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McCleery J, Diamond E, Kelly R, Li L, Ackerman KE, Adams WM, Kraus E. Centering the female athlete voice in a sports science research agenda: a modified Delphi survey with Team USA athletes. Br J Sports Med 2024:bjsports-2023-107886. [PMID: 38981661 DOI: 10.1136/bjsports-2023-107886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES To co-construct a sports medicine and exercise science research and translational agenda with Team USA elite female athletes serving as the experts on their health, performance and well-being. METHODS 40 Team USA female athletes across sports disciplines participated in an online, anonymous, modified Delphi survey by ranking topics on a Likert scale (1='strongly disagree' and 5='strongly agree') and providing qualitative justification regarding whether they believed having more information and research on each topic would support their athletic performance, health and well-being. After each Delphi round, quantitative rankings of topics and qualitative justifications were analysed, informing revisions to the list of topics for review in the subsequent round. Researchers provided athletes with a detailed report of findings and revisions following each round. RESULTS The final list contained 14 ranked topics. The top five were menstrual cycle symptoms (4.58±0.74), recovery (4.58±0.59), birth control (4.55±0.89), mental health (4.50±0.55) and fueling and the menstrual cycle (4.43±0.74). New topics originating from athletes included recovery, menstrual cycle symptoms, fueling and the menstrual cycle, mental health and sports performance, team dynamics, and institutionalised sexism. CONCLUSION This is the first study to co-construct a research and translational agenda with Team USA elite female athletes. The list of sports science research topics developed by focusing on elite female athletes' voices lays the foundation for future research and provides valuable insight into the specific needs of female athletes.
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Affiliation(s)
- Julie McCleery
- Center for Leadership in Athletics, University of Washington College of Education, Seattle, Washington, USA
| | - Ellie Diamond
- Female Athlete Science and Translational Research Program, Stanford University Department of Orthopaedic Surgery, Redwood City, California, USA
| | - Rose Kelly
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Longxi Li
- Center for Leadership in Athletics, University of Washington College of Education, Seattle, Washington, USA
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - William M Adams
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, Colorado, USA
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - Emily Kraus
- Female Athlete Science and Translational Research Program, Stanford University Department of Orthopaedic Surgery, Redwood City, California, USA
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Evenson KR, Brown WJ, Brinson AK, Budzynski-Seymour E, Hayman M. A review of public health guidelines for postpartum physical activity and sedentary behavior from around the world. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:472-483. [PMID: 38158180 PMCID: PMC11184298 DOI: 10.1016/j.jshs.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The period following pregnancy is a critical time window when future habits with respect to physical activity (PA) and sedentary behavior (SB) are established; therefore, it warrants guidance. The purpose of this scoping review was to summarize public health-oriented country-specific postpartum PA and SB guidelines worldwide. METHODS To identify guidelines published since 2010, we performed a (a) systematic search of 4 databases (CINAHL, Global Health, PubMed, and SPORTDiscus), (b) structured repeatable web-based search separately for 194 countries, and (c) separate web-based search. Only the most recent guideline was included for each country. RESULTS We identified 22 countries with public health-oriented postpartum guidelines for PA and 11 countries with SB guidelines. The continents with guidelines included Europe (n = 12), Asia (n = 5), Oceania (n = 2), Africa (n = 1), North America (n = 1), and South America (n = 1). The most common benefits recorded for PA included weight control/management (n = 10), reducing the risk of postpartum depression or depressive symptoms (n = 9), and improving mood/well-being (n = 8). Postpartum guidelines specified exercises to engage in, including pelvic floor exercises (n = 17); muscle strengthening, weight training, or resistance exercises (n = 13); aerobics/general aerobic activity (n = 13); walking (n = 11); cycling (n = 9); and swimming (n = 9). Eleven guidelines remarked on the interaction between PA and breastfeeding; several guidelines stated that PA did not impact breast milk quantity (n = 7), breast milk quality (n = 6), or infant growth (n = 3). For SB, suggestions included limiting long-term sitting and interrupting sitting with PA. CONCLUSION Country-specific postpartum guidelines for PA and SB can help promote healthy behaviors using a culturally appropriate context while providing specific guidance to public health practitioners.
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Affiliation(s)
- Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8050, USA.
| | - Wendy J Brown
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Alison K Brinson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3115, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8120, USA
| | | | - Melanie Hayman
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
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Moholdt T, Sujan MAJ, Ashby ER, Beetham K. Interval training and cardiometabolic health in reproductive-aged females. Appl Physiol Nutr Metab 2024; 49:993-1001. [PMID: 38478956 DOI: 10.1139/apnm-2023-0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
Physical activity and exercise training are especially important for reproductive-aged females as exercise-induced health benefits can also affect their infants. However, levels of physical inactivity remain high among females in this age group, before, during, and after pregnancy. There is a great need for practical and feasible exercise modes to increase adherence to exercise in this population, and interval training may be a time-efficient training modality. Interval training is a form of exercise involving intermittent bouts of intense effort interspersed with recovery periods of rest or lower-intensity exercise. A substantial amount of research indicates that interval training induces superior cardiometabolic health benefits compared with iso-energetic moderate-intensity continuous exercise. This review provides a comprehensive overview of research on interval training interventions in reproductive-aged females across various life stages, focusing on the cardiometabolic health benefits. We discuss the potential role of interval training in premenopausal females with overweight/obesity, polycystic ovary syndrome, and subfertility, as well as the potential influence of oral contraceptives on cardiometabolic adaptations to interval training. Furthermore, this review also highlights recent findings supporting the beneficial role of high-intensity interval training for cardiometabolic health outcomes during pregnancy. In summary, the existing evidence suggests that interval training can improve several cardiometabolic and reproductive outcomes in females spanning different life stages. However, more research is needed to further strengthen the evidence-base for physical activity recommendations for females in their reproductive years of life.
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Affiliation(s)
- T Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Women's Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - M A J Sujan
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Women's Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - E R Ashby
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Beetham
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
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Schmitt EM, DeGroot DW, Sitler CA, Lustik M, Gehrich AP. Effect of Serial Pregnancies on Physical Fitness. Mil Med 2024:usae335. [PMID: 38943536 DOI: 10.1093/milmed/usae335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/19/2024] [Accepted: 06/18/2024] [Indexed: 07/01/2024] Open
Abstract
INTRODUCTION Pregnancy has a profound impact on physical fitness, and delivery does not allow for rapid return to peak performance levels as physiologic changes can persist for greater than 1 year postpartum. Multiple studies across all military services have documented decrements in physical performance with pregnancy among women. The purpose of this study was to determine the impact of serial pregnancies on physical fitness and body composition in a cohort of Army women. We hypothesized that a second pregnancy would be associated with increasing decrements in physical fitness in active duty soldiers beyond that seen following a first delivery. MATERIALS AND METHODS This retrospective cohort study screened all active duty soldiers who had delivered a singleton pregnancy of ≥32 weeks gestation between January 1, 2011 and March 31, 2017 at a single military medical center. This roster of eligible women was used to extract Army Physical Fitness Test (APFT) and height/weight data from the U.S. Army Digital Training Management System. Soldiers who delivered their first 2 pregnancies over this period were included. Select antepartum, intrapartum, and postpartum data were collected from the electronic medical record. The primary outcome variables were raw scores for push-ups, sit-ups, and run events as well as weight measures across the 2 pregnancies. The secondary outcomes were the failure rates on both the APFT events and body mass index measurements. Data were analyzed using paired t-tests to compare the means of APFT scores across the 2 pregnancies. The subjects served as their own controls. This study was approved by Regional Health Command-Pacific. RESULTS A total of 2,103 active duty soldiers delivered singleton pregnancies at Tripler Army Medical Center between January 2011 and March 2017. Among these, 16 women delivered both their first- and second-term pregnancies and had APFT data available for analysis. Average age at time of first and second delivery was 26.1 and 28.1 years, respectively. Mean time separating the first postpartum APFT from the delivery was 8.8 months for the first pregnancy and 7.3 months following the second.A significant decrease in mean sit-up score was found comparing APFT-1 with APFT-2 (72.1 vs 65.7, P = .043) and comparing APFT-1 to APFT-3 (72.1 vs 60.9, P = .002). A significant increase in mean run time was found comparing APFT-1 to APFT-3 (16.9 minutes vs 17.9 minutes, P = .010) and APFT-2 to APFT-3 (17.5 minutes vs 17.9 minutes, P = .027). Comparing APFT-1 to APFT-3 showed a significant decrease in sit-up raw scores (P = .002), run times (P = .010), and total APFT scores (P = .01). Overall, the data show a trend of decreasing performance in all APFT events across the 3 APFTs and a trend toward higher failure rates. This cohort of soldiers did not experience weight gain following the pregnancies. CONCLUSIONS The present study is the first to analyze the association of serial pregnancies on physical fitness utilizing a validated physical fitness test, and the results suggest that a second pregnancy is associated with progressive worsening of performance. This study is limited by the small sample size, and future studies could further elucidate the degree to which serial pregnancies affect physical fitness.
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Affiliation(s)
- Eric M Schmitt
- Gynecologic Surgery and Obstetrics Department, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - David W DeGroot
- Army Heat Center, Martin Army Community Hospital, Fort Moore, GA 31905, USA
| | - Collin A Sitler
- Gynecologic Surgery and Obstetrics Department, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Michael Lustik
- Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Alan P Gehrich
- Gynecologic Surgery and Obstetrics Department, Tripler Army Medical Center, Honolulu, HI 96859, USA
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Woodroffe L, Slayman T, Paulson A, Kruse N, Mancuso A, Hall M. Return to Running for Postpartum Elite and Subelite Athletes. Sports Health 2024:19417381241256973. [PMID: 38864285 DOI: 10.1177/19417381241256973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
CONTEXT There is little evidence to guide elite athletes who desire returning to competition after giving birth to a child. Ultimately, this can result in decreased performance and increased risk of injury. This paper addresses aspects that must be considered when building and monitoring a return to running program for a postpartum elite or subelite athlete, including pelvic floor and core stability, progressive reloading of the musculoskeletal system, monitoring of nutritional parameters, and considerations for lactation. EVIDENCE ACQUISITION PubMed and CINAHL (Cumulative Index for Nursing and Allied Health Literature) were searched with the following search strategy: (extreme sports OR elite athletes OR running OR exercise) AND (breastfeeding OR lactation OR bone density OR fetal weight OR gestational weight gain OR postpartum or post-partum OR postnatal OR post-natal OR pregnancy OR childbirth). The following information is based on best available evidence and clinical experience. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Due to the interplay between cardiovascular fitness, postpartum nutrition, lactation, and progressive reloading of the muscular and skeletal system, we propose a multimodal, multidisciplinary approach to safely and successfully allow an athlete to return to an elite level of competition. CONCLUSION Return to running in the postpartum period is a highly individualized process that benefits from multidisciplinary, individualized care. This includes monitoring of nutrition, core and pelvic floor function, bone reloading, muscle and tendon reloading, and breastfeeding care when applicable. STRENGH OF RECOMMENDATION TAXONOMY (SORT) C.
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Affiliation(s)
- Lisa Woodroffe
- University of Iowa Institute of Orthopedics Sports Medicine and Rehabilitation, University of Iowa Healthcare, Iowa City, Iowa
| | - Tyler Slayman
- University of Iowa Institute of Orthopedics Sports Medicine and Rehabilitation, University of Iowa Healthcare, Iowa City, Iowa
| | - Amanda Paulson
- University of Iowa Institute of Orthopedics Sports Medicine and Rehabilitation, University of Iowa Healthcare, Iowa City, Iowa
| | - Natalie Kruse
- University of Iowa Healthcare Main Campus, Iowa City, Iowa
| | - Abigail Mancuso
- University of Iowa Healthcare Main Campus, Iowa City, Iowa
- University of Iowa Healthcare West Des Moines Campus, West Des Moines, Iowa
| | - Mederic Hall
- University of Iowa Institute of Orthopedics Sports Medicine and Rehabilitation, University of Iowa Healthcare, Iowa City, Iowa
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Afifi T, Barrack MT, Casey E, Huddle M, Kliethermes SA, Kraus E, Toresdahl BG, Wasfy MM, Tenforde AS. Infographic. Head to toe considerations for the postpartum endurance athlete. Br J Sports Med 2024; 58:630-632. [PMID: 38448197 DOI: 10.1136/bjsports-2023-107624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Toqa Afifi
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Network, Charlestown, Massachusetts, USA
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, California, USA
| | - Ellen Casey
- Hospital for Special Surgery, New York, New York, USA
| | | | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Emily Kraus
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, California, USA
| | | | - Meagan M Wasfy
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
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Brites-Lagos C, Maranhão C, Szumilewicz A, Santos-Rocha R. Development and validation of the physical exercise program "Active Mums" for postpartum recovery: application of the CReDECI-2 guidelines. BMC Pregnancy Childbirth 2024; 24:378. [PMID: 38769520 PMCID: PMC11103992 DOI: 10.1186/s12884-024-06387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/02/2024] [Indexed: 05/22/2024] Open
Abstract
Postpartum physical activity is a public health issue. Reporting on the quality of exercise interventions designs must be ensured in view of the reproducibility and successful implementation of such studies. The objective was to develop and preliminary validate a physical exercise program for postpartum recovery, aiming to promote physical fitness and health of the new mothers. The study was carried out through the three stages of development, piloting, and evaluation. The Consensus on Exercise Reporting Template (CERT) was used to describe the postpartum exercise program. The Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare (CReDECI2) was followed to develop and preliminary validate the program. A tailored postpartum exercise program was developed based on evidence-based international recommendations to be implemented by qualified exercise professionals. A pilot intervention of 16 weeks was carried out, engaging a group of postpartum women. The viability of the program was subsequently evaluated by all participants. The present work provided guidance to develop a study protocol with a larger sample in order to prove the effectiveness of a supervised postpartum exercise program on selected parameters of health.
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Affiliation(s)
- Carla Brites-Lagos
- ESDRM Sport Sciences School of Rio Maior - Santarem Polytechnic University, Rio Maior, Portugal
| | - Cristiana Maranhão
- ESDRM Sport Sciences School of Rio Maior - Santarem Polytechnic University, Rio Maior, Portugal
| | - Anna Szumilewicz
- Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Rita Santos-Rocha
- ESDRM Sport Sciences School of Rio Maior - Santarem Polytechnic University, Rio Maior, Portugal.
- SPRINT - Sport Physical Activity and Health Research and Innovation Center - Santarem Polytechnic University, Rio Maior, Portugal.
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Gallo-Galán LM, Gallo-Vallejo MA, Gallo-Vallejo JL. [Medical recommendations from primary care on physical exercise in the postpartum]. Semergen 2024; 50:102148. [PMID: 38064768 DOI: 10.1016/j.semerg.2023.102148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 04/01/2024]
Abstract
There is evidence that demonstrates the benefits of practicing physical activity/exercise for the mother after childbirth. However, this postpartum period (PP) is often a missed opportunity in a lifetime for women to start or resume physical exercise and get the great benefits that it can bring them. The objective of this article was to analyze the benefits of physical exercise during PP; the prescription of physical exercise; recommendations on when to resume your practice; barriers and facilitators; physical exercise during breastfeeding; as well as its role in the most frequent illnesses and discomforts in this period, always keeping in mind that the work of the primary care doctor is essential to motivate and encourage women to perform physical exercise in the PP.
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Affiliation(s)
- L M Gallo-Galán
- Servicio de Obstetricia y Ginecología, Hospital Universitario Sanitas La Moraleja, Madrid, España
| | - M A Gallo-Vallejo
- Centro de Medicina Deportiva, Concejalía de Deportes del Ayuntamiento de Granada, Granada, España
| | - J L Gallo-Vallejo
- Servicio de Obstetricia y Ginecología, Hospital Universitario Virgen de las Nieves, Granada, España; Departamento de Obstetricia y Ginecología de la Universidad de Granada, Granada, España.
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9
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Nose-Ogura S, Yoshino O, Nakamura-Kamoto H, Kanatani M, Harada M, Hiraike O, Saito S, Fujii T, Osuga Y. Medical issues for female athletes returning to competition after childbirth. PHYSICIAN SPORTSMED 2024; 52:147-153. [PMID: 36872580 DOI: 10.1080/00913847.2023.2188395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND In recent years, the number of athletes who aim to return to competition after childbirth has increased. However, few international reports have investigated complications during pregnancy, and changes in physical function after childbirth in many athletes. OBJECTIVE To conduct a retrospective investigation of medical problems during pregnancy, and postpartum, in female athletes who aim to return to competition after childbirth, and to identify the barriers and facilitators for their return. METHODS A voluntary web-based survey was aimed at former female athletes who became pregnant with their first child and gave birth during their active sports career. The survey items included respondent background, their exercise activities during and after childbirth, perinatal complications, mode of delivery, symptoms and physical function after childbirth. The participants were divided into a vaginal delivery group and a cesarean section group. RESULTS Three hundred and twenty-eight (29.1 ± 5.1 years old) former athletes were included in the analysis, and about half reported undertaking exercise during pregnancy. The most common perinatal complication was anemia (27.4%). The appearance of any symptoms after childbirth, including low back pain (44.2%) and urinary incontinence (39.9%), was reported by 80.5%. The rate of urinary incontinence may be higher in the vaginal delivery than in the cesarean section group (p = 0.05). The most common physical decline after childbirth was in muscular strength, followed by speed and endurance. CONCLUSION Addressing pregnancy-associated anemia and managing low back pain is critical for athletes aiming to return to competition after childbirth. Additionally, interventions to reduce the risk for and treat urinary incontinence are important. In addition, in order to return to competition after childbirth, it is important to strengthen muscles, especially the lower limbs and trunk, as well as to create a training program that takes into account the sport/events.
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Affiliation(s)
- Sayaka Nose-Ogura
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, University of Yamanashi, Yamanashi, Japan
| | | | - Mayuko Kanatani
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Osamu Hiraike
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Sanno Hospital, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
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Christopher SM, Donnelly G, Brockwell E, Bo K, Davenport MH, De Vivo M, Dufour S, Forner L, Mills H, Moore IS, Olson A, Deering RE. Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement. Br J Sports Med 2024; 58:299-312. [PMID: 38148108 DOI: 10.1136/bjsports-2023-107489] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/28/2023]
Abstract
Female athletes have identified a lack of guidance as a barrier to successfully returning to running postpartum, and existing guidelines are vague. Our aim was to define the current practice of determining postpartum run-readiness through a consensus survey of international clinicians and exercise professionals in postpartum exercise to assist clinicians and inform sport policy changes.A three-round Delphi approach was used to gain international consensus from clinicians and exercise professionals on run-readiness postpartum. Professionals who work with postpartum runners participated in an online survey to answer open-ended questions about the following postpartum return-to-running topics: definitions (runner and postpartum), key biopsychosocial milestones that runners need to meet, recommended screening, timeline to initiate running, support items, education topics and factors that contribute to advising against running. Consensus was defined as ≥75% participant agreement.One hundred and eighteen professionals participated in round I, 107 participated in round II (response rate 90.6%) and 95 participated in round III (response rate 80.5%). Responses indicated that, following a minimum 3-week period of rest and recovery, an individualised timeline and gradual return to running progression can be considered. Screening for medical and psychological concerns, current physical capacity, and prior training history is recommended prior to a return to running.This study proposes recommendations for the initial guidance on return-to-running postpartum, framed in the context of current research and consensus from professionals. Future research is needed to strengthen and validate specific recommendations and develop guidelines for best practice when returning-to-running after childbirth.
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Affiliation(s)
- Shefali Mathur Christopher
- Department of Rehabilitation Sciences, Doctor of Physical Therapy, Tufts University, Seattle, Washington, USA
- Elon University, Elon, North Carolina, USA
| | - Gráinne Donnelly
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marlize De Vivo
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, UK
- Active Pregnancy Foundation, None, UK
| | - Sinead Dufour
- The World of my Baby (WOMB), Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Lori Forner
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Hayley Mills
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, UK
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Rita E Deering
- Department of Physical Therapy, Carroll University, Waukesha, Wisconsin, USA
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
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11
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Fallon T, Heron N, Moore IS, Donnelly GM. What should be included in an Olympic Sports International Federations' pregnancy and postpartum policy and guidance? Br J Sports Med 2024:bjsports-2023-107778. [PMID: 38442952 DOI: 10.1136/bjsports-2023-107778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Thomas Fallon
- Queen's University Belfast, Belfast, UK
- Edinburgh Sports Medicine Research Network & UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), Institute for Sport, PE and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Neil Heron
- Queen's University Belfast, Belfast, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Keele University Faculty of Medicine & Health Sciences, Keele, UK
| | - Isabel S Moore
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK
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12
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Smith SVM, Darroch FE, Giles AR, Wykes D. Fatherhood and Elite Athletics: Sacrifice, Selfishness, and Gaining "Dad Strength". THE JOURNAL OF MEN'S STUDIES 2024; 32:152-177. [PMID: 38269335 PMCID: PMC10803200 DOI: 10.1177/10608265231204564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
This study contributes to a growing body of scholarly discussions around the many aspects and challenges of combining parenthood with elite-level sport, with a particular focus on the experiences of male elite athletes who are fathers. We used a caring masculinities theoretical framework, community-based participatory research, and semi-structured interviews to explore the experiences of 10 elite/international and world-class athletes (n = 9 fathers, n = 1 expectant father). Through reflexive thematic analysis, we identified three main themes: fatherhood can (1) improve and (2) impede elite athlete-fathers' athletic performance; and (3) athlete-fathers experience a trade-off between athletic performance and fatherhood responsibilities. Our findings underscore the ways in which male athletes' experiences with parenthood reflect the new era of involved fatherhood and are analogous to some of the identity tensions that have been reported with regard to the experiences of elite female athletes who are pregnant and/or mothers. Recognizing the impact of children on male athletes' athletic careers and the parallels between fatherhood, motherhood, and elite sport may lead to better support for athlete-fathers while also contributing to diminishing the expectation that women are primary caregivers to children.
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Affiliation(s)
- Sydney V. M. Smith
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Francine E. Darroch
- Department of Health Sciences, Faculty of Science, Carleton University, Ottawa, ON, Canada
| | - Audrey R. Giles
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Dylan Wykes
- Mile2Marathon Coaching Inc., Ottawa, ON, Canada
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13
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Schulz JM, Thornton JS. Infographic. Return to activity/sport postpartum: a summary of current recommendations. Br J Sports Med 2024:bjsports-2023-107856. [PMID: 38355283 DOI: 10.1136/bjsports-2023-107856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Jenna M Schulz
- Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Bone & Joint Institute, Western University, London, Ontario, Canada
| | - Jane S Thornton
- Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Bone & Joint Institute, Western University, London, Ontario, Canada
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Kinesiology, Western University, London, Ontario, Canada
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14
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Santos-Rocha R, Szumilewicz A. Fostering the social and physical challenges of female recreational or professional athletes in pregnancy and postpartum. BMC Pregnancy Childbirth 2024; 24:128. [PMID: 38350891 PMCID: PMC10863130 DOI: 10.1186/s12884-024-06312-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
Combining pregnancy and parenthood with sporting activities or a professional athletic career can be challenging. The objective of this Collection is to gain a deeper understanding of the effects of pregnancy and postpartum on female athletes, both recreational and professional, in order to improve their health and fitness outcomes and support their continued success in sports.
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Affiliation(s)
- Rita Santos-Rocha
- ESDRM-Sport Sciences School of Rio Maior-Santarem Polytechnic University, Rio Maior, Portugal.
- SPRINT-Sport Physical Activity and Health Research & Innovation Center , Santarem Polytechnic University, Rio Maior, Portugal.
| | - Anna Szumilewicz
- Gdansk University of Physical Education and Sport, Gdansk, Poland
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15
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Xu L, Li Y, He Y, Chen M, Zhang Y, Liu C, Zhang L. Knowledge Mapping Analysis of Research on Pregnancy-Related Pelvic Girdle Pain (PPGP) from 2002 to 2022 Using Bibliometrics. J Pain Res 2024; 17:643-666. [PMID: 38371481 PMCID: PMC10874224 DOI: 10.2147/jpr.s431438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
Background Pregnancy-related Pelvic Girdle Pain (PPGP) is a prevalent condition characterized by various physiological and pathological processes in the female body. The objective of this study is to offer a comprehensive understanding of the current research landscape, key areas of interest, and potential future directions in the field of PPGP. Methods Using Web of Science, we explored PPGP literature from 2002 to 2022. VOSviewer and CiteSpace facilitated a quantitative analysis, revealing co-authorship patterns, co-occurring themes, citations, and co-citations. Results We identified, peaking at 99 publications in 2021. The United States led with 138 publications and the highest citation count (3160). The Karolinska Institute boasted the highest tally of publications (n = 21). Regarding the volume of publications, the esteemed journal of BMC Pregnancy and Childbirth attained the foremost position. Notably, Gutke, Annelie emerged as the most prolific and highly cited author. The analysis of keyword co-occurrence and co-citation clustering unveiled an intricate tapestry of PPGP studies, spanning various domains including risk factors, mechanistic intricacies, diagnostic benchmark, treatment modalities, and far-reaching ramifications on one's quality of life. Conclusion Research endeavors exploring PPGP have unveiled an enduring trajectory of growth in contemporary times. The existing body of research primarily focuses on delving into the intricate interplay of epidemiological factors and the profound implications of interventions encompassing physical therapy, exercise protocols, and diverse modes of pain management within the domain of PPGP. Multidisciplinary integration encapsulates a prevailing trajectory of progress within this domain, while the focal point of future inquiries into PPGP may revolve around subjects pertaining to standardized outcome reporting.
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Affiliation(s)
- Linli Xu
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yuanchao Li
- Clinical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yanan He
- Clinical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People’s Republic of China
| | - Mengtong Chen
- Clinical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yuting Zhang
- Clinical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People’s Republic of China
| | - Chunlong Liu
- Clinical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People’s Republic of China
| | - Li Zhang
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People’s Republic of China
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16
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Deering RE, Donnelly GM, Brockwell E, Bo K, Davenport MH, De Vivo M, Dufour S, Forner L, Mills H, Moore IS, Olson A, Christopher SM. Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement. Br J Sports Med 2024; 58:183-195. [PMID: 38191239 DOI: 10.1136/bjsports-2023-107490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
Returning to running postpartum presents challenges such as musculoskeletal pain and pelvic floor dysfunction for some females, but there is little guidance on developing and progressing postpartum training programmes. This study aims to establish expert consensus recommendations on designing and modifying a postpartum return-to-running training programme, highlight costs and access to qualified professionals as potential barriers and discuss clinical, research and sports policy implications.A three-round Delphi survey of clinical and exercise professionals working with postpartum runners was conducted. Round I consisted of open-ended questions related to designing the training plan, modifications based on biopsychosocial factors, key muscle groups to train and referral and payment sources. Rounds II and III involved Likert-scale voting to identify consensus (≥75% agreement).118 participants completed Round I, 107 completed Round II (response rate 90.6%) and 95 completed Round III (response rate 80.5%). Consensus was reached in 42/47 (89%) statements, including recommendations for a period of relative rest, gradual increases in duration and intensity, starting with a walk-run protocol and incorporating strength training. Training should be modified based on musculoskeletal or pelvic symptoms, sleep, mental health, lactation or energy availability concerns. Cost and access to experienced postpartum running professionals were identified as potential barriers for runners to receive care.Consensus recommendations for a postpartum return-to-running programme include an individualised exercise prescription, gradual increases in physical activity, walk-run protocols and targeted muscle strengthening. Further research and improved access to clinical and exercise professionals are needed to inform and facilitate best practices.
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Affiliation(s)
- Rita E Deering
- Department of Physical Therapy, Carroll University, Waukesha, Wisconsin, USA
- Department of Orthopedics and Rehabilitation, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Gráinne M Donnelly
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Kari Bo
- Department of Sport Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lorenskog, Norway
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marlize De Vivo
- The Active Pregnancy Foundation, England, UK
- Sheffield Hallam University, Sheffield, UK
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Sinead Dufour
- McMaster University Faculty of Health Sciences, Hamilton, southeastern Ontario, Canada
| | - Lori Forner
- University of Queensland, Brisbane, Queensland, Australia
| | - Hayley Mills
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Shefali Mathur Christopher
- Doctor of Physical Therapy Program, Tufts University, Seattle, Washington, USA
- Elon University, Elon, North Carolina, USA
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17
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Schulz JM, Marmura H, Hewitt CM, Parkinson LJ, Thornton JS. Navigating the 'new normal': what guidelines exist for postpartum return to physical activity and sport? A scoping review. Br J Sports Med 2023; 57:1573-1578. [PMID: 37898507 DOI: 10.1136/bjsports-2023-107166] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE Women are often advised to return to activity (RTA) as early as 6 weeks postpartum, despite undergoing significant physical, physiological and psychological changes. Our objective was to examine existing evidence and clinical practice guidelines to navigate a safe and successful RTA or return to sport (RTS) postpartum. METHODS We searched CINAHL, Embase, Medline, PsycINFO and SPORTDiscus and included any secondary studies with recommendations or guidelines for RTA or RTS postpartum. Grey literature and primary sources were excluded. Four reviewers independently screened titles and abstracts, followed by full-text review for eligibility, with conflicts resolved by a third-party reviewer. One reviewer extracted data, which was cross-referenced by another reviewer. RESULTS 5851 studies were screened, and 33 were included in this scoping review. Most studies stated that RTS postpartum can begin once 'medically safe', around 6 weeks postpartum, but this term was generally left undefined. In addition, most studies recommended engaging in 150 min of moderate-vigorous physical activity per week after 6 weeks postpartum, but the type of exercise recommended was often non-specific. CONCLUSION A lack of consistent, evidence-based guidelines exist for RTA or RTS postpartum. Multiple evidence gaps require additional research to inform patient and activity specific guidelines for a safe and successful RTA or RTS postpartum.
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Affiliation(s)
- Jenna M Schulz
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Fowler-Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Bone & Joint Institute, Western University, London, Ontario, Canada
| | - Hana Marmura
- Fowler-Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Bone & Joint Institute, Western University, London, Ontario, Canada
- Department of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Chloe M Hewitt
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Laura J Parkinson
- Department of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jane S Thornton
- Fowler-Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Bone & Joint Institute, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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18
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Davenport MH, Ray L, Nesdoly A, Thornton JS, Khurana R, McHugh TLF. Filling the evidence void: exploration of coach and healthcare provider experiences working with pregnant and postpartum elite athletes - a qualitative study. Br J Sports Med 2023; 57:1559-1565. [PMID: 37879857 DOI: 10.1136/bjsports-2023-107100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Recent research grounded in the experiences of elite female athletes has shed light on the complex challenges of navigating sport environments that do not support or value pregnant or postpartum athletes. The purpose of this study was to explore the unique experiences of coaches and healthcare providers working with pregnant and postpartum elite athletes, and to identify actionable steps for research, policy and culture change to support them. METHODS Sixteen participants (five coaches, three physicians and eight physiotherapists), who have worked with pregnant and/or postpartum elite athletes within the last 5 years, participated in this qualitative study. Thirteen participants self-identified as women, and three as men. Data were generated via semistructured one-on-one interviews that were audiorecorded, transcribed verbatim and analysed through a process of content analysis. RESULTS The findings of this research are represented by five main themes: (a) lack of female athlete reproductive research, (b) need for evidence-informed education and training, (c) need to develop evidence-based progression for sport participation in pregnancy and postpartum, (d) open communication to support athlete-centred care and (e) essential supports and changes required for pregnant/postpartum athletes. CONCLUSION Findings from this study, which are grounded in the unique perspectives of coaches and healthcare providers, outline specific recommendations to inform policy and practices that support athletes through the perinatal period, such as developing evidence-based return-to-sport protocols.
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Affiliation(s)
- Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren Ray
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Autumn Nesdoly
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jane S Thornton
- Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Rshmi Khurana
- Departments of Medicine and Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Tara-Leigh F McHugh
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
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19
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Tighe BJ, Williams SL, Porter C, Hayman M. Barriers and enablers influencing female athlete return-to-sport postpartum: a scoping review. Br J Sports Med 2023; 57:1450-1456. [PMID: 37758322 DOI: 10.1136/bjsports-2023-107189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Motherhood within sport has become more common with many female athletes seeking to return-to-sport (RTS) postpartum; yet few sport organisations possess policies that support female athletes to RTS postpartum. Our aim was to synthesise existing literature to identify the barriers and enablers that influence female athlete RTS postpartum to help guide the development of evidence-based policies to support postpartum athlete RTS. DESIGN Scoping review. DATA SOURCES Ovid-Medline, Embase, SportDiscus and Scopus were systematically searched. Reference lists of eligible studies were also searched to identify additional studies of relevance. ELIGIBILITY CRITERIA Original, empirical, peer-reviewed, English-language studies reporting on female athletes and their RTS postpartum. Reviews, book chapters and grey literature were excluded. RESULTS Twenty-two studies were included in this review. Identified barriers and enablers reflected 11 categories which occurred within and/or across three domains of the socioecological model. Five key factors were found to significantly influence female athlete RTS postpartum including (1) postpartum recovery time; (2) time to manage motherhood and sport demands; (3) sport organisation policies; (4) stereotypes; and (5) social support. CONCLUSION Various barriers and enablers exist that influence successful RTS postpartum. These factors present opportunities for clinicians and sport organisations to improve their support of postpartum athletes. Paid maternity leave, offering job security, travel support for carer and child and affordable and accessible childcare are critical policy inclusions to appropriately support female athletes in their RTS postpartum.
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Affiliation(s)
- Boden Joel Tighe
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Queensland, Australia
- Sport Performance Innovation and Knowledge Excellence, Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Susan L Williams
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Queensland, Australia
| | - Courtney Porter
- Sport Performance Innovation and Knowledge Excellence, Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Melanie Hayman
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Queensland, Australia
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20
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Danos N, Patrick M, Barretto J, Bilotta F, Lee M. Effects of pregnancy and lactation on muscle-tendon morphology. J Anat 2023; 243:860-869. [PMID: 37350269 PMCID: PMC10557392 DOI: 10.1111/joa.13916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/08/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
Pregnancy and lactation hormones have been shown to mediate anatomical changes to the musculoskeletal system that generates animal movement. In this study, we characterize changes in the medial gastrocnemius muscle, its tendon and aponeuroses that are likely to have an effect on whole animal movement and energy expenditure, using the rat model system, Rattus norvegicus. We quantified muscle architecture (mass, cross-sectional area, and pennation angle), muscle fiber type and diameter, and Young's modulus of stiffness for the medial gastrocnemius aponeuroses as well as its contribution to Achilles tendon in three groups of three-month-old female rats: virgin, primiparous pregnant, and primiparous lactating animals. We found that muscle mass drops by 23% during lactation but does not change during pregnancy. We also found that during pregnancy muscle fibers switch from Type I to IIa and during lactation from Type IIb to Type I. The stiffness of connective tissues that has a demonstrated role in locomotion, the aponeurosis and tendon, also changed. Pregnant animals had a significantly less stiff aponeurosis. However, tendon stiffness was most affected during lactation, with a significant drop in stiffness and interindividual variation. We propose that the energetic demands of locomotion may have driven the evolution of these anatomical changes in muscle-tendon units during pregnancy and lactation to ensure more energy can be allocated to fetal development and lactation.
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Affiliation(s)
- Nicole Danos
- Biology DepartmentUniversity of San DiegoSan DiegoCaliforniaUSA
| | | | - Jacob Barretto
- Biology DepartmentUniversity of San DiegoSan DiegoCaliforniaUSA
| | | | - Megan Lee
- Biology DepartmentUniversity of San DiegoSan DiegoCaliforniaUSA
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21
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Brites-Lagos C, Ramos L, Szumilewicz A, Santos-Rocha R. Feasibility of a Supervised Postpartum Exercise Program and Effects on Maternal Health and Fitness Parameters-Pilot Study. Healthcare (Basel) 2023; 11:2801. [PMID: 37893875 PMCID: PMC10606677 DOI: 10.3390/healthcare11202801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/27/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
The postpartum period is marked by profound changes in women at physical, psychological, and physiological levels. Many of these changes persist after four to six weeks postpartum, and most women do not resume their levels of physical activity, which increases the risk of remaining inactive for many years. It is crucial to implement effective programs that promote exercise during the postpartum period. The objective of this study was to test the feasibility and analyze the effects of a structured and supervised postpartum exercise program on maternal health and fitness parameters. To analyze the potential effects of the intervention, the level of physical activity, quality of life, pelvic girdle and low back pain, fatigue, depression, and the level of functional and physical fitness were assessed at baseline, after 8 weeks, and after 16 weeks of intervention. Feedback on the exercise program was collected after the final assessment. The results showed that a structured and supervised postpartum exercise program was feasible and safe and produced positive effects on selected maternal health and fitness parameters. These results will encourage a study protocol with a larger sample in order to prove its effectiveness, improve the guidelines for postpartum exercise, and incorporate this program into a routine healthcare setting.
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Affiliation(s)
- Carla Brites-Lagos
- ESDRM, Department of Physical Activity and Health, Sport Sciences School of Rio Maior, Polytechnic Institute of Santarem, 2040-413 Rio Maior, Portugal; (C.B.-L.); (L.R.)
| | - Liliana Ramos
- ESDRM, Department of Physical Activity and Health, Sport Sciences School of Rio Maior, Polytechnic Institute of Santarem, 2040-413 Rio Maior, Portugal; (C.B.-L.); (L.R.)
- CIEQV, Life Quality Research Center, Polytechnic Institute of Santarem, 2040-413 Rio Maior, Portugal
| | - Anna Szumilewicz
- Department of Fitness, Faculty of Physical Culture, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Rita Santos-Rocha
- ESDRM, Department of Physical Activity and Health, Sport Sciences School of Rio Maior, Polytechnic Institute of Santarem, 2040-413 Rio Maior, Portugal; (C.B.-L.); (L.R.)
- CIPER, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, 1499-002 Cruz Quebrada, Portugal
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22
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Deering RE, Mountjoy ML. REDs and the lactating athlete: an evidence gap. Br J Sports Med 2023; 57:1065-1066. [PMID: 37752008 DOI: 10.1136/bjsports-2023-107080] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Rita E Deering
- Physical Therapy, Carroll University, Waukesha, Wisconsin, USA
| | - Margo L Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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23
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Moore IS, Crossley KM, Bo K, Mountjoy M, Ackerman KE, Antero JDS, Sundgot Borgen J, Brown WJ, Bolling CS, Clarsen B, Derman W, Dijkstra P, Donaldson A, Elliott-Sale KJ, Emery CA, Haakstad L, Junge A, Mkumbuzi NS, Nimphius S, Palmer D, van Poppel M, Thornton JS, Tomás R, Zondi PC, Verhagen E. Female athlete health domains: a supplement to the International Olympic Committee consensus statement on methods for recording and reporting epidemiological data on injury and illness in sport. Br J Sports Med 2023; 57:1164-1174. [PMID: 37349084 PMCID: PMC10579182 DOI: 10.1136/bjsports-2022-106620] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/24/2023]
Abstract
The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan; (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) to female athlete health data.In May 2021, five researchers and clinicians with expertise in sports medicine, epidemiology and female athlete health convened to form a consensus working group, which identified key themes. Twenty additional experts were invited and an iterative process involving all authors was then used to extend the IOC consensus statement, to include issues which affect female athletes.Ten domains of female health for categorising health problems according to biological, life stage or environmental factors that affect females in sport were identified: menstrual and gynaecological health; preconception and assisted reproduction; pregnancy; postpartum; menopause; breast health; pelvic floor health; breast feeding, parenting and caregiving; mental health and sport environments.This paper extends the IOC consensus statement to include 10 domains of female health, which may affect female athletes across the lifespan, from adolescence through young adulthood, to mid-age and older age. Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies.
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Affiliation(s)
- Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Kay M Crossley
- La Trobe Sport and Exercise Sports Medicine Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
| | - Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Wendy J Brown
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Caroline S Bolling
- Amsterdam Collaboration on Health & Safety in Sports, Department of Orthopaedic Surgery, Amsterdam Movement Science, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Benjamin Clarsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty Health Sciences Stellenbosch University, Cape Town, South Africa
| | - Paul Dijkstra
- Medical Education Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Amber Donaldson
- Department of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- U.S Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | | | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lene Haakstad
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Astrid Junge
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Nonhlanhla S Mkumbuzi
- NtombiSport, Cape Town, South Africa
- Department of Rehabilitation, Midlands State University, Gweru, Midlands, Zimbabwe
- Department of Sports, Exercise, and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
- Department of Human Movement Science, Nelson Mandela University, Qheberha, South Africa
| | - Sophia Nimphius
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Perth, Western Australia, Australia
| | - Debbie Palmer
- Edinburgh Sports Medicine Research Network, Institute for Sport Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Mireille van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Jane S Thornton
- Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada
| | - Rita Tomás
- Portugal Football School, Portuguese Football Federation, Oeiras, Portugal
| | - Phathokuhle C Zondi
- High Performance Commission, Medical Advisory Committee, South African Sports Confederation and Olympic Committee, Salt Rock, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC, Amsterdam, The Netherlands
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24
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Rhodes RE, Blanchard CM, Hartson KR, Symons Downs D, Warburton DER, Beauchamp MR. Affective Response to Exercise and Affective Judgments as Predictors of Physical Activity Intention and Behavior among New Mothers in their first 6-Months Postpartum. Ann Behav Med 2023; 57:344-353. [PMID: 36745018 DOI: 10.1093/abm/kaac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Understanding the predictors of moderate to vigorous physical activity (MVPA) during early postpartum is important to improve promotion efforts. Affect-related constructs are key predictors of MVPA but have limited research in mothers during the postpartum period. PURPOSE To examine two affect-related constructs (affective response to exercise and affective judgments) as predictors of MVPA intention and behavior across three months, among a sample of new mothers. METHODS Participants were 105 mothers (M age = 30.64 years; SD = 3.93) who completed measures during postpartum at 2-months post-birth of their first child. The affective response to exercise (assessed at baseline [2-months postpartum] during a submaximal treadmill test), affective judgments and intention (baseline, 6-weeks after baseline), and MVPA (baseline, 6- and 12-weeks after baseline) were assessed via self-report. RESULTS Path analysis, using ordinary least squares regression, showed that the affective response during exercise was a significant predictor of intention (baseline, 6-weeks), as well as change in intention from baseline to 6-weeks. By contrast, affective judgments predicted intention at 6-weeks, but not at baseline or in the change model. Past MVPA did not moderate these findings, although the affective response during exercise also had a significant indirect effect on MVPA through intention at 6-weeks and 12-weeks. CONCLUSIONS Interventions targeting women's affective response during exercise may be important during postpartum, perhaps through self-paced physical activity guidance. Affective judgments may not be predictive of MVPA, in part due to unanticipated changes during early postpartum leading to inaccurate expectations of the physical activity experience.
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Affiliation(s)
- Ryan E Rhodes
- University of Victoria, School of Exercise Science, Physical and Health Education, Victoria, Canada
| | | | | | - Danielle Symons Downs
- Departments of Kinesiology and Obstetrics and Gynecology, The Pennsylvania State University, University Park, USA
| | - Darren E R Warburton
- University of British Columbia, School of Kinesiology (Faculty of Education), Vancouver, Canada.,Experimental Medicine Program (Faculty of Medicine), Vancouver, Canada
| | - Mark R Beauchamp
- University of British Columbia, School of Kinesiology (Faculty of Education), Vancouver, Canada
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Diggles A. The "Mother Load" and Return to Sport: A Case Report of Returning to Professional Netball Following Cesarean Section. Int J Sports Phys Ther 2023; 18:228-239. [PMID: 36793569 PMCID: PMC9897013 DOI: 10.26603/001c.65894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background Increasing numbers of elite female athletes are competing in professional sport, and many wish to become pregnant and return to competitive sport after childbirth. Athletes have a higher risk of pelvic floor dysfunction (PFD) than non-athletes (54% versus 7%) and there is also an increased prevalence in post-partum women compared to nulliparous women (35% versus 2.8-7.9%). Additionally, PFD has been shown to influence athletic performance. High quality evidence for elite athletes is lacking, and there are no exercise guidelines specifically for these women to prepare or effectively guide their safe return to sport (RTS). The purpose of this case report is to detail the management of an elite athlete who presented following cesarean section (CS) with the goal of RTS within 16 weeks. Case Description A 27-year-old primiparous Caucasian professional netballer presented at four weeks post- caesarean section (CS) for RTS screening and assessment of pelvic floor muscle (PFM) function. Assessment included readiness and fear of movement screening, dynamic pelvic floor muscle function, structural integrity of the CS wound, levator hiatal dimensions, bladder neck descent, and early global neuromuscular screening. Measures were collected at four weeks, eight weeks, and six months post-partum. The post-partum athlete demonstrated alterations in pelvic floor muscle function, reduced lower limb power and psychological readiness. A functionally staged dynamic and sport specific pelvic floor muscle training program was implemented and adapted to the patient for her early post-partum timeline. Results Rehabilitation strategies were effective in achieving the primary outcome of RTS at 16 weeks post-partum with no adverse events reported at 6 months follow-up. Discussion This case highlights the need for a holistic and individualised RTS management approach that includes women's and pelvic health risk factors in a professional athlete. Level of Evidence 5.
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Strenuous physical activity, exercise, and pelvic organ prolapse: a narrative scoping review. Int Urogynecol J 2023:10.1007/s00192-023-05450-3. [PMID: 36692525 DOI: 10.1007/s00192-023-05450-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS High-intensity physical activity and exercise have been listed as possible risk factors for pelvic organ prolapse (POP). The aim of the present study is to conduct a literature review on the prevalence and incidence of POP in women who engage in regular physical activity. In addition, we review the effects of a single exercise or a single session of exercise on pelvic floor support. Finally, the effect of exercises on POP in the early postpartum period is reviewed. METHODS This is a narrative scoping review. We searched PubMed and Ovid Medline, the Physiotherapy Evidence Database (PEDro), and the Cochrane Database of Systematic Reviews up to May 2022 with the following MeSH terms: "physical activity" AND "exercise" AND "pelvic floor" AND "pelvic organ prolapse". RESULTS Eight prevalence studies were retrieved. Prevalence rates of symptomatic POP varied between 0 (small study within different sports) and 23% (Olympic weightlifters and power lifters). Parity was the only factor associated with POP in most studies. Three studies evaluated the pelvic floor after a single exercise or one session of exercise and found increased vaginal descent or increased POP symptoms. One prospective cohort study reported the development of POP after 6 weeks of military parashot training, and one randomized trial reported increased POP symptoms after transverse abdominal training. There is scant knowledge on exercise and POP in the postpartum period. CONCLUSIONS Prevalence of POP in sports varies widely. Experimental and prospective studies indicate that strenuous exercise increased POP symptoms and reduced pelvic floor support.
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Darroch F, Schneeberg A, Brodie R, Ferraro ZM, Wykes D, Hira S, Giles AR, Adamo KB, Stellingwerff T. Effect of Pregnancy in 42 Elite to World-Class Runners on Training and Performance Outcomes. Med Sci Sports Exerc 2023; 55:93-100. [PMID: 35975937 DOI: 10.1249/mss.0000000000003025] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The International Olympic Committee expert group on pregnancy has identified a paucity of information regarding training and performance in truly elite athletes. Thus, the purpose of this study was to quantify elite runners' training volume throughout pregnancy and postpartum competition performance outcomes. METHODS Forty-two elite (>50% competed at the World Championships/Olympic) middle-/long-distance runners' training before, during, and after pregnancy (quality/quantity/type) data (retrospective questionnaire) and competition data (published online) were collected. RESULTS Running volume decreased significantly ( P < 0.01) from the first trimester (63 ± 34 km·wk -1 ) to the third trimester (30 ± 30 km·wk -1 ). Participants returned to activity/exercise at ~6 wk postpartum and to 80% of prepregnancy training volumes by 3 months. Participants who intended to return to equivalent performance levels postpregnancy, there was no statistical decrease in performance in the 1 to 3 yr postpregnancy compared with prepregnancy, and ~56% improved performances postpregnancy. CONCLUSIONS This study features the largest cohort of elite runners training and competition outcomes assessed throughout pregnancy, with training volumes being approximately two to four times greater than current guidelines. For the first time, performance was directly assessed (due to the quantifiable nature of elite running), and study participants who intended to return to high-level competition did so at a statistically similar level of performance in the 1- to 3-yr period postpregnancy. Taken together, this article provides much needed insights into current training practices and performance of elite pregnant runners, which should help to inform future training guidelines as well as sport policy and sponsor expectations around return to training timelines and performance.
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Affiliation(s)
| | | | - Ryan Brodie
- Canadian Sport Institute Pacific, Victoria, BC, CANADA
| | - Zachary M Ferraro
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, ON, CANADA
| | | | - Sarita Hira
- Health Sciences, Carleton University, Ottawa, ON, CANADA
| | - Audrey R Giles
- Human Kinetics, University of Ottawa, Ottawa, ON, CANADA
| | - Kristi B Adamo
- Human Kinetics, University of Ottawa, Ottawa, ON, CANADA
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Davenport MH, Ray L, Nesdoly A, Thornton J, Khurana R, McHugh TLF. We're not Superhuman, We're Human: A Qualitative Description of Elite Athletes' Experiences of Return to Sport After Childbirth. Sports Med 2023; 53:269-279. [PMID: 35900698 PMCID: PMC9331002 DOI: 10.1007/s40279-022-01730-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND A growing number of athletes return to elite sport following childbirth. Yet, they face significant barriers to do so safely and successfully. The experiences of elite athletes returning to sport following delivery are necessary to support evidence-informed policy. OBJECTIVE The purpose of this qualitative description was to describe the experiences of elite athletes as they returned to sport following childbirth, and to identify actionable steps for research, policy and culture-change to support elite athlete mothers. METHODS Eighteen elite athletes, primarily from North America, who had returned to sport following childbirth in the last 5 years were interviewed. Data were generated via one-on-one semi-structured interviews that were audio-recorded, transcribed verbatim, and analyzed through a process of content analysis. RESULTS The findings of this study are represented by one overarching theme: Need for More Time, and five main themes: (a) Training "New Bodies" Postpartum, (b) Injuries and Safe Return to Sport, (c) Breastfeeding While Training, (d) Critical Supports for Return to Sport, (e) Navigating Motherhood and Sport. The athletes identified the urgent need to develop best-practice policies and funding to support return to sport, as well as develop evidence-based return-to-sport protocols to support a safe and injury-free return. CONCLUSION Athletes shared detailed stories highlighting the challenges, barriers and successes elite athletes experience returning to elite-level sport following childbirth. Participants provided clear recommendations for policy and research to better support the next generation of elite athlete mothers.
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Affiliation(s)
- Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, 1-059 D Li Ka Shing Centre for Health Research Innovation, 8602-112 St, Edmonton, AB, T6G 2E1, Canada.
| | - Lauren Ray
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Autumn Nesdoly
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Jane Thornton
- Department of Family Medicine, Fowler Kennedy Sports Medicine Clinic, Western University, London, ON, Canada
- Department of Epidemiology, and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rshmi Khurana
- Department of Medicine, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
- Department of Obstetrics and Gynecology, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Tara-Leigh F McHugh
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
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L’Heveder A, Chan M, Mitra A, Kasaven L, Saso S, Prior T, Pollock N, Dooley M, Joash K, Jones BP. Sports Obstetrics: Implications of Pregnancy in Elite Sportswomen, a Narrative Review. J Clin Med 2022; 11:jcm11174977. [PMID: 36078907 PMCID: PMC9456821 DOI: 10.3390/jcm11174977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Increasing numbers of females are participating in elite sports, with a record number having competed at the Tokyo Olympic Games. Importantly, the ages of peak performance and fertility are very likely to coincide; as such, it is inevitable that pregnancy will occur during training and competition. Whilst there is considerable evidence to promote regular exercise in pregnancy, with benefits including a reduction in hypertensive disorders, gestational diabetes, and reduced rates of post-natal depression, few studies have been conducted which include elite athletes. Indeed, there are concerns that high-intensity exercise may lead to increased rates of miscarriage and preterm labour, amongst other pregnancy-related complications. There is minimal guidance on the obstetric management of athletes, and consequently, healthcare professionals frequently adopt a very conservative approach to managing such people. This narrative review summarises the evidence on the antenatal, intrapartum, and postpartum outcomes in elite athletes and provides recommendations for healthcare providers, demonstrating that generally, pregnant athletes can continue their training, with a few notable exceptions. It also summarises the physiological changes that occur in pregnancy and reviews the literature base regarding how these changes may impact performance, with benefits arising from pregnancy-associated cardiovascular adaptations at earlier gestations but later changes causing an increased risk of injury and fatigue.
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Affiliation(s)
- Ariadne L’Heveder
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Correspondence: ; Tel.: +44-07989356191
| | - Maxine Chan
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Anita Mitra
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Lorraine Kasaven
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Srdjan Saso
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Tomas Prior
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Noel Pollock
- Institute of Sport, Exercise & Health, University College London, London W1T 7HA, UK
- British Athletics, National Performance Institute, Loughborough, LE11 3TU, UK
| | | | - Karen Joash
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Benjamin P. Jones
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
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Dietz P, Legat L, Sattler MC, van Poppel MNM. Triple careers of athletes: exploring the challenges of planning a pregnancy among female elite athletes using semi-structured interviews. BMC Pregnancy Childbirth 2022; 22:643. [PMID: 35971097 PMCID: PMC9377111 DOI: 10.1186/s12884-022-04967-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background The challenging factors that elite athletes perceive for combining their sportive career with planning a pregnancy and motherhood need to be identified in order to develop supportive measures. Therefore, this phenomenological qualitative study aimed to explore challenges associated with planning a pregnancy among female, non-pregnant elite athletes. Methods Semi-structured skype-interviews were performed among female elite athletes (athletes competing on national or international level) aged 28 years or older. Using Mayring’s qualitative content analysis approach, anchor examples served to identify potential challenges of planning a pregnancy which were categorized independently by two researchers. Results Interviews of 16 elite athletes (mean age 30.7 years) entered analysis. Eleven challenges of planning a pregnancy were identified, categorized into organizational / environmental, financial, personal, and physical factors. Conclusions With regard to financial challenges, we propose mandatory maternity leave and continuation of the contracts and salary. Furthermore, mentoring programs may help to provide support and advice to new generations of female elite athletes and help to reduce concerns regarding the wish of becoming pregnant during a sportive career. In order to reduce physical concerns regarding pregnancy and exercise, we see a need for scientific studies investigating the association of sport discipline specific characteristics on sportive performance and the mother´s, fetus’ and child´s health. Finally, the results of the current study may be used in future quantitative studies to test specific hypotheses.
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Affiliation(s)
- Pavel Dietz
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, University of Mainz, Mainz, Germany.
| | - Larissa Legat
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, University of Mainz, Mainz, Germany
| | - Matteo C Sattler
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
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Forstmann N, Meignié A, De Larochelambert Q, Duncombe S, Schaal K, Maître C, Toussaint JF, Antero J. Does maternity during sports career jeopardize future athletic success in elite marathon runners? Eur J Sport Sci 2022; 23:896-903. [PMID: 35703008 DOI: 10.1080/17461391.2022.2089054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The impact of maternity (Mat) on subsequent athletic performance is not well known. This study aims to investigate the impact of maternity among elite marathoners on their overall performance progression. For each runner listed in the top 150 female marathoners, who had experienced a mid-career maternity, performance development was reconstituted throughout the career. Maternity data and career break time span (Ttotal) were collected from publicly available informations. Performances were modelled according to the known age-performance relationship and the impact of maternity was added into the model. Linear mixed effect model was used to study the influence of maternity on the overall career. Among this sample, 37 runners had at least 1 child during her career. Among them, 14 had 2 children. Eleven runners (29.72%) made their personal best performance before Mat, which occurred at an average age of 28.40 ± 4.00 years. Twenty-six runners (70.28%) establish their best performances after Mat, at an average age of 32.20 ± 4.28. The age-performance relationship model explains 92% of the performance variability during the career's progression. When age is considered, maternity does not have significant impact on performance development. World's most competitive marathoners can still perform at their best level after pregnancy. The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance during career development.Highlights Mid-career maternity does not have a significant impact on overall progression in high level runners, who return to official races.The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance.Age is the variable that explains most of performance progression, independently of mid-career maternity occurrence(s).
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Affiliation(s)
- Nicolas Forstmann
- IRMES, Institute for Research in bioMedicine and Epidemiology of Sport, Paris, FRANCE.,INSEP, National Institute of Sports Expertise and Performance, Paris, FRANCE
| | - Alice Meignié
- IRMES, Institute for Research in bioMedicine and Epidemiology of Sport, Paris, FRANCE.,INSEP, National Institute of Sports Expertise and Performance, Paris, FRANCE
| | - Quentin De Larochelambert
- IRMES, Institute for Research in bioMedicine and Epidemiology of Sport, Paris, FRANCE.,INSEP, National Institute of Sports Expertise and Performance, Paris, FRANCE.,Institut de Mathématiques de Bourgogne, UMR 5584 CNRS, Université Bourgogne Franche-Comté, Dijon, France
| | - Stephanie Duncombe
- IRMES, Institute for Research in bioMedicine and Epidemiology of Sport, Paris, FRANCE.,School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia
| | - Karine Schaal
- Department of Neurology, Physiology and Behavior, University of California, Davis, CA, USA.,Department of Kinesiology, California State University, Sacramento, CA, USA
| | | | - Jean-François Toussaint
- IRMES, Institute for Research in bioMedicine and Epidemiology of Sport, Paris, FRANCE.,INSEP, National Institute of Sports Expertise and Performance, Paris, FRANCE.,Université de Paris Cité, Paris, France.,Center for Sports Medicine Research, CIMS, Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Juliana Antero
- IRMES, Institute for Research in bioMedicine and Epidemiology of Sport, Paris, FRANCE.,INSEP, National Institute of Sports Expertise and Performance, Paris, FRANCE
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Dakic JG, Cook J, Hay-Smith J, Lin KY, Ekegren C, Frawley HC. Pelvic Floor Symptoms Are an Overlooked Barrier to Exercise Participation: A Cross-Sectional Online Survey of 4556 Women Who Are Symptomatic. Phys Ther 2022; 102:pzab284. [PMID: 34939122 DOI: 10.1093/ptj/pzab284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/28/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to: (1) investigate barriers to exercise in women with pelvic floor (PF) symptoms (urinary incontinence [UI], anal incontinence [AI], and pelvic organ prolapse [POP]); (2) determine factors associated with reporting PF symptoms as a substantial exercise barrier; and (3) investigate the association between reporting PF symptoms as an exercise barrier and physical inactivity. METHODS In this cross-sectional survey, Australian women who were 18 to 65 years of age and had PF symptoms completed an anonymous online survey (May-September 2018) containing validated PF and physical activity questionnaires: Questionnaire for Female Urinary Incontinence Diagnosis, Incontinence Severity Index, Pelvic Floor Bother Questionnaire, and International Physical Activity Questionnaire. Participants reported exercise barriers and the degree to which the barriers limited participation. Binary logistic regression was used to identify variables associated with (1) identifying PF symptoms as a substantial exercise barrier and (2) physical inactivity. RESULTS In this cohort (N = 4556), 31% (n = 1429) reported PF symptoms as a substantial exercise barrier; UI was the most frequently reported barrier. Two-thirds of participants who identified POP and UI as exercise barriers had stopped exercising. The odds of reporting PF symptoms as a substantial exercise barrier were significantly higher for women with severe UI (odds ratio [OR] = 4.77; 95% CI = 3.60-6.34), high symptom bother (UI OR = 10.19; 95% CI = 7.24-14.37; POP OR = 22.38; 95% CI = 13.04-36.60; AI OR = 29.66; 95% CI = 7.21-122.07), those who had a vaginal delivery (1 birth OR = 2.04; 95% CI = 1.63-2.56), or those with a third- or fourth-degree obstetric tear (OR = 1.47; 95% CI = 1.24-1.76). The odds of being physically inactive were greater in women who identified PF symptoms as an exercise barrier than in those who did not (OR = 1.33; 95% CI = 1.1-1.59). CONCLUSION One in 3 women reported PF symptoms as a substantial exercise barrier, and this was associated with increased odds of physical inactivity. IMPACT Physical inactivity is a major cause of mortality and morbidity in women. Pelvic floor symptoms stop women participating in exercise and are associated with physical inactivity. Screening and management of PF symptoms could allow women to remain physically active across their life span. LAY SUMMARY Pelvic floor symptoms are a substantial barrier to exercise in women of all ages, causing them to stop exercising and increasing the odds of being physical inactive. Physical therapists can screen and help women manage their PF symptoms so that they remain physically active.
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Affiliation(s)
- Jodie G Dakic
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Kuan-Yin Lin
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Christina Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia
| | - Helena C Frawley
- Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia
- Allied Health Research, The Royal Women's Hospital, Parkville, Victoria, Australia
- Allied Health Research, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Davenport MH, Nesdoly A, Ray L, Thornton JS, Khurana R, McHugh TLF. Pushing for change: a qualitative study of the experiences of elite athletes during pregnancy. Br J Sports Med 2022; 56:452-457. [PMID: 35135828 PMCID: PMC8995814 DOI: 10.1136/bjsports-2021-104755] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/04/2022]
Abstract
Objectives Athletes train and compete at the elite level during their reproductive years, yet sport policies that support pregnant athletes are lacking. The experiences of elite athletes during pregnancy are vastly under-represented, and such voices are needed to support evidence-informed policy. Thus, the purpose of this qualitative study was to describe the experiences of elite female athletes as they navigate pregnancy, and to identify sport policy considerations regarding participation during pregnancy. Methods Twenty athletes (mean age 35±5 years) who, within the last 5 years, had trained or competed at the elite level immediately prior to becoming pregnant were included. Data were generated via one-on-one semistructured interviews that were audio-recorded, transcribed verbatim and analysed through a process of content analysis. Results The findings of this study are represented by one overarching message: mother versus athlete, and five main themes: (1) pregnancy planning and fertility, (2) pregnancy disclosure and discrimination, (3) training pregnant athletic bodies, (4) safety concerns, and (5) supportive network and equitable funding. Conclusion In-depth stories shared by participants highlight the many significant decisions athletes must make as they navigate pregnancy alongside elite sport participation. The shared experiences of pregnant athletes highlight clear challenges that should be considered in the development of sport policy and practices that are inclusive and supportive of female athletes.
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Affiliation(s)
- Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Insitute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Autumn Nesdoly
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren Ray
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jane S Thornton
- Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Rshmi Khurana
- Departments of Medicine and Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Tara-Leigh F McHugh
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
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Jackson T, Bostock EL, Hassan A, Greeves JP, Sale C, Elliott-Sale KJ. The Legacy of Pregnancy: Elite Athletes and Women in Arduous Occupations. Exerc Sport Sci Rev 2021; 50:14-24. [PMID: 34669626 DOI: 10.1249/jes.0000000000000274] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Best-practice guidance and management of pregnant and postpartum elite athletes and women in arduous occupations is limited by the lack of high-quality evidence available within these populations. We have summarised the adaptations and implications of pregnancy and childbirth; proposed a novel integrative concept to address these changes; and made recommendations to progress research in this area.
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Affiliation(s)
- Thea Jackson
- Sport Health and Performance Enhancement (SHAPE) Research Centre, Department of Sport Science, Nottingham Trent University, Nottingham, UK Army Health and Performance Research, Army Headquarters, Andover, UK Institute of Sport, Exercise & Health (ISEH), Division of Surgery & Interventional Science, University College London, London, UK Norwich Medical School, University of East Anglia, Norwich, UK
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Musculoskeletal Considerations for Exercise and Sport: Before, During, and After Pregnancy. J Am Acad Orthop Surg 2021; 29:e805-e814. [PMID: 34043597 DOI: 10.5435/jaaos-d-21-00044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/03/2021] [Indexed: 02/01/2023] Open
Abstract
There is little written in the orthopaedic literature regarding common musculoskeletal problems that women encounter in relation to pregnancy and their clinical and surgical management. Exercise and other physical activity are generally recommended for most women before, during, and after pregnancy. Unfortunately, a variety of musculoskeletal issues may keep women from starting, continuing, or resuming a healthy exercise regimen throughout a notable portion of their reproductive years. Untreated and undertreated orthopaedic conditions in female athletes may therefore have further unintended negative effects on maternal and fetal health. This article reviews the existing literature on musculoskeletal health considerations before, during, and after pregnancy to provide practical information to orthopaedic surgeons who treat women of all ages and athletic abilities.
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Christopher SM, Cook CE, Snodgrass SJ. What are the biopsychosocial risk factors associated with pain in postpartum runners? Development of a clinical decision tool. PLoS One 2021; 16:e0255383. [PMID: 34383792 PMCID: PMC8360599 DOI: 10.1371/journal.pone.0255383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/14/2021] [Indexed: 01/29/2023] Open
Abstract
Background In 2019, a majority of runners participating in running events were female and 49% were of childbearing age. Studies have reported that women are initiating or returning to running after childbirth with up to 35% reporting pain. There are no studies exploring running-related pain or risk factors for this pain after childbirth in runners. Postpartum runners have a variety of biomechanical, musculoskeletal, and physiologic impairments from which to recover from when returning to high impact sports like running, which could influence initiating or returning to running. Therefore, the purpose of this study was to identify risk factors associated with running-related pain in postpartum runners with and without pain. This study also aimed to understand the compounding effects of multiple associative risk factors by developing a clinical decision tool to identify postpartum runners at higher risk for pain. Methods Postpartum runners with at least one child ≤36 months who ran once a week and postpartum runners unable to run because of pain, but identified as runners, were surveyed. Running variables (mileage, time to first postpartum run), postpartum variables (delivery type, breastfeeding, incontinence, sleep, fatigue, depression), and demographic information were collected. Risk factors for running-related pain were analyzed in bivariate regression models. Variables meeting criteria (P<0.15) were entered into a multivariate logistic regression model to create a clinical decision tool. The tool identified compounding factors that increased the probability of having running-related pain after childbirth. Results Analyses included 538 postpartum runners; 176 (32.7%) reporting running-related pain. Eleven variables were included in the multivariate model with six retained in the clinical decision tool: runner type-novice (OR 3.51; 95% CI 1.65, 7.48), postpartum accumulated fatigue score of >19 (OR 2.48; 95% CI 1.44, 4.28), previous running injury (OR 1.95; 95% CI 1.31, 2.91), vaginal delivery (OR 1.63; 95% CI 1.06, 2.50), incontinence (OR 1.95; 95% CI 1.31, 2.84) and <6.8 hours of sleep on average per night (OR 1.89; 95% CI 1.28, 2.78). Having ≥ 4 risk factors increased the probability of having running-related pain to 61.2%. Conclusion The results of this study provide a deeper understanding of the risk factors for running-related pain in postpartum runners. With this information, clinicians can monitor and educate postpartum runners initiating or returning to running. Education could include details of risk factors, combinations of factors for pain and strategies to mitigate risks. Coaches can adapt running workload accounting for fatigue and sleep fluctuations to optimize recovery and performance. Future longitudinal studies that follow asymptomatic postpartum women returning to running after childbirth over time should be performed to validate these findings.
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Affiliation(s)
- Shefali Mathur Christopher
- Department of Physical Therapy Education, Elon University, Elon, NC, United States of America
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
- * E-mail:
| | - Chad E. Cook
- Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University School of Medicine, Durham, NC, United States of America
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
- Duke Department of Population Health Sciences, Durham, NC, United States of America
| | - Suzanne J. Snodgrass
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
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Kimber ML, Meyer S, McHugh TL, Thornton J, Khurana R, Sivak A, Davenport MH. Health Outcomes after Pregnancy in Elite Athletes: A Systematic Review and Meta-analysis. Med Sci Sports Exerc 2021; 53:1739-1747. [PMID: 33560776 DOI: 10.1249/mss.0000000000002617] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to evaluate postpartum maternal health and training outcomes of females who were competing or training as elite athletes before or during pregnancy. METHODS Online databases were searched up to August 26, 2020. Studies of any design and language were eligible if they contained information on the relevant population (postpartum athletes [any period after pregnancy]), exposure (engaged in the highest level of sport immediately before or during pregnancy), comparators (sedentary/active controls), and outcomes: maternal (breastfeeding initiation and duration, postpartum weight retention or loss, bone mineral density, low back or pelvic girdle pain, incontinence [prevalence or severity of stress, urge or mixed urinary incontinence, fecal incontinence], injury, anemia, diastasis recti, breast pain, depression, anxiety) and training (<6 wk time to resume activity, training volume or intensity, performance level). RESULTS Eleven studies (n = 482 females, including 372 elite athletes) were included. We identified "very low" certainty evidence demonstrating a higher rate of return to sport before 6 wk postpartum among elite athletes compared with nonelite athletes (n = 145, odds ratio = 6.93, 95% confidence interval = 2.73-17.63, I2 = 11). "Very low" certainty evidence from three studies (n = 179) indicated 14 elite athletes obtained injuries postpartum (7 stress fractures, 9 "running injuries"). "Very low" certainty evidence from five studies (n = 262) reported that 101 (40.5%) elite athletes experienced improved performance postpartum. CONCLUSION Compared with controls, "very low" quality evidence suggests that elite athletes return to physical activity early in the postpartum period and may have an increased risk of injury. Additional high-quality evidence is needed to safely guide return to sport of elite athletes in the postpartum period.
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Affiliation(s)
- Miranda L Kimber
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sports and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, CANADA
| | - Sarah Meyer
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sports and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, CANADA
| | - Tara-Leigh McHugh
- Faculty of Kinesiology, Sports, and Recreation, University of Alberta, Edmonton, AB, CANADA
| | - Jane Thornton
- Department of Family Medicine, Fowler Kennedy Sports Medicine Clinic, and Department of Epidemiology, and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, CANADA
| | - Rshmi Khurana
- Departments of Medicine and Obstetrics and Gynecology, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, CANADA
| | - Allison Sivak
- University of Alberta Libraries, University of Alberta, Edmonton, AB, CANADA
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sports and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, CANADA
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The effect of pregnancy and the duration of postpartum convalescence on the physical fitness of healthy women: A cohort study of active duty servicewomen receiving 6 weeks versus 12 weeks convalescence. PLoS One 2021; 16:e0255248. [PMID: 34320030 PMCID: PMC8318247 DOI: 10.1371/journal.pone.0255248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/03/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Pregnancy profoundly affects cardiovascular and musculoskeletal performance requiring up to 12 months for recovery in healthy individuals. Objective To assess the effects of extending postpartum convalescence from 6 to 12 weeks on the physical fitness of Active Duty (AD) soldiers as measured by the Army Physical Fitness Test (APFT) and Body Mass Index (BMI). Methods We conducted a retrospective study of AD soldiers who delivered their singleton pregnancy of ≥ 32weeks gestation at a tertiary medical center. Pre- and post-pregnancy APFT results as well as demographic, pregnancy, and postpartum data were collected. Changes in APFT raw scores, body composition measures, and failure rates across the 6-week and 12-week convalescent cohorts were assessed. Multivariable regressions were utilized to associate risk factors with failure. Results Four hundred sixty women met inclusion criteria; N = 358 in the 6 week cohort and N = 102 in the 12 week cohort. Demographic variables were similar between the cohorts. APFT failure rates across pregnancy increased more than 3-fold in both groups, but no significant differences were found between groups in the decrement of performance or weight gain. With the combined cohort, multivariable regression analysis showed failure on the postpartum APFT to be independently associated with failure on the pre-pregnancy APFT (OR = 16.92, 95% CI 4.96–57.77), failure on pre-pregnancy BMI (OR = 8.44, 95% CI 2.23–31.92), elevated BMI at 6–8 weeks postpartum (OR = 4.02, 95% CI 1.42–11.35) and not breastfeeding at 2 months (OR = 3.23, 95% CI 1.48–7.02). Within 36 months of delivery date, 75% of women had achieved pre-pregnancy levels of fitness. Conclusion An additional 6 weeks of convalescence did not adversely affect physical performance or BMI measures in AD Army women following pregnancy. Modifiable factors such as pre- and post-pregnancy conditioning and weight, weight gain in pregnancy and always breastfeeding were found to be significant in recovery of physical fitness postpartum.
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Moore IS, James ML, Brockwell E, Perkins J, Jones AL, Donnelly GM. Multidisciplinary, biopsychosocial factors contributing to return to running and running related stress urinary incontinence in postpartum women. Br J Sports Med 2021; 55:1286-1292. [PMID: 34144950 DOI: 10.1136/bjsports-2021-104168] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To examine contributory factors behind postpartum return-to-running and return to pre-pregnancy running level, in addition to risk factors for postpartum running-related stress urinary incontinence (SUI). METHODS 881 postpartum women completed an online questionnaire. Clinically and empirically derived questions were created relating to running experiences and multidisciplinary, biopsychosocial contributory factors. Logistic regression was used to determine predictors for return-to-running, returning to pre-pregnancy level of running and running-related SUI. RESULTS Median time to first postpartum run was 12 weeks. Running during pregnancy (OR: 2.81 (1.90 to 4.15)), a high weekly running volume (OR: 1.79 (1.22 to 2.63)), lower fear of movement (OR: 0.53 (0.43 to 0.64)) and not suffering vaginal heaviness (OR: 0.52 (0.35-0.76)) increased the odds of return-to-running. Factors that increased the odds of returning to pre-pregnancy running level were a low weekly running volume (OR: 0.38 (0.26 to 0.56)), having more than one child (OR: 2.09 (1.43 to 3.05)), lower fear of movement (OR: 0.78 (0.65 to 0.94)), being younger (OR: 0.79 (0.65 to 0.96)) and shorter time to running after childbirth (OR: 0.74 (0.60 to 0.90)). Risk factors for running-related SUI were having returned to running (OR: 2.70 (1.51 to 4.76)) and suffering running-related SUI pre-pregnancy (OR: 4.01 (2.05 to 7.82)) and during pregnancy (OR: 4.49 (2.86 to 7.06)); having a caesarean delivery decreased the odds (OR: 0.39 (0.23 to 0.65)). CONCLUSION Running during pregnancy may assist women safely return-to-running postpartum. Fear of movement, the sensation of vaginal heaviness and running-related SUI before or during pregnancy should be addressed early by healthcare providers.
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Affiliation(s)
- Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Megan L James
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Emma Brockwell
- Private practice, Oxted, UK.,Perinatal Physical Activity Research Group, Canterbury Christchurch University, Canterbury, UK
| | | | - Alex L Jones
- Department of Psychology, Swansea University, Swansea, UK
| | - Gráinne M Donnelly
- Perinatal Physical Activity Research Group, Canterbury Christchurch University, Canterbury, UK.,Private practice, ABSOLUTE.PHYSIO, Maguiresbridge, UK.,University of Ulster, Coleraine, Londonderry, UK
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Obourn PJ, Benoit J, Brady G, Campbell E, Rizzone K. Sports Medicine-Related Breast and Chest Conditions-Update of Current Literature. Curr Sports Med Rep 2021; 20:140-149. [PMID: 33655995 DOI: 10.1249/jsr.0000000000000824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT This article reviews the most up-to-date evidence-based recommendations pertaining to breast and upper chest conditions, specifically for the sports medicine physician. Because of the unique circumstances of the team physician, they can see a wide breadth of pathology. Athletes may not have a primary care physician and may prefer to present to their team physician for breast and upper chest conditions. It is often more comfortable and convenient for athletes to seek treatment in the team setting. Therefore, it is important that the medical professional be aware of not only common pathology but also of that which is rarer. Any delay in evaluation can result in unnecessary morbidity and lead to complications or extended time lost from sport. Consequently, it also is important to facilitate an atmosphere encouraging early presentation and workup.
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Affiliation(s)
- Peter J Obourn
- Department of Orthopaedics, Division of Sports Medicine, University of Rochester Medical Center, Rochester, NY
| | - Janeeka Benoit
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN
| | - Geena Brady
- Sports and Spine Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Elisabeth Campbell
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN
| | - Katherine Rizzone
- Department of Orthopaedics, Division of Sports Medicine, University of Rochester Medical Center, Rochester, NY
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Christopher SM, Garcia AN, Snodgrass SJ, Cook C. Common musculoskeletal impairments in postpartum runners: an international Delphi study. Arch Physiother 2020; 10:19. [PMID: 33117595 PMCID: PMC7586674 DOI: 10.1186/s40945-020-00090-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Postpartum runners report musculoskeletal pain with running. Because of inadequate research, little is known about the origin and pain-related classification. Through expert consensus, this study is the first attempt to understand the musculoskeletal impairments that these runners present with. The objective of this survey was to gather expert consensus on characteristics of reported impairments in postpartum runners that have musculoskeletal pain. Methods A web-based Delphi survey was conducted and was composed of five categories: strength, range of motion, alignment and flexibility impairments, as well as risk factors for pain in postpartum runners. Results A total of 117 experts were invited. Forty-five experts completed round I and forty-one completed rounds II and III. The strength impairments that reached consensus were abdominal, hip and pelvic floor muscle weakness. The range of motion impairments that reached consensus were hip extension restriction, anterior pelvic tilt and general hypermobility. The alignment impairments that reached consensus were a Trendelenburg sign, dynamic knee valgus, lumbar lordosis, over-pronation and thoracic kyphosis. The flexibility impairments that reached consensus were abdominal wall laxity, and tightness in hip flexors, lumbar extensors, iliotibial band and hamstrings. The risk factors for pain in postpartum runners were muscular imbalance, poor lumbopelvic control, too much too soon, life stressors, pain during pregnancy and pelvic floor trauma. Conclusion This study presents a framework for clinicians to understand pain in postpartum runners and that can be investigated in future cohort studies. Level of evidence 5.
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Affiliation(s)
- Shefali M Christopher
- Department of Physical Therapy Education, Elon University, Campus box 2085, Elon, NC 27244 Australia.,Discipline of Physiotherapy, School of health Sciences, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Alessandra N Garcia
- College of Pharmacy & Health Sciences, Doctor of Physical Therapy Program, Campbell University, Lillington, NC 27506 USA
| | - Suzanne J Snodgrass
- Department of Physical Therapy Education, Elon University, Campus box 2085, Elon, NC 27244 Australia
| | - Chad Cook
- Division of Physical Therapy, Department of Orthopaedic Surgery, Duke University, 2200 W.Main St, Durham, NC 27705 USA
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Chen H, D’Onofrio G, Hameed F. Role of Exercise Treatment of Low Back Pain in Pregnancy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00292-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Tennfjord MK, Engh ME, Bø K. The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum. Phys Ther 2020; 100:1681-1689. [PMID: 32367136 DOI: 10.1093/ptj/pzaa084] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/01/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There is limited knowledge on how exercise impacts the pelvic floor muscles (PFM) and prevalence of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) postpartum. The purpose of this study was to investigate whether early onset of general exercise postpartum negatively affects the PFM and/or increases the risk of SUI and POP 12 months postpartum. METHODS This study used a prospective cohort design. At 6 weeks postpartum, 57 women classified as exercisers (exercising ≥3 times at ≥30 min/wk) were compared with 120 nonexercisers (mean age = 29 years, SD = 4.3). Manometry was used to measure vaginal resting pressure, PFM strength, and PFM endurance, and symptoms of SUI and POP were assessed using questionnaires. Data were presented as standardized beta coefficients (B) and odds ratios (OR). RESULTS No differences were found between exercisers (n = 57) and non-exercisers (n = 120) at 6 weeks postpartum on vaginal resting pressure (B = -0.04 [95% CI = -3.4 to 2.1]), PFM strength (B = 0.03 [95% CI = -4.7 to 7.4]), PFM endurance (B = -0.02 [95% CI = -59 to 46]), or symptoms of SUI (OR = 0.51 [95% CI = 0.25 to 1.1]) or POP (OR = 0.62 [95% CI = 0.26 to 1.5]) measured at 12 months postpartum. Adjusting for covariates, women with body mass index between 25 and 29.9 and >30 were more likely to report SUI 12 months postpartum (OR = 2.2 [95% CI = 1.0 to 4.7] and OR = 3.3 [95% CI = 1.2 to 9.4], respectively). Women with physically strenuous occupations were more likely to report POP 12 months postpartum (OR = 3.0 [95% CI = 1.2 to 7.3]). CONCLUSIONS This study suggests that regular exercise 6 weeks postpartum has no negative effect on PFM function or on SUI or POP. Being overweight, however, was associated with more SUI, and women with physically strenuous occupations reported more POP. IMPACT Results from this study suggest that first-time mothers should be encouraged to start general exercise within the first 6 weeks after giving birth. Women at risk for PFD should be advised accordingly and potentially modifiable risk factors should be addressed prior to delivery. LAY SUMMARY First-time mothers are encouraged to talk with a physical therapist about starting regular general exercise in the early postpartum weeks. Health care providers should advise patients on possible preventive measures for women at risk for PFD.
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Affiliation(s)
- Merete Kolberg Tennfjord
- School of Health Science, Kristiania University College, Kirkegata 24, Oslo 0107, Norway; Department of Obstetrics and Gynaecology, Akershus University Hospital, Lorenskog, Norway; and Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Marie Ellström Engh
- Department of Obstetrics and Gynaecology, Akershus University Hospital; and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences and Department of Obstetrics and Gynaecology, Akershus University Hospital
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Wise SL, Binkley JL, Binkley HM. Pregnancy and Postpartum Training: Coaching Considerations. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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From Childbirth to the Starting Blocks: Are We Providing the Best Care to Our Postpartum Athletes? J Orthop Sports Phys Ther 2020; 50:281-284. [PMID: 32476582 DOI: 10.2519/jospt.2020.0607] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is minimal evidence to guide return to exercise after pregnancy and childbirth, and even less information on safe return to competitive sport. The International Olympic Committee has suggested a 3-phase approach to postpartum recovery in athletes. This Viewpoint expands on that 3-phase model and incorporates a multidisciplinary approach to ensure comprehensive care of postpartum athletes to facilitate safe return to sport with optimal health and performance outcomes. Adopting a multidisciplinary approach may also open new research avenues to ameliorate the dearth of knowledge regarding musculoskeletal recovery and facilitate the development of guidelines to inform clinicians and postpartum women about safe return to exercise, particularly, high-intensity or high-impact activities. J Orthop Sports Phys Ther 2020;50(6):281-284. doi:10.2519/jospt.2020.0607.
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Moss W, Shaw JM, Yang M, Sheng X, Hitchcock R, Niederauer S, Packer D, Nygaard IE. The Association Between Pelvic Floor Muscle Force and General Strength and Fitness in Postpartum Women. Female Pelvic Med Reconstr Surg 2020; 26:351-357. [PMID: 30921083 PMCID: PMC6764904 DOI: 10.1097/spv.0000000000000718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether measures of muscular strength and fitness are associated with pelvic floor muscle (PFM) force 1-year postpartum in a population of primiparous women who delivered vaginally. METHODS This cross-sectional analysis is an ancillary study to an ongoing prospective cohort study and includes 203 primiparous women. Procedures collected 1-year postpartum included maximal PFM force, grip strength, trunk flexor muscle endurance, percent body fat, intra-abdominal pressure during trunk flexor endurance testing, intra-abdominal pressure during strain, and self-reported physical activity. RESULTS The mean (SD) age was 29.8 (5.0) years and the mean (SD) body mass index was 24.5 (5.2) kg/m. Nineteen percent were of Hispanic ethnicity. The median (interquartile range) PFM force was 5.05 (2.86-7.94) N. The median (interquartile range) trunk flexor endurance time was 146.0 (78.0-267.0), whereas the mean (SD) grip strength and percent fat were 32.4 (6.4) kg and 29.4% (10.0), respectively.There were no statistically significant associations between PFM force and any of the measures tested on analyses unadjusted or adjusted for self-report of doing PFM exercises. Of other factors evaluated, non-Hispanic ethnicity, increasing age, self-reported family history of pelvic organ prolapse or urinary incontinence, and normal and obese body mass index (both compared with overweight) were associated with lower PFM force. CONCLUSIONS In primiparous women 1-year postpartum, we found no associations between PFM force and measures of strength and fitness. This study's results are consistent with existing literature that specific, targeted, and consistent pelvic floor exercises are the best way to improve PFM strength.
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Affiliation(s)
| | - Janet M. Shaw
- Department of Health, Kinesiology, and Recreation, University of Utah, College of Health,
| | - Meng Yang
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT,
| | - Xiaoming Sheng
- College of Nursing, University of Utah, Salt Lake City, UT,
| | - Robert Hitchcock
- Department of Bioengineering, University of Utah, Salt Lake City, UT,
| | | | - Diane Packer
- Department of Physical Therapy, University of Utah College of Health,
| | - Ingrid E. Nygaard
- Department of Obstetrics and Gynecology, University of Utah School of Medicine,
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Review of Recent Physical Activity Guidelines During Pregnancy to Facilitate Advice by Health Care Providers. Obstet Gynecol Surv 2020; 74:481-489. [PMID: 31418450 DOI: 10.1097/ogx.0000000000000693] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Physical activity during pregnancy can offer many maternal and fetal health benefits. Objective The aim was to summarize American, Canadian, and international recommendations published recently on physical activity during pregnancy to aid health care providers in their delivery of advice on the topic. Evidence Acquisition A descriptive review of 3 national guidelines and 1 international guideline on physical activity during pregnancy was conducted. The guidelines included the 2019 Canadian recommendations, the 2018 United States' Physical Activity Guidelines for Americans (second edition), the 2015 (reaffirmed in 2017) American College of Obstetrics and Gynecology guideline, and the 2016-2018 International Olympic Committee recommendations for recreational and elite athletes. Results For apparently healthy women, under the guidance of their health care provider, moderate-intensity physical activity using both aerobic and muscle conditioning activities is recommended. The guidelines recommended at least 150 min/wk spread throughout the week (Canada, United States) or at least 20 to 30 min/d (American College of Obstetrics and Gynecology). Conclusions and Relevance This summary of 4 recent guidelines can facilitate use of updated recommendations by health care providers regarding physical activity during pregnancy. More detailed evidence-based guidelines on physical activity during postpartum are needed.
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Sundgot-Borgen J, Sundgot-Borgen C, Myklebust G, Sølvberg N, Torstveit MK. Elite athletes get pregnant, have healthy babies and return to sport early postpartum. BMJ Open Sport Exerc Med 2019; 5:e000652. [PMID: 31803497 PMCID: PMC6887505 DOI: 10.1136/bmjsem-2019-000652] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2019] [Indexed: 12/11/2022] Open
Abstract
Objectives To enhance knowledge on pregnancy and return to sport in the postpartum period in elite female athletes. Methods 34 Norwegian elite athletes (33.1 years) and 34 active controls (31.5 years) were asked about training and competitive history, pregnancy-related issues, injuries, body dissatisfaction (BD), drive for thinness (DT), eating disorders (ED) and practical experiences, through a questionnaire and interview. Independent samples T-tests or χ² tests for between-group differences and paired-samples T-tests and repeated measures analysis of variance for within group differences were used. Results No group differences in fertility problems, miscarriage, preterm birth or low birth weight were found. Both groups decreased training volume all trimesters and the first two postpartum periods compared with prepregnancy, and more athletes returned to sport/exercise at week 0–6 postpartum. We found no group differences in complications during pregnancy and delivery, but athletes reported fewer common complaints. Four athletes experienced stress fracture postpartum. Athletes had higher BD and DT postpartum, while controls reduced DT score. Number of athletes with clinical ED was reduced postpartum, while constant in controls. Athletes were not satisfied with advice related to strength training and nutrition during pregnancy. Conclusion Elite athletes and active controls get pregnant easily, deliver healthy babies and decrease training during pregnancy and the first postpartum periods compared with prepregnancy. Most athletes and every third control returned to sport or exercise at week 0–6 postpartum. Athletes report stress fractures and increased BD and DT, but decreased ED postpartum. However, since relatively few athletes were included these findings need further investigation.
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Affiliation(s)
| | | | - Grethe Myklebust
- The Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo Sport Trauma Research Center, Oslo, Norway
| | - Nina Sølvberg
- Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo, Norway
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The Association between Neighborhood Environments and Physical Activity from Pregnancy to Postpartum: a Prospective Cohort Study. J Urban Health 2019; 96:703-719. [PMID: 31342403 PMCID: PMC6814694 DOI: 10.1007/s11524-019-00376-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objectives of this study were to determine if neighborhood measures were associated with physical activity cross-sectionally during late pregnancy (27-30 weeks' gestation), 3 months postpartum, and 12 months postpartum, and longitudinally with an increase in physical activity from late pregnancy to 12 months postpartum. Data are from the Pregnancy, Infection, and Nutrition (PIN3) and Postpartum Prospective Cohort Study. Dichotomized self-reported recreation and total physical activity hours/week were explored cross-sectionally at three time points, and as an increase over time. Four factors from a neighborhood environmental audit were examined: arterial or thoroughfare, walkable neighborhood, physical incivilities, and decoration. Secondary spatial data included population density, hilliness, intersection density, distance to nearest major road, distance to nearest park, distance to nearest physical activity facility, and distance to nearest bus stop. Multilevel mixed-effects logistic regression models were used to assess the association between environmental variables and physical activity measures. A number of environmental variables were associated with total and recreation physical activity at the three time points in cross-sectional models. For increase in recreation physical activity over time, a moderate distance to nearest major road was significantly associated with increased recreation physical activity from 3 to 12 months postpartum (tertile 2 OR 2.13, 95% CI 1.08, 4.22). Living the furthest distance from the nearest park was inversely associated with an increase in recreation physical activity from pregnancy to 3 months postpartum (tertile 3 OR 0.50, 95% CI 0.29, 0.85). The findings of this study indicate that several aspects of the neighborhood environment, such as walkability, access to transit, distance to recreation facilities, and road networks, are associated with physical activity during different stages of pregnancy and postpartum. Since physical activity may result in long-term health benefits for both the woman and child, environments that support this activity should be encouraged.
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Nguyen PTH, Binns CW, Nguyen CL, Van Ha AV, Chu KT, Duong DV, Do DV, Lee AH. Physical Activity During Pregnancy is Associated with Improved Breastfeeding Outcomes: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101740. [PMID: 31100948 PMCID: PMC6571814 DOI: 10.3390/ijerph16101740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Abstract
Physical activity is important for health, but little is known about associations between physical activity during pregnancy and breastfeeding. The aim of this study was to investigate any association between antenatal physical activity and breastfeeding duration. A prospective cohort of 2030 Vietnamese women, recruited between 24 and 28 week-gestation was followed up to twelve months postpartum. Physical activity was determined using the pregnancy physical activity questionnaire at baseline interview. Data was available for 1715 participants at 12 months, a 15.5% attrition rate. At 12 months 71.8% of mothers were still breastfeeding. A total of 20.9% women met physical activity targets and those mothers undertaking higher levels of physical activity had a lower risk of breastfeeding cessation by twelve months [hazard ratios HR = 0.59 (95% CI 0.47–0.74), p < 0.001, and HR = 0.74 (0.60–0.92), p = 0.006; respectively] when compared to the lowest tertile. Similarly, women with increased levels of physical activity have higher rates of breastfeeding at twelve months, compared to the lowest level [odds ratio OR = 1.71 (95% CI 1.29–2.25) and 1.38 (1.06–1.79)]. Higher levels of physical activity by pregnant women are associated with improved breastfeeding outcomes.
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Affiliation(s)
- Phung Thi Hoang Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam.
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Colin W Binns
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Cong Luat Nguyen
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
- National Institute of Hygiene and Epidemiology, Ha Noi 100000, Vietnam.
| | - Anh Vo Van Ha
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam.
| | - Khac Tan Chu
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
- Epidemiology Department, Hai Phong University of Medicine and Pharmacy, Hai Phong City 180000, Vietnam.
| | - Dat Van Duong
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Dung Van Do
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam.
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
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