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Alfaqih AM, Alqassim AY, Hakami MH, Sumayli AM, Bakri NE, Alhazmi SA, Ageeli AM, Kobaice RA, Hakami NA, Hamadah AF, Masmali AM, Hobani AH. The Impact of Physical Activity on Depression, Anxiety, and Stress during Pregnancy in Saudi Arabia: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1263. [PMID: 39202544 PMCID: PMC11355941 DOI: 10.3390/medicina60081263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 09/03/2024]
Abstract
Background and Objective: This study aimed to explore the impact of physical activity on depression, anxiety, and stress among pregnant women in the Jazan region of Saudi Arabia. Materials and Methods: A descriptive cross-sectional study was conducted among pregnant women attending randomly selected prenatal clinics in primary healthcare hospitals in Jazan, Saudi Arabia. The calculated sample size was 350. Data were collected conveniently through a semi-structured questionnaire covering demographic details, pregnancy-related characteristics, physical activity assessed using the Pregnancy Physical Activity Questionnaire (PPAQ), and mental health parameters evaluated by the Depression, Anxiety, and Stress Scale-21 (DASS-21). The statistical analyses included descriptive statistics and Wilcoxon and Kruskal-Wallis rank sum tests, with significance levels set at p < 0.05. Results: The study involved 406 pregnant females. Nearly a third (31%) had a family history of depression, anxiety, or distress. The prevalence of depression, anxiety, and stress was 62.6%, 68.7%, and 38.4%, respectively. The mean sedentary, light, moderate, vigorous, and total energy expenditures were 1.512, 24.35, 22.32, 4.84, and 53.02 metabolic equivalent tasks/day. Anxious females exhibited higher light activity (median 24, p = 0.033), while stressed ones showed higher light (median 25, p = 0.039), moderate (median 20, p < 0.001), and vigorous activity (median 3, p < 0.001). A significant association was observed between total energy expenditure and stress levels (p < 0.001). Conclusions: This study underscores the importance of physical activity in managing depression, anxiety, and stress among pregnant women in Jazan, Saudi Arabia. The findings suggest a need for tailored interventions to promote physical activity to improve mental well-being during pregnancy.
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Affiliation(s)
- Abdulaziz M. Alfaqih
- Saudi Board of Preventive Medicine and Public Health, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ahmad Y. Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia;
| | - Mohammed H. Hakami
- Al Madaya Primary Health Care, Ministry of Health, Jazan 45142, Saudi Arabia;
| | - Ahmed M. Sumayli
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (A.M.S.); (N.E.B.); (S.A.A.); (A.M.A.); (R.A.K.); (A.M.M.)
| | - Nawaf E. Bakri
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (A.M.S.); (N.E.B.); (S.A.A.); (A.M.A.); (R.A.K.); (A.M.M.)
| | - Shorog A. Alhazmi
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (A.M.S.); (N.E.B.); (S.A.A.); (A.M.A.); (R.A.K.); (A.M.M.)
| | - Amal M. Ageeli
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (A.M.S.); (N.E.B.); (S.A.A.); (A.M.A.); (R.A.K.); (A.M.M.)
| | - Remas A. Kobaice
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (A.M.S.); (N.E.B.); (S.A.A.); (A.M.A.); (R.A.K.); (A.M.M.)
| | - Nasser A. Hakami
- Surgery Department, College of Medicine, Jazan University, Jazan 45142, Saudi Arabia;
| | - Abdullah Fouad Hamadah
- Department of Obstetrics and Gynecology, Maternity and Children Hospital, Makkah 21955, Saudi Arabia;
| | - Alanoud M. Masmali
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (A.M.S.); (N.E.B.); (S.A.A.); (A.M.A.); (R.A.K.); (A.M.M.)
| | - Alhassan H. Hobani
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (A.M.S.); (N.E.B.); (S.A.A.); (A.M.A.); (R.A.K.); (A.M.M.)
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Manca A, Meloni M, Ventura L, Consoli G, Fenu S, Mura G, Deriu F, Cugusi L. Dose-Response Effects on LBP, Sleep, and Depression of Online Pre-Partum and Post-Partum Pilates-Based Programs. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024:1-10. [PMID: 38837186 DOI: 10.1080/02701367.2024.2340047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/31/2024] [Indexed: 06/06/2024]
Abstract
Purpose: Pilates-based programs can help pregnant women deal with the physical and psychological burden derived by major changes in their body. This study was designed to primarily test, in pregnant women, the dose-response and health effects of both pre-partum and post-partum, online Pilates-based program on weight control, low back pain (LBP) severity, sleep disturbances, mood and depression levels. Methods: A total of 136 pregnant women were screened for eligibility (low-risk pregnancy; aged 18-45 years; single pregnancy; 20-28-week gestational age, normal BMI). Participants completed an online Pilates-based program during pregnancy and after delivery, through an online platform guided by a Pilates, Yoga and Lagree certified instructor. Main outcomes (weight control, LBP disability, sleep quality, mood, and mental health) were assessed at baseline and at the completion of pre- and post-partum programs. Results: Regarding pre-partum, significant gains in weight were observed only in low- and intermediate-amount exercisers. Only high-amount exercisers did not display significant increase in LBP-related disability (+42.7%; p = .21) unlike low (+12.2%; p < .0001) and intermediate exercisers (+9.6%; p < .0001). Sleep disturbances increased significantly in low- (+24.3%; p = .005) but not in intermediate- (+4.6%; p = .50) and high-amount exercisers (-0.1%; p = .91). Regardless of the amount of exercise, depression scores improved in all groups. Following post-partum intervention (n = 40), only intermediate-amount exercisers showed significant reductions in sleep disturbances (-24.1%; p = .003) and depression (15.9%; p = .04). Conclusions: Approximately 270 min/week of an online Pilates-based program were needed to prevent LBP worsening, and sleep deterioration in pregnant women. A different pattern was outlined for those women resuming the Pilates-based intervention at post-partum, with 150 min/week emerging as the "dose" of exercise capable of inducing the largest improvements in LBP, sleep, and mood disturbances.
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Affiliation(s)
| | | | | | | | | | | | - F Deriu
- University of Sassari
- AOU Sassari, Unit of Endocrinology, Nutritional and Metabolic Disorders
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Rodrigues-Denize N, Zolnikov BTR, Furio F. A systematic review on the physical, mental, and occupational effects of exercise on pregnant women. DIALOGUES IN HEALTH 2024; 4:100181. [PMID: 38813580 PMCID: PMC11133494 DOI: 10.1016/j.dialog.2024.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/18/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
Complications in pregnancy have been proven to be less frequent with exercise. The American College of Obstetrics and Gynecology suggests pregnant women should exercise an average of 20 to 30 min a day; however, only 13% of pregnant women exercise throughout their pregnancy. This amount could be improved if women are aware that exercise: 1. Can help avoid pregnancy complications or death and 2. Comes in various forms with different health outcomes associated with it. For this reason, this systematic literature review was conducted to review different types of exercise for pregnant women. Peer-reviewed articles were selected to discuss the benefits of the most researched exercises for pregnant women, which included yoga, resistance training, aquatic exercises, dance, and aerobic exercise such as running, walking, and cycling. Data from the review revealed that different types of exercises led to various benefits at different stages of pregnancy. Aquatic activities and yoga helped pregnant women toward the end of their pregnancies, whereas resistance training, dance, and aerobic exercises provided the most benefits during the first trimester. Other studies found that any form of exercise for 30 min a day or every other day for 60 min provided extensive beneficial results. Ultimately, this information could be used to create individualized exercise plans for pregnant women to adhere to throughout their pregnancy.
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Affiliation(s)
| | - By Tara Rava Zolnikov
- National University, Department of Community Health, San Diego, CA, USA
- California Southern University, School of Behavioral Sciences, Costa Mesa, CA, USA
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Pahlavani HA, Laher I, Weiss K, Knechtle B, Zouhal H. Physical exercise for a healthy pregnancy: the role of placentokines and exerkines. J Physiol Sci 2023; 73:30. [PMID: 37964253 PMCID: PMC10718036 DOI: 10.1186/s12576-023-00885-1] [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: 08/14/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023]
Abstract
Complications such as diabetes and preeclampsia can occur during pregnancy. Moderate-intensity exercise can prevent such complications by releasing placentokines and exerkines, such as apelin, adiponectin, leptin, irisin, and chemerin. Exercise and apelin increase thermogenesis and glucose uptake in pregnancy by activating AMPK, PI3K, PGC-1α, AKT1, UCP3, and sarcolipin. Exercise increases apelin levels to reduce preeclampsia symptoms by increasing eNOS, NO, placental growth factor (PlGF), and VEGF and decreasing levels of fms-like tyrosine kinase 1 (sFlt-1), soluble endoglin (sEng), and oxidative stress. A negative relationship has been reported between plasma leptin and VO2peak/kg and VO2peak in women with gestational diabetes. In active women, decreases in leptin levels reduce the risk of preeclampsia by ~ 40%. Higher adiponectin levels are associated with greater physical activity and lead to increased insulin sensitivity. Increased adiponectin levels in preeclampsia and exercise counteract inflammatory and atherogenic activities while also having vascular protective effects. Exercise increases irisin levels that correlate negatively with fasting glucose, insulin concentration, and glycosylated hemoglobin levels. Irisin augments mRNA expression levels of UCP1 and cell death-inducing DNA fragmentation factor-like effector A (cidea) to cause browning of adipose tissue, increased thermogenesis, and increased energy consumption. Irisin concentrations in mothers with preeclampsia in the third trimester negatively correlate with systolic and diastolic blood pressure. Expression levels of chemerin, IL-6, and TNF-α are increased in gestational diabetes, and the increases in chemerin in late pregnancy positively correlate with the ratio of sFlt-1 to PlGF as a marker of preeclampsia. The effects of physical exercise on placentokines and exerkines in women at various stages of pregnancy remain poorly understood.
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Affiliation(s)
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
- Medbase St Gallen Am Vadianplatz, Vadianstrasse 26, 9001, St. Gallen, Switzerland.
| | - Hassane Zouhal
- Movement Sport, Health and Sciences Laboratory (M2S) UFR-STAPS, University of Rennes 2-ENS Cachan, Charles Tillon, France.
- Institut International Des Sciences Du Sport (2IS), Irodouer, France.
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Flor-Alemany M, Acosta-Manzano P, Migueles JH, Henriksson P, Löf M, Aparicio VA. Impact of Exercise Intervention Combined with Optimal Mediterranean Diet Adherence during Pregnancy on Postpartum Body Composition: A Quasi-Experimental Study-The GESTAFIT Project. Nutrients 2023; 15:4413. [PMID: 37892487 PMCID: PMC10609918 DOI: 10.3390/nu15204413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
This study aimed to investigate whether the effects of an exercise program during pregnancy on postpartum body composition are moderated by following a healthy dietary pattern (i.e., Mediterranean diet (MD)). Eighty-three pregnant women (control n = 40, exercise n = 43) were included in the present quasi-experimental study. The exercise intervention consisted of a 60 min, 3 day/week throughout pregnancy from gestational week 17, supervised concurrent (aerobic + resistance) exercise program. A food frequency questionnaire and the MD Score (min-max: 0-50) were employed to assess dietary habits and the MD adherence during pregnancy, respectively. Postpartum body composition was measured with dual-energy X-ray absorptiometry, 6 weeks postpartum. The body mass index and the gynecoid fat mass at postpartum were lower in the exercise compared to the control group (p = 0.018 and p = 0.047, respectively). There was an interaction showing that the MD adherence during pregnancy positively moderated the effects of the exercise intervention on postpartum lean mass (p = 0.024), fat mass percentage (p = 0.092), android fat mass (p = 0.076), and android-to-gynecoid fat mass (p = 0.019). The Johnson-Neyman technique revealed that the effects of exercise were enhanced at a MD score of ~31 for lean mass, ~25 for fat mass, ~23 for android fat mass and ~29 for android-to-gynecoid fat mass. Our results suggest that a concurrent-exercise training plus an optimal MD adherence during pregnancy might be a useful strategy to promote a healthier body composition at the postpartum period.
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Affiliation(s)
- Marta Flor-Alemany
- Department of Physiology, University of Granada, 18071 Granada, Spain; (M.F.-A.); (V.A.A.)
- Biomedical Research Centre (CIBM), Institute of Nutrition and Food Technology (INYTA), University of Granada, 18016 Granada, Spain
- Sport and Health University Research Institute (IMUDS), 18007 Granada, Spain;
| | - Pedro Acosta-Manzano
- Sport and Health University Research Institute (IMUDS), 18007 Granada, Spain;
- Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria
| | - Jairo H. Migueles
- PROFITH “Promoting FITness and Health through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden;
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, 14152 Huddinge, Sweden;
| | - Virginia A. Aparicio
- Department of Physiology, University of Granada, 18071 Granada, Spain; (M.F.-A.); (V.A.A.)
- Biomedical Research Centre (CIBM), Institute of Nutrition and Food Technology (INYTA), University of Granada, 18016 Granada, Spain
- Sport and Health University Research Institute (IMUDS), 18007 Granada, Spain;
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Bernardo DS, Carvalho CB, Conde M, Mota JA, Santos PC. Effectiveness of a structured exercise intervention in gestational weight gain in pregnant women with overweight and obesity: A systematic review with meta-analysis. Int J Gynaecol Obstet 2023; 162:811-822. [PMID: 36825992 DOI: 10.1002/ijgo.14741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES To assess the effectiveness of exercise interventions during pregnancy in managing gestational weight gain (GWG), excessive GWG, gestational diabetes (GD), hypertensive disorders, 2-h post-oral glucose tolerance test (OGTT), and birth weight in pregnant women with overweight/obesity (OW/OB). METHODS The search strategy was conducted in five electronic databases, restricting to articles published within the past 10 years. Randomized controlled trials comparing exercise intervention with usual prenatal care in pregnant women with OW/OB were considered. Two reviewers extracted data and assessed the risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials and the quality of studies using Grading of Recommendations Assessment, Development and Evaluation classification. Continuous data were calculated as mean differences (MDs) and dichotomous data as risk ratios (RRs). RESULTS Seven trials comprising 1648 pregnant women were included. Exercise interventions were associated with lower GWG (MD, -1.19 kg [95% confidence interval, CI, -1.79 to -0.60]) and lower incidence of GD (RR, 0.56 [95% CI, 0.40-0.78]). When analyzing excessive GWG, 2-h post-OGTT, birth weight, and hypertensive disorders, there was no statistically significant difference between the exercise and usual care groups. The strength of evidence was considered moderate. CONCLUSION Exercise interventions during pregnancy in women with OW/OB were shown to influence GWG and the incidence of GD.
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Affiliation(s)
- Diana Salvador Bernardo
- KinesioLab Research Unit in Human Movement, Department of Physiotherapy, School of Health, Piaget Institute, Vila Nova de Gaia, Portugal
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
| | | | - Monserrat Conde
- Nuffield Department of Primary Care Health Sciences, Center for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Jorge Augusto Mota
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), FADEUP-Faculty of Sport, University of Porto, Porto, Portugal
| | - Paula Clara Santos
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto (FADEUP), Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), FADEUP-Faculty of Sport, University of Porto, Porto, Portugal
- Department of Physiotherapy, Health School, Polytechnic of Porto (ESS), Porto, Portugal
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic of Porto, Porto, Portugal
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Flor-Alemany M, Migueles JH, Alemany-Arrebola I, Aparicio VA, Baena-García L. Exercise, Mediterranean Diet Adherence or Both during Pregnancy to Prevent Postpartum Depression-GESTAFIT Trial Secondary Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14450. [PMID: 36361335 PMCID: PMC9657805 DOI: 10.3390/ijerph192114450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/24/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Targeting lifestyle behaviors during pregnancy is crucial to prevent the highly prevalent postpartum depression and its consequences. In these secondary analyses of an intervention trial to investigate the effects of concurrent exercise training on postpartum depression, we aimed to investigate the potential role of Mediterranean diet (MD) adherence on the exercise effects. A total of 85 pregnant women met the per-protocol criteria (exercise n = 46, control n = 39). The exercise program was delivered in 60 min sessions, 3 days/week, from the 17th gestational week until birth. Women's dietary habits were assessed with a food frequency questionnaire. The Mediterranean Food Pattern (an MD index) was derived from it to assess MD adherence. We used the Edinburgh Postnatal Depression Scale to assess postpartum depression. The postpartum depression score was not statistically different between control and exercise groups (p > 0.05). A higher consumption of fruits (β = -0.242, p = 0.022), lower intake of red meat and subproducts (β = 0.244, p = 0.020), and a greater MD adherence (β = -0.236, p = 0.027) were associated with lower levels of postpartum depression. Greater adherence to the MD during pregnancy was associated with fewer depressive symptoms and a lower risk of postpartum depression. Postnatal depression was not reduced by prenatal exercise. Promoting fruit consumption while controlling the intake of red meat during pregnancy might prevent postnatal depression.
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Affiliation(s)
- Marta Flor-Alemany
- Department of Physiology, University of Granada, 18071 Granada, Spain
- Institute of Nutrition and Food Technology (INYTA), Biomedical Research Centre (CIBM), University of Granada, 18016 Granada, Spain
- Sport and Health University Research Institute (IMUDS), 18007 Granada, Spain
| | - Jairo H. Migueles
- Department of Biosciences and Nutrition, Karolinska Institutet, 141 52 Huddinge, Sweden
- PROFITH “Promoting FITness and Health through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
| | - Inmaculada Alemany-Arrebola
- Department of Developmental and Educational Psychology, Faculty of Education and Sports Sciences, University of Granada, 52005 Melilla, Spain
| | - Virginia A. Aparicio
- Department of Physiology, University of Granada, 18071 Granada, Spain
- Institute of Nutrition and Food Technology (INYTA), Biomedical Research Centre (CIBM), University of Granada, 18016 Granada, Spain
- Sport and Health University Research Institute (IMUDS), 18007 Granada, Spain
| | - Laura Baena-García
- Sport and Health University Research Institute (IMUDS), 18007 Granada, Spain
- Department of Nursing, Faculty of Health Sciences, University of Granada, 51001 Ceuta, Spain
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Beyene MM, Shimbre MS, Ukke GG, Gebremichael MA, Gurara MK. Factors associated with antenatal exercise in Arba Minch town, Southern Ethiopia: A community-based cross-sectional study. PLoS One 2022; 17:e0260840. [PMID: 35192634 PMCID: PMC8863279 DOI: 10.1371/journal.pone.0260840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Many health risks in pregnant women and their foetuses can be reduced by practicing antenatal exercise. However, the adequate practice of antenatal exercise among pregnant women is low in Ethiopia. Therefore, this study aimed to assess the practice of antenatal exercise and its associated factors among pregnant women in Arba Minch town. Methods A community-based cross-sectional study design was conducted. Data were collected by using a structured questionnaire from 422 pregnant women selected by a simple random sampling technique. Descriptive statistics were computed and a binary logistic regression model was fitted. In multivariable logistic-regression adjusted odds ratio (AOR) with 95% confidence intervals were used to determine the strength of associations. The significance level was declared at a p-value < 0.05. Results Among 410 participants, 32.9% (95% CI 28%-37%) adequately practiced antenatal exercise. Factors negatively associated with an adequate antenatal exercise were husband’s primary school level [Adjusted odds ratio (AOR) = 0.3, (95% CI: 0.1, 0.7)], history of miscarriage [AOR = 0.3, (95% CI: 0.1, 0.7)], inadequate knowledge [AOR = 0.2, (95% CI: 0.1, 0.3)], and unfavorable attitude [AOR = 0.3, (95% CI 0.2, 0.5)]. Whereas, factors positively associated with an adequate antenatal exercise were employment status of women [AOR = 4.8, (95% CI: 1.8, 13.1)], and a practice of regular exercise before current pregnancy [AOR = 1.9, (95% CI: 1.1, 3.2)]. Conclusions The findings of this study indicated that adequate practice of antenatal exercise was found to be low. Appropriate measures should be taken to improve the husband’s educational level, mother’s occupation, knowledge, and attitudes towards antenatal exercise. Special consideration should be given to those with a history of miscarriage and women should be encouraged to practice regular exercise before pregnancy.
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Affiliation(s)
- Maechel Maile Beyene
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
| | - Mulugeta Shegaze Shimbre
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gebresilasea Gendisha Ukke
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mathewos Alemu Gebremichael
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mekdes Kondale Gurara
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Alizadeh Pahlavani H. Possible roles of exercise and apelin against pregnancy complications. Front Endocrinol (Lausanne) 2022; 13:965167. [PMID: 36093083 PMCID: PMC9452694 DOI: 10.3389/fendo.2022.965167] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022] Open
Abstract
The prevalence of maternal obesity during pregnancy is associated with the risk of gestational diabetes, preeclampsia, and cardiomyopathy. Environmental factors such as active lifestyles and apelin may lead to beneficial changes. In rats, apelin and exercise (45 to 65% VO2max for 6 to 9 weeks) during pregnancy increase brown adipose tissue (BAT) proteins such as Cidea, Elovl3, UCP1, PRDM16, and PGC-1α in males and females fetuses, while white adipose tissue (WAT) is reduced. In humans and animals, apelin and exercise stimulate the expression of the glucose transporters (GLUT1/2/4) in the muscle and adipose tissue through the PI3K/Akt and AMPK pathways. Hence, exercise and apelin may are known as regulators of energy metabolism and be anti-obesity and anti-diabetic properties. In mice, exercise also creates a short-term hypoxic environment in the pregnant mother, activating HIF-1, VEGF, and VEGFR, and increasing angiogenesis. Exercise and apelin also increase vasodilation, angiogenesis, and suppression of inflammation through the L-arginine/eNOS/NO pathway in humans. Exercise can stimulate the ACE2-Ang-(1-7)-Mas axis in parallel with inhibiting the ACE-Ang II-AT1 pathway. Exercise and apelin seem to prevent preeclampsia through these processes. In rats, moderate-intensity exercise (60 to 70% VO2max for 8 weeks) and apelin/APJ also may prevent pathological hypertrophy in pregnancy by activating the PI3K/Akt/mTOR/p70S6K pathway, PI3k-Akt-ERK1/2-p70S6K pathway, and the anti-inflammatory cytokine IL-10. Since pre-clinical studies have been more on animal models, future research with scientific guidelines should pay more attention to human specimens. In future research, time factors such as the first, second, and third trimesters of pregnancy and the intensity and duration of exercise are important variables that should be considered to determine the optimal intensity and duration of exercise.
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Chae SA, Son JS, Du M. Prenatal exercise in fetal development: a placental perspective. FEBS J 2021; 289:3058-3071. [PMID: 34449982 DOI: 10.1111/febs.16173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/09/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
Maternal obesity (MO) and gestational diabetes mellitus (GDM) are common in Western societies, which impair fetal development and predispose offspring to metabolic dysfunction. Placenta is the organ linking the mother to her fetus, and MO suppresses the development of vascular system and expression of nutrient transporters in placenta, thereby affecting fetal development. For maintaining its proper physiological function, placenta is energy demanding, which is met through extensive oxidative phosphorylation. However, the oxidative capacity of placenta is suppressed due to MO and GDM. Recently, several studies showed that physical activity during pregnancy enhances oxidative metabolism and improves placental function, which might be partially mediated by exerkines, referring to cytokines elicited by exercise. In addition, as an endocrine organ, placenta secretes cytokines, termed placentokines, including apelin, superoxide dismutase 3, irisin, and adiponectin, which mediate fetal development and maternal metabolism. Possible molecular mechanisms linking maternal exercise and placentokines to placental and fetal development are further discussed. As an emerging field, up to now, available studies are limited, mostly conducted in rodents. Given the epidemics of obesity and metabolic disorders, as well as the prevalence of maternal sedentary lifestyle, the effects of exercise of pregnant women on placental function and placentokine secretion, as well as their impacts on fetal development, need to be further examined.
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Affiliation(s)
- Song Ah Chae
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
| | - Jun Seok Son
- Laboratory of Perinatal Kinesioepigenetics, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Min Du
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
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11
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Campos MDSB, Buglia S, Colombo CSSDS, Buchler RDD, Brito ASXD, Mizzaci CC, Feitosa RHF, Leite DB, Hossri CAC, Albuquerque LCAD, Freitas OGAD, Grossman GB, Mastrocola LE. Position Statement on Exercise During Pregnancy and the Post-Partum Period - 2021. Arq Bras Cardiol 2021; 117:160-180. [PMID: 34320089 PMCID: PMC8294738 DOI: 10.36660/abc.20210408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Susimeire Buglia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil.,Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | | | - Rica Dodo Delmar Buchler
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil.,Ergometria DASA, São Paulo, SP - Brasil
| | | | | | | | - Danielle Batista Leite
- Real Hospital Português, Recife, PE - Brasil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
| | | | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil.,Clínica Cardionuclear, Porto Alegre, RS - Brasil
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12
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Siyad S, Mustafa N, Banu SS, Buharoon MA, Al Mulla MA, Ankarali H, Carrick FR, Abdulrahman M. Pregnant women's perceptions of physical activity: Adaptation of the pregnancy physical activity questionnaire in Dubai, a multicultural society. J Public Health Res 2021; 11. [PMID: 34351094 PMCID: PMC8883572 DOI: 10.4081/jphr.2021.2261] [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: 03/21/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background: There are major health benefits of physical activity (PA) during pregnancy, yet there is scant data about a woman’s knowledge and understanding of these benefits globally. Design and Methods: We aimed to evaluate the knowledge, attitude, and practice of pregnant women in the United Arab Emirates concerning exercise. We wanted to investigate why some women exercise while others do not exercise during pregnancy. We used a cross-sectional study using a paper-based questionnaire involving pregnant women at antenatal clinics in the Dubai health Authority. The Modified form of Pregnancy Physical Activity Questionnaire (PPAQ) was adapted in both Arabic and English and used in this study. Results: Women aging 25-35 that had a higher educational level, were employed, having 1 or 2 previous pregnancies, and having better knowledge on the benefits of Physical Activity (PA) during pregnancy had better exercise profiles. Conclusions: Our results demonstrate that the majority of the women that participated in our study were shown to have low PA during pregnancy. Better education and communication of the benefits of PA during pregnancy are needed to improve exercise among pregnant women in the UAE population. We found that improved education of women specific to PA with involvement of a healthcare provider were associated with an increase in PA during pregnancy. Significance for public health Our findings show a tremendous need for educating women on Physical Activity (PA) during pregnancy in primary health care and maternity clinics. These efforts have to be part of an organizational strategic plan. We recommend more campaigns on the benefits of PA for pregnant women. More efforts are needed to assess the barriers that could be solved and corrected within our health care for pregnant women. Promoting a cost-effective intervention in our antenatal care clinics could decrease maternal-fetal complications that are associated with a sedentary lifestyle.
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Affiliation(s)
- Sadhiya Siyad
- Department of Public Health, Dubai Medical College, Dubai.
| | - Naima Mustafa
- Department of Public Health, Dubai Medical College, Dubai.
| | | | | | | | - Handan Ankarali
- University of Central Florida College of Medicine, Orlando, FL.
| | | | - Mahera Abdulrahman
- Health Informatics and Smart Health Department, Health Regulation Sector, Dubai Health Authority, Dubai.
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13
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Heslehurst N, Flynn AC, Ngongalah L, McParlin C, Dalrymple KV, Best KE, Rankin J, McColl E. Diet, Physical Activity and Gestational Weight Gain Patterns among Pregnant Women Living with Obesity in the North East of England: The GLOWING Pilot Trial. Nutrients 2021; 13:1981. [PMID: 34207613 PMCID: PMC8227571 DOI: 10.3390/nu13061981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 02/04/2023] Open
Abstract
Maternal diet, physical activity (PA) behaviours, and gestational weight gain (GWG) are important for optimum health of women and their babies. This secondary analysis of the GLOWING pilot cluster trial explored these among women living with obesity in high deprivation. Pregnant women completed food frequency, PA and psychosocial questionnaires. Weights were retrieved from medical records and measured during routine appointments with midwives. Descriptive and regression analyses were stratified by obesity class. A total of 163 women were recruited; 54.0% had class 1 obesity, 25.8% class 2, 20.2% class 3, and 76.1% lived in the two most deprived quintiles. Women had suboptimal dietary intake, particularly for oily fish, fruit and vegetables. PA was predominantly light intensity, from household, care and occupational activities. Most women gained weight outside of Institute of Medicine (IOM) guideline recommendations (87.8%); women in class 3 obesity were most likely to have inadequate GWG below IOM recommendations (58.3%, p < 0.01) and reduced odds of excessive GWG compared with class 1 (AOR 0.13, 95% 0.04-0.45). Deprived women with obesity have a double inequality as both increase pregnancy risks. This population requires support to meet guideline recommendations for diet, PA and GWG. Further research exploring obesity classes would inform policies and care to achieve the best pregnancy outcomes.
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Affiliation(s)
- Nicola Heslehurst
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (L.N.); (J.R.); (E.M.)
| | - Angela C. Flynn
- Department of Women and Children’s Health, Kings College London, Strand, London WC2R 2LS, UK; (A.C.F.); (K.V.D.)
| | - Lem Ngongalah
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (L.N.); (J.R.); (E.M.)
| | - Catherine McParlin
- Faculty of Health and Life Sciences, Northumbria University, Sutherland Building, Newcastle upon Tyne NE1 8ST, UK;
| | - Kathryn V. Dalrymple
- Department of Women and Children’s Health, Kings College London, Strand, London WC2R 2LS, UK; (A.C.F.); (K.V.D.)
| | - Kate E. Best
- Leeds Institute of Health Sciences, University of Leeds, Woodhouse, Leeds LS2 9JT, UK;
| | - Judith Rankin
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (L.N.); (J.R.); (E.M.)
| | - Elaine McColl
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (L.N.); (J.R.); (E.M.)
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14
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Chae SA, Son JS, Zhu MJ, De Avila JM, Du AM. Treadmill Running of Mouse as a Model for Studying Influence of Maternal Exercise on Offspring. Bio Protoc 2020; 10:e3838. [PMID: 33659487 DOI: 10.21769/bioprotoc.3838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Epidemiological studies robustly show the beneficial effects of maternal exercise in reducing maternal birth complications and improving neonatal outcomes, though underlying mechanisms remain poorly understood. To facilitate mechanistic exploration, a protocol for maternal exercise of mice is established, with the regimen following the exercise guidelines for pregnant women. Compared to volunteer wheel running, treadmill running allows precise control of exercise intensity and duration, dramatically reducing variations among individual mouse within treatments and facilitating translation into maternal exercise in humans. Based on the maximal oxygen consumption rate (VO2max) before pregnancy, the treadmill exercise protocol is separated into three stages: early stage (E1.5 to E7.5 at 40% VO2max), mid stage (E8.5 to E14.5 at 65% VO2max), and late stage of pregnancy (E15.5 to birth at 50% VO2max), which demonstrated persistent beneficial effects on maternal health and fetal development. This protocol can be useful for standardizing maternal treadmill exercise using mice as an experimental model.
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Affiliation(s)
- Song Ah Chae
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
| | - Jun Seok Son
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
| | - Mei-Jun Zhu
- School of Food Science, Washington State University, Pullman, WA 99164, USA
| | - Jeanene M De Avila
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
| | - And Min Du
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
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15
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Son JS, Chae SA, Wang H, Chen Y, Bravo Iniguez A, de Avila JM, Jiang Z, Zhu MJ, Du M. Maternal Inactivity Programs Skeletal Muscle Dysfunction in Offspring Mice by Attenuating Apelin Signaling and Mitochondrial Biogenesis. Cell Rep 2020; 33:108461. [PMID: 33264618 PMCID: PMC8137280 DOI: 10.1016/j.celrep.2020.108461] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/14/2020] [Accepted: 11/10/2020] [Indexed: 12/25/2022] Open
Abstract
Although maternal exercise (ME) becomes increasingly uncommon, the effects of ME on offspring muscle metabolic health remain largely undefined. Maternal mice are subject to daily exercise during pregnancy, which enhances mitochondrial biogenesis during fetal muscle development; this is correlated with higher mitochondrial content and oxidative muscle fibers in offspring muscle and improved endurance capacity. Apelin, an exerkine, is elevated due to ME, and maternal apelin administration mirrors the effect of ME on mitochondrial biogenesis in fetal muscle. Importantly, both ME and apelin induce DNA demethylation of the peroxisome proliferator-activated receptor γ coactivator-1α (Ppargc1a) promoter and enhance its expression and mitochondrial biogenesis in fetal muscle. Such changes in DNA methylation were maintained in offspring, with ME offspring muscle expressing higher levels of PGC-1α1/4 isoforms, explaining improved muscle function. In summary, ME enhances DNA demethylation of the Ppargc1a promoter in fetal muscle, which has positive programming effects on the exercise endurance capacity and protects offspring muscle against metabolic dysfunction. Son et al. demonstrate that maternal exercise facilitates fetal muscle development, which improves muscle function and exercise endurance in offspring. Maternal administration of apelin, an exerkine, mirrors the beneficial effects of maternal exercise on mitochondrial biogenesis and fetal muscle development. These findings suggest apelin and its receptor as potential drug targets for improving fetal muscle development of sedentary mothers.
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Affiliation(s)
- Jun Seok Son
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA; School of Molecular Biosciences, Washington State University, Pullman, WA 99164, USA
| | - Song Ah Chae
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
| | - Hongyang Wang
- Institute of Animal Husbandry and Veterinary Science, Shanghai Academy of Agricultural Sciences, Shanghai, China
| | - Yanting Chen
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
| | | | - Jeanene M de Avila
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
| | - Zhihua Jiang
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
| | - Mei-Jun Zhu
- School of Food Science, Washington State University, Pullman, WA 99164, USA
| | - Min Du
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA; School of Molecular Biosciences, Washington State University, Pullman, WA 99164, USA.
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16
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Nadholta P, Bali P, Singh A, Anand A. Potential benefits of Yoga in pregnancy-related complications during the COVID-19 pandemic and implications for working women. Work 2020; 67:269-279. [PMID: 33044208 DOI: 10.3233/wor-203277] [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] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pregnancy is a vulnerable period of growth and enrichment along with many physiological and psychological challenges. These changes can lead to complications if compounded by external stress and anxiety. COVID-19 has emerged as a chief stressor among the general population and is a serious threat among vulnerable populations. Therefore, there is a need for stress management tools, such as Yoga and physical exercises, both at home and at work. These can be adopted during the pandemic with proper maintenance of social distancing. OBJECTIVE To evaluate and compile literature that has reported the health outcomes of Yoga intervention on pregnancy at the workplace and analyzes both the restrictions as well as advantages of its beneficial effects in comparison to physical exercises. METHODOLOGY A comprehensive literature review was conducted utilizing PubMed and Google Scholar. The keywords used for the search include "Yoga", "work", "complications", "physical exercise", "drugs" and "COVID" indifferent permutations and combinations with "pregnancy". We compiled the literature with respect to pregnancy complications and the effects of drugs, physical activity and Yoga for preventing these complications. RESULTS We noted that pregnancy-related complications are becoming more prevalent because of a sedentary lifestyle, restricted physical activity and growing stress. In such situations, a home or workplace Yoga protocol can combine both exercise and mindfulness-based alleviation of anxiety for both working and non-working women. CONCLUSION Yoga can be effective for combating stress and anxiety besides boosting immunity in pregnant working women confronted with the COVID-19 pandemic.
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Affiliation(s)
- Pooja Nadholta
- Neuroscience Research Lab, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Bali
- Department of Biophysics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Singh
- Swami Vivekananda Yoga Research Foundation (SVYASA), Bangalore, India
| | - Akshay Anand
- Neuroscience Research Lab, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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17
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Ferrari N, Schmitz L, Schmidt N, Mahabir E, Van de Vondel P, Merz WM, Lehmacher W, Stock S, Brockmeier K, Ensenauer R, Fehm T, Joisten C. A lifestyle intervention during pregnancy to reduce obesity in early childhood: the study protocol of ADEBAR - a randomized controlled trial. BMC Sports Sci Med Rehabil 2020; 12:55. [PMID: 32944252 PMCID: PMC7487987 DOI: 10.1186/s13102-020-00198-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The prevalence of obesity in childhood is increasing worldwide and may be affected by genetic factors and the lifestyle (exercise, nutrition behavior) of expectant parents. Lifestyle factors affect adipokines, namely leptin, resistin, and adiponectin as well as cytokines such as tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6), which are involved in the regulation of maternal metabolic homeostasis, glucose metabolism, and the development of insulin resistance, metabolic syndrome, gestational diabetes mellitus, and hypertension. However, studies focusing on the effect of exercise or a combination of parental exercise and nutrition on the above-mentioned markers in newborns (venous cord blood) and especially on the long-term development of infants' weight gain are lacking. The study will investigate the effects of a multimodal intervention (regular exercise, diet) on parental and childhood adipocytokines (leptin, resistin, adiponectin, TNF-α, IL-6, BDNF). The effect of a lifestyle-related change in "fetal environmental conditions" on the long-term weight development of the child up to the age of two will also be assessed. METHODS/DESIGN A randomized multi-center controlled trial will be conducted in Germany, comparing supervised aerobic and resistance training 2x/week (13th to 36th weeks of gestation) and nutritional counseling (6th to 36th weeks of gestation) during pregnancy with usual care. Thirty women (pre-pregnancy Body Mass Index ≥25 kg/m2, 6th-10th week of gestation) will be included in each group. Maternal anthropometric and physical measurements as well as blood sampling will occur at the 6th-10th, 13th-14th, 21st-24th, and 36th week of gestation, at delivery as well as 8 weeks and 24 months postpartum. Neonatal measurements and umbilical blood sampling will be performed at birth. Maternal and infants' weight development will be assessed every 6 months till 24 months postpartum. A difference in childhood BMI of 1 kg/m2 at the age of two years between both groups will be assumed. A power size of 80% using a significance level of 0.05 and an effect size of 1.0 is presumed. DISCUSSION A better understanding of how lifestyle-related changes in the fetal environment might influence infants' outcome after two years of life could have a profound impact on the prevention and development of infants' obesity. TRIAL REGISTRATION The trial is registered at the German Clinical Trial Register (DRKS00007702); Registered on 10th of August 2016; retrospectively registered https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007702.
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Affiliation(s)
- Nina Ferrari
- Cologne Centre for Prevention in Childhood and Youth/ Heart Centre Cologne, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
- Department for physical activity in public health, Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Laura Schmitz
- Department for physical activity in public health, Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Nikola Schmidt
- Department for physical activity in public health, Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Esther Mahabir
- Comparative Medicine, Center for Molecular Medicine, University of Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
- Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Joseph-Stelzmann-Str. 9, 50931 Cologne, Germany
| | | | - Waltraut M. Merz
- Department of Obstetrics and Prenatal Medicine, University Bonn Medical School, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Walter Lehmacher
- Department of Biometry (IMSIE), Faculty of medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Stephanie Stock
- Cologne Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne, Gleueler Strasse 176 - 178/II, 50935 Cologne, Germany
| | - Konrad Brockmeier
- Cologne Centre for Prevention in Childhood and Youth/ Heart Centre Cologne, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
- Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Regina Ensenauer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children’s Hospital, University of Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
- Institute of Child Nutrition, Max Rubner-Institut, Haid-und-Neu-Str. 9, 76131 Karlsruhe, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, University of Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Christine Joisten
- Cologne Centre for Prevention in Childhood and Youth/ Heart Centre Cologne, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
- Department for physical activity in public health, Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
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18
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Wise SL, Binkley JL, Binkley HM. Pregnancy and Postpartum Training: Coaching Considerations. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Sitzberger C, Oberhoffer-Fritz R, Meyle K, Wagner M, Lienert N, Graupner O, Ensenauer R, Lobmaier SM, Wacker-Gußmann A. Gestational Diabetes: Physical Activity Before Pregnancy and Its Influence on the Cardiovascular System. Front Pediatr 2020; 8:465. [PMID: 32923415 PMCID: PMC7456967 DOI: 10.3389/fped.2020.00465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 07/03/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives: Gestational diabetes mellitus (GDM) is a common complication in pregnancy, affecting around 14% of all pregnancies each year. It will likely further increase, as obesity becomes more prevalent. The impact of GDM on cardiovascular changes in pregnant women and her child is still unclear. The aim of the study was to measure the effects of physical activity before pregnancy on the cardiovascular system in patients with GDM in pregnancy. Methods: Two hundred and six pregnant women were included in this observational study. All participants were recruited at the tertiary level teaching University Hospital "Klinikum rechts der Isar" between 28 and 32 weeks gestation. Questionnaires dealing with pre-pregnancy daily and physical activity (PA) were evaluated. The cardiovascular status of the mothers included measurements of the intima-media thickness (IMT) of the carotid arteries. PA level was performed with a standardized 6-min-walking-test. Results: Ninety-nine women with GDM with a mean age of 33.84 (± 4.7) years were examined. One hundred seven healthy pregnant women aged 32.6 (± 4.2) years served as controls. The mean weight in the study group was 73.0 (± 20.3) kg and 61.7 (± 9.5) kg in the control group. Based on the higher weight in the study group, the Body Mass Index (BMI) was also significantly higher than in the control group (26.3 ± 7.1 vs. 21.6 ± 3; p < 0.001). The frequency of PA was significantly higher in the control group (p < 0.001). The objective fitness level was worse in pregnant women with GDM compared to healthy controls (472 vs. 523 m, p < 0.001). PA before and during pregnancy was less performed in the study group (86 vs. 64.5%, p = 0.002; 69 vs. 45.7%, p = 0.003). Women who were physically inactive before pregnancy had a 3-times higher risk to develop GDM compared to active women (OR = 2.67). The IMT was significantly thicker in the study group (0.48 ± 0.042 mm vs. 0.45 ± 0.042) mm; p = 0.006). Conclusion: Physical activity before pregnancy and a lower initial weight reduces the risk of developing GDM and cardiovascular risk factors in pregnancy. The development of prevention programs is certainly necessary.
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Affiliation(s)
- Christina Sitzberger
- Faculty of Sports and Health Sciences Technische Univeristät Munich, Institute of Preventive Paediatric, Munich, Germany
| | - Renate Oberhoffer-Fritz
- Faculty of Sports and Health Sciences Technische Univeristät Munich, Institute of Preventive Paediatric, Munich, Germany.,German Heart Centre Department of Paediatric Cardiology and Congenital Heart Defects, Munich, Germany
| | - Kristina Meyle
- Faculty of Sports and Health Sciences Technische Univeristät Munich, Institute of Preventive Paediatric, Munich, Germany
| | - Maike Wagner
- Faculty of Sports and Health Sciences Technische Univeristät Munich, Institute of Preventive Paediatric, Munich, Germany
| | - Nadine Lienert
- Faculty of Sports and Health Sciences Technische Univeristät Munich, Institute of Preventive Paediatric, Munich, Germany
| | - Oliver Graupner
- Klinikum rechts der Isar, Department of Gynaecology and Obstetrics, Munich, Germany
| | - Regina Ensenauer
- Research Centre, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Experimental Paediatrics, Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Silvia M Lobmaier
- Klinikum rechts der Isar, Department of Gynaecology and Obstetrics, Munich, Germany
| | - Annette Wacker-Gußmann
- Faculty of Sports and Health Sciences Technische Univeristät Munich, Institute of Preventive Paediatric, Munich, Germany.,German Heart Centre Department of Paediatric Cardiology and Congenital Heart Defects, Munich, Germany
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20
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Adanaş Aydın G, Taşan HA, Tarhan N, Çakar E, Şenol Güler N, Ankaralı H, Tandoğan B. Reliability and validity of Turkish version of pregnancy physical activity questionnaire (PPAQ) in patients with gestational diabetes mellitus . J OBSTET GYNAECOL 2019; 40:176-181. [PMID: 31466492 DOI: 10.1080/01443615.2019.1606178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gestational diabetes mellitus (GDM) is a common complication during pregnancy. Evaluation of the quantitative physical activity in diabetic pregnant women is critical. The aim of this study was to test the reliability and validity of the Pregnancy Physical Activity Questionnaire (PPAQ) in Turkish patients with GDM. A total of 120 pregnant women between the ages of 18 and 44 years with GDM were included. The reliability of the questionnaire was measured by internal consistency and analysis of 2-week test-retest reliability. Of the patients, 74 completed the test-retest procedure. Concurrent validity was examined by comparing the PPAQ with the Short Form of the International Physical Activity Questionnaire (IPAQ) in 36 patients. Test-retest intraclass correlation coefficient scores varied between 0.72 and 0.95. The Spearman rank correlation analysis showed that the PPAQ total activity values were statistically significantly correlated with the total values of IPAQ-Short Form (r = 0.410 and p = .030). In conclusion, the Turkish version of the PPAQ is a valid and reliable tool for the measurement of the physical activity level of pregnant women with GDM.Impact statementWhat is already known on this subject? The pregnancy physical activity questionnaire (PPAQ) developed in 2004 by Chasan-Taber et al.; is a simple and short questionnaire measuring the frequency, duration, and intensity of physical activity in pregnant women. To date, this questionnaire has been translated into many languages and has been used in a number of studies.What do the results of this study add? The aim of this study was to test the reliability and validity of the PPAQ in Turkish pregnant women with GDM. On the basis of our study results, we suggest that the Turkish version of the PPAQ is a valid and reliable tool for the measurement of the physical activity level of pregnant women with GDM.What are the implications of these findings for clinical practice and/or further research? Evaluation of the quantitative physical activity in diabetic pregnant women may contribute to gain a better understanding of the role of physical activity during treatment and may be useful to compare the results of different studies carried out in different places more effectively.
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Affiliation(s)
- Gültekin Adanaş Aydın
- Department of Obstetrics and Gynecology, Bursa Çekirge State Hospital, Bursa, Turkey
| | - Habibe Ayvacı Taşan
- Department of Obstetrics and Gynecology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Nazan Tarhan
- Department of Obstetrics and Gynecology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Erbil Çakar
- Department of Obstetrics and Gynecology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Nilgün Şenol Güler
- Department of Physical Therapy and Rehabilitation, Balıkesir University, Balıkesir, Turkey
| | - Handan Ankaralı
- Medical Faculty, Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Bülent Tandoğan
- Department of Obstetrics and Gynecology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
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21
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Sussman D, Saini BS, Schneiderman JE, Spitzer R, Seed M, Lye SJ, Wells GD. Uterine artery and umbilical vein blood flow are unaffected by moderate habitual physical activity during pregnancy. Prenat Diagn 2019; 39:976-985. [PMID: 31254464 DOI: 10.1002/pd.5517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aims to noninvasively quantify blood flow in the uterine arteries (UTAs) and umbilical vein (UV) using phase-contrast magnetic resonance imaging (PC-MRI) and test whether these correlate with maternal fitness parameters. METHOD Resting UTA and UV flows were measured in 23 healthy 30 ± 3-year-old women who engaged in moderate-intensity physical activity during pregnancy. Participant fitness was characterized in the second and third trimesters using the submaximal oxygen uptake (VO2 ) test measuring heart rate (HR), VO2 , ventilation (ventilatory equivalent [VE]/VO2 ), and the Borg rating of perceived exertion (respiratory quotient [RQ]). Linear regression models were used to determine the associations between blood flow and maternal fitness measures. RESULTS Blood flows in the UTA (957 ± 241 mL/min) and UV (132 ± 38 mL/min/kg) were successfully measured in 20 (87%) participants. Neither was associated with any physical fitness parameters (HR, VO2 , VE/VO2 , and RQ) nor with any second-to-third trimester change in these parameters. CONCLUSION PC-MRI can be used to noninvasively measure blood flow in the UTA and UV. Neither resting UTA nor UV flow is associated with maternal fitness parameters. This is the first MRI-based study to provide novel hemodynamic data suggesting decoupling between maternal moderate fitness level and the maternal-placental-fetal hemodynamic system in healthy, normal body mass index (BMI) pregnancies.
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Affiliation(s)
- Dafna Sussman
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Brahmdeep S Saini
- Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Jane E Schneiderman
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,Clinical Research Services, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rachel Spitzer
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada.,Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike Seed
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Stephen J Lye
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Greg D Wells
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
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22
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Son JS, Liu X, Tian Q, Zhao L, Chen Y, Hu Y, Chae SA, de Avila JM, Zhu MJ, Du M. Exercise prevents the adverse effects of maternal obesity on placental vascularization and fetal growth. J Physiol 2019; 597:3333-3347. [PMID: 31115053 DOI: 10.1113/jp277698] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
KEY POINTS Maternal exercise improves the metabolic health of maternal mice challenged with a high-fat diet. Exercise intervention of obese mothers prevents fetal overgrowth. Exercise intervention reverses impaired placental vascularization in obese mice. Maternal exercise activates placental AMP-activated protein kinase, which was inhibited as a result of maternal obesity. ABSTRACT More than one-third of pregnant women in the USA are obese and maternal obesity (MO) negatively affects fetal development, which predisposes offspring to metabolic diseases. The placenta mediates nutrient delivery to fetuses and its function is impaired as a result of MO. Exercise ameliorates metabolic dysfunction resulting from obesity, although its effect on placental function of obese mothers has not been explored. In the present study, C57BL/6J female mice were randomly assigned into two groups fed either a control or a high-fat diet (HFD) and then the mice on each diet were further divided into two subgroups with/without exercise. In HFD-induced obese mice, daily treadmill exercise during pregnancy reduced body weight gain, lowered serum glucose and lipid concentration, and improved insulin sensitivity of maternal mice. Importantly, maternal exercise prevented fetal overgrowth (macrosomia) induced by MO. To further examine the preventive effects of exercise on fetal overgrowth, placental vascularization and nutrient transporters were analysed. Vascular density and the expression of vasculogenic factors were reduced as a result of MO but were recovered by maternal exercise. On the other hand, the contents of nutrient transporters were not substantially altered by MO or exercise, suggesting that the protective effects of exercise in MO-induced fetal overgrowth were primarily a result of the alteration of placental vascularization and improved maternal metabolism. Furthermore, exercise enhanced downstream insulin signalling and activated AMP-activated protein kinase in HFD placenta. In sum, maternal exercise prevented fetal overgrowth induced by MO, which was associated with improved maternal metabolism and placental vascularization in obese mothers with exercise.
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Affiliation(s)
- Jun Seok Son
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
| | - Xiangdong Liu
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
| | - Qiyu Tian
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
| | - Liang Zhao
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
| | - Yanting Chen
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
| | - Yun Hu
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
| | - Song Ah Chae
- Department of Movement Sciences, University of Idaho, Moscow, ID, USA
| | - Jeanene M de Avila
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
| | - Mei-Jun Zhu
- School of Food Science, Washington State University, Pullman, WA, USA
| | - Min Du
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, USA
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23
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Influence of maternal physical exercise on fetal and maternal heart rate responses. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2019. [DOI: 10.1007/s12662-019-00582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Narvaez-Sanchez R, Calderón JC, Vega G, Trillos MC, Ospina S. Skeletal muscle as a protagonist in the pregnancy metabolic syndrome. Med Hypotheses 2019; 126:26-37. [PMID: 31010495 DOI: 10.1016/j.mehy.2019.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/12/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
The pregnant woman normally shows clinical manifestations similar to a metabolic syndrome (MS), due to her metabolic and hemodynamic adaptations in order to share nutrients with the child. If those adjustments are surpassed, a kind of pregnancy MS (PregMS) could appear, characterized by excessive insulin resistance and vascular maladaptation. Skeletal muscle (SKM) must be a protagonist in the PregMS: SKM strength and mass have been associated inversely with MS incidence in non-pregnant patients, and in pregnant women muscular activity modulates metabolic and vascular adaptations that favor better outcomes. Of note, a sedentary lifestyle affects exactly in the other way. Those effects may be explained not only by the old paradigm of SKM being a great energy consumer and store, but because it is an endocrine organ whose chronic activity or deconditioning correspondingly releases myokines modulating insulin sensitivity and cardiovascular adaptation, by direct or indirect mechanisms not well understood. In this document, we present evidence to support the concept of a PregMS and hypothesize on the role of the SKM mass, fiber types composition and myokines in its pathophysiology. Also, we discuss some exercise interventions in pregnancy as a way to test our hypotheses.
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Affiliation(s)
- Raul Narvaez-Sanchez
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia; Red iberoamericana de trastornos vasculares y del embarazo, RIVATREM, Colombia.
| | - Juan C Calderón
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Gloria Vega
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Maria Camila Trillos
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
| | - Sara Ospina
- Physiology and Biochemistry Research Group PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia. http://www.udea.edu.co/physis
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25
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Gustafsson MK, Romundstad PR, Stafne SN, Helvik AS, Stunes AK, Mørkved S, Salvesen KÅ, Thorsby PM, Mosti MP, Syversen U. The effect of an exercise program in pregnancy on vitamin D status among healthy, pregnant Norwegian women: a randomized controlled trial. BMC Pregnancy Childbirth 2019; 19:76. [PMID: 30786861 PMCID: PMC6381613 DOI: 10.1186/s12884-019-2220-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 02/11/2019] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Vitamin D insufficiency is common in pregnant women worldwide. Regular prenatal exercise is considered beneficial for maternal and fetal health. There is a knowledge gap regarding the impact of prenatal exercise on maternal vitamin D levels. The objective of this study was to investigate whether a prenatal exercise program influenced serum levels of total, free and bioavailable 25-hydroxyvitamin D (25(OH)D) and related parameters. This is a post hoc analysis of a randomized controlled trial with gestational diabetes as the primary outcome. METHODS Healthy, pregnant women from two Norwegian cities (Trondheim and Stavanger) were randomly assigned to a 12-week moderate-intensity exercise program (Borg perceived rating scale 13-14) or standard prenatal care. The intervention group (n = 429) underwent exercise at least three times weekly; one supervised group training and two home based sessions. The controls (n = 426) received standard prenatal care, and exercising was not denied. Training diaries and group training was used to promote compliance and evaluate adherence. Serum levels of 25(OH)D, parathyroid hormone, calcium, phosphate, magnesium and vitamin D-binding protein were measured before (18-22 weeks' gestation) and after the intervention (32-36 weeks' gestation). Free and bioavailable 25(OH)D concentrations were calculated. Regression analysis of covariance (ANCOVA) was applied to assess the effect of the training regime on each substance with pre-intervention levels as covariates. In a second model, we also adjusted for study site and sampling month. Intention-to-treat principle was used. RESULTS A total of 724 women completed the study. No between-group difference in serum 25(OH)D and related parameters was identified by ANCOVA using baseline serum levels as covariates. The second model revealed a between-group difference in levels of 25(OH)D (1.9, 95% CI 0.0 to 3.8 nmol/L; p = 0.048), free 25(OH)D (0.55, 95% CI 0.10 to 0.99 pmol/L; p = 0.017) and bioavailable 25(OH)D (0.15 95% CI 0.01 to 0.29 nmol/L; p = 0.036). No serious adverse events related to regular exercise were seen. CONCLUSION This study, a post hoc analysis, indicates that exercise may affect vitamin D status positively, and emphasizes that women with uncomplicated pregnancies should be encouraged to perform regular exercise. TRIAL REGISTRATION ClinicalTrials.gov: NCT00476567 , registered May 22, 2007.
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Affiliation(s)
- Miriam K Gustafsson
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491, Trondheim, Norway. .,Division of Mental Health Care, Trondheim University Hospital (St. Olavs hospital), Trondheim, Norway.
| | - Pål R Romundstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491, Trondheim, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491, Trondheim, Norway.,Clinic of Clinical Services, Trondheim University Hospital (St. Olavs hospital), Trondheim, Norway
| | - Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491, Trondheim, Norway.,Trondheim University Hospital (St. Olavs hospital), Trondheim, Norway
| | - Astrid Kamilla Stunes
- Trondheim University Hospital (St. Olavs hospital), Trondheim, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Siv Mørkved
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491, Trondheim, Norway.,Trondheim University Hospital (St. Olavs hospital), Trondheim, Norway
| | - Kjell Åsmund Salvesen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Obstretics and Gynaecology, Trondheim University Hospital (St. Olavs hospital), Trondheim, Norway
| | - Per Medbøe Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Aker sykehus, Oslo, Norway
| | - Mats Peder Mosti
- Trondheim University Hospital (St. Olavs hospital), Trondheim, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Unni Syversen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Endocrinology, Trondheim University Hospital (St. Olavs hospital), Trondheim, Norway
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26
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Di Biase N, Balducci S, Lencioni C, Bertolotto A, Tumminia A, Dodesini AR, Pintaudi B, Marcone T, Vitacolonna E, Napoli A. Review of general suggestions on physical activity to prevent and treat gestational and pre-existing diabetes during pregnancy and in postpartum. Nutr Metab Cardiovasc Dis 2019; 29:115-126. [PMID: 30642790 DOI: 10.1016/j.numecd.2018.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 10/21/2018] [Accepted: 10/27/2018] [Indexed: 12/16/2022]
Abstract
The aim of this review is to provide general suggestions on physical activity (PA) in pre-gestational and gestational diabetes mellitus (GDM) and encourage women to take part in safe and effective activities throughout pregnancy, in the absence of other contraindications. PA before and during pregnancy and in postpartum has many positive effects on the mother, as it could reduce the risk of GDM, excessive weight gain and lower back pain and also prevents, in the postpartum, diabetes mellitus. It may also reduce the duration of labour and complications at childbirth, fatigue, stress, anxiety and depression, thereby leading to an improved sense of wellbeing. Clinically, it is thought to help prevent preeclampsia and premature birth even though RCTs provide conflicting evidence with regard to the prevention of GDM. The main reason for this rests on the fact that the majority of clinical trials have not been able to replicate the preventive effect of PA on the onset of GDM, such as the different adherence of the patient to PA. Herein, we survey the literature regarding exercise and PA on GDM prevention and treatment as well as on clinical outcomes in pre-GDM in pregnancy. On the basis of the current literature, we also present a series of general recommendations and suggestions on PA and exercise training in pregnancy among both diabetic patients and those at risk for GDM.
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Affiliation(s)
| | - S Balducci
- Metabolic Fitness Association, Monterotondo, Rome, Italy; Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
| | - C Lencioni
- Diabetes Unit, USL Toscana Nord Ovest, Lucca, Italy
| | - A Bertolotto
- Diabetes and Metabolic Disease Section, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - A Tumminia
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - A R Dodesini
- U.S.C. Malattie endocrine, Diabetologia ASST Papa Giovanni XXIII, Bergamo, Italy
| | - B Pintaudi
- Diabetes Unit, ASST Niguarda Ca Granda Hospital, Milan, Italy
| | - T Marcone
- SSD Diabetology, University Hospital OORR Foggia, Foggia, Italy
| | - E Vitacolonna
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti-Pescara, Chieti, Italy
| | - A Napoli
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
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27
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Harrison AL, Taylor NF, Frawley HC, Shields N. Women with gestational diabetes mellitus want clear and practical messages from credible sources about physical activity during pregnancy: a qualitative study. J Physiother 2019; 65:37-42. [PMID: 30573442 DOI: 10.1016/j.jphys.2018.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 01/15/2023] Open
Abstract
QUESTIONS What are the attitudes of women diagnosed with gestational diabetes mellitus (GDM) towards physical activity during pregnancy? What are the perceived barriers to and enablers of physical activity during pregnancy in women with GDM? DESIGN A qualitative study with phenomenology and interpretative description as theoretical frameworks. PARTICIPANTS Pregnant women experiencing an uncomplicated singleton pregnancy, diagnosed with GDM, and aged 18 to 40 years were recruited using purposive sampling. METHOD Semi-structured interviews were recorded, transcribed verbatim and returned to participants for member checking. Three researchers independently and thematically analysed the qualitative data using an inductive method. Data were coded and compared, and themes were developed, discussed and defined. Recruitment continued until data saturation. Emergent themes were sent to participants and peer reviewed for confirmation. RESULTS The participants were 27 women, with mean age 32 years (SD 3), mean gestation 30 weeks (SD 5), mean pre-pregnancy body mass index 26 kg/m2 (SD 5), and born in 10 different countries. The process of communicating information about physical activity (messaging) was the main theme to emerge. Sub-themes included: wanting information about physical activity from credible sources; wanting clear, specific information about safe physical activity during a GDM pregnancy; receiving information at GDM diagnosis because this event triggered women's desire to be more physically active; understanding why physical activity is important to improving outcomes for themselves and their babies; and wanting information about flexible, convenient and practical physical activity options. CONCLUSION To feel confident and safe about being physically active during pregnancy, women with GDM wanted clear, simple and GDM-specific messages from credible sources. Health professionals can support women with a GDM pregnancy with targeted physical activity messages.
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Affiliation(s)
- Anne L Harrison
- School of Allied Health, La Trobe University, Melbourne, Australia; Physiotherapy Department, Werribee Mercy Hospital, Melbourne, Australia.
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
| | - Helena C Frawley
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Centre for Allied Health Research and Education, Cabrini Health, Melbourne, Australia
| | - Nora Shields
- School of Allied Health, La Trobe University, Melbourne, Australia
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Lemmens PMC, Sartor F, Cox LGE, den Boer SV, Westerink JHDM. Evaluation of an activity monitor for use in pregnancy to help reduce excessive gestational weight gain. BMC Pregnancy Childbirth 2018; 18:312. [PMID: 30064390 PMCID: PMC6069538 DOI: 10.1186/s12884-018-1941-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 07/13/2018] [Indexed: 12/04/2022] Open
Abstract
Background Excessive weight gain during pregnancy increases the risk for negative effects on mother and child during pregnancy, delivery, and also postnatally. Excessive weight gain can be partially compensated by being sufficiently physically active, which can be measured using activity trackers. Modern activity trackers often use accelerometer data as well as heart rate data to estimate energy expenditure. Because pregnancy affects the metabolism and cardiac output, it is not evident that activity trackers that are calibrated to the general population can be reliably used during pregnancy. We evaluated whether an activity monitor designed for the general population is sufficiently accurate for estimating energy expenditure in pregnant women. Methods Forty pregnant women (age: 30.8 ± 4.7 years, BMI: 25.0 ± 4.0) from all three trimesters performed a 1-h protocol including paced and self-paced exercise activities as well as household activities. We tracked reference energy expenditure using indirect calorimetry and used equivalence testing to determine whether the estimated energy expenditure from the activity monitor was within the limits of equivalence. Results Overall we found an averaged underestimation of 10 kcal (estimated energy expenditure was 97% of the reference measurement). The 90% CI for the cumulative total energy expenditure was 94–100%. The activities of self-paced cycling, household activities, stair-walking, and yoga had one of their equivalence boundaries outside a 80–125% range of equivalence; for exercise on a cross-trainer, for self-paced and fixed-pace walking, fixed-paced cycling, and resting, the estimations were within the limits of equivalence. Conclusions We conclude that the activity monitor is sufficiently accurate for every-day use during pregnancy. The observed deviations can be accounted for and are acceptable from a statistical and an applied perspective because the positive and negative deviations that we observed cancel out to an accurate average energy expenditure over a day, and estimations during exercise are sufficiently accurate to enable coaching on physical activity. The positive and negative deviations themselves were relatively small. Therefore, the activity monitor can be used to help in preventing excessive weight gain during pregnancy by accurately tracking physical activity.
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Affiliation(s)
- Paul M C Lemmens
- Philips Research, High Tech Campus 34, 5656 AE, Eindhoven, the Netherlands.
| | - Francesco Sartor
- Philips Research, High Tech Campus 34, 5656 AE, Eindhoven, the Netherlands
| | - Lieke G E Cox
- Philips Research, High Tech Campus 34, 5656 AE, Eindhoven, the Netherlands
| | | | - Joyce H D M Westerink
- Philips Research, High Tech Campus 34, 5656 AE, Eindhoven, the Netherlands.,Eindhoven University of Technology, Het Eeuwsel, 5612 AZ, Eindhoven, the Netherlands
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Sartor F, Gelissen J, van Dinther R, Roovers D, Papini GB, Coppola G. Wrist-worn optical and chest strap heart rate comparison in a heterogeneous sample of healthy individuals and in coronary artery disease patients. BMC Sports Sci Med Rehabil 2018; 10:10. [PMID: 29881626 PMCID: PMC5984393 DOI: 10.1186/s13102-018-0098-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Abstract
Background The need for unobtrusive HR (heart rate) monitoring has led to the development of a new generation of strapless HR monitors. The aim of this study was to determine whether such an unobtrusive, wrist-worn optical HR monitor (OHRM) could be equivalent and therefore a valid alternative to a traditional chest strap during a broad range of activities in a heterogeneous healthy population and coronary artery disease (CAD) patients. Methods One hundred ninety-nine healthy volunteers, 84 males and 115 females, including 35 overweight-obese subjects, 53 pregnant women, and 20 CAD patients were tested in the present study. Second-by-second HR measured by the OHRM was concurrently evaluated against an ECG-based chest strap monitor during a broad range of activities (i.e., walking, running, cycling, gym, household, and sedentary activities). Results Data coverage, percentage of time the OHRM provides a HR not larger than 10 bpm from the reference, went from a minimum of 92% of the time in the least periodic activity (i.e., gym), to 95% during the most intense activity (i.e., running), and to a maximum of 98% for sedentary activities. The limits of agreement of the difference between the OHRM and the chest strap HR were within the range of ±15 bpm. The OHRM showed a concordance correlation coefficient of 0.98. Overall, the mean absolute error was not larger than 3 bpm, which can be considered clinically acceptable for a number of applications. A similar performance was found for CAD (94.2% coverage, 2.4 bpm error), but the small sample size does not allow any quantitative comparison. Conclusion Heart rate measured by OHRM at the wrist and ECG-based HR measured via a traditional chest strap are acceptably close in a broad range of activities in a heterogeneous, healthy population, and showed initial promising results also in CAD patients. Electronic supplementary material The online version of this article (10.1186/s13102-018-0098-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesco Sartor
- 1Department of Personal Health, Philips Research, High Tech Campus 34, p.005, P.O. Box WB61, 5656 AE Eindhoven, The Netherlands
| | - Jos Gelissen
- 1Department of Personal Health, Philips Research, High Tech Campus 34, p.005, P.O. Box WB61, 5656 AE Eindhoven, The Netherlands
| | - Ralph van Dinther
- 2Standardization Research & Robust Sensing, Philips Research, Eindhoven, The Netherlands
| | - David Roovers
- Connected Sensing, Philips Patient Care & Monitoring Solutions, Eindhoven, The Netherlands
| | - Gabriele B Papini
- 1Department of Personal Health, Philips Research, High Tech Campus 34, p.005, P.O. Box WB61, 5656 AE Eindhoven, The Netherlands.,4Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Giuseppe Coppola
- Connected Sensing, Philips Patient Care & Monitoring Solutions, Eindhoven, The Netherlands
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30
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Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. J Physiother 2018; 64:24-32. [PMID: 29289592 DOI: 10.1016/j.jphys.2017.11.012] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 12/11/2022] Open
Abstract
QUESTION What are the attitudes, barriers and enablers to physical activity perceived by pregnant women? DESIGN In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework. PARTICIPANTS Pregnant women. INTERVENTION Not applicable. OUTCOME MEASURES Attitudes and perceived barriers and enablers to physical activity during pregnancy. RESULTS Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity. CONCLUSION Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women's positive attitudes into increased physical activity participation. REGISTRATION PROSPERO CRD42016037643. [Harrison AL, Taylor NF, Shields N, Frawley HC (2018) Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. Journal of Physiotherapy 64: 24-32].
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Zheng J, Wang H, Ren M. Influence of exercise intervention on gestational diabetes mellitus: a systematic review and meta-analysis. J Endocrinol Invest 2017; 40:1027-1033. [PMID: 28401529 DOI: 10.1007/s40618-017-0673-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 04/03/2017] [Indexed: 01/12/2023]
Abstract
AIMS Exercise intervention might be a promising approach to prevent gestational diabetes mellitus. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the effect of exercise intervention on gestational diabetes mellitus. METHODS PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of exercise intervention on gestational diabetes mellitus were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was the incidence of gestational diabetes mellitus, preterm birth, and gestational age at birth. Meta-analysis was performed using random-effect model. RESULTS Five RCTs involving 1872 patients were included in the meta-analysis. Overall, compared with control intervention, exercise intervention was found to significantly reduce the risk of gestational diabetes mellitus (std. mean difference 0.62; 95% CI 0.43-0.89; P = 0.01), but demonstrated no influence on preterm birth (OR 0.93; 95% CI 0.44-1.99; P = 0.86), gestational age at birth (std. mean difference -0.03; 95% CI -0.12 to 0.07; P = 0.60), glucose 2-h post-OGTT (std. mean difference -1.02; 95% CI -2.75 to 0.71; P = 0.25), birth weight (std. mean difference -0.10; 95% CI -0.25 to 0.04; P = 0.16), Apgar score less than 7 (OR 0.78; 95% CI 0.21-2.91; P = 0.71), and preeclampsia (OR 1.05; 95% CI 0.53-2.07; P = 0.88). CONCLUSIONS Compared to control intervention, exercise intervention was found to significantly reduce the incidence of gestational diabetes mellitus, but had no significant influence on preterm birth, gestational age at birth, glucose 2-h post-OGTT, birth weight, Apgar score less than 7, and preeclampsia.
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Affiliation(s)
- J Zheng
- Department of Endocrinology, Chongqing People's Hospital, Chongqing, China
| | - H Wang
- Department of Endocrinology, Chongqing People's Hospital, Chongqing, China
| | - M Ren
- Digestive Department, Chongqing People's Hospital, Chongqing, China.
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Fragoso J, Lira ADO, Chagas GS, Lucena Cavalcanti CC, Beserra R, de Santana-Muniz G, Bento-Santos A, Martins G, Pirola L, da Silva Aragão R, Leandro CG. Maternal voluntary physical activity attenuates delayed neurodevelopment in malnourished rats. Exp Physiol 2017; 102:1486-1499. [DOI: 10.1113/ep086400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/17/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Jéssica Fragoso
- Department of Nutrition; Federal University of Pernambuco; 50670-901 Recife PE Brazil
| | | | - Guilherme Souza Chagas
- Department of Physical Education and Sports Science, CAV; Federal University of Pernambuco; 55608-680 Recife PE Brazil
| | | | - Renata Beserra
- Department of Nutrition; Federal University of Pernambuco; 50670-901 Recife PE Brazil
| | | | - Adriano Bento-Santos
- Department of Physical Education and Sports Science, CAV; Federal University of Pernambuco; 55608-680 Recife PE Brazil
| | - Gerffeson Martins
- Department of Physical Education and Sports Science, CAV; Federal University of Pernambuco; 55608-680 Recife PE Brazil
| | - Luciano Pirola
- INSERM U1060, Lyon-1 University; South Lyon Medical Faculty; 69921 Oullins France
| | - Raquel da Silva Aragão
- Department of Physical Education and Sports Science, CAV; Federal University of Pernambuco; 55608-680 Recife PE Brazil
| | - Carol Góis Leandro
- Department of Nutrition; Federal University of Pernambuco; 50670-901 Recife PE Brazil
- Department of Physical Education and Sports Science, CAV; Federal University of Pernambuco; 55608-680 Recife PE Brazil
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Abstract
Reduced physical activity in pregnancy is often associated with a progressive increase of chronic metabolic disease and to an enhanced risk for the child. The majority of women are less physically active during pregnancy, despite the motivation to improve their health, quality of life, and fitness. Education on the benefits of regular physical activity in pregnancy is determinant as suggested by obstetricians and gynecologists. The specific programs need to be supported by specialists in Sports Medicine. Counseling and support by nurses can also be helpful in encouraging women to maintain a sufficient level of physical activity during pregnancy or to modify their lifestyle, adapting the single models and specific physical activity programs to their needs.
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Poston L, Bell R, Briley AL, Godfrey KM, Nelson SM, Oteng-Ntim E, Sandall J, Sanders TAB, Sattar N, Seed PT, Robson SC, Trépel D, Wardle J. Improving pregnancy outcome in obese women: the UK Pregnancies Better Eating and Activity randomised controlled Trial. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BackgroundObesity in pregnancy is associated with insulin resistance, which underpins many common complications including gestational diabetes mellitus (GDM) and fetal macrosomia.ObjectivesTo assess the effect of a complex behavioural intervention based on diet and physical activity (PA) on the risk of GDM and delivery of a large-for-gestational age (LGA) infant.DesignThree phases: (1) the development phase, (2) the pilot study and (3) a multicentre randomised controlled trial (RCT) comparing a behavioural intervention to improve glycaemic control with standard antenatal care in obese pregnant women. A cost–utility analysis was undertaken to estimate the cost-effectiveness of the health training (intervention) over and above standard care (control).SettingPilot study: antenatal clinics in four inner-city UK hospitals. RCT: eight antenatal clinics in eight UK inner-city hospitals.ParticipantsWomen were eligible for inclusion if they had a body mass index of ≥ 30 kg/m2, were pregnant with a single fetus and at 15+0to 18+6weeks’ gestation, were able to give written informed consent and were without predefined disorders.InterventionThe intervention comprised an initial session with a health trainer, followed by eight weekly sessions. Dietary advice recommended foods with a low dietary glycaemic index, avoidance of sugar-sweetened beverages and reduced saturated fats. Women were encouraged to increase daily PA.Main outcome measuresDevelopment phase: intervention development, acceptability and optimal approach for delivery. Pilot study: change in dietary and PA behaviours at 28 weeks’ gestation. RCT: the primary outcome of the RCT was, for the mother, GDM [as measured by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG)’s diagnostic criteria] and, for the infant, LGA delivery (i.e. customised birthweight ≥ 90th centile for gestational age).ResultsDevelopment phase: following a literature meta-analysis, a study of dietary intention questionnaires and semistructured interviews, an intervention based on behavioural science was developed that incorporated optimal and acceptable methods for delivery. Pilot study: the pilot study demonstrated improvement in dietary behaviours in the intervention compared with the standard care arm but no increase in objectively measured PA. Process evaluation demonstrated feasibility and general acceptability. RCT: the RCT showed no effect of the intervention on GDM in obese pregnant women or the number of deliveries of LGA infants. There was a reduction in dietary glycaemic load (GL) and reduced saturated fat intake, an increase in PA and a modest reduction in gestational weight gain, all secondary outcomes. Lower than expected was the number of LGA infant deliveries in all women, which suggested that universal screening for GDM with IADPSG’s diagnostic criteria, and subsequent treatment, may reduce the number of deliveries of LGA infants. According to the cost–utility analysis, the estimated probability that the UK Pregnancies Better Eating and Activity Trial (UPBEAT) behavioural intervention is cost-effective at the £30,000/quality-adjusted life-year willingness-to-pay threshold was 1%.LimitationsIncluded the high refusal rate for participation and self-reported assessment of diet and PA.ConclusionsThe UPBEAT intervention, an intense theoretically based intervention in obese pregnant women, did not reduce the risk of GDM in women or the number of LGA infant deliveries, despite successfully reducing the dietary GL. Based on total cost to the NHS provider and health gains, the UPBEAT intervention provided no supporting evidence to suggest that the intervention represents value for money based on the National Institute for Health and Care Excellence benchmarks for cost-effectiveness.Future workAlternative strategies for reducing the risk of GDM in obese pregnant women and the number of LGA infant deliveries should be considered, including development of clinically effective interventions to prevent obesity in women of reproductive age, of clinically effective interventions to reduce weight retention following pregnancy and of risk stratification tools in early pregnancy.Trial registrationCurrent Controlled Trials ISRCTN89971375 and UK Clinical Research Network Portfolio 5035.FundingThis project was funded by the NIHR Programme Grant for Applied Research programme and will be published in full inProgramme Grants for Applied Research, Vol. 5, No. 10. See the NIHR journals library website for further project information. Contributions to funding were also provided by the Chief Scientist Office CZB/4/680, Scottish Government Health Directorates, Edinburgh; Guys and St Thomas’ Charity, Tommy’s Charity (Lucilla Poston, Annette L Briley, Paul T Seed) and the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, UK and the Academy of Finland, Finland. Keith M Godfrey was supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre. Lucilla Poston and Keith M Godfrey were supported by the European Union’s Seventh Framework Programme (FP7/2007-2013), project EarlyNutrition under grant agreement number 289346.
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Affiliation(s)
- Lucilla Poston
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annette L Briley
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Keith M Godfrey
- Lifecourse Epidemiology Unit and NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Jane Sandall
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Thomas AB Sanders
- Division of Diabetes and Nutritional Sciences, King’s College London, London, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Paul T Seed
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
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Fournier D, Feeney G, Mathieu ME. Outcomes of Exercise Training Following the Use of a Birthing Ball During Pregnancy and Delivery. J Strength Cond Res 2017; 31:1941-1947. [PMID: 28079671 DOI: 10.1519/jsc.0000000000001672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fournier, D, Feeney, G, and Mathieu, M-E. Outcomes of exercise training following the use of a birthing ball during pregnancy and delivery. J Strength Cond Res 31(7): 1941-1947, 2017- Using a birthing ball (BB) is an exercise form that is growing in popularity. Improved delivery outcomes have been recently reported with as little a 6-8 hours of training per week; however, little is known regarding lower and higher training levels. The aim of this study was to document whether more time spent training with a BB resulted in improved delivery outcomes for the mother and the newborn. This quasi-experimental study was conducted with a sample of women who participated in 1 to 28 supervised exercise classes during pregnancy according to the Ballon Forme program offered in nonclinical settings (http://ballonforme.com), with the option of completing the supervised BB exercises performed at home. Thirty women who gave birth naturally were included in the study. Mean BB training time was 22.3 hours (SD = 16.6 hours). A greater BB training time was significantly associated with shorter labor duration (r = -0.408; p = 0.031) and specific stages of labor (stage 1 [dilatation/active stage] [r = -0.372; p = 0.043] and stage 2 [expulsion] [r = -0.415; p = 0.028]). Increased participation in BB supervised classes was more closely associated with quicker deliveries than those of home based BB exercises. No associations between training time and adverse effects of labor parameters or the baby's health were noted. Greater involvement in BB training seems to lead to quicker deliveries than lower levels of involvement; it also has the benefit of supervised practice.
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Affiliation(s)
- Danielle Fournier
- 1Department of Kinesiology, University of Montreal, Montreal, QC, Canada; and 2Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
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36
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Garland M. Physical Activity During Pregnancy: A Prescription for Improved Perinatal Outcomes. J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Leite CF, do Nascimento SL, Helmo FR, dos Reis Monteiro MLG, dos Reis MA, Corrêa RRM. An overview of maternal and fetal short and long-term impact of physical activity during pregnancy. Arch Gynecol Obstet 2016; 295:273-283. [DOI: 10.1007/s00404-016-4204-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/06/2016] [Indexed: 01/04/2023]
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Aparicio VA, Ocón O, Padilla-Vinuesa C, Soriano-Maldonado A, Romero-Gallardo L, Borges-Cósic M, Coll-Risco I, Ruiz-Cabello P, Acosta-Manzano P, Estévez-López F, Álvarez-Gallardo IC, Delgado-Fernández M, Ruiz JR, Van Poppel MN, Ochoa-Herrera JJ. Effects of supervised aerobic and strength training in overweight and grade I obese pregnant women on maternal and foetal health markers: the GESTAFIT randomized controlled trial. BMC Pregnancy Childbirth 2016; 16:290. [PMID: 27680325 PMCID: PMC5041398 DOI: 10.1186/s12884-016-1081-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 09/22/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND During pregnancy, a sedentary lifestyle may have negative consequences on maternal and foetal health status. The main objective of this project is to assess the effects of an exercise intervention in overweight and grade I obese pregnant on maternal and foetal health markers. METHODS/DESIGN The present study aims to recruit 60 overweight and grade I obese women interested in participating in an exercise intervention program from the 17th gestational week until delivery. Women will be randomized to either an exercise (three 60-min sessions/week of combined aerobic and strength training and pelvic floor exercises), or usual care (control) group (30 women per group). The primary outcome measures are maternal weight gain, and maternal and neonatal glycaemic profile. Secondary outcome measures are: i) perinatal obstetric records; i) body composition; iii) dietary patterns; iv) physical fitness; v) low-back pain; vi) objectively measured physical activity and sedentary behaviour; vii) haematology and biochemical analyses; viii) oxidative stress; ix) pro- and anti-inflammatory markers; x) bone health biomarkers; xi) sleep quality; xii) mental health, quality of life and positive health. DISCUSSION The findings of this project will help to identify strategies for primary prevention and health promotion based on this exercise-based intervention program among overweight and grade I obese pregnant women. TRIAL REGISTRATION NCT02582567 ; Date of registration: 20/10/2015.
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Affiliation(s)
- Virginia A. Aparicio
- Department of Physiology, Faculty of Pharmacy and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
- Department of Public and Occupational Health, and EMGO+ Institute for Health and Care Research, VU University medical center, Amsterdam, The Netherlands
| | - Olga Ocón
- Department of Obstetrics and Gynecology, University of Granada, Granada, Spain
| | - Carmen Padilla-Vinuesa
- Department of Obstetrics and Gynecology, University of Granada, Granada, Spain
- Obstetrics and Gynecology Service, University Hospital Complex, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Lidia Romero-Gallardo
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Milkana Borges-Cósic
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Irene Coll-Risco
- Department of Physiology, Faculty of Pharmacy and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Pilar Ruiz-Cabello
- Department of Physiology, Faculty of Pharmacy and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Pedro Acosta-Manzano
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Fernando Estévez-López
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Clinical and Health Psychology, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Manuel Delgado-Fernández
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Jonatan R. Ruiz
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Mireille N. Van Poppel
- Department of Public and Occupational Health, and EMGO+ Institute for Health and Care Research, VU University medical center, Amsterdam, The Netherlands
- Institute of Sport Science, University of Graz, Graz, Austria
| | - Julio J. Ochoa-Herrera
- Department of Physiology, Faculty of Pharmacy and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
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Ong MJ, Wallman KE, Fournier PA, Newnham JP, Guelfi KJ. Enhancing energy expenditure and enjoyment of exercise during pregnancy through the addition of brief higher intensity intervals to traditional continuous moderate intensity cycling. BMC Pregnancy Childbirth 2016; 16:161. [PMID: 27417194 PMCID: PMC4946108 DOI: 10.1186/s12884-016-0947-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current guidelines recommend that pregnant women without contraindications should engage in 30 min or more of moderate intensity exercise on most days of the week, however, many women fail to achieve this goal. This study examined the effect of adding brief higher intensity intervals to traditional continuous moderate intensity exercise on energy expenditure and the enjoyment of exercise in late pregnancy. This is important to determine given that any additional energy expenditure resulting from higher intensity intervals may be meaningless if enjoyment is compromised, since long-term adherence will likely be low. METHODS In this study, 12 healthy pregnant women at 30 ± 1 weeks gestation, aged 35 ± 6 years with a BMI of 27.1 ± 4.3 kg/m(2) performed either 30 min of continuous cycling exercise (CONT) at a steady power output equivalent to 65 % age-predicted heart rate maximum or an equivalent period of interval cycling (INTV) consisting of continuous cycling at the same power output as CONT, but with the addition of six 15-s self-paced higher intensity efforts throughout, performed at regular intervals, on separate occasions in a counterbalanced order. RESULTS Mean cycling power output, heart rate, oxygen consumption and energy expenditure were higher during INTV compared with CONT (P < 0.05). However, there was no difference in mean rate of perceived exertion between conditions. Enjoyment of exercise was higher with INTV (P = 0.01). CONCLUSIONS The addition of six 15-s higher intensity intervals to continuous moderate intensity exercise effectively increased energy expenditure by 28 %, at the same time as enhancing the enjoyment of exercise in late pregnancy. While these findings may be specific to recreationally active women, this study provides a rationale for future studies to examine the physiological and psychological responses to regular interval training during pregnancy to optimise exercise prescription. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616000680460 . 25 May 2016 (Registered retrospectively).
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Affiliation(s)
- Ming Jing Ong
- School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Karen E Wallman
- School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Paul A Fournier
- School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - John P Newnham
- School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia
| | - Kym J Guelfi
- School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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Çırak Y, Yılmaz GD, Demir YP, Dalkılınç M, Yaman S. Pregnancy physical activity questionnaire (PPAQ): reliability and validity of Turkish version. J Phys Ther Sci 2015; 27:3703-9. [PMID: 26834336 PMCID: PMC4713775 DOI: 10.1589/jpts.27.3703] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/02/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to translate the Pregnancy Physical Activity Questionnaire into Turkish and test its reliability and validity among Turkish pregnant women. [Subjects and Methods] The subjects were 204 healthy, single pregnant women between the ages 18 and 40 who volunteered to participate in this study. Reliability was evaluated by measuring the one-week test-retest reliability with the intraclass correlation coefficient and Pearson's correlation analysis. Concurrent validity was examined by comparing the Pregnancy Physical Activity Questionnaire with the long form of the International Physical Activity Questionnaire and step counts with pedometer. [Results] The mean age of the participants was 28.23±4.94 years, and the mean for BMI was 26.09±4.40. For test-retest reliability, r values were respectively 0.961, 0.934, 0.957 and 0.981 for self-reported sedentary, light, moderate, and vigorous activity, respectively. Intraclass correlation coefficient scores ranged from 0.924 to 0.993. For validity, the Pearson's correlation coefficients between the Pregnancy Physical Activity Questionnaire and long form of the International Physical Activity Questionnaire ranged from moderate (r = 0.329) to high (r = 0.672). The correlation value between the total score of the Pregnancy Physical Activity Questionnaire and the step counts was 0.70. [Conclusion] The Turkish version of the Pregnancy Physical Activity Questionnaire is a valid and reliable tool for measurement of the physical activity level of pregnant women.
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Affiliation(s)
- Yasemin Çırak
- Department of Cardiopulmonary Physiotherapy, School of Physiotherapy and Rehabilitation, Turgut Özal University, Turkey
| | - Gül Deniz Yılmaz
- Department of Musculoskeletal Physiotherapy, School of Physiotherapy and Rehabilitation, Turgut Özal University, Turkey
| | - Yasemin Parlak Demir
- Department of Neurological Physiotherapy, School of Physiotherapy and Rehabilitation, Turgut Özal University, Turkey
| | - Murat Dalkılınç
- Department of Neurological Physiotherapy, School of Physiotherapy and Rehabilitation, Turgut Özal University, Turkey
| | - Selen Yaman
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Turkey
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Kehler AK, Heinrich KM. A selective review of prenatal exercise guidelines since the 1950s until present: Written for women, health care professionals, and female athletes. Women Birth 2015; 28:e93-8. [PMID: 26210535 PMCID: PMC5523977 DOI: 10.1016/j.wombi.2015.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Traditional society values have long-held the notion that the pregnant woman is construed as a risk to her growing fetus and is solely responsible for controlling this risk to ensure a healthy pregnancy. It is hard to ignore the participation of pregnant women in sport and exercise today, especially in high-level sports and popular fitness programs such as CrossFit™. This challenges both traditional and modern prenatal exercise guidelines from health care professionals and governing health agencies. The guidelines and perceived limitations of prenatal exercise have drastically evolved since the 1950s. AIM The goal of this paper is to bring awareness to the idea that much of the information regarding exercise safety during pregnancy is hypersensitive and dated, and the earlier guidelines had no scientific rigor. Research is needed on the upper limits of exercise intensity and exercise frequency, as well as their potential risks (if any) on the woman or fetus. DISCUSSION Pregnant women are physically capable of much more than what was once thought. There is still disagreement about the types of exercise deemed appropriate, the stage at which exercise should begin and cease, the frequency of exercise sessions, as well as the optimal level of intensity during prenatal exercise. CONCLUSION Research is needed to determine the upper limits of exercise frequency and intensity for pregnant women who are already trained. Healthy women and female athletes can usually maintain their regular training regime once they become pregnant.
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Affiliation(s)
- Ainslie K Kehler
- Functional Intensity Training Lab, Department of Kinesiology, Kansas State University, Manhattan, KS, USA.
| | - Katie M Heinrich
- Functional Intensity Training Lab, Department of Kinesiology, Kansas State University, Manhattan, KS, USA
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Health Behaviours during Pregnancy in Women with Very Severe Obesity. Nutrients 2015; 7:8431-43. [PMID: 26457716 PMCID: PMC4632423 DOI: 10.3390/nu7105403] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/16/2015] [Accepted: 09/22/2015] [Indexed: 11/17/2022] Open
Abstract
The health behaviours of pregnant women with very severe obesity are not known, though these women are at high risk of pregnancy complications. We carried out a prospective case-control study including 148 very severely obese (BMI >40 kg/m2) and 93 lean (BMI <25 kg/m2) pregnant women. Diet, physical activity, smoking, alcohol and folic acid consumption were assessed by questionnaire in early and late (16 and 28 weeks gestation) pregnancy. Circulating levels of iron, vitamin B12 and folate and other essential trace elements and minerals were measured in a subset at each time point. The findings biochemically confirmed that very severely obese women consumed diets that were energy-rich but poor in essential micronutrients. A third of all women met physical activity recommendations for pregnancy. A third of very severely obese women and two thirds of lean women took folic acid supplements prior to pregnancy. Very severely obese women were more likely to smoke but less likely to drink alcohol than lean women (all p < 0.05). Women with very severe obesity have low self-reported intakes and circulating levels of essential micronutrients in pregnancy and few follow current recommendations for pregnancy nutrition and lifestyle. These high-risk women represent a group to target for education about health behaviours prior to and during pregnancy.
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Poston L, Bell R, Croker H, Flynn AC, Godfrey KM, Goff L, Hayes L, Khazaezadeh N, Nelson SM, Oteng-Ntim E, Pasupathy D, Patel N, Robson SC, Sandall J, Sanders TAB, Sattar N, Seed PT, Wardle J, Whitworth MK, Briley AL. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2015; 3:767-77. [PMID: 26165396 DOI: 10.1016/s2213-8587(15)00227-2] [Citation(s) in RCA: 451] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Behavioural interventions might improve clinical outcomes in pregnant women who are obese. We aimed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants. METHODS The UK Pregnancies Better Eating and Activity Trial (UPBEAT) is a randomised controlled trial done at antenatal clinics in eight hospitals in multi-ethnic, inner-city locations in the UK. We recruited pregnant women (15-18 weeks plus 6 days of gestation) older than 16 years who were obese (BMI ≥30 kg/m(2)). We randomly assigned participants to either a behavioural intervention or standard antenatal care with an internet-based, computer-generated, randomisation procedure, minimising by age, ethnic origin, centre, BMI, and parity. The intervention was delivered once a week through eight health trainer-led sessions. Primary outcomes were gestational diabetes (diagnosed with an oral glucose tolerance test and by criteria from the International Association of Diabetes in Pregnancy Study Groups) and large-for-gestational-age infants (≥90th customised birthweight centile). Analysis was by intention to treat. This trial is registered with Current Controlled Trials, ISCRTN89971375. Recruitment and pregnancy outcomes are complete but childhood follow-up is ongoing. FINDINGS Between March 31, 2009, and June 2, 2014, we assessed 8820 women for eligibility and recruited 1555, with a mean BMI of 36·3 kg/m(2) (SD 4·8). 772 were randomly assigned to standard antenatal care and 783 were allocated the behavioural intervention, of which 651 and 629 women, respectively, completed an oral glucose tolerance test. Gestational diabetes was reported in 172 (26%) women in the standard care group compared with 160 (25%) in the intervention group (risk ratio 0·96, 95% CI 0·79-1·16; p=0·68). 61 (8%) of 751 babies in the standard care group were large for gestational age compared with 71 (9%) of 761 in the intervention group (1·15, 0·83-1·59; p=0·40). Thus, the primary outcomes did not differ between groups, despite improvements in some maternal secondary outcomes in the intervention group, including reduced dietary glycaemic load, gestational weight gain, and maternal sum-of-skinfold thicknesses, and increased physical activity. Adverse events included neonatal death (two in the standard care group and three in the intervention group) and fetal death in utero (ten in the standard care group and six in the intervention group). No maternal deaths were reported. Incidence of miscarriage (2% in the standard care group vs 2% in the intervention group), major obstetric haemorrhage (1% vs 3%), and small-for-gestational-age infants (≤5th customised birthweight centile; 6% vs 5%) did not differ between groups. INTERPRETATION A behavioural intervention addressing diet and physical activity in women with obesity during pregnancy is not adequate to prevent gestational diabetes, or to reduce the incidence of large-for-gestational-age infants. FUNDING National Institute for Health Research, Guys and St Thomas' Charity, Chief Scientist Office Scotland, Tommy's Charity.
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Affiliation(s)
- Lucilla Poston
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK.
| | - Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Croker
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
| | - Angela C Flynn
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Louise Goff
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Louise Hayes
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Dharmintra Pasupathy
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Nashita Patel
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, Uterine Cell Signalling Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Sandall
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Thomas A B Sanders
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Paul T Seed
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
| | - Melissa K Whitworth
- Maternity Services, Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, UK
| | - Annette L Briley
- Division of Women's Health, King's College London, St Thomas' Hospital, London, UK
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Abstract
Context: Health professionals who care for pregnant women should discuss potential health benefits and harms of exercise. Although most pregnant women do not meet minimal exercise recommendations, there are a growing number of physically active women who wish to continue training throughout pregnancy. Evidence Acquisition: A search of the Web of Science database of articles and reviews available in English through 2014. The search terms exercise pregnancy, strenuous exercise pregnancy, and vigorous exercise pregnancy were used. Study Design: Clinical review. Level of Evidence: Level 3. Results: With proper attention to risk stratification and surveillance, exercise is safe for the mother and fetus. Benefits of exercise in pregnancy include reduction in Cesarean section rates, appropriate maternal and fetal weight gain, and managing gestational diabetes. Exercise as a means of preventing gestational diabetes, preeclampsia, or perinatal depression cannot be reliably supported. Overall, the current evidence suffers from a lack of rigorous study design and compliance with physical activity interventions. Conclusion: Research thus far has been unable to consistently demonstrate proposed benefits of exercise in pregnancy, such as preventing gestational diabetes, preeclampsia, or perinatal depression. However, moderate- and high-intensity exercise in normal pregnancies is safe for the developing fetus and clearly has several important benefits. Thus, exercise should be encouraged according to the woman’s preconception physical activity level.
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Affiliation(s)
- Sally K Hinman
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Kristy B Smith
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - David M Quillen
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - M Seth Smith
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
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Effect of an exercise intervention on gestational diabetes mellitus: a randomized controlled trial. Obstet Gynecol 2015; 125:1195-1204. [PMID: 25932848 DOI: 10.1097/aog.0000000000000738] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the effect of an individually tailored, motivationally matched prenatal exercise intervention on gestational diabetes mellitus (GDM) and other measures of glucose intolerance among ethnically diverse prenatal care patients at increased risk for GDM. METHODS The Behaviors Affecting Baby and You study randomized eligible women at a mean (standard deviation) of 18.2 (4.1) weeks of gestation to a 12-week individually tailored, motivationally matched exercise intervention or a comparison health and wellness intervention. The goal of the exercise intervention was to achieve the American College of Obstetricians and Gynecologists' guidelines for physical activity during pregnancy. Diagnosis of GDM, impaired glucose tolerance, abnormal glucose screen, and screening glucose values (mg/dL) were abstracted from medical records. A sample size of 352 women (176 per group) was planned to have 80% power to detect reductions in risk of 35% or larger. RESULTS From July 2007 to December 2012, a total of 251 (86.5%) women completed the intervention; n=124 and 127 in the exercise and comparison interventions, respectively. Based on an intention-to-treat analysis, no statistically significant differences between the intervention groups were observed; the relative odds of GDM in the exercise group was 0.61 (95% confidence interval [CI] 0.28-1.32) as compared with the health and wellness comparison group. Odds ratios for impaired glucose tolerance and abnormal glucose screen were 0.68 (95% CI 0.35-1.34) and 0.86 (95% CI 0.51-1.47), respectively. The intervention had no effect on birth outcomes. CONCLUSION In this randomized trial among ethnically diverse pregnant women at increased risk for GDM, we found that a prenatal exercise intervention implemented in the second trimester did not result in a statistically significant reduction in relative odds for GDM, impaired glucose tolerance, or abnormal glucose screen. LEVEL OF EVIDENCE I.
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Poyatos-León R, García-Hermoso A, Sanabria-Martínez G, Álvarez-Bueno C, Sánchez-López M, Martínez-Vizcaíno V. Effects of exercise during pregnancy on mode of delivery: a meta-analysis. Acta Obstet Gynecol Scand 2015; 94:1039-47. [DOI: 10.1111/aogs.12675] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 05/06/2015] [Indexed: 01/16/2023]
Affiliation(s)
| | - Antonio García-Hermoso
- Physical Activity, Sport and Health Sciences Laboratory; University of Santiago de Chile; USACH; Santiago de Chile Chile
| | | | | | - Mairena Sánchez-López
- School of Education; University of Castilla-La Mancha; Ciudad Real Spain
- Health and Social Research Center; University of Castilla-La Mancha; Cuenca Spain
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Seneviratne SN, McCowan LME, Cutfield WS, Derraik JGB, Hofman PL. Exercise in pregnancies complicated by obesity: achieving benefits and overcoming barriers. Am J Obstet Gynecol 2015; 212:442-9. [PMID: 24909342 DOI: 10.1016/j.ajog.2014.06.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/08/2014] [Accepted: 06/03/2014] [Indexed: 01/21/2023]
Abstract
An increasing number of women are entering pregnancy in an overweight or obese state. Obese women and their offspring are at increased risk of adverse perinatal outcomes, which may be improved by regular moderate-intensity antenatal exercise. Current guidelines recommend that all pregnant women without contraindications engage in ≥30 minutes of moderate-intensity exercise on a daily basis. However, obese women are usually less physically active and tend to further reduce activity levels during pregnancy. This commentary summarizes the potential short- and long-term benefits of antenatal exercise in obese pregnant women, highlights the challenges they face, and discusses means of improving their exercise levels. In addition, we make recommendations on exercise prescription for pregnancies complicated by obesity.
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Affiliation(s)
- Sumudu N Seneviratne
- Liggins Institute, University of Auckland, Auckland, New Zealand; Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand; Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand; Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand.
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Jing W, Huang Y, Liu X, Luo B, Yang Y, Liao S. The effect of a personalized intervention on weight gain and physical activity among pregnant women in China. Int J Gynaecol Obstet 2015; 129:138-41. [PMID: 25697965 DOI: 10.1016/j.ijgo.2014.11.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 11/07/2014] [Accepted: 01/14/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine whether personalized interventions could improve dietary intake and physical activity among pregnant women. METHODS A randomized controlled trial was conducted at a center in Chengdu, China, between September 2012 and February 2013. Women with a singleton pregnancy (aged ≥18years, could understand written Chinese, did not have pre-existing diabetes) were enrolled at approximately 12weeks of pregnancy. They were randomly assigned (1:1) to an intervention group (received personalized educational materials) or a control group (conventional interventions only). Data for dietary intake and physical activity were recorded via questionnaires. Only pregnant women who completed the study were included in the analysis. RESULTS Analyses included 106 women in the control group and 115 in the intervention group. After intervention, the intake of energy, protein, fruit, milk, seafood, and nuts differed significantly between groups (P<0.05), with intakes closer to the recommended amounts in the intervention group. Women in the intervention group spent significantly less time resting (P=0.033) and more time doing mild activity (P=0.016). Mean weight gain per week was significantly lower in the intervention group (P=0.023), and significantly fewer women in this group developed gestational diabetes (P=0.043). CONCLUSION Personalized educational interventions can improve dietary behavior and physical activity levels, and reduce prevalence of gestational diabetes among pregnant women in China. Chinese Clinical Trial Register: ChiCTR-IPR-15005809.
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Affiliation(s)
- Wenjuan Jing
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Huang
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinghui Liu
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Biru Luo
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Yi Yang
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shujuan Liao
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Nogueira RC, Weeks BK, Beck BR. Exercise to improve pediatric bone and fat: a systematic review and meta-analysis. Med Sci Sports Exerc 2014; 46:610-21. [PMID: 23899893 DOI: 10.1249/mss.0b013e3182a6ab0d] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE This study aimed to determine the effects of school-based, bone-focused exercise interventions on bone, fat, and lean mass in children by systematically reviewing and meta-analyzing the literature. METHODS Potentially relevant articles were identified by searching electronic databases. Abstracts were included if they described the effects of an in-school exercise intervention for children 5-17 yr old compared with controls and presented baseline and follow-up results for bone, fat, and lean measures. Identified studies were systematically reviewed for methodological quality. Meta-analyses were performed for whole body, lumbar spine, and femoral neck bone mineral content (BMC), fat, and lean mass. RESULTS Sixteen eligible trials were identified including eight randomized controlled trials, three clinical controlled trials, and five nonrandomized, nonmatched studies. The quality analysis revealed two studies had low, nine had medium, and five had a high risk of bias. Meta-analyses revealed a small positive effect of bone-targeted exercise on whole body BMC (standardized mean difference [SMD] = 0.483, 95% CI = 0.132-0.833), femoral neck BMC (SMD = 0.292, 95% CI = -0.022 to 0.607), lumbar spine BMC (SMD = 0.384, 95% CI = 0.193-0.575), fat mass (SMD = -0.248, 95% CI = -0.406 to -0.089), and lean mass (SMD = 0.159, 95% CI = -0.076 to 0.394). CONCLUSIONS Beneficial effects of school-based, bone-targeted exercise were observed for bone and fat, but not for lean mass. Excluding trials with high risk of bias strengthened that effect. Considerable study heterogeneity may have obscured effects on lean mass. The effects observed for bone and fat support the pursuit of brief, jumping-focused interventions to reduce fat as well as enhance musculoskeletal tissue in school age children.
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Affiliation(s)
- Rossana C Nogueira
- 1Centre for Musculoskeletal Research, Griffith Health Institute, Gold Coast, Queensland, AUSTRALIA; 2School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, AUSTRALIA
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Opala-Berdzik A, Bacik B, Markiewicz A, Cieślińska-Świder J, Swider D, Sobota G, Błaszczyk JW. Comparison of static postural stability in exercising and non-exercising women during the perinatal period. Med Sci Monit 2014; 20:1865-70. [PMID: 25293983 PMCID: PMC4199463 DOI: 10.12659/msm.890846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of the study was to determine whether women who exercised during and after pregnancy had better static postural stability compared to those who did not exercise. MATERIAL AND METHODS Posturographic tests were performed in 31 women at 34-39 weeks gestation, and again at 6-10 weeks postpartum. The center of pressure mean velocity (with directional subcomponents) and sway area were computed from 30-s quiet standing trials on a stationary force plate with eyes open or closed. The women were surveyed about their lifestyle and physical activity in the perinatal period. Based on the survey, 12 of the women were assigned as regular exercisers and 19 as non-exercisers. A Mann-Whitney U test was used to compare data of the exercisers and the non-exercisers in their advanced pregnancy and again at 2 months postpartum. RESULTS Postural sway measures were not significantly different between the exercisers and the non-exercisers in advanced pregnancy and at 2 months postpartum (p>0.05). CONCLUSIONS Individually performed physical activity during the perinatal period did not affect pregnant/postpartum women's postural stability characteristics of quiet standing.
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Affiliation(s)
- Agnieszka Opala-Berdzik
- Department of Physiotherapy in Internal Diseases, Academy of Physical Education, Katowice, Poland
| | - Bogdan Bacik
- Department of Human Motor Behavior, Academy of Physical Education, Katowice, Poland
| | - Andrzej Markiewicz
- Department of Physiotherapy in Internal Diseases, Academy of Physical Education, Katowice, Poland
| | - Joanna Cieślińska-Świder
- Department of Physiotherapy of the Nervous and Locomotor Systems, Academy of Physical Education, Katowice, Poland
| | - Dariusz Swider
- Institute of Computer Science, Silesian University of Technology, Gliwice, Poland
| | - Grzegorz Sobota
- Department of Human Motor Behavior, Academy of Physical Education, Katowice, Poland
| | - Janusz W Błaszczyk
- Department of Neurophysiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
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