The effect of pregnancy and the duration of postpartum convalescence on the physical fitness of healthy women: A cohort study of active duty servicewomen receiving 6 weeks versus 12 weeks convalescence

The associations between social support and mental health among Chinese immigrant pregnant and parenting women

BACKGROUND

While it is recognized that social support can alleviate mental health symptoms, this relationship is not well-understood among Chinese pregnant and parenting immigrants in the United States. This study aims to bridge this gap by exploring the relationships between different types of social support and women's anxiety and depression, and examining how these associations vary with pregnancy status.

METHODS

Data were obtained from a cross-sectional survey conducted in Simplified Chinese or Mandarin between March-June 2021 among 526 women who were pregnant and/or parenting a child under five years. The Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Depression, and Social Support scales were used to measure anxiety, depression, and social support levels. Descriptive statistics, t-tests, chi-square tests, and Pearson's correlations were employed for analysis. Hierarchical regression was conducted to investigate the main and interaction effects of social support types and pregnancy status on mental health outcomes.

RESULTS

Compared to non-pregnant women, pregnant women reported higher mean scores for anxiety (non-pregnant: 55, pregnant: 59, p < 0.01) and depression (non-pregnant: 54, pregnant: 56, p = 0.02). Instrumental support displayed a significant main effect in relation to anxiety (β=-0.13, p = 0.01) and depression (β=-0.16, p < 0.01); emotional support exhibited a significant main effect solely on depression (β=-0.13, p = 0.01). Notably, the interaction effects between pregnancy status and both instrumental (β=-0.28, p = 0.01) and emotional support (β=-0.42, p < 0.01) were significant for anxiety. In contrast, informational support did not exhibit a significant impact on either anxiety or depression.

CONCLUSIONS

The findings indicate that tailoring support to the cultural context is crucial, especially for pregnant women in this Chinese immigrant community, with instrumental and emotional support being particularly beneficial in mitigating maternal anxiety.

Extending Air Force Physical Fitness Postpartum Dwell Time Improves Maternal Physical Readiness

INTRODUCTION

Research suggests women are more likely to fail their military physical fitness assessment in the immediate postpartum period than in the prenatal period. In 2015, the United States Air Force physical fitness postpartum testing dwell time increased from 6 months to 12 months postpartum. The primary aim of this study was to assess if Air Force active duty women's physical readiness, as indicated by individual physical fitness test results, was impacted by this change. The secondary aim was to determine the postpartum duration for active duty Air Force women to return to their prenatal anthropometric measurements.

METHODS

All active duty Air Force women who gave birth from 2011-2019 in the military medical system were considered for analysis. A total of 6,726 women meeting inclusion criteria were grouped to 6 month testers (delivery between 2011-February 2015) and 12 month testers (delivery between March 2015 and 2019). Logistic regression and general linear models were used to assess the associations and predictability of the various fitness and anthropometric components of the physical fitness testing requirements (6 vs. 12 month testers), controlling for covariates (age, military rank, marital status, and ethnicity).

RESULTS

Those testing at 12 months had decreased odds (odds ratio = 0.40, 95% CI = 0.32-0.49, P < .0001) of failing their initial postpartum fitness test than those testing at 6 months. The prevalence of test failure at the first exam postpartum was 10.4% among 6 month testers and 4% among 12 month testers. Women who tested at 6 months retained relatively more weight (2.7 ± 5.0 kg, 4.2% increase), body mass index (1.0 ± 2.1 kg/m2, 4.5% increase), and abdominal circumference (2.4 ± 4.9 cm, 3.5% increase) than their counterparts testing at 12 months (1.8 ± 5.4 kg, 2.8% increase; 0.7 ± 2.2 kg/m2, 3.0% increase; and 1.8 ± 5.0 cm, 2.7% increase; respectively) (P < .0001). When comparing those with prenatal fitness status of "excellent," "pass," or "fail," no group attained prenatal weight status in the 24 months monitored. Average weight and abdominal circumference retention for all groups at 24 months postpartum were 2.8 kg and 1.3 cm, respectively. Among initial postpartum fitness testing failures, the component most failed was sit-ups (34.5%), followed by the 1.5-mile run (29.8%). Six month testers were more likely, across all prenatal fitness categories ("fail," "pass" and "excellent") to fail postpartum fitness testing compared to 12 month testers (26.1%, 17.7%, and 5.6% vs.19.4%, 7.3% and 2%, respectively).

CONCLUSIONS

The decision of the Air Force to increase the minimal required time between childbirth and postpartum physical fitness testing for women has positively impacted fitness test failure rates and anthropometric measure changes. Additional policy should be implemented to support postpartum holistic health interventions.

Effect of Serial Pregnancies on Physical Fitness

INTRODUCTION

Pregnancy has a profound impact on physical fitness, and delivery does not allow for rapid return to peak performance levels as physiologic changes can persist for greater than 1 year postpartum. Multiple studies across all military services have documented decrements in physical performance with pregnancy among women. The purpose of this study was to determine the impact of serial pregnancies on physical fitness and body composition in a cohort of Army women. We hypothesized that a second pregnancy would be associated with increasing decrements in physical fitness in active duty soldiers beyond that seen following a first delivery.

MATERIALS AND METHODS

This retrospective cohort study screened all active duty soldiers who had delivered a singleton pregnancy of ≥32 weeks gestation between January 1, 2011 and March 31, 2017 at a single military medical center. This roster of eligible women was used to extract Army Physical Fitness Test (APFT) and height/weight data from the U.S. Army Digital Training Management System. Soldiers who delivered their first 2 pregnancies over this period were included. Select antepartum, intrapartum, and postpartum data were collected from the electronic medical record. The primary outcome variables were raw scores for push-ups, sit-ups, and run events as well as weight measures across the 2 pregnancies. The secondary outcomes were the failure rates on both the APFT events and body mass index measurements. Data were analyzed using paired t-tests to compare the means of APFT scores across the 2 pregnancies. The subjects served as their own controls. This study was approved by Regional Health Command-Pacific.

RESULTS

A total of 2,103 active duty soldiers delivered singleton pregnancies at Tripler Army Medical Center between January 2011 and March 2017. Among these, 16 women delivered both their first- and second-term pregnancies and had APFT data available for analysis. Average age at time of first and second delivery was 26.1 and 28.1 years, respectively. Mean time separating the first postpartum APFT from the delivery was 8.8 months for the first pregnancy and 7.3 months following the second.A significant decrease in mean sit-up score was found comparing APFT-1 with APFT-2 (72.1 vs 65.7, P = .043) and comparing APFT-1 to APFT-3 (72.1 vs 60.9, P = .002). A significant increase in mean run time was found comparing APFT-1 to APFT-3 (16.9 minutes vs 17.9 minutes, P = .010) and APFT-2 to APFT-3 (17.5 minutes vs 17.9 minutes, P = .027). Comparing APFT-1 to APFT-3 showed a significant decrease in sit-up raw scores (P = .002), run times (P = .010), and total APFT scores (P = .01). Overall, the data show a trend of decreasing performance in all APFT events across the 3 APFTs and a trend toward higher failure rates. This cohort of soldiers did not experience weight gain following the pregnancies.

CONCLUSIONS

The present study is the first to analyze the association of serial pregnancies on physical fitness utilizing a validated physical fitness test, and the results suggest that a second pregnancy is associated with progressive worsening of performance. This study is limited by the small sample size, and future studies could further elucidate the degree to which serial pregnancies affect physical fitness.

Associations Between Rank, Sex, and Parity With Musculoskeletal Injuries Sustained During Annual Military Physical Fitness Test

ABSTRACT

Edwards, CM, da Silva, DF, Puranda, JL, Souza, SCS, Semeniuk, K, and Adamo, KB. Associations between rank, sex, and parity with musculoskeletal injuries sustained during annual military physical fitness test. J Strength Cond Res 38(2): 367-373, 2024-Musculoskeletal injuries pose a significant threat to the well-being of military personnel. Attempts to use physical employment standard test results as predictors of injury are underway, but little is known about injuries sustained during the tests. This study sought to identify body regions most likely to be reported as injured during the annual Canadian Armed Forces (CAF) physical fitness evaluation. In addition, sex, rank, and parity status are explored as possible associated factors for injury. A total of 1,796 actively serving CAF members were categorized by sex (1,030 male participants; 766 female participants), rank (1,142 Non-Commissioned Members [NCM]; 638 Officers), and parity (314 parous female participants; 435 nulliparous female participants). Sex, rank, and parity were associated with body regions reportedly injured during an annual CAF fitness assessment (significance p ≤ 0.05). When compared with male participants, female participants were more likely to be injured {aOR: 1.797 (95% [confidence interval] CI: 1.45-2.23)} and more prone to injury of the wrist (adjusted odds ratio [aOR]: 1.933 [95% CI: 1.20-3.12]), hip (aOR: 3.445 [95% CI: 2.07-5.728]), or lower back (aOR: 1.55 [95% CI: 1.18-2.04]). Non-Commissioned Members were more likely to injure the neck (aOR: 2.14 [95% CI: 1.18-3.88]) or shoulder (aOR: 2.03 [95% CI: 1.31-3.15]), when compared with Officers. Parous female participants reported pelvis/abdomen injury at a higher rate than the nulliparous group (5 vs. 1.7%, p = 0.019). Injuries sustained during an annual CAF fitness assessment differ based on sex, rank, and parity. Canadian Armed Forces female participants, NCM, and parous female participants may require specific physical fitness support in preparation for the annual physical fitness test.

Occupational and Environmental Challenges for Women

ABSTRACT

The prevalence of women in the global workforce is increasing. Women increasingly participate in nontraditional employment settings in previously male-dominated industries and manually intensive professions, such as military service, emergency response, health care, aviation, space, agriculture, and technical trades. Limited occupational and environmental hazard data specific to women exist for these work environments. Physiologic and biomechanical differences between sexes create unique workplace challenges specific to women. This article will summarize challenges confronting women working in nontraditional employment and identify strategies to mitigate risk within these populations.

Comparing functional outcomes in minimally invasive versus open inguinal hernia repair using the army physical fitness test

PURPOSE

The advantages of minimally invasive inguinal hernia repair (MIHR) over open hernia repair (OHR) continue to be debated. We compared MIHR to OHR by utilizing the Army Physical Fitness Test (APFT) as an outcome measure.

METHODS

The APFT is a three-component test scored on a normalized 300 point scale taken semiannually by active-duty military. We identified 1119 patients who met inclusion criteria: 588 in the OHR group and 531 in the MIHR group. Changes in APFT scores, time on post-operative duty restrictions (military profile), and time interval to first post-operative APFT were compared using regression analysis.

RESULTS

Postoperatively, no APFT score change difference was observed between the OHR or MIHR groups (- 7.3 ± 30 versus - 5.5 ± 27.7, p = 0.2989). Service members undergoing OHR and MIHR underwent their first post-operative APFT at equal mean timeframes (6.6 ± 5 months versus 6.7 ± 5.1, p = 0.74). No difference was observed for time in months spent on an official temporary duty restriction (military profile) for either OHR or MIHR (0.16 ± 0.16 versus 0.15 ± 0.17, p = 0.311). On adjusted regression analysis, higher pre-operative APFT scores and BMI ≥ 30 were independently associated with reduction in post-operative APFT scores. Higher-baseline APFT scores were independently associated with less time on a post-operative profile, whereas higher BMI (≥ 30) and lower rank were independently associated with longer post-operative profile duration. Higher-baseline APFT scores and lower rank were independently associated with shorter time intervals to the first post-operative APFT.

CONCLUSION

Overall, no differences in post-operative APFT scores, military profile time, or time to first post-operative APFT were observed between minimally invasive or open hernioplasty in this military population.

Factor Analysis and Mental Health Prevention of Employee Turnover under the Profit-Centered Development of Modern Service Industry

Recently, the employee turnover rate of the modern service industry has continued to increase, leading to a decline in the service quality, customer turnover, and an increase in human costs. Meanwhile, fierce competition and enterprises' internal pressure have brought great psychological trauma to employees and affected their mental health. Understanding and finding out the factors that affect employees' resignations are the solutions to employees' mental health problems. The research innovation lies in building a relationship model between turnover intention, psychological contract, and job satisfaction; analyzing the influence mechanism and interaction of various variables in the model; and providing reference and thinking for the service industry to solve the problem of excessive turnover of employees. Besides, the questionnaire design and investigation are carried out, and 60 front-line employees of a service company are selected as the research objects. The results show that the overall internal consistency coefficient of SCL-90 is 0.96, and the overall consistency coefficient is directly proportional to the scale's reliability. The validity coefficient of SCL-90 is 0.79, which has good compatibility validity. Moreover, the correlation coefficient between the psychological contract and turnover intention is 0.621, and the Sig value is 0.00. The correlation coefficient between job satisfaction and turnover intention is −0.663, and the Sig value is 0.00. The psychological contract is positively correlated with turnover intention, and job satisfaction is negatively correlated with turnover intention. After the standard dance experiment, the P values of psychological indicators such as somatization, interpersonal relationship, depression, anxiety, and psychosis factors of employees in the control and experimental groups are all less than 0.05, indicating a significant correlation. Therefore, through 12 weeks of standard dance practice, all psychological indicators of the experimental group are significantly improved. However, the change results of the terror factor and paranoia factor are P > 0.05, showing no significant difference. After the standard dance experiment, there is a significant difference between the control and experimental groups in mental health factors, but no significant difference in terror and paranoia factors. This study has significant reference value for the prevention of employee turnover and mental health.

Pre-Pregnancy Physical Fitness, Body Mass Index and Gestational Weight Gain as Risk Factors for Cesarean Delivery: A Study of Active Duty Women

INTRODUCTION

The World Health Organization considers the optimal rate of delivery by Cesarean among healthy nulliparous women to be <15%. In 2020, the rate of primary Cesarean delivery (CD) in the US among nulliparous women with singleton, vertex pregnancies was 26%. An enhanced understanding of factors associated with women undergoing CD may assist in reducing this rate. One potential factor is the level of physical fitness in women before pregnancy. Active duty (AD) soldiers provide a cohort of women who begin pregnancy while actively pursuing physical fitness. The research team sought to assess the effects of pre-pregnancy physical fitness of AD soldiers as measured by the Army Physical Fitness Test (APFT) on the incidence of CD in AD women, in addition to examining known demographic and pregnancy risk factors in this cohort.

MATERIALS AND METHODS

We conducted a retrospective study of healthy AD nulliparous women who delivered their singleton pregnancy of >32 weeks at a tertiary medical center between 2011 and 2016. Soldiers undergoing non-labored CD were excluded. Demographics, pre-pregnancy APFT results, antepartum and labor and delivery data were collected from the Digital Training Management System, the outpatient, and inpatient medical records respectively. Weight gain in pregnancy was assessed using the Institute of Medicine Guidelines for pregnancy. Fisher's exact tests and chi-squared tests assessed associations between categorical outcomes, and unpaired t-tests assessed differences in APFT scores between women who underwent CD vs. vaginal delivery. Multivariable logistic regression analysis was used to assess for independent risk factors among all collected variables. The protocol was approved by the Regional Health Command-Pacific Institutional Review Board.

RESULTS

Five-hundred-and-twenty-three women delivering singleton pregnancies between 2011 and 2016 were reviewed for this study. Three-hundred ninety women met inclusion criteria: 316 in the vaginal delivery cohort, and 74 in the CD cohort, with a CD rate of 19%. Twenty non-labored CDs were excluded. Neither total APFT performance nor performance on the individual push-up, sit-up or run events in the 15 months prior to pregnancy was associated with mode of delivery. Excessive gestational weight gain (EWG) and neonatal birth weight were the only two factors independently associated with an increased rate of cesarean delivery. Women who had excessive gestational weight gain, were twice as likely to undergo CD as those who had adequate or insufficient weight gain (24% vs. 12%, p = 0.004). Soldiers delivering a neonate ≥4,000 g were 2.8 times as likely to undergo CD as those delivering a neonate <4,000 g (47% vs. 17%, p < 0.001). Age, race, and rank, a surrogate marker for socioeconomic status, were not associated with mode of delivery.

CONCLUSION

Pre-pregnancy fitness levels as measured by the APFT among healthy physically active nulliparous AD women showed no association with the incidence of labored CD. EWG is one modifiable factor which potentially increases the risk for CD in this cohort and has been documented as a risk factor in a recent metanalysis (RR-1.3). Counseling on appropriate weight gain in pregnancy may be the most effective way to reduce the rate of CD among this population of healthy and physically active women.