Does aerobic exercise reduce postpartum depressive symptoms? A systematic review and meta-analysis

Background There is currently no specific guidance on the role of exercise in managing postpartum depression in the UK and US, and international guidance is inconsistent. Aim To assess the effectiveness of aerobic exercise on postpartum depressive symptoms. Design and setting Systematic review and meta-analysis. There was no restriction to study site or setting. Method The databases MEDLINE, EMBASE, Cochrane Library, PsycINFO, SportDiscus, Clinical Trials.gov, and the World Health Organization International Clinical Trials Registry Platform were searched. Titles and abstracts, then full-text articles, were screened against inclusion criteria: RCTs measuring depressive symptoms in mothers ≤1 year postpartum; and interventions designed to increase aerobic exercise compared with usual care or other comparators. Included studies were assessed using the Cochrane Collaboration's risk of bias tool. Meta-analysis was conducted. Pre-planned subgroup analyses explored heterogeneity. Results Thirteen RCTs were included, with 1734 eligible participants. Exercise significantly reduced depressive symptoms when all trials were combined (standardised mean difference -0.44; 95% confidence interval = -0.75 to -0.12). Exploration of heterogeneity did not find significant differences in effect size between women with possible depression and in general postpartum populations; exercise only and exercise with co-interventions; and group exercise and exercise counselling. Conclusion This systematic review provides support for the effectiveness of exercise in reducing postpartum depressive symptoms. Group exercise, participant-chosen exercise, and exercise with co-interventions all may be effective interventions. These results should be interpreted with caution because of substantial heterogeneity and risk of bias

Is weight cycling associated with adverse health outcomes? A cohort study

Evidence about the health effects of weight cycling is not consistent, with some studies suggesting it is harmful for health. Here we investigated whether weight cycling was associated with weight change and mental health outcomes in 10,428 participants in the mid-age cohort of The Australian Longitudinal Study of Women's Health (ALSWH) over 12 years. In 1998 the women were asked how many times they had ever intentionally lost at least 5 kg and how many times had they regained this amount. Women were categorised into four weight pattern groups: frequent weight cyclers (FWC, three or more weight cycles), low frequency weight cyclers (LFWC, one or two weight cycles), non-weight cyclers (NWC), and weight loss only (WL). We used generalised linear modelling to investigate relationships between weight pattern group, weight change and mental health outcomes. In 1998, 15% of the women were FWC, 24% LFWC, 46% NWC and 15% were WL. Weight change was similar across weight pattern groups in women with obesity, however healthy weight and overweight FWC gained more weight than women who did not weight cycle. We found no difference in overall mental health scores between groups, but both LFWC and FWC had higher odds of depressive symptoms (adjusted OR 1.5, 95%CI: 1.1 to 1.9 and 1.7, 95%CI: 1.1 to 2.4, respectively) than NWC. Our results suggest that, although weight cycling is not associated with greater weight gain in women with obesity, it may increase depressive symptoms

Self management of patients with mild COPD in primary care: randomised controlled trial

Objective: To evaluate the effectiveness of nurse-led telephone health coaching to encourage self-management in a primary care population with mild symptoms of COPD. Design: Pragmatic, multi-centre randomised controlled trial. Setting: 71 general practices in four areas of England. Participants: 577 people, with MRC dyspnoea grade 1 or 2, recruited from primary care COPD registers with spirometry confirmed diagnosis, were randomised to the intervention (n=289) or usual care (n=288). Interventions: Nurse-delivered telephone health coaching intervention, underpinned by Social Cognitive Theory, promoting: accessing smoking cessation services, increasing physical activity, medication management and action planning (4 sessions over 11 weeks; postal information at weeks 16 and 24). Nurses received two days of training. The usual care group received a leaflet about COPD. Main outcome measures: The primary outcome was health related quality of life at 12 months using the short version of the St Georges Respiratory Questionnaire (SGRQ-C). Results: The intervention was delivered with good fidelity: 86% of scheduled calls were delivered; 75% of participants received all four calls. 92% participants were followed-up at six months and 89% at 12 months. There was no difference in SGRQ-C total score at 12 months (mean difference -1.3, 95%CI -3.6 to 0.9; p=0.2). Compared to usual care participants, at six months follow-up, the intervention group reported significantly greater physical activity, more had received a care plan (44% v 30%), rescue packs of antibiotics (37% v 29%) and inhaler technique check (68% v 55%). There were no differences in other secondary outcomes (dyspnoea, smoking cessation, anxiety, depression, self-efficacy, objectively measured physical activity). Conclusions A novel telephone health coaching intervention to promote behaviour change in primary care patients with mild symptoms of dyspnoea did lead to changes in self-management activities, but did not improve health related quality of life. Trial registration Current controlled trials ISRCTN 0671039

The experiences of postnatal women and healthcare professionals of a brief weight management intervention embedded within the national child immunisation programme

BackgroundAfter childbirth, most women do not lose the extra weight gained during pregnancy. This is important because postnatal weight retention contributes to the development of obesity in later life. Research shows that postnatal women living with overweight would prefer to weigh less, are interested in implementing weight loss strategies, and would like support. Without evidence for the benefit of weight management interventions during pregnancy, postnatal interventions are increasingly important. Research has focused on intensive weight loss programmes, which cannot be offered to all postnatal women. Instead, we investigated the feasibility of a brief intervention delivered to postnatal women at child immunisation appointments. This qualitative study explored the views of women who received the intervention and healthcare professionals who delivered it.MethodsThe intervention was delivered within the context of the national child immunisation programme. The intervention group were offered brief support encouraging self-management of weight when attending general practices to have their child immunised at two, three and four months of age. The intervention involved motivation and support from practice nurses to encourage women to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. Nurses provided external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a weight record card. Nested within this trial, semi-structured interviews explored the experiences of postnatal women who received the intervention and nurses who delivered it.ResultsThe intervention was generally acceptable to participants and child immunisation appointments considered a suitable intervention setting. Nurses were hesitant to discuss maternal weight, viewing the postnatal period as a vulnerable time. Whilst some caveats to implementation were discussed by nurses, they felt the intervention was easy to deliver and would motivate postnatal women to lose weight.ConclusionsParticipants were keen to lose weight after childbirth. Overall, they reported that the intervention was acceptable, convenient, and, appreciated support to lose weight after childbirth. Although nurses, expressed concerns about raising the topic of weight in the early postnatal period, they felt the intervention was easy to deliver and would help to motivate women to lose weight.</div

Gender differences in response to an opportunistic brief intervention for obesity in primary care: data from the BWeL trial

Weight loss programmes appeal mainly to women, prompting calls for gender-specific programmes. In the United Kingdom, general practitioners (GPs) refer nine times as many women as men to community weight loss programmes. GPs endorsement and offering programmes systematically could reduce this imbalance. In this trial, consecutively attending patients in primary care with obesity were invited and 1882 were enrolled and randomized to one of two opportunistic 30-second interventions to support weight loss given by GPs in consultations unrelated to weight. In the support arm, clinicians endorsed and offered referral to a weight loss programme and, in the advice arm, advised that weight loss would improve health. Generalized linear mixed effects models examined whether gender moderated the intervention. Men took effective weight loss action less often in both arms (support: 41.6% vs 60.7%; advice: 12.1% vs 18.3%; odds ratio (OR) = 0.38, 95% confidence interval (CI), 0.27, 0.52, P < .001) but there was no evidence that the relative effect differed by gender (interaction P = .32). In the support arm, men accepted referral and attended referral less often, 69.3% vs 82.4%; OR = 0.48, 95% CI, 0.35, 0.66, P < .001 and 30.4% vs 47.6%; OR = 0.48, 95% CI, 0.36, 0.63, P < .001, respectively. Nevertheless, the gender balance in attending weight loss programmes closed to 1.6:1. Men and women attended the same number of sessions (9.7 vs 9.1 sessions, P = .16) and there was no evidence weight loss differed by gender (6.05 kg men vs 4.37 kg women, P = .39). Clinician-delivered opportunistic 30-second interventions benefits men and women equally and reduce most of the gender imbalance in attending weight loss programmes

Cumulative incidence of diabetes, hypertension, IHD, and stroke or TIA for women with GDM and control women.

<p>The analyses for diabetes and hypertension are adjusted for age, Townsend quintile, BMI, and smoking. The analyses for IHD and stroke or TIA are adjusted for the above covariates, prescribed lipid-lowering medication, and hypertension. BMI, body mass index; GDM, gestational diabetes mellitus; IHD, ischemic heart disease; TIA, transient ischemic attack.</p

Supplementary Information Files for Snacktivity™ to promote physical activity: a qualitative study

Supplementary Information Files for Snacktivity™ to promote physical activity: a qualitative studyBackground Adults should achieve a minimum of 150 min of moderate-to-vigorous intensity physical activity per week, but many people do not achieve this. Changes to international guidance have removed the requirement to complete physical activity in bouts of at least 10 min. Snacktivity is a novel and complementary approach that could motivate people to be physically active. It focuses on promoting shorter (2–5 min) and more frequent bouts, or ‘snacks’ of physical activity throughout the day. It is not known whether promoting physical activity in shorter bouts is acceptable to the public, or whether it likely to translate into health behaviour change. Methods As part of a larger research programme, this study explored the merits of using small bouts of physical activity to help the public become physically active (the Snacktivity™ programme). Thirty-one inactive adults used the approach for fve days then participated in semi- structured interviews about their experiences. The data were analysed using the Framework approach. Results Whilst participants highlighted some potential barriers to implementation, they expressed the ease with which Snacktivity could be achieved, which gave them a new awareness of opportunities to do more physical activity throughout the day. Participants raised the importance of habit formation to achieve regular small bouts of physical activity. Conclusions Findings demonstrated that participants liked the Snacktivity concept and viewed it as a motivating approach. Guidance about physical activity must lead to advice that has the best chance of preserving and promoting health and Snacktivity has potential to meet this ambition.<br

Follow-up screening for women with gestational diabetes mellitus (GDM, <i>n =</i> 9,118) and control women (<i>n =</i> 37,281).

<p>Follow-up screening for women with gestational diabetes mellitus (GDM, <i>n =</i> 9,118) and control women (<i>n =</i> 37,281).</p

Participant baseline characteristics.

<p>Participant baseline characteristics.</p

Baseline characteristics of participants according to the time of data collection and in total; figures are presented as N (%) unless otherwise stated.

Baseline characteristics of participants according to the time of data collection and in total; figures are presented as N (%) unless otherwise stated.</p