To the Editor,

We read with interest the recent paper by Barakat et al entitled “An exercise program throughout pregnancy: Barakat model” (in this issue), which introduces the need for professional supervision of physical exercise during pregnancy.

The author puts forward the importance of the training of specialists in this perspective (Barakat, 2020). Indeed, the author presents scientific evidence of the advantages of supervised exercise programs compared to autonomous exercise programs on perinatal health outcomes. The results of the latter—that is, without supervision—being inconclusive, the approach of supervised programs is an interesting option for health authorities.

Optimizing the content of these programs is a challenge, to which Barakat's model provides a framework. The universal acceptance of such a model, however, may have limited feasibility considering the current context of health inequality (The Lancet, 2018)? The goal of the World Health Organization is that every pregnant woman receive quality care throughout pregnancy, in particular by promoting health including physical activity (WHO, 2016).

Health promotion through primary health care can generate positive, although not large, changes in health outcomes and physical activity levels. These health promotion programs are feasible and acceptable to all pregnant women using sustainable resources (Zinsser, Stoll, Wieber, Pehlke‐Milde, & Gross, 2020). The involvement and skills of health professionals can contribute to the success or failure of such programs (Lion et al., 2018; Yaghoubi, Karamali, & Bahadori, 2019).

The health promotion approach alleviates barriers to physical activity such as cost and the availability of exercise professionals trained specifically to promote and oversee exercise in pregnant women. Indeed, the lack of information/advice as well as the lack of training/resources are reported, respectively, by pregnant women and health professionals (Coll, Domingues, Gonçalves, & Bertoldi, 2017; De Vivo & Mills, 2019). These two approaches, are they really exclusive from one another?

We do not think so. We believe that a physical activity promotion approach is just as important when considering future lines of research and public health practice. In a practical sense, the physical activity promotion may reach more women and have the potential to synergize with programs supervised by professionals when they are accessible and available.

Subsequently, physical activity promotion should be integrated together with Barakat's model within a larger strategy, addressed to impact women with a range of socioeconomic status, health behaviors, and health systems.

致编辑，

我们饶有兴趣地阅读了 Barakat 等人最近发表的题为“整个孕期的锻炼计划：Barakat 模型”的论文（本期），其中介绍了对孕期体育锻炼进行专业监督的必要性。

作者从这个角度提出了专家培训的重要性（Barakat，2020）。事实上，作者提供了科学证据，证明在围产期健康结果方面，监督锻炼计划与自主锻炼计划相比具有优势。后者的结果——即没有监督——是不确定的，监督项目的方法对卫生当局来说是一个有趣的选择。

优化这些程序的内容是一项挑战，Barakat 的模型为此提供了一个框架。然而，考虑到当前健康不平等的背景，这种模式的普遍接受性可能有限（《柳叶刀》，2018 年）？世界卫生组织的目标是让每位孕妇在整个怀孕期间都能获得优质护理，特别是通过促进包括身体活动在内的健康（WHO，2016 年）。

通过初级卫生保健促进健康可以在健康结果和身体活动水平方面产生积极的变化，虽然不是很大。所有使用可持续资源的孕妇都可以接受这些健康促进计划（Zinsser、Stoll、Wieber、Pehlke-Milde 和 Gross，2020 年）。卫生专业人员的参与和技能有助于此类计划的成功或失败（Lion 等，2018 年；Yaghoubi、Karamali 和 Bahadori，2019 年）。

健康促进方法减轻了体育活动的障碍，例如成本和专门培训的运动专业人员的可用性，以促进和监督孕妇的运动。事实上，孕妇和卫生专业人员分别报告了缺乏信息/建议以及缺乏培训/资源（Col、Domingues、Gonçalves 和 Bertoldi，2017 年；De Vivo 和 Mills，2019 年）。这两种方法，它们真的相互排斥吗？

我们不这么认为。我们认为，在考虑未来的研究方向和公共卫生实践时，促进身体活动的方法同样重要。在实际意义上，体育活动推广可能会惠及更多女性，并有可能与专业人士监督的项目在可获得和可用时协同作用。

随后，身体活动促进应与 Barakat 的模型结合在一个更大的战略中，旨在影响具有一系列社会经济地位、健康行为和卫生系统的女性。