate, and vigorous
activities, classifying individuals into low,
moderate, or high levels, and is especially useful
in pregnant women due to its ease of application
(Craig et al., 2003). Complementarily, the
Hamilton Anxiety Scale (HAM-A) is widely
recognized for evaluating the severity of somatic
and cognitive symptoms associated with anxiety,
allowing the identification of clinical changes
before and after interventions, which is relevant
in studies on the impact of physical activity on
emotional well-being (Maier et al., 2020).
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119
The relationship between physical activity and
anxiety has been extensively studied, and it has
been demonstrated that exercise constitutes an
effective intervention to reduce anxiety levels
during pregnancy. According to Davenport et al.
(2020), pregnant women who regularly participate
in physical activity programs present a significant
reduction in anxiety, an effect attributed to the
release of neurotransmitters such as endorphins
and serotonin, as well as the decrease in
sympathetic nervous system activation.
Furthermore, physical activity favors a greater
sense of control over one's own body, improves
the perception of self-efficacy, and generates
benefits for emotional health in general, which is
especially relevant to ensure a healthier pregnancy
and a better experience during childbirth
(Nascimento et al., 2021).
The justification for the present research seeks
to contribute new knowledge about how physical
activity influences the reduction of anxiety in
pregnant women, by analyzing its effects on
stress, anxiety, and mood during gestation. This
study will benefit the general population, with
special emphasis on pregnant mothers, by
significantly contributing to the improvement of
their quality of life through physical activity via
accessible, safe, and evidence-based strategies.
Likewise, it will have a positive impact on the
family environment, as it will provide parents,
siblings, and other family members with
knowledge about the favorable effects of physical
activity during pregnancy. In this way, active
family participation in the gestational process will
be encouraged, strengthening the bonds of
support, understanding, and emotional
accompaniment that are essential for the
comprehensive well-being of the pregnant
woman.
The research is grounded in the
biopsychosocial model of well-being, as well as
the theory of self-determination, which holds
that physical exercise improves emotional state by
satisfying the basic needs of autonomy,
competence, and relatedness. According to
Davenport et al. (2020), moderate physical
activity acts as a natural antidepressant,
promoting the release of endorphins, which are
hormones responsible for feelings of happiness
and emotional well-being. Meanwhile, Rodríguez-
Blanque (2021) highlights the efficacy of physical
activity as a non-pharmacological strategy to
improve anxiety in pregnant women.
Physical activity during pregnancy is a topic of
growing interest in the community, as it has been
observed to have a significant impact on the
anxiety of pregnant women. According to the
World Health Organization (WHO), moderate
physical activity reduces symptoms of anxiety and
depression, contributing to a more positive mood
and better self-esteem. According to Lindsay
(2020), women who engage in physical activity
during pregnancy report a significant reduction in
anxiety symptoms, improving their emotional
well-being and satisfaction with their pregnancy
experience.
The causes of this problem lie in hormonal
changes, the different trimesters of pregnancy,
fear of childbirth, insecurity about motherhood,
and negative thoughts. The consequences of this
inactivity are increased anxiety, stress, and a
greater risk of complications during childbirth
and postpartum, affecting both the physical and
emotional health of the mother, which in turn
negatively influences the baby's development.
The motivation to research this topic lies in
improving the quality of life of young women
during pregnancy, providing scientific evidence
through the results obtained in the research on
the importance of physical activity.
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120
Materials and Methods
The methodological design selected for this
research corresponds to a mixed methods nested
(embedded) design with quantitative dominance,
which is pertinent due to the nature of the
research problem and the objectives set. This
design allowed for the integration of quantitative
and qualitative data within a single research
process, providing greater interpretive robustness
to the findings. As Hernández Sampieri,
Fernández, and Baptista (2020) point out, nested
mixed designs are characterized by including a
secondary approach within a predominant one,
with the purpose of complementing and
enriching the understanding of the phenomenon
under study, maintaining a clear hierarchy
between both. In this study, the dominant
approach is quantitative, as the central purpose is
to measure the influence of a physical activity
program on anxiety levels in a pregnant woman.
In this study, the dominant approach is
quantitative, as the central purpose is to measure
the influence of a physical activity program on
anxiety levels in a pregnant woman.
Research Techniques and Instruments
For the development of the research,
psychometric techniques, self-recording
methods, and clinical interviews were employed,
organized according to their quantitative and
qualitative components. Regarding the
quantitative component, firstly, the International
Physical Activity Questionnaire (IPAQ, short
version) was used to quantify the baseline weekly
physical activity level and the estimated energy
expenditure in MET-minutes/week of the
pregnant woman. Its application technique
consisted of a self-report survey administered at
pre- and post-intervention moments, this being a
standardized instrument with broad international
validity and adequate internal consistency in adult
populations (Craig et al., 2003).
Secondly, to evaluate the severity and
evolution of the somatic and psychic symptoms
of anxiety, the Hamilton Anxiety Scale (HAM-A)
was applied.
Its application technique was structured
through a semi-structured clinical interview pre-
and post-intervention; to guarantee the rigor of
the procedure and avoid bias, the assessment was
carried out by an external clinical psychologist
linked to the participant's emotional support
center. This instrument presents satisfactory
psychometric properties and is highly
recommended for intervention studies (Maier et
al., 1988).
Finally, the Borg Rating of Perceived Exertion
(RPE 6-20) Scale was employed for the
continuous monitoring and quantification of the
physical workload intensity in each training
session. The technique consisted of a visual and
numerical self-report record, which the patient
completed immediately following the conclusion
of the exercise blocks. This procedure was
grounded in the scale's established properties for
regulating exercise intensity in special populations
and its consistent correlations with physiological
indicators (Borg, 1998).
Regarding the qualitative component, data
were gathered through in-session micro-
interviews, aimed at longitudinally capturing the
emotional sensations, perceived well-being, and
situational factors affecting the pregnant woman's
mood. These were administered as brief
qualitative interviews, structured as natural
conversations at the outset and closure of each
session. Furthermore, the spontaneous verbal
descriptions provided by the participant when
registering her score on the Borg Scale were also
incorporated; these served as embedded
qualitative data, complementing and enriching
the interpretation of the subjective perceived
effort throughout the process.
Participants
Patient Data
The patient presents the anthropometric data
and vital signs evaluated during the third trimester
of pregnancy. A height of 1.48 m was recorded, a
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121
weight of 60 kg, and a body mass index (BMI) of
27.39, corresponding to the overweight range.
Regarding vital signs, the patient showed oxygen
saturation of 95%, heart rate of 97 beats per
minute, pulse of 78 bpm, respiratory rate of 17
rpm within physiological parameters, and blood
pressure of 100/60 mmHg. Taken together, these
values allow for the description of the pregnant
woman's general condition, with BMI standing
out as a relevant parameter for clinical follow-up
during the intervention process.
Procedure and Data Analysis
Phase 1: Initial evaluation. The participant
received information about the study and signed
the informed consent form. The quantitative
instruments (IPAQ, HAM-A, and Borg) were
applied, and the first micro-interviews were
conducted to explore her initial perception of
anxiety and physical activity.
Phase 2: Physical activity intervention. A
structured and safe program for pregnancy was
implemented, with intensity controlled by the
Borg Scale and direct supervision. During all
sessions, subjective responses and behavioral
observations were recorded and incorporated
into the qualitative analysis.
Phase 3: Final evaluation. The quantitative
instruments were again applied to measure
changes, along with interviews and qualitative
observations, allowing the documentation of the
evolution of anxiety and the perception of
physical activity.
Phase 4: Data integration. Quantitative data
were analyzed to identify changes and trends,
while qualitative data were thematically coded to
contextualize and explain numerical results,
following the nested mixed model of Hernández
Sampieri et al. (2020).
The patient is a 21-year-old pregnant woman in
her third trimester of gestation who presents a
very severe state of anxiety. An adapted physical
activity program will be applied with the objective
of reducing her anxiety levels and promoting
better physical and emotional well-being. This
intervention aims not only to contribute to
anxiety control but also to promote physiological
and psychological benefits that facilitate a normal
delivery, improving the comprehensive
preparation of the pregnant woman for this
process.
Results
The pregnant woman is in the third trimester
of pregnancy. Following the application of the
Hamilton Anxiety Scale and the analysis of the
results obtained, a very severe state of anxiety was
evidenced. Likewise, through the application of
the International Physical Activity Questionnaire
(IPAQ) and the corresponding analysis, it was
determined that she does not reach the
recommended minimum level of 600 MET-
min/week, thus being classified within the low
physical activity level.
Table 1.
International Physical Activity Questionnaire (IPAQ)
Type of Activity
Days/Week
Minutes/day
ME
T
MET-
min/week
Observation
Vigorous physical activity
(e.g., aerobics, weight lifting)
1
10
8
80
Low frequency
and intensity
Moderate physical activity
(e.g., regular cycling, carrying
light weight)
2
20
4
160
Low level
Walking ≥10 min/day
3
20
3.3
198
Low level
Total weekly physical activity
438 MET-
min/week
Physical activity
level: Low
Note: Own elaboration (2025).
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122
According to Table No. 2, following the application of the International Physical Activity
Questionnaire (IPAQ) and the corresponding analysis of the responses, the weekly physical activity level
in MET-min/week was calculated using the formula: MET × minutes per day × days per week. The
patient does not reach the recommended minimum level of 600 MET-min/week, presenting a low level
of physical activity. This indicates that before the intervention, her activity level was insufficient to obtain
the physical and psychological benefits associated with exercise, which justifies the application of the
supervised physical activity program.
Table 2.
Hamilton Scale Results
Item
Anxiety Symptom
Response
Anxiety
Level
Observation
1
Anxious mood
Very severe
4
Intense alteration
2
Tension
Severe
3
High bodily tension
3
Fears
Severe
3
Pronounced fears
4
Insomnia
Severe
3
Significant sleep
problems
5
Intellectual-cognitive
Very severe
4
Concentration difficulties
6
Depressed mood
Very severe
4
Intense emotional
alteration
7
General somatic symptoms
(muscular)
Severe
3
Physical discomfort
8
Somatic symptoms (sensory)
Very severe
4
Intense physical
manifestations
9
Cardiovascular symptoms
Moderate
2
Mild physiological
alteration
10
Respiratory symptoms
Severe
3
Perceptible respiratory
difficulty
11
Gastrointestinal symptoms
Very severe
4
Significant digestive
discomfort
12
Genitourinary symptoms
Moderate
2
Mild affectation
13
Autonomic symptoms
Severe
3
Notable physiological
activation
14
Behavior during interview
Very severe
4
Intense observable
reactions
Total /
Mean
3.5
Anxiety level: Very
severe
Note. Own Elaboration (2025).
Table 3 presents the results obtained through the application of the Hamilton Anxiety Scale. The total
mean of 3.5 indicates that the patient presented very severe anxiety before the intervention, with multiple
dimensions significantly affected, especially anxious mood, cognitive, somatic, and behavioral aspects.
This result evidences the need for an intervention to reduce anxiety levels and improve emotional well-
being during pregnancy.
Intervention
The physical activity program is designed for a 21-year-old pregnant woman in her third trimester, with
the main objective of reducing anxiety levels through systematic practice of adapted, controlled, and safe
physical activity. The plan covers a period of eight weeks, distributed in three phases: adaptation,
improvement, and maintenance, progressively increasing weekly exercise time and maintaining intensities
within a safe range of 35% to 65%, in accordance with recommendations for pregnant women.
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123
The program combines different types of exercises with physical, respiratory, and psychological
approaches, also integrating periodic evaluations (IPAQ, Hamilton, and Borg) to monitor the
patient's evolution in both physical condition and anxiety level.
Table 3.
Physical Activity Level in Post-Test
Type of Activity
Days/Week
Minutes/
Day
ME
T
MET-
min/week
Observation
Vigorous physical activity
(e.g., aerobics,
weightlifting)
1
10
8
80
Low frequency, slight
increase in intensity
Moderate physical activity
(e.g., regular cycling,
carrying light weight)
2
40
4
320
Longer duration,
significant
improvement
Walking ≥10 min/day
3
20
3.3
198
Slight increase in
frequency and
duration
Total weekly physical
activity
598 MET-
min/week
Physical activity
level: Moderate
Note. Own elaboration (2025).
According to Table No. 4, after the intervention, the patient increased her physical activity level from
438 MET-min/week to 598 MET-min/week, approaching the recommended threshold of 600 MET-
min/week. This indicates a significant improvement in physical activity behavior, with increased duration
and frequency of moderate activity, reflecting adherence to the program and greater functional capacity.
STAGES EV.PH
Days Mon Wed Fri Mon Wed Fri Mon Wed Fri Mon Wed Fri Mon Wed Fri Mon Wed Fri Mon Wed Fri Mon Wed Fri
Date 15 17 19 22 24 26 29 1 3 6 8 10 13 15 17 20 22 24 27 29 31 3 5 7
Minutes/Weekly
Minutes/Daily
Directions
Functional Exercises x x x x x x x x x x x x x
Breathing and Relaxation Exercises x x x x x x x x x x x x x x
Aquatic exercises x x x x x x
Kegel exercises and relaxation techniques x x x x x x
Psichological quiz x x x x x x x x x x x x x x x x x x x x x
IPAQ quiz x x
Hamilton Anxiety Scale x x
Borg Scale x x x x x x x x x x x x x x x x x x x x x x x
Medical Evaluation x x
420'
570'
35-40%
45-55%
60-65%
60-65%
60-65%
60-65%
60-65%
WEEK 8
Month/Week
90'
90'
120'
150'
150'
150'
150'
150'
SEPTEMBER
OCTOBER
NOVEMBER
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
WEEK 6
WEEK 7
Adaptation phase
Improvement Stage
Maintenance phase
EVA. PHASE
PROGRAM OBJECTIVE: To reduce anxiety levels through adapted and controlled physical activity in the 21-year-old pregnant woman.
PATIENT: Pregnant woman
PATIENT'S NAME: Dominga
TRAINER: Jhonny Vidal Corpus
START DATE: 09/15/25 END DATE: 11/07/25
PHYSICAL ACTIVITY PROGRAM FOR A 21-YEAR-OLD PREGNANT WOMAN IN THE 3rd TRIMESTER
RIAF Journal ISSN: 2953-6693 Vol – 4 No. 2, July 2026
124
Table 4.
Hamilton Anxiety Scale
Item
Anxiety Symptom
Response
Anxiety
Level
Observation
1
Anxious mood
Moderate
2
Notable improvement
2
Tension
Mild
1
Significant reduction
3
Fears
Moderate
2
Decrease in fears
4
Insomnia
Mild
1
Better sleep quality
5
Intellectual-cognitive
Moderate
2
Better concentration
6
Depressed mood
Moderate
2
Reduction of depressive
symptoms
7
General somatic symptoms
(muscular)
Mild
1
Less physical discomfort
8
Somatic symptoms (sensory)
Moderate
2
Decrease in physical
manifestations
9
Cardiovascular symptoms
Moderate
2
Mild reduction of symptoms
10
Respiratory symptoms
Mild
1
Better breathing and relaxation
11
Gastrointestinal symptoms
Moderate
2
Less digestive discomfort
12
Genitourinary symptoms
Moderate
2
Mild improvement
13
Autonomic symptoms
Moderate
2
Less physiological activation
14
Behavior during interview
Mild
1
Observed improvement in
behavior
Total /
Mean
1.9
Anxiety level: Moderate
Note. Own elaboration (2025).
Table No. 5 indicates the results according to the Hamilton Anxiety Scale (HAM-A). The total mean
decreased from 3.5 (very severe) to 1.9 (moderate), representing a 45.7% reduction in anxiety levels.
Improvement is observed in all dimensions, especially in tension, insomnia, and somatic symptoms,
showing that the physical activity intervention had a significant and positive effect on the patient's
emotional regulation and well-being.
Table 5.
Data Triangulation
Hamilton Anxiety Scale
Theoretical Support
Pre-test
Post-test
Inference
In the pre-test, very
severe scores were
recorded for anxious
mood, intellectual-
cognitive functioning,
depressed mood,
sensory somatic
symptoms, respiratory
symptoms,
gastrointestinal
symptoms, and
behavior during the
interview; while
tension, fears,
insomnia, general
somatic symptoms
were rated as severe.
Cardiovascular and
genitourinary
symptoms
The patient presented a
moderate level in
anxious mood, fears,
intellectual-cognitive
functioning, depressed
mood, somatic
symptoms (sensory
and general),
cardiovascular,
gastrointestinal,
genitourinary, and
autonomic symptoms.
Tension, insomnia,
respiratory symptoms,
and behavior during
the interview were
rated as mild. These
results determine that
the patient presents a
moderate level of
The comparison
between pre- and
post-test evidences a
significant decrease in
anxiety symptoms.
The patient went from
a very severe level
characterized by
intense alterations in
anxious mood,
somatic symptoms,
cognitive functioning,
and autonomic
manifestations to a
moderate level, where
several dimensions
were reduced to
moderate or mild
intensities. This
demonstrates that the
The Hamilton
Anxiety Scale (HAM-
A) is a widely
validated clinical
instrument for
assessing anxiety
severity and changes
produced after an
intervention.
Hamilton (1959)
provides evidence that
techniques such as
diaphragmatic
breathing, progressive
muscle relaxation, and
physical activity
contribute to
decreasing
physiological
activation and
RIAF Journal ISSN: 2953-6693 Vol – 4 No. 2, July 2026
125
reached a moderate
level. These results
determine that the
patient presents a very
severe level of anxiety.
anxiety.
applied intervention
generated a positive
impact, favoring clear
emotional and
physiological
Improvement.
improving emotional
regulation, favoring
the reduction of
anxiety symptoms.
The comparison between pre-test and post-test in Table No. 6 shows significant changes in the patient's
anxiety. Initially, she presented a very severe level of anxiety, with high scores in anxious mood, cognitive
functioning, and somatic symptoms. In the post-test, her anxiety level was reduced to moderate, with
symptoms classified as moderate or mild. This indicates a positive impact of the intervention, improving
both her emotional and physiological well-being. The Hamilton Anxiety Scale (HAM-A) supports these
results, confirming the effectiveness of techniques such as breathing and relaxation in reducing anxiety.
Table 6.
Statistical Data Triangulation
Instrument
Pre-test
Post-test
%
Change
Qualitative Data
Inference
Hamilton
Anxiety Scale
(HAM-A) -
total level
3.5 (Very
severe)
1.9
(Moderate)
45,7%
↓
The patient reports
less tension, less
fear, greater
relaxation, and
concentration in
daily activities.
The physical activity
intervention significantly
decreased anxiety,
confirming the subjective
perception of well-being.
IPAQ - MET-
min/week (total
physical
activity)
438
598
36.5%
↑
The patient
expresses greater
energy, confidence,
and motivation to
exercise, and a sense
of achievement.
Physical activity increased
considerably, agreeing with
the improvement in
perception of well-being
and reduction of anxiety.
Borg Scale -
effort
perception
(session
average)
Light (0-
3)
Light to
heavy (3-6)
N/A
The patient
expresses
satisfaction and
control over exercise
intensity; adapts
effort according to
bodily sensation.
The perception of effort
reflects progressive
adaptation and self-
regulation, contributing to
emotional and physical
well-being.
Note:
Borg does not require %, as it is qualitative/ordinal and is complemented by the description of
subjective experience.
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126
According to Table No. 7, on the triangulation
of quantitative and qualitative results, a
comprehensive understanding of the impact of
physical activity on the patient's anxiety is
observed. According to the Hamilton Anxiety
Scale (HAM-A), total anxiety decreased from a
mean of 3.5 (very severe) in the pre-test to 1.9
(moderate) in the post-test, representing a 45.7%
reduction. This decrease is also reflected in the
participant's testimonies, who reported less
tension, reduced fear, and greater relaxation and
concentration in her daily activities. In relation to
physical activity measured by IPAQ, the patient
went from 438 MET-min/week in the pre-test to
598 MET-min/week in the post-test,
corresponding to an increase of 36.5%. This
increase in physical activity was accompanied by
qualitative comments that evidenced greater
energy, motivation, and confidence in the
execution of the exercises, as well as satisfaction
with the achievement. The Borg Scale, used both
as a quantitative instrument and a qualitative
source, showed that the patient's effort
perception evolved from light levels (0-3) to light
to heavy (3-6), reflecting progressive adaptation
to the physical load. This perception was
complemented by expressions of self-regulation
and enjoyment during the sessions, indicating that
the patient learned to control the intensity of
exercises according to her bodily sensations.
Overall, the triangulation evidences that the
supervised physical activity program produced
significant improvements in the patient's anxiety
and general well-being, confirming the
convergence between objective indicators and
subjective experience.
At the beginning of the study, the 21-year-old
patient in her third trimester of gestation
presented a low level of physical activity, with 438
MET-min/week according to the International
Physical Activity Questionnaire (IPAQ). During
the supervised physical activity program, the level
increased to 598 MET-min/week, representing
an increase of 36.5%.
Qualitatively, the participant expressed greater
energy, confidence, and motivation to perform
the exercises, also indicating satisfaction with the
improvement achieved:
"Now I can do the exercises for longer and I
feel calmer after each session."
This demonstrates that the intervention
positively impacted both the objective level of
physical activity and the subjective experience of
well-being (Craig et al., 2003).
The Hamilton Anxiety Scale (HAM-A)
indicated that the patient initially presented a very
severe level of anxiety, with high scores in anxious
mood, depressed mood, intellectual-cognitive
functioning, and somatic symptoms. After the
intervention, the post-test showed a decrease to a
moderate level, with a 45.7% reduction in the
total anxiety mean (from 3.5 to 1.9).
The patient also expressed qualitative
improvements in her emotional state:
"After doing the exercises I feel more relaxed
and less worried about everything."
These results evidence that supervised
physical activity contributed to the reduction of
anxiety and greater psychological well-being
during pregnancy (Hamilton, 1959).
The Borg Scale allowed the evaluation of
subjective effort perception and adjustment of
intensity in an individualized manner. During
sessions, effort perception fluctuated between
"light" (0-3) at the beginning and "light to heavy"
(3-6) in intermediate sessions, reflecting
progressive adaptation and self-regulation of
exercise (Table 3).
Qualitatively, the patient reported:
"I can control how I exert myself and I enjoy
the exercises more."
This indicates that intensity adaptation
contributed both to physical safety and emotional
well-being.
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127
Discussion
The general objective of this research was to
determine the influence of a physical activity
program on anxiety during pregnancy in a 21-
year-old woman in her third trimester of
gestation. The results obtained through the single
case study design and data triangulation confirm
the alternative hypothesis (Ha), categorically
demonstrating that the implementation of a
supervised physical activity program significantly
reduced anxiety levels in the participant. This
central finding validates adapted physical activity
as an effective and non-pharmacological strategy
for managing gestational anxiety, which is a
common psychosocial risk factor in the advanced
gestational period.
The success of the intervention is evidenced
by the positive bifocal change experienced by the
patient throughout the eight weeks of the
program. Initially, the participant presented a
diagnosis of very severe anxiety, with a total mean
of 3.5 according to the Hamilton Anxiety Scale
(HAM-A), and a low level of physical activity,
recording 438 MET-min/week through the
International Physical Activity Questionnaire
(IPAQ). After the intervention, anxiety was
notably reduced to a moderate level (mean of 1.9),
representing a total reduction of 45.7% in anxiety
levels. Simultaneously, physical activity increased
to 598 MET-min/week, being classified as a
moderate level and approaching the minimum
threshold recommended by the World Health
Organization (WHO) of 600 MET-min/week.
This improvement process is grounded in the
biopsychosocial model of well-being and the
theory of self-determination, which explain how
exercise acts as a natural antidepressant by
promoting the release of endorphins and
serotonin, thus improving emotional state and
perception of control.
The results of this case study are in full
agreement with the international scientific
literature. The reduction in anxiety is consistent
with previous studies, such as those by Mottola
(2021) in Canada, Smith et al. (2020) in the United
States, and Lee et al. (2022) in South Korea,
which consistently reported that moderate-
intensity physical activity reduces anxiety
symptoms in pregnant women, with reduction
percentages ranging between 30% and 40%. The
finding that regular physical activity is associated
with lower levels of anxiety and higher self-
esteem is also supported by research such as that
of Silva et al. (2019) in Brazil. The current study,
by documenting the evolution from a case of
severe clinical anxiety to a manageable state,
reinforces this global consensus and underscores
the importance of moderate intensity in symptom
reduction.
The robustness of the research is due to the
mixed-methods nested (embedded) design with
quantitative dominance, which allowed the
integration of objective and subjective data for a
complete understanding of the effect. The
quantitative component measured the magnitude
of change in anxiety (HAM-A) and physical
activity (IPAQ). The qualitative component,
obtained through micro-interviews and the use of
the Borg Rating of Perceived Exertion (RPE)
Scale, was fundamental for contextualizing and
interpreting the numerical results. The use of the
Borg Scale facilitated the control of exercise
intensity in a safe manner for the pregnant
woman, and the patient's expressions, such as
"less tension, less fear, greater relaxation and
concentration" and that "she feels calmer after
each session," confirmed that the objective
improvement corresponded with the subjective
perception of well-being. In addition to anxiety
reduction, the program contributed to the
improvement of physical condition and effort
self-regulation, factors that significantly
contribute to the general emotional well-being of
the pregnant woman.
RIAF Journal ISSN: 2953-6693 Vol – 4 No. 2, July 2026
128
In conclusion, the rigorous triangulation of data
validates the implementation of structured and
controlled programs as a fundamental practice for
improving the quality of life of pregnant women,
especially in cases of elevated anxiety,
demonstrating that physical activity is an essential
component for comprehensive care during
pregnancy.
Conclusions
The general objective of this research was to
determine the influence of a physical activity
program on anxiety during pregnancy in a 21-
year-old woman. The results obtained through
rigorous data triangulation (quantitative and
qualitative) robustly confirmed the efficacy of the
program, demonstrating that adapted and
controlled physical activity during the third
trimester of gestation has a positive and
significant influence on the reduction of the
participant's anxiety levels.
It was determined that the patient presented a
low level of physical activity before the
intervention. Based on the detailed data from the
International Physical Activity Questionnaire
(IPAQ), an initial value of 438 MET-min/week
was recorded, which was notably below the
minimum threshold of 600 MET-min/week
recommended for health.
It was concluded that the participant,
evaluated with the Hamilton Anxiety Scale
(HAM-A) in the pre-test, presented a very severe
level of anxiety. This initial diagnosis evidenced
intense alterations in multiple dimensions,
including anxious mood, intellectual-cognitive
functioning, depressed mood, and various
somatic symptoms.
The post-test results demonstrated a
significant reduction in anxiety. The patient
presented a moderate level of anxiety, with a
45.7% reduction in the total mean (from 3.5 to
1.9), and her symptoms were predominantly
classified as moderate or mild, indicating clear
emotional and physiological improvement.
The comparison of pre- and post-intervention
values reveals a positive bifocal change: The
patient went from a "low" level of physical
activity (438 MET-min/week) to a "moderate"
level (598 MET-min/week), reflecting a 36.5%
increase in her total physical activity.
Simultaneously, anxiety decreased from a "very
severe" level to "moderate." Additionally, the use
of the Borg Scale evidenced a progressive
improvement in the patient's ability to recognize
and self-regulate her physical effort (fluctuating
between "light" and "light to heavy"), which
contributed to safe, efficient practice and her
emotional well-being.
This research validates physical activity as an
accessible, safe, and evidence-based strategy to
mitigate gestational anxiety in the third trimester.
The effectiveness of structured and controlled
programs is confirmed, demonstrating that
physical activity is fundamental for improving
emotional, physical well-being, and quality of life
for young women during pregnancy.
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Declaration of no conflicts of interest:
The authors declare no conflicts of interest.
Declaration of author participation in the
research:
The authors participated in the research process,
from the theoretical foundation, diagnosis, data
collection before and after the intervention with
the patient.