Does regular strength training cause urinary incontinence in overweight inactive women? : A randomized controlled trial

Introduction and hypothesis: Urinary incontinence (UI) is common in women who exercise. We aimed to investigate new onset UI in formerly inactive, overweight or obese women (BMI > 25) participating in three different strength training modalities compared with a non-exercising control group. Methods: This was a secondary analysis of an assessor blinded randomized controlled trial investigating the effect of 12 weeks of three strength training concepts for women on muscle strength and body composition. None of the programs included pelvic floor muscle training. International Consensus on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was used to investigate primary outcome; new onset UI, and secondary outcome; ICIQ-UI-SF sum score. Suissa and Shuster’s exact unconditional test was used to analyze difference in new onset UI. Difference in ICIQ-UI-SF sum score is presented as mean with 95% CI. Results: At baseline 40 out of 128 (31.2%) participants reported UI. Three out of 27, 2 out of 17, 2 out of 23, and 0 out of 21 women in the three training and control groups respectively had new onset UI. There were no statistically significant differences in new onset UI across the groups or when collapsing new onset UI in the intervention groups compared with the controls (7 out of 67 vs 0 out of 21), p = 0.124. After the intervention the control group reported worse ICIQ-UI-SF sum score than any of the training groups; mean difference − 6.6 (95% CI: −11.9, −1.27), p = 0.012, but there was no difference in change from baseline to 12 weeks between the groups p = 0.145). Conclusions: There was no statistically significant change in UI after strength training.publishedVersio

How does a lifestyle intervention during pregnancy influence perceived barriers to leisure-time physical activity? The Norwegian fit for delivery study, a randomized controlled trial

Background: To develop effective health promotional and preventive prenatal programs, it is important to understand perceived barriers to leisure-time physical activity during pregnancy, including exercise and sport participation. The aims of the present study was 1) to assess the effect of prenatal lifestyle intervention on the perceived barrier to leisure-time physical activity during pregnancy and the first year after delivery and 2) identify the most important perceived barriers to leisure-time physical activity at multiple time points during and after pregnancy. Methods: This secondary analysis was part of the Norwegian Fit for Delivery study, a combined lifestyle intervention evaluated in a blinded, randomized controlled trial. Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥ 18 years and body mass index ≥19 kg/m2 were recruited via healthcare clinics in southern Norway, including urban and rural settings. Participants were randomized to either twice-weekly supervised exercise sessions and nutritional counselling (n = 303) or standard prenatal care (n = 303). The principal analysis was based on the participants who completed the standardized questionnaire assessing their perceived barriers to leisure-time physical activity at inclusion (gestational week 16, n = 589) and following intervention (gestational week 36, n = 509), as well as six months (n = 470) and 12 months (n = 424) postpartum. Results: Following intervention (gestation week 35.4 ± 1.0), a significant between-group difference in perceived barriers to leisure-time physical activity was found with respect to time constraints: “... I do not have the time” (intervention: 22 vs. control: 38, p = 0.030), mother-child safety concerns: “... afraid to harm the baby” (intervention: 8 vs. control: 25, p = 0.002) and self-efficacy: “... I do not believe/think that I can do it” (intervention: 3 vs. control: 10, p = 0.050). No positive effect was seen at postpartum follow-up. Intrapersonal factors (lack of time, energy and interest) were the most frequently perceived barriers, and consistent over time among all participants. Conclusion: The intervention had effect on intrapersonal perceived barriers in pregnancy, but not in the postpartum period. Perceived barriers to leisure-time physical activity were similar from early pregnancy to 12 months postpartum.publishedVersionNivå

Evaluation of implementing a community-based exercise intervention during pregnancy

Objective: To evaluate the implementation of a community-based exercise intervention (the Norwegian Fit for Delivery study) during pregnancy. Design: Descriptive, explorative. Setting: Healthcare clinics in southern Norway, including urban and rural settings. Participants: Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥18 years and body mass index ≥19 kg/m2. Methods: Women were randomized to either twice-weekly supervised exercise sessions combined with nutritional counselling (n=303) or standard prenatal care (n=303). The exercise program was based on ACOG guidelines, with the same low-impact workout for all participants, including 60 minutes of moderate-intensity cardiovascular and strength training, performed in a group of maximum 25 women. The aim of the present secondary analysis was to report on the intervention group's experience with participating in an exercise program in the 2nd and 3rd trimester, including satisfaction, adherence, adverse effects, as well as motives and barriers for attending the classes. Results: Of 303 women randomized to exercise, 274 (92.6%) attended at least one class and 187 (68.2%) completed a questionnaire after completion of the trial assessing their experience with the group sessions. For 71.7%, self-reported exercise dosage was ≥75% of the twice-weekly exercise program and more than seven out of 10 reported to be satisfied or very satisfied with the exercise sessions. A total of 95.1% answered that they would recommend this type of exercise for pregnant friends. Reported motives and health benefits included better aerobic capacity, increased energy levels and exercise enjoyment. No harmful effects of the exercise intervention were noted in the mother or the fetus. Key conclusions and implications for practice: Results demonstrated that regular group exercise was feasible, safe, and well tolerated in pregnancy, which may encourage incorporating this program into a routine health care setting.acceptedVersionNivå

Reliability and concurrent validity of the International Physical Activity Questionnaire short form among pregnant women

Background: The International Physical Activity Questionnaire short-form (IPAQ-SF) is frequently used to assess physical activity (PA) level in the general adult population including pregnant women. However, the reliability and validity of the questionnaire in pregnancy is unknown. Therefore, the aims of the present study were to investigate test-retest reliability and concurrent validity of IPAQ-SF among pregnant women, and whether PA is reported differently among those who fulfill (active) vs. do not fulfill (inactive) recommendations of ≥150 min of weekly moderate intensity PA in pregnancy. Method: Test-retest reliability was examined by answering IPAQ-SF twice, two weeks apart (n = 88). To assess validity, IPAQ-SF was compared to the physical activity monitor SenseWear Armband® (SWA) (n = 64). The participants wore SWA for 8 consecutive days before answering IPAQ-SF. PA level was reported as time spent in moderate-, vigorous- and moderate-to-vigorous intensity PA (MPA, VPA and MVPA) corresponding to the cut-off points 3–6, >6 and >3 Metabolic Equivalents (METs), respectively. Results: Test-retest intraclass-correlation of MPA, VPA and MVPA ranged from 0.81-0.84 (95% Confidence Intervals: 0.69,0.90). Comparing time spent performing PA at various intensities; the mean differences and limits of agreement (±1.96 Standard Deviation) from Bland-Altman plots were−84 ± 402 min/week for MPA,−85 ± 452 min/week for MVPA and 26 ± 78 min/week for VPA, illustrating that the total group under-reported MPA by 72% and MVPA by 52%, while VPA was over-reported by 1400%. For the inactive group corresponding numbers were 44 ± 327 min/week for MPA, 52 ± 355 min/week for MVPA and 16 ± 33 min/week for VPA, illustrating that the inactive group over-reported MPA by 13% and MVPA by 49%, while VPA was not detected by SWA, but participants reported 16 min of VPA/week. In contrast, corresponding numbers for the active group were−197 ± 326 min/week for MPA,−205 ± 396 min/week for MVPA and 35 ± 85 min/week for VPA, illustrating that the active group under-reported MPA by 81% and MVPA by 60%, while they over-reported VPA by 975%. Conclusion: IPAQ-SF had good test-retest reliability, but low to fair concurrent validity for MPA, VPA and MVPA compared to an objective criterion measure among pregnant women. Further, women fulfilling PA guidelines in pregnancy under-reported, while inactive women over-reported PA level.publishedVersionNivå

Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: a randomized controlled trial

OBJECTIVE: To determine whether participation in a group fitness class for pregnant women can prevent and treat pelvic girdle pain and low back pain. DESIGN: An observer-blinded randomized controlled trial. PARTICIPANTS: A total of 105 sedentary, nulliparous pregnant women, mean age 30.7 years (standard deviation (SD) 4.0), mean pre-pregnancy body mass index (BMI) 23.8 (SD 4.3), were assigned to either control or exercise groups at mean gestation week 17.7 (SD 4.2). METHODS: The exercise intervention followed the guidelines of American College of Obstetricians and Gynecologists and included a 60 min general fitness class, with 40 min of endurance training and 20 min of strength training including stretching, performed at least twice per week for a minimum of 12 weeks. Outcome measures were number of women reporting pelvic girdle pain and low back pain after the intervention (mean pregnancy week 36.6 (SD 0.9)) and postpartum (mean 7.7 (SD 1.7)). RESULTS: There were no statistically significant differences between the exercisers and controls in numbers reporting the 2 conditions after the intervention (pelvic girdle pain: odds ratio (OR) = 1.34, CI = 0.56–3.20 or low back pain: OR = 1.10, CI = 0.47–2.60) or postpartum (pelvic girdle pain: OR = 0.38, CI = 0.13–1.10 or low back pain: OR = 1.45, CI = 0.54–3.94). A comparison of the women who had attended at least 80% of the weekly exercise classes with the control participants did not change the results. CONCLUSION: Participation in regular group fitness classes during pregnancy did not alter the proportion of women reporting pelvic girdle pain or low back pain during pregnancy or after childbirth

The marathon of labour—Does regular exercise training influence course of labour and mode of delivery?: Secondary analysis from a randomized controlled trial

Objectives: Today all pregnant women are recommended to participate in moderate intensity aerobic and resistance-based physical activity/exercise ≥150 min/week. However, there are still controversies and scant knowledge on the role of regular exercise on delivery outcomes, including mode of delivery and length of active labour. In addition, nutritional counselling have often been examined together with exercise, which may independently effect the outcomes. Hence, the aims of the present study were to investigate the sole effect of supervised group exercise, including pelvic floor muscle training on course of labour and mode of delivery. Study design: A single blind, randomized controlled trial, performed in the municipality of Oslo, Norway. Out of 105 healthy, inactive nulliparous women, initially enrolled (gestation week 17.7 ± 4.2) to study the effect regular aerobic exercise (60 min 2/week) on health benefits for both mother and her baby, 90 (85.7%) completed postpartum follow-up (7.7 ± 1.7) on labour outcomes (exercise: 43 and control: 47). Data were collected via standardized interviews and birth partographs from hospital records, reported on the postpartum visit (weeks after labour 7.6 ± 1.6). The primary investigator was unaware of the original randomization at the time of the interviews. The principal analysis was done on an intention to treat basis (ITT). For the planned subgroup analyses (per protocol), acceptable intervention adherence was defined as attending ≥ 80% of the recommended exercise program (≥ 19 exercise sessions). Results: There were no differences between the exercise and control groups in induction of labour, use of analgesia, duration of active labour or prolonged labour, according to ITT. Per protocol analyses, showed a shorter duration of total active labour in the exercise group (6.8 ± 5.5 h) than the control group (9.8 ± 5.4 h), with a mean between group difference of 3.1 h (95% CI 0.31–5.9, p = 0.029). Rate of normal vaginal delivery was 85.7% among adherent participants and 62.3% in the control group (p = 0.051). Conclusions: Regular exercise during pregnancy decreased duration of total active labour and showed a trend towards more normal vaginal deliveries among participants who adhered to the prescribed program

What the health? information sources and maternal lifestyle behaviors

Background: Regular physical activity (PA), adequate gestational weight gain (GWG), and healthy eating are important for the long-term health of both mother and baby. Hence, it is important that women receive current and updated advice on these topics and are encouraged to adopt a healthy lifestyle during pregnancy. Objective: The aim of this study was to investigate the main information sources among pregnant women regarding PA, GWG, and nutrition as well as to evaluate how these information sources may affect their health behaviors. Methods: A cross-sectional study design, comprising an electronic questionnaire, was distributed to 2 antenatal clinics, as well as pregnancy-related online chat forums and social media. The inclusion criteria were ≥18 years, ≥20 weeks gestation, and able to read and write Norwegian. In total, 150 pregnant women answered the questionnaire, which was a mix of 11-point Likert scales, close-ended questions, and semi–close-ended questions with the option to elaborate. The relationship between information sources and selected variables, including health behaviors and descriptive variables, were assessed by logistic regression, linear regression, or chi-square as appropriate (P<.05). Results: Mean age (years), gestation week, and prepregnancy body mass index (kg/m2) were 31.1 (SD 4.3), 30.6 (SD 5.9), and 24.2 (SD 4.2), respectively. More than eight out of 10 had received or retrieved information about nutrition (88.7%, 133/150) and PA (80.7%, 121/150), whereas 54.0% (81/150) reported information on GWG. When combining all 3 lifestyle factors, 38.5% had retrieved information from blogs and online forums and 26.6%, from their midwife or family physician. Women who reported the internet and media as their primary source of information on weight gain had increased odds of gaining weight below the Institute of Medicine (IOM) guidelines compared with gaining within the guidelines (odds ratio [OR] 15.5, 95% CI 1.4-167.4; P=.02). Higher compliance with nutritional guidelines was seen among those who cited the internet and media as their main source of information on nutrition (beta=.7, 95% CI 0.07-1.3; P=.03). On the other side, receiving advice from friends and family on weight gain was significantly associated with gaining weight above the IOM guidelines compared with gaining within the guidelines (OR 12.0, 95% CI 1.3-111.7; P=.03). No other associations were found between information sources and health behaviors. Conclusions: The small number of health professionals giving information and the extensive use of internet- and media-based sources emphasize the need to address the quality of internet advice and guide women toward trustworthy sources of information during pregnancy. The association between information sources and PA, GWG, and nutrition requires further research

Stages of change model for participation in physical activity during pregnancy

Background. The transtheoretical model (TTM) has been successful in promoting health behavioral change in the general population. However, there is a scant knowledge about physical activity in relation to the TTM during pregnancy. Hence, the aims of the present study were (1) to assess readiness to become or stay physically active according to the TTM and (2) to compare background and health variables across the TTM. Methods. Healthy pregnant women () were allocated to the study from Oslo University Hospital, Norway. The participants filled in a validated self-administered questionnaire, physical activity pregnancy questionnaire (PAPQ) in gestation, weeks 32–36. The questionnaire contained 53 questions with one particular question addressing the TTM and the five stages: (1) precontemplation stage, (2) contemplation stage, (3) preparation stage, (4) action stage, and (5) maintenance stage. Results. More than half of the participants (53%) were involved in regular exercise (stages 4-5); however, only six specified that they had recently started an exercise program (stage 4). About 33% reported engaging in some physical activity, but not regularly (stage 3). The results showed that receiving advice from health professionals to exercise during pregnancy increased the likeliness of being in stages 4-5, while higher age, multiparity, pregravid overweight, unhealthy eating habits, pelvic girdle pain, and urinary incontinence were more prevalent with low readiness to change exercise habits (stages 1–3). Conclusion. According to the TTM, more than half of the participants reported to be physically active. Moreover, most of the participants classified as inactive showed a high motivational readiness or intention to increase their physical activity level. Hence, pregnancy may be a window of opportunity for the establishment of long-term physical activity habits

Are changes in physical fitness, body composition and weight associated with exercise attendance and dropout among fitness club members? Longitudinal prospective study

Objectives: The primary aim of the present study was to investigate if changes in physical fitness, body composition and weight are associated with exercise attendance and dropout among fitness club members. Secondary, we wanted to identify motives for fitness club membership and exercise. Setting: New members at 25 fitness clubs in Oslo, Norway. Participants In total, 125 new fitness club members were recruited. Eligible criteria were <4 weeks of membership, untrained (exercising <60min once a week) and ≥18 years. At inclusion, and after 3 (n=87) and 12 months (n=64), participants answered a questionnaire (including motives for membership and exercise, and attendance) and performed measurements of maximum oxygen uptake (VO2max), one repetition maximum (bench press and leg press), body composition and weight. In total, 56 participants underwent measurements at all time points. Based on self-reported attendance, participants were divided into three groups: regular attendance (≥2 sessions per week), low attendance (<2 sessions per week) and exercise dropout (no sessions the last month). Results: At 3months, regular attendees had significantly higher VO2max than dropout (6.54mL/min/kg, 95%CI 2.00 to 11.07, p=0.003). At 12 months, a difference in VO2max of 5.32mL/min/kg (95%CI −0.08 to 10.72, p=0.054) was found between regular attendees and dropout, and between regular and low exercise attendance (6.17mL/ min/kg, 95%CI 0.19 to 12.15, p=0.042). VO2max was the only factor showing an association with attendance. No differences or associations were observed in maximal muscle strength or body composition between the three groups. Primary motive for fitness club membership and exercise was increase in physical fitness (92.8%). Conclusions: VO2max was the only factor associated with exercise attendance at two time points. Increased physical fitness was primary motive for fitness club membership and exercise

Investigating self-perceived health and quality of life: A longitudinal prospective study among beginner recreational exercisers in a fitness club setting

Objectives: This study investigated self-perception of overall health (SPH) and quality of life (QoL) at onset and after 3, 6 and 12 months of fitness club membership. Also, we compared SPH and QoL between those who reported regular use of the fitness club (≥2 exercise sessions/week the last month) with those who did not (one exercise session/week or no exercise the last month). Design: Longitudinal prospective study. Setting: 25 fitness clubs in Oslo, Norway. Participants: In total, 250 newly registered fitness club members (equal numbers of men and women, mean age=36.4±11.3 years, mean body mass index=25.7±4.4) were recruited. At onset (n=250), after 3 (n=224), 6 (n=213) and 12 months (n=187), the participants answered an electronic questionnaire, covering background variables, exercise involvement, perceived SPH and QoL. Outcome measures: SPH was measured by a single-item question, rating health status from poor to excellent on a 5-point scale. High SPH was dichotomised as excellent or good, and low SPH as moderate, fair or poor. QoL was measured on a 7-item scale, rating five statements and dichotomised according to a total max sum score of 35, with low QoL ≤25 and high QoL >25. Results: Repeated measurements did not show any changes in SPH. In QoL, we observed an improvement in QoL sum score and a significant increase in mean scores for two out of five statements at 12 months follow-up: ‘In most ways, my life is close to my ideal’ (p=0.036) and ‘If I could live my life over, I would change almost nothing’ (p<0.001). Regular use of the fitness club was associated with high SPH (OR 3.532 (95% CI 1.60–7.82), p=0.002) and high QoL (OR 1.914 (95% CI 0.95–3.86), p=0.069). The results were unchanged after adjusting for confounders. Conclusion: Regular attendance at a fitness club was associated with high SPH and high QoL at 12 months follow-up