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Jones PAT, Moolyk A, Ruchat SM, Ali MU, Fleming K, Meyer S, Sjwed TN, Wowdzia JB, Maier L, Mottola M, Sivak A, Davenport MH. Impact of postpartum physical activity on cardiometabolic health, breastfeeding, injury and infant growth and development: a systematic review and meta-analysis. Br J Sports Med 2024:bjsports-2024-108483. [PMID: 39375006 DOI: 10.1136/bjsports-2024-108483] [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: 09/09/2024] [Indexed: 10/09/2024]
Abstract
OBJECTIVE To examine the relationship between postpartum physical activity and maternal postnatal cardiometabolic health, breastfeeding, injury, and infant growth and development. DESIGN Systematic review with random-effects meta-analysis and meta-regression. DATA SOURCES Eight online databases were searched up until 12 January 2024. ELIGIBILITY CRITERIA Studies of all designs in all languages were eligible (except case studies and reviews) if they contained information on the population (postpartum people), intervention (frequency, intensity, duration, volume, or type of exercise, alone ('exercise-only') or in combination with other intervention components (eg, dietary; 'exercise+co-intervention'), comparator (no or low volumes of physical activity), and outcomes: hypertension, diabetes, cardiometabolic risk factors (systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, high density lipoproteins, low density lipoproteins, and triglycerides, glycated hemoglobin (HbA1C), glucose and insulin concentration), breastfeeding (breast milk quality and volume), infant growth (length and weight) and development, or postpartum injury. RESULTS 46 unique studies (n=8766 participants) from 20 countries were included. Moderate certainty of evidence showed exercise+co-interventions reduced the odds of developing diabetes by 28% (7 randomised controlled trials (RCTs), n=2496; OR 0.72 95% CI 0.54, 0.98, I2 12%), reduced SBP (10 RCTs, n=2753; mean difference (MD) -2.15 95% CI -3.89 to -0.40, I2 73%) and DBP (9 RCTs, n=2575; MD -1.38 95% CI -2.60 to -0.15, I2 66%) compared with controls. Infant growth and development, breast milk quality and quantity, and risk of injury were not different between exercise and control groups. CONCLUSIONS Physical activity improves cardiometabolic health without adversely impacting breast milk supply or quality, infant growth or maternal injury.
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Affiliation(s)
- Paris A T Jones
- 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
| | - Amy Moolyk
- 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
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
| | - Muhammad Usman Ali
- McMaster Evidence Review and Synthesis Centre and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Karen Fleming
- Department of Family & Community Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Sarah Meyer
- 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
| | - Talia Noel Sjwed
- 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
| | - Jenna B Wowdzia
- 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
| | - Lauren Maier
- 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
| | - Michelle Mottola
- R. Samuel McLaughlin Foundation- Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Allison Sivak
- Geoffrey & Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - 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
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Pongpanit K, Dayan N, Janaudis-Ferreira T, Roig M, Spahija J, Bertagnolli M. Exercise effects on maternal vascular health and blood pressure during pregnancy and postpartum: a systematic review and meta-analysis. Eur J Prev Cardiol 2024; 31:1606-1620. [PMID: 38711399 DOI: 10.1093/eurjpc/zwae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/27/2024] [Accepted: 05/02/2024] [Indexed: 05/08/2024]
Abstract
AIMS This systematic review aimed to assess the effects of exercise training during pregnancy and the postpartum period on maternal vascular health and blood pressure (BP). METHODS AND RESULTS The outcome of interest was pulse wave velocity (PWV), flow-mediated dilation (FMD), and BP from pregnancy to 1-year postpartum. Five databases, including Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library, were systematically searched from inception to August 2023. Studies of randomized controlled trials (RCTs) comparing the effects of prenatal or postpartum exercise to a non-exercise control group were included. The risk of bias and the certainty of evidence were assessed. Random-effects meta-analyses and sensitivity analyses were conducted. In total, 20 RCTs involving 1221 women were included. Exercise training, initiated from Week 8 during gestation or between 6 and 14 weeks after delivery, with the programme lasting for a minimum of 4 weeks up to 6 months, showed no significant impact on PWV and FMD. However, it resulted in a significant reduction in systolic BP (SBP) [mean difference (MD): -4.37 mmHg; 95% confidence interval (CI): -7.48 to -1.26; P = 0.006] and diastolic BP (DBP) (MD: -2.94 mmHg; 95% CI: -5.17 to -0.71; P = 0.01) with very low certainty. Subgroup analyses revealed consistent trends across different gestational stages, types of exercise, weekly exercise times, and training periods. CONCLUSION Exercise training during pregnancy and the postpartum period demonstrates a favourable effect on reducing maternal BP. However, further investigations with rigorous methodologies and larger sample sizes are needed to strengthen these conclusions.
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Affiliation(s)
- Karan Pongpanit
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3630 prom. Sir-William-Osler, Montreal, Quebec H3G 1Y5, Canada
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thasmmasat University, Khlong Nueng, Khlong Luang District, Pathum Thani 12120, Thailand
- Hospital Sacré-Cœur Research Center, CIUSSS Nord-de-l'Île-de-Montréal, 5400 Boul Gouin Ouest, Montreal, Quebec H4J 1C5, Canada
| | - Natalie Dayan
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Cardiovascular Health Across the Lifespan Program, Research Institute of the McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada
| | - Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3630 prom. Sir-William-Osler, Montreal, Quebec H3G 1Y5, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc Roig
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3630 prom. Sir-William-Osler, Montreal, Quebec H3G 1Y5, Canada
| | - Jadranka Spahija
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3630 prom. Sir-William-Osler, Montreal, Quebec H3G 1Y5, Canada
- Hospital Sacré-Cœur Research Center, CIUSSS Nord-de-l'Île-de-Montréal, 5400 Boul Gouin Ouest, Montreal, Quebec H4J 1C5, Canada
| | - Mariane Bertagnolli
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3630 prom. Sir-William-Osler, Montreal, Quebec H3G 1Y5, Canada
- Hospital Sacré-Cœur Research Center, CIUSSS Nord-de-l'Île-de-Montréal, 5400 Boul Gouin Ouest, Montreal, Quebec H4J 1C5, Canada
- Cardiovascular Health Across the Lifespan Program, Research Institute of the McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada
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Aamir AB, Kumari R, Latif R, Ahmad S, Rafique N, Salem AM, Alasoom LI, Alsunni A, Alabdulhadi AS, Chander S. Effects of intermittent fasting and caloric restriction on inflammatory biomarkers in individuals with obesity/overweight: A systematic review and meta-analysis of randomized controlled trials. Obes Rev 2024:e13838. [PMID: 39289905 DOI: 10.1111/obr.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 08/08/2024] [Accepted: 08/18/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Obesity is characterized by chronic low-grade inflammation. This study presents an updated systematic review and meta-analysis on the effect of caloric restriction (CR) and intermittent fasting (IF) on plasma inflammatory biomarkers (C-reactive protein [CRP], tumor necrosis factor [TNF]-alpha, and interleukin [IL]-6) in individuals with obesity/overweight compared with unrestricted or ad libitum feeding. METHODS PubMed, Web of Science, and SCOPUS databases were searched for randomized controlled trials (RCTs) reporting inflammatory biomarkers after at least 8 weeks of intervention. Standardized mean differences (SMDs) were calculated using a fixed effect model. Heterogeneity was determined using I2 statistics. Sensitivity analysis was conducted using the "leave-one-out" approach. RESULTS Relatively few RCTs have investigated the effect of IF on inflammatory biomarkers than with CR (6 vs. 15). Analysis of pooled data showed that CR was associated with a significant reduction in CRP with low heterogeneity (SMD -0.15 mg/L [95% CI -0.30 to -0.00], p = 0.04; I2 = 0%, p = 0.69) and IL-6 with high heterogeneity (SMD -0.31 pg/mL [95% CI -0.51 to -0.10], p = 0.004; I2 = 73%, p = 0.001). IF was associated with a significant decrease in TNF-alpha with moderate heterogeneity (SMD -0.32 pg/mL [95% CI -0.63 to -0.02], p = 0.04; I2 = 44%, p = 0.13). No associations were detected between IF and CRP or IL-6 and CR and TNF-alpha. CONCLUSION CR may be more effective in reducing chronic low-grade inflammation than IF. However, there were some concerns regarding the included studies' randomization and allocation sequence concealment process.
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Affiliation(s)
- Ahmad Bin Aamir
- Punjab Medical College, Faisalabad Medical University, Faisalabad, Pakistan
| | - Roopa Kumari
- Department of Surgical Pathology, Mayo Clinic Rochester, MN, USA
| | - Rabia Latif
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shakil Ahmad
- Directorate of Library Affairs, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nazish Rafique
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ayad M Salem
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Lubna I Alasoom
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed Alsunni
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Aseel S Alabdulhadi
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Subhash Chander
- Department of Critical Care Medicine, Mayo Clinic Rochester, MN, USA
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Øhman EA, Fossli M, Rasmussen KM, Winkvist A, Løland BF, Holven KB, Brekke HK. Effects of Breastfeeding Promotion Intervention and Dietary Treatment in Postpartum Women with Overweight and Obesity: Results from a Randomized Controlled Trial on Weight and Cardiometabolic Risk Factors. J Nutr 2024; 154:2448-2458. [PMID: 38901636 DOI: 10.1016/j.tjnut.2024.06.006] [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: 03/22/2024] [Revised: 05/27/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Childbearing increases the risk of weight gain and cardiometabolic disease. The reset hypothesis suggests that lactation has protective cardiometabolic effects on the mother. The hypothesis is based on observational studies, and the possible interacting role of weight loss needs to be elucidated. OBJECTIVES This study aimed to examine the individual and interaction effects of a breastfeeding promotion intervention (BPI) and dietary intervention for weight loss postpartum (Diet) on body weight and cardiometabolic risk factors at 6 mo postpartum. METHODS Pregnant women (n = 156) with a prepregnancy BMI of 25 to 35 kg/m2 were randomized to 4 groups in a 2 × 2 factorial design: BPI, Diet, both treatments, or no treatment. BPI consisted of individual counseling by a lactation consultant during pregnancy, at childbirth, and monthly thereafter or more frequently based on individual needs. Diet was initiated at 11 wk postpartum. Body weight, body composition, waist and hip circumferences, markers of lipid and glucose metabolism, and blood pressure were measured at 2 wk and 6 mo postpartum. We analyzed main and interaction effects using 2-way analysis of covariance adjusted for baseline values. RESULTS Among the participants attending both visits (n = 108), 99% practiced any breastfeeding at baseline and 97% at follow-up. The BPI did not affect rates of exclusive or partial breastfeeding, age at introduction of complementary foods, or have main effects on body weight or cardiometabolic risk factors. There was a main effect of Diet reducing body weight, fat mass, fat-free mass, percentage fat mass, waist and hip circumferences, fasting glucose, and insulin (all P ≤ 0.03), with no interactions between the treatments. CONCLUSIONS There were no effects of BPI on body weight or cardiometabolic risk factors at 6 mo postpartum. Diet caused weight loss and had favorable effects on risk factors for cardiovascular disease and type 2 diabetes. This study was registered at clinicaltrials.gov as NCT03580057.
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Affiliation(s)
- Elisabeth A Øhman
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Maria Fossli
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway
| | | | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Beate F Løland
- Cluster for Research and Analysis of the Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Hilde K Brekke
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
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Wagner KA, St Laurent CW, Pekow P, Marcus B, Rosal MC, Braun B, Manson JE, Whitcomb BW, Sievert LL, Chasan-Taber L. The Impact of a Lifestyle Intervention on Postpartum Cardiometabolic Risk Factors Among Hispanic Women With Abnormal Glucose Tolerance During Pregnancy: Secondary Analysis of a Randomized Trial. J Phys Act Health 2024; 21:40-50. [PMID: 37890839 DOI: 10.1123/jpah.2023-0145] [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: 04/06/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Women with abnormal glucose tolerance during pregnancy are at risk for cardiovascular disease (CVD), with higher rates among Hispanics. However, studies on the impact of lifestyle interventions on postpartum CVD profiles are sparse. METHODS This is a secondary analysis of a controlled trial among a subsample of Hispanic women with abnormal glucose tolerance participating in Estudió PARTO (Project Aiming to Reduce Type twO diabetes; mean age = 28.2 y, SD: 5.8) who were randomized to a culturally modified Lifestyle intervention (n = 45) or a comparison Health and Wellness intervention (n = 55). Primary endpoints were biomarkers of cardiovascular risk (lipids, C-reactive protein, fetuin-A, and albumin-to-creatinine ratio) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment, leptin, tumor necrosis factor-alpha, and adiponectin) measured at baseline (6-wk postpartum) and 6 and 12 months. RESULTS In intent-to-treat analyses, there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year. In prespecified sensitivity analyses, women adherent with the Lifestyle Intervention had more favorable improvements in insulin (intervention effect = -4.87, SE: 1.93, P = .01) and HOMA-IR (intervention effect = -1.15, SE: 0.53, P = .03) compared with the Health and Wellness arm. In pooled analyses, regardless of intervention arm, women with higher postpartum sports/exercise had greater increase in HDL-cholesterol (intervention effect = 6.99, SE: 1.72, P = .0001). CONCLUSIONS In this randomized controlled trial among Hispanic women with abnormal glucose tolerance, we did not observe a significant effect on postpartum biomarkers of CVD risk or insulin resistance. Women adherent to the intervention had more favorable changes in insulin and HOMA-IR.
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Affiliation(s)
- Kathryn A Wagner
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Christine W St Laurent
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Penelope Pekow
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Bess Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Barry Braun
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Joann E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA
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Øhman EA, Fossli M, Ottestad I, Holven KB, Ulven SM, Løland BF, Brekke HK. Dietary treatment postpartum in women with obesity reduces weight and prevents weight gain: a randomised controlled trial. BMC Pregnancy Childbirth 2023; 23:695. [PMID: 37752466 PMCID: PMC10521473 DOI: 10.1186/s12884-023-05976-w] [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: 04/05/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Women with pre-pregnancy obesity have an increased risk of retaining or gaining weight postpartum and may benefit from weight loss treatment. However, evidence is lacking for weight loss strategies in women with BMIs in the higher obesity classes. A dietary treatment for postpartum weight loss resulted in a 10% weight reduction in lactating women with a mean BMI of 30 kg/m2. We aimed to examine the effects of this dietary treatment on changes in weight, markers of lipid and glucose metabolism, waist and hip circumference and postpartum weight retention (PPWR) in postpartum women with higher BMIs than tested previously. METHODS At baseline, approximately 8 weeks postpartum, 29 women with a mean (SD) BMI = 40.0 (5.2) kg/m2 were randomised to a 12-week dietary treatment (n 14) or to a control treatment (n 15). Measurements were made at baseline and after 3 and 12 months. Data was analysed using mixed model. RESULTS The mean weight change in the diet group was -2.3 (3.1) kg compared to 1.7 (3.1) kg in the control group after 3 months (P = 0.003) and -4.2 (5.6) kg compared to 4.8 (11.8) kg in the control group after 12 months (P = 0.02). The dietary treatment led to reduced waist circumference (P < 0.04) and PPWR (P < 0.01) compared to the control treatment at both time points. The treatment lowered fasting blood glucose at 12 months (P = 0.007) as the only effect on markers of lipid and glucose metabolism. CONCLUSION The dietary treatment postpartum reduced weight and prevented weight retention or weight gain in women with obesity. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov (NCT03579667) 06/07/2018. In a randomised, controlled trial, 29 postpartum women with obesity were allocated to a dietary treatment or a control treatment. The dietary treatment reduced weight and prevented postpartum weight retention or weight gain after 12 months. Reference: Adapted from "Randomized, Placebo-Controlled, Parallel Study Design (2 Arms, Graphical)", by BioRender.com (2022). Retrieved from https://app.biorender.com/biorender-templates .
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Affiliation(s)
- Elisabeth A Øhman
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - Maria Fossli
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Adipol, Women's Clinic, Oslo University Hospital, Oslo, Norway
- The Clinical Nutrition Outpatient Clinic, Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit On Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Stine M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Beate F Løland
- Unit for Breastfeeding, Norwegian Institute of Public Health, Oslo, Norway
| | - Hilde K Brekke
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Murray Horwitz ME, Tabani A, Brédy GS, Flynn DB, Edwards CV, Curran NJ, Parikh NI. The effect of postpartum lifestyle interventions on blood pressure: a systematic literature review. J Hypertens 2023; 41:1231-1238. [PMID: 37404053 DOI: 10.1097/hjh.0000000000003477] [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: 07/06/2023]
Abstract
Postpartum lifestyle modification is recommended to hypertension risk. We conducted a systematic literature review to assess the evidence for postpartum lifestyle interventions to reduce blood pressure. We searched for relevant publications from 2010 through November 2022. Two authors independently conducted article screening and data extraction; a third resolved discrepancies. Ultimately, nine studies met inclusion criteria. Most were randomized controlled trials and had sample sizes <100. In all but one of the eight studies reporting race data, nearly all participants identified as White. None of the studies reported a significant intervention effect on blood pressure. However, most interventions were associated with improvements in other outcomes, such as physical activity. Overall, the evidence for postpartum lifestyle interventions to reduce blood pressure is limited to a handful of studies characterized by small sample sizes and a lack of racial diversity. Additional research with larger samples, more diverse populations, and intermediate outcomes is warranted.
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Affiliation(s)
- Mara E Murray Horwitz
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine
| | | | - G Saradjha Brédy
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine
| | - David B Flynn
- Boston University Chobanian & Avedisian School of Medicine
| | - Camille V Edwards
- Section of Hematology and Oncology, Evans Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Nadia J Curran
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, USA
| | - Nisha I Parikh
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine
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Effects of dietary and exercise treatments on HDL subclasses in lactating women with overweight and obesity: a secondary analysis of a randomised controlled trial. Br J Nutr 2022; 128:2105-2114. [PMID: 35067237 PMCID: PMC9661371 DOI: 10.1017/s0007114522000241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Childbearing decreases HDL-cholesterol, potentially contributing to the increased risk of CVD in parous women. Large HDL particles (HDL-P) are associated with lower risk of CVD. In this secondary analysis of a randomised controlled trial, we investigated the effects of 12-week dietary and exercise treatments on HDL-P subclass concentration, size and apoA1 in lactating women with overweight/obesity. At 10-14 weeks postpartum, 68 women with pre-pregnant BMI 25-35 kg/m2 were randomised to four groups using 2 × 2 factorial design: (1) dietary treatment for weight loss; (2) exercise treatment; (3) both treatments and (4) no treatment. Lipoprotein subclass profiling by NMR spectroscopy was performed in serum at randomisation and after 3 and 12 months, and the results analysed with two-way ANCOVA. Lipid concentrations decline naturally postpartum. At 3 months (5-6 months postpartum), both diet (P = 0·003) and exercise (P = 0·008) reduced small HDL-P concentration. Concurrently, exercise limited the decline in very large HDL-P (P = 0·002) and the effect was still significant at 12 months (15 months postpartum) (P = 0·041). At 12 months, diet limited the decline in very large HDL-P (P = 0·005), large HDL-P (P = 0·001) and apoA1 (P = 0·002) as well as HDL size (P = 0·002). The dietary treatment for weight loss and the exercise treatment both showed effects on HDL-P subclasses in lactating women with overweight and obesity possibly associated with lower CVD risk. The dietary treatment had more effects than the exercise treatment at 12 months, likely associated with a 10 % weight loss.
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Sturgeon SR, Sibeko L, Balasubramanian R, Arcaro KF. New Moms Wellness Study: the randomized controlled trial study protocol for an intervention study to increase fruit and vegetable intake and lower breast cancer risk through weekly counseling and supplemental fruit and vegetable box delivery in breastfeeding women. BMC Womens Health 2022; 22:389. [PMID: 36153518 PMCID: PMC9509588 DOI: 10.1186/s12905-022-01967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Laboratory studies indicate that chemicals in fruits and vegetables have anti-carcinogenic and anti-inflammatory activities that can lower breast cancer risk. However, epidemiologic studies of the association between fruit and vegetable intake and breast cancer risk have produced mixed results. Measurement error, confounding, and an emphasis on diet in later adulthood may contribute to weak associations. This paper describes a randomized controlled diet intervention trial in breastfeeding women to examine the effect of high fruit and vegetable intake on breast cancer risk factors, including weight, DNA methylation and inflammatory markers. Methods Eligible breastfeeding women who reside within a 35-mile radius of Amherst, MA are enrolled at five to six weeks postpartum and randomly assigned to a Fruit and Vegetable Intervention Arm (target n = 200) or to a USDA MyPlate Control Arm (target n = 200). The Fruit and Vegetable Intervention group receives weekly telephone or video-based counseling to encourage intake of at least eight to ten daily servings of fruits and vegetables and a weekly delivery of a supplemental box of fruits and vegetables for 20 weeks, and less intensive counseling for up to one year. Breastmilk and infant fecal specimens are collected at baseline, 10 and 20 weeks. Anthropometric measurements are obtained at these timepoints and at the 1-year follow-up. The primary outcomes are change in DNA methylation in breast epithelial cells and change in inflammatory markers in breastmilk from randomization to 20 weeks; and change in weight, waist circumference, and fruit and vegetable intake for the period from randomization to 20 weeks and 1 year. Discussion This 1-year randomized diet intervention trial in breastfeeding women will assess whether intake of at least eight to ten daily servings of fruits and vegetables per day improves biomarkers of breast cancer risk directly in the breast (i.e., DNA methylation and inflammatory markers) and helps women maintain a healthy weight. Trial registration: ClinicalTrials.gov Identifier: NCT04374747. Registered May 5, 2020. https://www.clinicaltrials.gov/ct2/show/NCT04374747.
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Kyle EM, Miller HB, Schueler J, Clinton M, Alexander BM, Hart AM, Larson-Meyer DE. Changes in Bone Mineral Density and Serum Lipids across the First Postpartum Year: Effect of Aerobic Fitness and Physical Activity. Nutrients 2022; 14:nu14030703. [PMID: 35277062 PMCID: PMC8839917 DOI: 10.3390/nu14030703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 12/20/2022] Open
Abstract
This study evaluated the changes in bone mineral density (BMD) and serum lipids across the first postpartum year in lactating women compared to never-pregnant controls, and the influence of physical activity (PA). The study also explored whether N-telopeptides, pyridinoline, and deoxypyridinoline in urine serve as biomarkers of bone resorption. A cohort of 18 initially lactating postpartum women and 16 never pregnant controls were studied. BMD (dual energy X-ray absorptiometry), serum lipid profiles, and PA (Baecke PA Questionnaire) were assessed at baseline (4–6 weeks postpartum), 6 months, and 12 months. Postpartum women lost 5.2 ± 1.4 kg body weight and BMD decreased by 1.4% and 3.1% in the total body and dual-femur, respectively. Furthermore, BMDdid not show signs of rebound. Lipid profiles improved, with increases in high-density lipoprotein-cholesterol (HDL-C) and decreases in low-density lipoprotein cholesterol (LDL-C) and the cholesterol/HDL-C ratio at 12 months (vs. baseline). These changes were not influenced by lactation, but the fall the Cholesterol/HDL-C ratio was influenced by leisure-time (p = 0.051, time X group) and sport (p = 0.028, time effect) PA. The decrease in BMD from baseline to 12 months in total body and dual femur, however, was greater in those who continued to breastfeed for a full year compared to those who stopped at close to 6 months. Urinary markers of bone resorption, measured in a subset of participants, reflect BMD loss, particularly in the dual-femur, and may reflect changes bone resorption before observed changes in BMD. Results provide support that habitual postpartum PA may favorably influence changes in serum lipids but not necessarily BMD. The benefit of exercise and use of urinary biomarkers of bone deserves further exploration.
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Affiliation(s)
- Erin M. Kyle
- Department of Family and Consumer Sciences, University of Wyoming, Laramie, WY 82071, USA; (E.M.K.); (J.S.); (M.C.)
| | - Hayley B. Miller
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA;
| | - Jessica Schueler
- Department of Family and Consumer Sciences, University of Wyoming, Laramie, WY 82071, USA; (E.M.K.); (J.S.); (M.C.)
| | - Michelle Clinton
- Department of Family and Consumer Sciences, University of Wyoming, Laramie, WY 82071, USA; (E.M.K.); (J.S.); (M.C.)
| | - Brenda M. Alexander
- Department of Animal Science, University of Wyoming, Laramie, WY 82071, USA;
| | - Ann Marie Hart
- School of Nursing, University of Wyoming, Laramie, WY 82071, USA;
| | - D. Enette Larson-Meyer
- Department of Family and Consumer Sciences, University of Wyoming, Laramie, WY 82071, USA; (E.M.K.); (J.S.); (M.C.)
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA;
- Correspondence: ; Tel.: +1-540-231-1025
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11
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Abstract
OBJECTIVE To evaluate adherence to and effect of postnatal physical activity (PA) interventions. DESIGN Systematic review of PA intervention randomised controlled trials in postnatal women. The initial search was carried out in September 2018, and updated in January 2021. DATA SOURCES Embase, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases, hand-searching references of included studies. The 25 identified studies included 1466 postnatal women in community and secondary care settings. ELIGIBILITY CRITERIA Studies were included if the PA interventions were commenced and assessed in the postnatal year. DATA EXTRACTION AND SYNTHESIS Data were extracted using a prespecified extraction template and assessed independently by two reviewers using Cochrane ROB 1 tool. RESULTS 1413 records were screened for potential study inclusion, full-text review was performed on 146 articles, 25 studies were included. The primary outcome was adherence to PA intervention. The secondary outcomes were the effect of the PA interventions on the studies' specified primary outcome. We compared effect on primary outcome for supervised and unsupervised exercise interventions. Studies were small, median n=66 (20-130). PA interventions were highly variable, targets for PA per week ranged from 60 to 275 min per week. Loss to follow-up (LTFU) was higher (14.5% vs 10%) and adherence to intervention was lower (73.6% vs 86%) for unsupervised versus supervised studies. CONCLUSIONS Studies of PA interventions inconsistently reported adherence and LTFU. Where multiple studies evaluated PA as an outcome, they had inconsistent effects, with generally low study quality and high risk of bias. Agreement for effect between studies was evident for PA improving physical fitness and reducing fatigue. Three studies showed no adverse effect of PA on breast feeding. High-quality research reporting adherence and LTFU is needed into how and when to deliver postnatal PA interventions to benefit postnatal physical and mental health. PROSPERO REGISTRATION NUMBER CRD42019114836.
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Affiliation(s)
- Edward Mullins
- Department of Metabolism, Surgery and Cancer, Imperial College London Faculty of Medicine, London, UK
- Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK
- The George Institute for global health, London, UK
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12
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Wardzinski EK, Hyzy C, Duysen KU, Melchert UH, Jauch-Chara K, Oltmanns KM. Hypocaloric Dieting Unsettles the Neuroenergetic Homeostasis in Humans. Nutrients 2021; 13:nu13103433. [PMID: 34684431 PMCID: PMC8541113 DOI: 10.3390/nu13103433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The effects of low-calorie dieting in obesity are disappointing in the long run. The brain’s energy homeostasis plays a key role in the regulation of body weight. We hypothesized that the cerebral energy status underlies an adaptation process upon body weight loss due to hypocaloric dieting in humans. Objective: We instructed 26 healthy obese participants to reduce body weight via replacement of meals by a commercial diet product for two weeks. The cerebral energy status was assessed by 31 phosphorus magnetic resonance spectroscopy (31 PMRS) before and after low-caloric dieting as well as at follow-up. A standardized test buffet was quantified after body weight loss and at follow-up. Blood glucose metabolism and neurohormonal stress axis activity were monitored. Results: Weight loss induced a decline in blood concentrations of insulin (p = 0.002), C-peptide (p = 0.005), ACTH (p = 0.006), and norepinephrine (p = 0.012). ATP/Pi (p = 0.003) and PCr/Pi ratios (p = 0.012) were increased and NADH levels reduced (p = 0.041) after hypocaloric dieting. At follow-up, weight loss persisted (p < 0.001), while insulin, C-peptide, and ACTH increased (p < 0.005 for all) corresponding to baseline levels again. Despite repealed hormonal alterations, ratios of PCr/Pi remained higher (p = 0.039) and NADH levels lower (p = 0.007) 6 weeks after ending the diet. ATP/Pi ratios returned to baseline levels again (p = 0.168). Conclusion: Low-calorie dieting reduces neurohormonal stress axis activity and increases the neuroenergetic status in obesity. This effect was of a transient nature in terms of stress hormonal measures. In contrast, PCr/Pi ratios remained increased after dieting and at follow-up while NADH levels were still reduced, which indicates a persistently unsettled neuroenergetic homeostasis upon diet-induced rapid body weight loss.
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13
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Amezcua-Prieto C, Naveiro-Fuentes M, Arco-Jiménez N, Olmedo-Requena R, Barrios-Rodríguez R, Vico-Zúñiga I, Manzanares Galán S, Mozas-Moreno J, Jiménez-Moleón JJ, Gallo-Vallejo JL. Walking in pregnancy and prevention of insomnia in third trimester using pedometers: study protocol of Walking_Preg project (WPP). A randomized controlled trial. BMC Pregnancy Childbirth 2020; 20:521. [PMID: 32912184 PMCID: PMC7481758 DOI: 10.1186/s12884-020-03225-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/01/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Previous studies in pregnancy have not focused in evaluating the effect of walking during pregnancy and prevention of insomnia. Our general objective is to determine the effect of a walking program in preventing the appearance of insomnia in the third trimester of pregnancy, increasing sleep quality and improving quality of life throughout pregnancy. METHODS Randomized Controlled trial in parallel in healthy sedentary pregnant women (n = 265), Walking_Preg Project (WPP), from university hospital in Granada, Spain. At 12th gestational week (GW), they will be invited to participate and randomly assigned to one of the three arms of study: the intervention group I1 (pedometer, goal of 11,000 steps/day), intervention group I2 (pedometer, no goal) and control (no pedometer). Duration of intervention: 13-32 GW. At 12th, 19th and 31st GW the average steps/day will be measured in groups I1 and I2. At 13th, 20th and 32nd GW, Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), Adherence to Mediterranean Diet (AMD), physical activity (short IPAQ), quality of life (PSI), and consumption of toxic substances (caffeine, illegal drugs, alcohol and tobacco) will be collected. Student t test or Mann-Whitney U will be used to compare 19th and 31st GW mean of daily steps between I1 and I2 groups. To compare differences between groups in terms of frequency of insomnia/quality of life for each trimester of pregnancy, Pearson's Chi-square test or Fisher's exact test will be used. To determine differences in hours of sleep and quality of sleep throughout each trimester of pregnancy, analysis of variance or Friedman test will be used. McNemar-Bowker test will be used to assess differences in life quality in pre-post analyses in the 3 arms. We will use Stata 15 statistical software. DISCUSSION promoting walking in second half of pregnancy through use of pedometer and health pre-registration of a goal to be achieved -'10,000-11,000 steps a day'- should prevent appearance of insomnia in third trimester, will increase sleep quality and quality of life in pregnant women. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03735381 . Registered 8th November, 2018.
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Affiliation(s)
- C Amezcua-Prieto
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Tower A, 8th Floor, Room 06, 18016, Granada, Spain.
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029, Madrid, Spain.
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain.
| | - M Naveiro-Fuentes
- Obstetrics and Gynecology Service, Virgen de las Nieves University Hospital, 8014, Granada, Spain
| | - N Arco-Jiménez
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Tower A, 8th Floor, Room 06, 18016, Granada, Spain
| | - R Olmedo-Requena
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Tower A, 8th Floor, Room 06, 18016, Granada, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029, Madrid, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - R Barrios-Rodríguez
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Tower A, 8th Floor, Room 06, 18016, Granada, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029, Madrid, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - I Vico-Zúñiga
- Obstetrics and Gynecology Service, Virgen de las Nieves University Hospital, 8014, Granada, Spain
| | - S Manzanares Galán
- Obstetrics and Gynecology Service, Virgen de las Nieves University Hospital, 8014, Granada, Spain
| | - J Mozas-Moreno
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
- Obstetrics and Gynecology Service, Virgen de las Nieves University Hospital, 8014, Granada, Spain
| | - J J Jiménez-Moleón
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Tower A, 8th Floor, Room 06, 18016, Granada, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029, Madrid, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - J L Gallo-Vallejo
- Obstetrics and Gynecology Service, Virgen de las Nieves University Hospital, 8014, Granada, Spain
- Department of Obstetrics and Gynecology, University of Granada, 18016, Granada, Spain
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14
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McAuliffe FM, Killeen SL, Jacob CM, Hanson MA, Hadar E, McIntyre HD, Kapur A, Kihara AB, Ma RC, Divakar H, Hod M. Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non-Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline. Int J Gynaecol Obstet 2020; 151 Suppl 1:16-36. [PMID: 32894590 PMCID: PMC7590083 DOI: 10.1002/ijgo.13334] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Chandni Maria Jacob
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Mark A Hanson
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Eran Hadar
- Maternal-Fetal Medicine Unit, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - H David McIntyre
- Mater Research, The University of Queensland, South Brisbane, Qld, Australia
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Anne B Kihara
- African Federation of Obstetricians and Gynaecologists, Khartoum, Sudan.,Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Moshe Hod
- Mor Comprehensive Women's Health Care Center, Tel Aviv, Israel.,FIGO Pregnancy and Non-Communicable Diseases Committee, International Federation of Gynecology and Obstetrics, London, UK
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15
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Kirkham AA, Beka V, Prado CM. The effect of caloric restriction on blood pressure and cardiovascular function: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr 2020; 40:728-739. [PMID: 32675017 DOI: 10.1016/j.clnu.2020.06.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/15/2020] [Accepted: 06/26/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS Preclinical evidence suggests that caloric restriction is an effective therapy for a number of cardiovascular insults. Whether caloric restriction has cardio-protective effects in humans is not well understood. The aim was to systematically review and meta-analyze human randomized control trials (RCTs) testing the effect of caloric restriction on blood pressure (BP) and cardiovascular function. METHODS A systematic review was performed using Medline, EMBASE, CINAHL (up to June 2017) to search for RCTs of adults receiving a calorie-restricted intervention versus a control/standard diet. Random-effect meta-analyses were performed to calculate weighted mean difference and 95% CI. RESULTS Thirty-two RCTs with 1722 participants assessing BP (n = 29 studies), heart rate (n = 10), VO2peak (n = 8), muscle sympathetic nerve activity (MSNA, n = 4), and endothelial function (n = 4) were included. Calorie-restricted interventions lasting 1-4 weeks had the largest effect on systolic (-5.5 mmHg, p < 0.001, 95% CI: -3.8, -7.1) and diastolic (-2.9 mmHg, p = 0.005, 95% CI: -5.0, -0.9) BP, but no effect on HR. Interventions lasting 1.5-6 months had similar effects on BP, and reduced HR (-4.4 beats/minute, p < 0.001, 95% CI: -6.1,-2.8). Relative VO2peak improved (1.8 mL/kg/min, p < 0.001, 95% CI: 1.3, 2.2). There were also potential positive effects on MSNA and endothelial function. CONCLUSIONS The effect of 1-4 weeks of calorie restriction on BP was similar to that expected with medications, and larger than that reported for other lifestyle interventions or supplements. Cardiovascular risk could be further reduced by caloric restriction lasting up to six months to lower heart rate and improve VO2peak.
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Affiliation(s)
- Amy A Kirkham
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, M5S 2C9, Canada.
| | - Vanesa Beka
- Faculty of Nursing, University of Alberta, Edmonton, T6G 2R3, Canada.
| | - Carla M Prado
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, T6G 2R3, Canada.
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16
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Bick D, Taylor C, Bhavnani V, Healey A, Seed P, Roberts S, Zasada M, Avery A, Craig V, Khazaezadah N, McMullen S, O’Connor S, Oki B, Oteng-Ntim E, Poston L, Ussher M. Lifestyle information and access to a commercial weight management group to promote maternal postnatal weight management and positive lifestyle behaviour: the SWAN feasibility RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Increasing numbers of UK women have overweight or obese body mass index scores when they become pregnant, or gain excessive weight in pregnancy, increasing their risk of adverse outcomes. Failure to manage postnatal weight is linked to smoking, non-healthy dietary choices, lack of regular exercise and poorer longer-term health. Women living in areas of higher social deprivation are more likely to experience weight management problems postnatally.
Objectives
The objectives were to assess the feasibility of conducting a definitive randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of lifestyle information and access to a commercial weight management group focusing on self-monitoring, goal-setting and motivation to achieve dietary change commencing 8–16 weeks postnatally to achieve and maintain weight management and positive lifestyle behaviour.
Design
The design was a randomised two-arm feasibility trial with a nested mixed-methods process evaluation.
Setting
The setting was a single centre in an inner city setting in the south of England.
Participants
Participants were women with body mass index scores of > 25 kg/m2 at antenatal ‘booking’ and women with normal body mass index scores (18.0–24.9 kg/m2) at antenatal booking who developed excessive gestational weight gain as assessed at 36 weeks’ gestation.
Main outcome measures
Recruitment, retention, acceptability of trial processes and identification of relevant economic data were the feasibility objectives. The proposed primary outcome was difference between groups in weight at 12 months postnatally, expressed as percentage weight change and weight loss from antenatal booking. Other proposed outcomes included assessment of diet, physical activity, smoking, alcohol consumption, body image, maternal esteem, mental health, infant feeding and NHS costs.
Results
Most objectives were achieved. A total of 193 women were recruited, 98 allocated to the intervention arm and 95 to the control arm. High follow-up rates (> 80%) were achieved to 12 months. There was an 8.8% difference in weight loss at 12 months between women allocated to the intervention arm and women allocated to the control arm (13.0% vs. 4.2%, respectively; p = 0.062); 47% of women in the intervention arm attended at least one weight management session, with low risk of contamination between arms. The greatest benefit was among women who attended ≥ 10 sessions. Barriers to attending sessions included capability, opportunity and motivation issues. Data collection tools were appropriate to support economic evaluation in a definitive trial, and economic modelling is feasible to quantify resource impacts and outcomes not directly measurable within a trial.
Limitations
The trial recruited from only one site. It was not possible to recruit women with normal body mass index scores who developed excessive pregnancy weight gain.
Conclusions
It was feasible to recruit and retain women with overweight or obese body mass index scores at antenatal booking to a trial comparing postnatal weight management plus standard care with standard care only and collect relevant data to assess outcomes. Approaches to recruit women with normal body mass index scores who gain excessive gestational weight need to be considered. Commercial weight management groups could support women’s weight management as assessed at 12 months postnatally, with probable greater benefit from attending ≥ 10 sessions. Process evaluation findings highlighted the importance of providing more information about the intervention on trial allocation, extended duration of time to commence sessions following birth and extended number of sessions offered to enhance uptake and retention. Results support the conduct of a future randomised controlled trial.
Trial registration
Current Controlled Trials ISRCTN39186148.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Andy Healey
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul Seed
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Sarah Roberts
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Amanda Avery
- Faculty of Science, University of Nottingham, Nottingham, UK
| | | | | | | | | | - Bimpe Oki
- Public Health, London Borough of Lambeth, London, UK
| | | | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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17
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Vincze L, Rollo M, Hutchesson M, Hauck Y, MacDonald-Wicks L, Wood L, Callister R, Collins C. Interventions including a nutrition component aimed at managing gestational weight gain or postpartum weight retention: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2020; 17:297-364. [PMID: 30870329 DOI: 10.11124/jbisrir-2017-003593] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objective of this systematic review was to evaluate the effectiveness of interventions that include a nutrition component aimed at improving gestational weight gain and/or postpartum weight retention. INTRODUCTION Excessive gestational weight gain and postpartum weight retention increase the risk of adverse maternal and neonatal outcomes. Current evidence comprises many interventions targeting gestational weight gain and postpartum weight retention that incorporate a nutrition component. To date, no review has synthesized evidence from pregnancy through the postpartum period or described the intervention approaches in detail. INCLUSION CRITERIA The review included women (≥18 years) during pregnancy and/or up to 12 months postpartum. Studies were included if they involved a weight management intervention with a nutrition component and had the primary objective of determining the impact of gestational weight gain and/or postpartum weight change. Interventions were compared to usual care (i.e. control conditions with no intervention or wait-list control or standard pregnancy or postpartum care) or "other" (alternative intervention). The review considered randomized controlled trials published between 1980 and January 21, 2016. Studies that included a weight related primary outcome measured during pregnancy and/or postpartum were included. METHODS Seven databases were searched and the reference lists of included studies were searched for additional studies not previously identified. Two independent reviewers assessed the methodological quality of studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI SUMARI). The JBI SUMARI standardized data extraction tool was used to extract data. A narrative synthesis was undertaken to qualitatively synthesize included studies, with meta-analyses used to pool weight outcome data from studies conducted separately for pregnancy and postpartum. Effect sizes for meta-analyses have been expressed as weighted mean differences (95% confidence intervals). RESULTS The search yielded 4063 articles of which 48 articles from 39 studies were included. Eleven of 20 studies during pregnancy reported significant reductions in gestational weight gain with the intervention when compared to control groups. One of five studies where the intervention was conducted during both pregnancy and postpartum reported statistically significant reductions in gestational weight gain, and postpartum weight retention between intervention and control groups. Nine of 14 studies conducted after childbirth reported statistically significant intervention effects, indicating lesser postpartum weight retention. Random effects meta-analyses indicated that despite considerable heterogeneity, interventions conducted during pregnancy (-1.25 kg; 95% CI: -2.10 kg, -0.40 kg; p = 0.004), and postpartum (-3.25 kg; 95% CI: -4.69 kg, -1.82 kg; p < 0.001) were significantly more effective at improving weight outcomes compared to usual care or other interventions. Most studies were of moderate quality due to lack of clarity in describing study details required for appraising methodological quality. Few interventions were conducted from pregnancy through the postpartum period (n = 5). Limited interventions adopted online modalities in intervention delivery (n = 4). Intention-to-treat analysis was used in only 12 studies. CONCLUSIONS The pregnancy and postpartum period presents a unique opportunity to engage women in interventions to help optimize lifestyle behaviors for weight management, however the optimal approach is unclear. Improving consistency in intervention implementation and reporting will improve future evidence synthesis.
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Affiliation(s)
- Lisa Vincze
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Megan Rollo
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia.,School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Melinda Hutchesson
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia.,School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Yvonne Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia.,Department Nursing Midwifery Education and Research, King Edward Memorial Hospital, Perth, Australia
| | - Lesley MacDonald-Wicks
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia.,School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Lisa Wood
- School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle, Australia.,Priority Research Centre Grow Up Well and Priority Research Centre Healthy Lungs, University of Newcastle, Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia.,School of Biomedical Sciences, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Clare Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia.,School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia.,The University of Newcastle Centre for Evidence Based Healthcare Informing Research (CEBHIR): a Joanna Briggs Institute Centre of Excellence
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18
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Effect of Behavioural Interventions for Obesity Prevention in Pregnancy on the Adequacy of Gestational Weight Gain and Retention: Metabolic Health of Indian Women. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2018-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study was to measure the adequacy of gestational weight gain (GWG) in Indian women using various behavioural interventions during pregnancy, which primarily aim to observe the effects on obesity markers and weight retention.
In this experimental study, one hundred and forty pregnant women underwent interventions in 5 groups, control (C), diet (D), home exercise (HE), supervised exercise (SE) and supervised exercise with diet (SED), from pregnancy through delivery with 2 months follow-up post-delivery. The outcome measures were GWG and baby birth weight.
A one-way ANOVA indicated no differences in the mean GWG between groups (12.39±4.71 kg, p=0.947). The control group had the most (50%) and both the supervised exercise groups had the fewest (32%) women who gained above the recommended GWG, followed by the diet group (33.3%). The D and HE groups had the most women who gained within the GWG range, while both the SE and SED groups had the most women who gained below the GWG range. However, these results did not affect the birth weight between the groups (mean 2.96 kg±0.40, p=0.203). In women with normal BMIs, (18.5-22.9 kg/m2), the diet group had the most effective maintenance of adequate GWG, with 15%, 55%, and 30% of the women gaining above, within, and below the recommended GWG, respectively. The SE and SED groups had the least postpartum weight retention (PPWR) at 2 months, followed by the HM, D and C groups; i.e., the results showed a trend in the desired direction clinically, although they were not statistically significant (p=0.12).
Supervised exercise can be effectively used as a pregnancy intervention to prevent excess GWG in Indian women. Diet counselling was found to be the next best intervention in combination with exercise, as well as for women with normal BMI.
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19
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Agurs-Collins T, Ross SA, Dunn BK. The Many Faces of Obesity and Its Influence on Breast Cancer Risk. Front Oncol 2019; 9:765. [PMID: 31555578 PMCID: PMC6737012 DOI: 10.3389/fonc.2019.00765] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/29/2019] [Indexed: 12/12/2022] Open
Abstract
Obesity is associated with increased risk of breast and other cancers. However, the complexity of the underlying mechanisms, together with the interplay of diet and physical activity—contributing to energy balance—and the role of adipose tissue, pose challenges to our understanding of the basis of this increased risk. Epidemiologic studies have documented a higher obesity prevalence in US black women compared to white women. Elucidation of the contribution of potential biological differences among racially distinct groups to their differences in breast cancer (BC) risk and mortality have been topics of considerable interest in recent years. The racial and ethnic variation in body fat distribution may account for at least part of the differences in breast cancer rates in these populations. Yet, while black women exhibit higher rates of obesity compared to white women, this does not translate directly into higher rates of BC. In fact, overall, BC in black women occurs with a lower incidence than BC in white women. Obesity is a known risk factor for postmenopausal breast cancer, and growing evidence suggests that abdominal obesity, also known as central obesity, may increase risk for triple negative breast cancer, which is more common in premenopausal women. The positive association of postmenopausal BC risk and specifically estrogen receptor (ER)-positive BC, is presumably due largely to accumulation of estrogen in the adipose tissue of the breast and other tissues. Of the two main types of adipose tissue—subcutaneous and visceral—visceral adipocytes are more active metabolically. Such adipose tissue harbors multiple molecular entities that promote carcinogenesis: endocrine molecules/hormones, immunologic factors, inflammatory cytokines, metabolic alterations, and other components of the microenvironment. Expression of these culpable entities is largely regulated by epigenetic mechanisms. The interrelationship between these entities and drivers of epigenetic alteration are critical to the regulation of pathways connecting obesity and cancer risk. Initiatives to counteract the carcinogenic effects of obesity have primarily involved modulation of energy balance by diet. However, targeting of specific molecular abnormalities characterizing adiposity offers an alternative approach to preventing cancer. Our goal in this review is to first discuss the major mechanisms contributing to the obesity-breast cancer link. We will also consider race, specifically black/white differences, as they relate to the association of obesity with breast cancer risk. Then we will enumerate strategies targeting these mechanisms to reduce BC risk, in large part by way of dietary interventions with potential to mitigate the cancer-promoting components of adiposity.
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Affiliation(s)
- Tanya Agurs-Collins
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, United States
| | - Sharon A Ross
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States
| | - Barbara K Dunn
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States
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20
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Wei L, Wen YT, Lee MC, Ho HM, Huang CC, Hsu YJ. Effects of isolated soy protein and strength exercise training on exercise performance and biochemical profile in postpartum mice. Metabolism 2019; 94:18-27. [PMID: 30731100 DOI: 10.1016/j.metabol.2019.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/19/2019] [Accepted: 01/23/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Postpartum women are at an increased risk for obesity and metabolic diseases because of excessive weight gain during pregnancy and weight retention after delivery. Maintenance of good nutrition and regular physical activity is used as a therapeutic approach for promotion of health and well-being in postpartum women. The aim of this study is to assess the independent and additive effects of isolated soy protein (ISP) and strength exercise training (ET) on weight management, exercise performance and health maintenance in postpartum mice. DESIGN AND METHODS Thirty-two postpartum mice (ICR, 14-weeks old) were divided into four groups (n = 8 per group): Group 1 mice were the sedentary control with vehicle (SC), Group 2 mice were the sedentary control with ISP supplementation (8.95 g·kg-1, SC + ISP), Group 3 mice received vehicle with exercise training (ET) and Group 4 mice received isolated soy protein with exercise training (ISP + ET). Animals in the ET and ISP + ET groups underwent strength exercise training for 6 weeks, 5 days a week. Exercise performance was evaluated by forelimb grip strength and exhaustive swimming time, as well as by changes in body composition and biochemical parameters at the end of the experiment. RESULTS Combined intervention of ISP and ET increased lean muscle mass and prevented body weight and fat elevation. The grip strength and exhaustive swimming time of the ISP + ET group were significantly higher than the other groups. The ISP + ET group showed significantly decreased serum levels of lactate, ammonia and creatinine phosphate kinase (CPK), and increased glucose level after the 15-min swimming test. The serum levels of aspartate transaminase (AST), triglyceride (TG) and creatinine after sacrifice were significantly decreased in the ET + ISP group. ISP combined with ET promoted fat oxidation in brown adipose tissue (BAT) as evidenced from the increased utilization of plasma and BAT tissue triglyceride. CONCLUSIONS We suggest that long-term supplementation with ISP can have a wide spectrum of bioactivities on health promotion, performance improvement and fitness. ISP with ET conferred better energy utilization, improved biochemical profiles and may be an effective ergogenic aid in strength training.
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Affiliation(s)
- Li Wei
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan; Division of Neurosurgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan.
| | - Ya-Ting Wen
- Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei 11696, Taiwan.
| | - Mon-Chien Lee
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan 33301, Taiwan.
| | - Hua-Ming Ho
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan 33301, Taiwan.
| | - Chi-Chang Huang
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan 33301, Taiwan.
| | - Yi-Ju Hsu
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan 33301, Taiwan.
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21
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Rodríguez-González GL, Castro-Rodríguez DC, Zambrano E. Pregnancy and Lactation: A Window of Opportunity to Improve Individual Health. Methods Mol Biol 2018; 1735:115-144. [PMID: 29380310 DOI: 10.1007/978-1-4939-7614-0_7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Human and animal studies indicate that obesity during pregnancy adversely impacts both maternal health and offspring phenotype predisposing them to chronic diseases later in life including obesity, dyslipidemia, type 2 diabetes mellitus, and hypertension. Effective interventions during human pregnancy and/or lactation are needed to improve both maternal and offspring health. This review addresses the relationship between adverse perinatal insults and its negative impact on offspring development and presents some maternal intervention studies such as diet modification, probiotic consumption, or maternal exercise, to prevent or alleviate the negative outcomes in both the mother and her child.
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Affiliation(s)
- Guadalupe L Rodríguez-González
- Reproductive Biology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Diana C Castro-Rodríguez
- Reproductive Biology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Elena Zambrano
- Reproductive Biology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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22
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Zavala-Crichton JP, Yáñez-Sepúlveda RA, Hernández-García NY, Barraza-Gómez FO, Mahecha-Matsudo SM. [Effects of the government's healthy living program on metabolic markers and physical capacity in Chilean women]. ACTA ACUST UNITED AC 2018; 20:618-622. [PMID: 33111896 DOI: 10.15446/rsap.v20n5.67041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 07/14/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the effects of the government's healthy living plan on metabolic markers and physical capacity in sedentary women from Villa Alemana, Chile. MATERIALS AND METHODS 63 women who participated in the study (41.2±11.2 years) underwent 12 months of multi- and interdisciplinary intervention (doctor, nutritionist, psychologist and physical education teacher) of 180 minutes of physical activity per week. Mean and standard deviation were used for statistical analysis, while the t-test of related samples was used to determine the effects of the program. The level of significance was estimated with a value of p<0.05. RESULTS There was a decrease in total cholesterol (p=0.003) and LDL cholesterol (p=0.048), improvement in the 6-minute test (p=0.000) and number of squats in thirty seconds (p=0.000) with a positive effect on delta recovery heart rate (p=0.001). CONCLUSIONS The government's strategy resulted in a decrease of cardiovascular risk due to improved metabolic markers and women's physical capacity.
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Affiliation(s)
- Juan P Zavala-Crichton
- JZ: Profesor de Educación Física. M. Sc. Nutrición Humana. Facultad de Educación y Ciencias Sociales, Universidad Andres Bello. Viña del Mar, Chile.
| | - Rodrigo A Yáñez-Sepúlveda
- RY: Profesor de Educación Física. M. Sc. Medicina y Ciencias del Deporte. Grupo IRyS, Escuela de Educación Física. Pontificia Universidad Católica de Valparaíso. Viña del Mar, Chile.
| | - Nayaded Y Hernández-García
- NH: Profesora de Educación Física. M. Sc. Gestión deportiva. Facultad de Educación y Ciencias Sociales, Universidad Andres Bello. Viña del Mar, Chile.
| | - Fernando O Barraza-Gómez
- FB: Profesor de Educación Física. M. Sc. Medicina y Ciencias del Deporte. Carrera de Pedagogía en Educación Física. Universidad Viña del Mar, Viña del Mar, Chile.
| | - Sandra M Mahecha-Matsudo
- SM: MD. Ph. D.; Post Doctorado en Ciencias del envejecimiento. Esp. Medicina Deportiva. Facultad de Ciencias, Universidad Mayor. Santiago, Chile.
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23
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Lee KS, Lee JK, Yeun YR. Effects of a 10-Day Intensive Health Promotion Program Combining Diet and Physical Activity on Body Composition, Physical Fitness, and Blood Factors of Young Adults: A Randomized Pilot Study. Med Sci Monit 2017; 23:1759-1767. [PMID: 28399076 PMCID: PMC5398424 DOI: 10.12659/msm.900515] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background A lifestyle characterized by poor eating habits and physical inactivity is a risk factor for multiple lifestyle diseases in young adults. This study assessed the effects of implementing an intensive 10-day health promotion program combining diet and physical activities on body composition, physical fitness, and biochemical parameters of young adults. Material/Methods In this randomized pilot study, 30 female undergraduate students were randomly allocated to an intervention and a control group. The health promotion program consisted of unlimited amounts of vegetarian food; aerobic, flexibility, and strength exercises (3 hours/day); lectures on health (3 hours/day); massage practice (2 hours/day); and healthy cooking practice (1 hour/day). The effects of the intervention were analyzed using the Mann-Whitney U test and the Wilcoxon signed-rank test. Results The intensive 10-day health promotion program significantly reduced body weight, body mass index, triglyceride, total cholesterol, low-density lipoprotein cholesterol, blood glucose, and the homeostasis model assessment of insulin resistance. At the same time, participants demonstrated increased back muscle, leg muscle, and grip strength; waist and shoulder flexibility; balance; and cardiorespiratory endurance. Conclusions The intensive 10-day health promotion program is a viable intervention for improving body composition, physical fitness, glycemic control, and blood lipid levels in young adults.
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Affiliation(s)
- Kyoung Soon Lee
- Department of Nursing, Sahmyook University, Seoul, South Korea
| | - Jae Koo Lee
- Department of Leisure and Sports Studies, Sahmyook University, Seoul, South Korea
| | - Young Ran Yeun
- Department of Nursing, Kangwon National University, Samcheok, South Korea
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24
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Nikolopoulos H, Mayan M, MacIsaac J, Miller T, Bell RC. Women's perceptions of discussions about gestational weight gain with health care providers during pregnancy and postpartum: a qualitative study. BMC Pregnancy Childbirth 2017; 17:97. [PMID: 28335749 PMCID: PMC5364680 DOI: 10.1186/s12884-017-1257-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 02/17/2017] [Indexed: 01/14/2023] Open
Abstract
Background Maternal body weight is an indicator of the health of a mother and her developing fetus. Risks of poor maternal and fetal health issues increase when women gain too little or too much weight during pregnancy. A study of 600 women from Alberta, Canada, reported approximately 30, 46, 80, and 80% of underweight, healthy weight, overweight, and obese women, respectively, gained in excess of Health Canada gestational weight gain guidelines. Behavioural interventions during pregnancy have shown to be effective at supporting women achieve gestational weight gain (GWG) recommendations and return to their pre-pregnancy weight postpartum, yet few women are counseled about weight gain during pregnancy. A discrepancy exists between health care providers’ (HCP) reported counseling behaviours and women’s perceptions of counseling by HCPs; most HCPs report counseling women about GWG; conversely, most women report not receiving counseling about GWG. This study explored women’s experiences with GWG and their perceptions of discussions about GWG with HCPs during pregnancy and postpartum. This will help to identify gaps in service delivery and highlight areas for improvement that may better support women to achieve GWG recommendations leading to better health outcomes for women and children. Methods Five focus groups (n = 26) were conducted with women up to 1 year postpartum across the five Alberta health zones. Focus groups were transcribed verbatim and analyzed using qualitative content analysis. Results GWG is important to women, for their health and for the health of their baby. In-depth conversations with HCPs about GWG or weight loss do not occur; however, women want the opportunity to discuss weight gain/loss with HCPs. Women would like discussions about gestational weight gain/loss to become part of standard care and offered to all women. Conclusions Women suggested that discussions about GWG should occur with all women, and that HCPs should initiate these discussions by asking women how they feel about discussing weight. Conversations should begin early on in pregnancy and continue through to the postpartum period. Interventions assessing discussions about GWG should be implemented and evaluated as this has been identified as a gap in prenatal service delivery.
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Affiliation(s)
- Hara Nikolopoulos
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, 4-126 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Maria Mayan
- University of Alberta, Community University Partnership, Facility of Extension, 2nd Floor, 2-281 Enterprise Square, 10230 Jasper Avenue, Edmonton, AB, T5J 4P6, Canada
| | - Jessica MacIsaac
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, 4-126 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Terri Miller
- Healthy Living, Population, Public and Aboriginal Health, Reproductive Health, Healthy Children and Families, Alberta Health Services, 10101 Southport Road SW cubicle #1740, Calgary, AB, T2W 3N2, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, 4-126 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.
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25
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Rimmer J, Lai B. Framing new pathways in transformative exercise for individuals with existing and newly acquired disability. Disabil Rehabil 2017; 39:173-180. [PMID: 26161458 PMCID: PMC5152554 DOI: 10.3109/09638288.2015.1047967] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/29/2015] [Accepted: 04/30/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE This paper describes a continuum of customized exercise options for people with an existing and newly acquired disability or diagnosis referred to as the Transformative Exercise Framework. BACKGROUND The period directly after rehabilitation is a critical juncture where many individuals return to life with high rates of sedentary behavior. After rehabilitation discharge, people with newly acquired disability or diagnoses often never make the transition into usage of community-based exercise services that are tailored, safe and effective. METHODS Narrative review. RESULTS The Transformative Exercise Framework supports a patient-to-participant, rehab-to-wellness model that emphasizes a linkage between physical and occupational therapists and community-based exercise trainers. The four focus areas - Rehabilitation, Condition-specific Exercise, Fitness and Lifetime Physical Activity - emphasize a range of options for people with newly acquired disability and diagnoses, or for people with existing disability and/or chronic health conditions who have a new injury, secondary condition or are severely deconditioned. CONCLUSION The concept of transformative exercise is to support people with disabilities and diagnoses with a seamless restore-improve-prevent continuum of programs and services. This continuum connects individuals to rehabilitation and exercise professionals in a dynamic framework, which maximizes the expertise of both sets of professionals and provides the most effective interventions to achieve the greatest gains in health and function and/or to avoid future health decline. Implications for Rehabilitation Patients discharged from rehabilitation should be transformed into participants in lifelong physical activity through a continuum of health services, which we refer to as Transformative Exercise. Transformative exercise is a continuum of individually tailored exercise strategies/programs that aims to improve the function of underperforming systems, which inhibit community and/or lifelong physical activity participation. The Transformative Exercise Framework can be used by a therapist or exercise trainer to design a program that maximizes performance and time and is based on a specific process for identifying short and long term goals.
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Affiliation(s)
- James Rimmer
- University of Alabama at Birmingham and Lakeshore Foundation,
Birmingham,
AL,
USA
| | - Byron Lai
- University of Alabama at Birmingham and Lakeshore Foundation,
Birmingham,
AL,
USA
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26
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Schmidt MI, Duncan BB, Castilhos C, Wendland EM, Hallal PC, Schaan BD, Drehmer M, Costa E Forti A, Façanha C, Nunes MA. Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil): study protocol for a multicenter randomized controlled trial. BMC Pregnancy Childbirth 2016; 16:68. [PMID: 27029489 PMCID: PMC4812654 DOI: 10.1186/s12884-016-0851-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 03/17/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM), a hyperglycemic state detected during pregnancy, is an established risk factor for diabetes. However, treatment during pregnancy in and of itself is not able to eliminate this risk, and a considerable fraction of women with GDM will develop frank diabetes in the decade following pregnancy. Our aim is to conduct a multicenter randomized controlled trial to investigate the effectiveness of a lifestyle intervention program implemented after a pregnancy complicated by GDM in delaying or preventing the development of type 2 diabetes. METHODS Women aged 18 or older identified as having recent GDM are recruited and followed by telephone to assess eligibility for the trial. To be eligible, women must have used insulin during pregnancy or present intermediate hyperglycemia postpartum. Women are encouraged to enter the trial as early as 10 weeks, and are permitted to do so up to 2 years after a pregnancy with GDM. An estimated 740 women will be randomized to either conventional care or to coach-based interventions focused on breastfeeding, weight loss, healthy eating, and increased physical activity, and predominantly delivered by telephone. Women are followed annually to detect new onset diabetes, the primary outcome, and additional secondary outcomes which include reversion to normoglycemia, weight loss, physical activity and fitness, and insulin resistance. DISCUSSION Though previous studies have demonstrated that type 2 diabetes can be delayed or prevented, no study has yet demonstrated the feasibility and effectiveness of similar interventions implemented in the postpartum period for women with recent GDM. If shown to be successful, this approach could become an important means of preventing diabetes in primary care settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02327286; Registered 23 December 2014.
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Affiliation(s)
- Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil. .,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Eliana Márcia Wendland
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil.,Department of Collective Health, Federal University of Health Sciences, Porto Alegre, RS, Brazil
| | - Pedro C Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Beatriz D'Agord Schaan
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Postgraduate Studies Program in Endocrinology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Michele Drehmer
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Adriana Costa E Forti
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.,Integrated Center for Diabetes and Hypertension, Ceará State Health Department, Fortaleza, Ceará, Brazil
| | - Cristina Façanha
- Integrated Center for Diabetes and Hypertension, Ceará State Health Department, Fortaleza, Ceará, Brazil.,School of Medicine, Centro Universitário Unichristus, Fortaleza, Ceará, Brazil
| | - Maria Angélica Nunes
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2600, Sala 414, Porto Alegre, RS, 90035-003, Brazil
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27
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Lim S, O'Reilly S, Behrens H, Skinner T, Ellis I, Dunbar JA. Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis. Obes Rev 2015; 16:972-87. [PMID: 26313354 DOI: 10.1111/obr.12312] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/14/2015] [Accepted: 07/17/2015] [Indexed: 12/31/2022]
Abstract
Post-partum weight loss is critical to preventing and managing obesity in women, but the results from lifestyle interventions are variable and the components associated with successful outcomes are not yet clearly identified. This study aimed to identify lifestyle intervention strategies associated with weight loss in post-partum women. MEDLINE, EMBASE, PubMed, CINAHL and four other databases were searched for lifestyle intervention studies (diet or exercise or both) in post-partum women (within 12 months of delivery) published up to July 2014. The primary outcome was weight loss. Subgroup analyses were conducted for self-monitoring, individual or group setting, intervention duration, intervention types, the use of technology as a support, and home- or centre-based interventions. From 12,673 studies, 46 studies were included in systematic review and 32 randomized controlled trials were eligible for meta-analysis (1,892 women, age 24-36 years). Studies with self-monitoring had significantly greater weight lost than those without (-4.61 kg [-7.08, -2.15] vs. -1.34 kg [-1.66, -1.02], P = 0.01 for subgroup differences). Diet and physical activity when combined were significantly more effective on weight loss compared with physical activity alone (-3.24 kg [-4.59, -1.90] vs. -1.63 kg [-2.16, -1.10], P < 0.001 for subgroup differences). Lifestyle interventions that use self-monitoring and take a combined diet-and-exercise approach have significantly greater weight loss in post-partum women.
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Affiliation(s)
- S Lim
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Hamilton, Vic., Australia
| | - S O'Reilly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Vic., Australia
| | - H Behrens
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - T Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, NT, Australia
| | - I Ellis
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - J A Dunbar
- Deakin Population Health Strategic Research Centre, Deakin University, Warrnambool, Victoria, Australia
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