The Concurrent Acceptability of a Postnatal Walking Group: A Qualitative Study Using the Theoretical Framework of Acceptability.

Walking groups are often enjoyed by postnatal women, but little is known about what makes them an acceptable activity to this group. This study aimed to investigate the acceptability of a postnatal walking group using the Theoretical Framework of Acceptability (TFA). Seventeen postnatal women took part in a walk-along interview during a walking group session. Semi-structured interviews were based on the TFA and findings were analysed deductively onto the seven TFA components. Overall, the walking group was found to be acceptable. Benefits included meeting other mothers and walking in an accessible and convenient location. Women understood the group aim of supporting new mothers and thought it achieved this aim. Most women reported that attending the group was little effort, although for some the timing did not fit well with their baby's schedule. Participants stated that meeting other mothers and being physically active aligned with their value system. In conclusion, the acceptability of the walking group was found to be multifaceted, of which enjoyment was one part. These findings can be used when advertising other walking groups or physical activities for the postnatal population

Feasibility and acceptability of a home-based physical activity program for postnatal women with depressive symptoms: A pilot study

Background Most postnatal women are inactive. Since new mothers, particularly those with heightened depressive symptoms experience several challenges to being active such as lack of time and childcare, home-based programs using hired exercise equipment may help overcome these barriers. This study tested the feasibility and acceptability of a home based treadmill intervention among postpartum women with heightened depressive symptoms. Methods Participants were 11 new mothers (3–9 months postpartum) who at baseline were insufficiently active and experiencing heightened depressive symptoms (based on the Edinburgh Postnatal Depression Scale). Following participation in a 12-week physical activity support program (which included free treadmill hire and access to a purposely designed smartphone web-app), semi-structured interviews were conducted with participants. Depressive symptoms were assessed at weeks 4 and 8 and change in depressive symptoms was analysed using repeated-measures analysis of variance (ANOVA). Thematic analyses were used to identify key themes in qualitative data. Results Quantitative data showed that there was a significant change over time with depressive symptoms decreasing from weeks 0–4 (mean difference = −5.9, 95% CI = −8.7, −5.5) and overall from weeks 0–8 (mean difference = −7.6, 95% CI = −9.8, −3.1). Postpartum women perceived the program to be convenient, flexible and acceptable. Women suggested that the program was useful in overcoming key barriers to physical activity and perceived that the program increased their physical activity and improved psychological health. Conclusion A home-based physical activity program involving cost-free exercise equipment hire was feasible and well accepted by postpartum women. The effectiveness of this program for increasing physical activity and improving mental health in this population should be further tested

Social ecological factors associated with physical activity and screen time amongst mothers from disadvantaged neighbourhoods over three years

Background: Mothers from socioeconomically disadvantaged neighbourhoods are at elevated risk of physical inactivity and high levels of screen time. Yet, little is known regarding the social ecological factors that are longitudinally associated with physical activity and screen time in this target group, and whether the age of their children impacts these relationships. This study aimed to longitudinally examine the social ecological factors associated with physical activity and screen time amongst mothers living in socioeconomically disadvantaged neighbourhoods, and whether these differed according to their child's age. Methods: Data were from 895 mothers living in socioeconomically disadvantaged neighbourhoods (mean age 36.7 years) at baseline and three-year follow-up. Mothers self-reported weekly discretionary physical activity (leisure-time, LTPA; transport-related, TRPA) and screen time durations. Linear regression models assessed associations between five intrapersonal, three social and five physical environmental factors and LTPA, TRPA and screen time, adjusting for confounding factors, clustering by neighbourhood and baseline variables. Interaction analysis was conducted for age of children (younger and older children (n = 442) and mothers with older children (aged 5-12 years) only (n = 453). Results: In adjusted models, all intrapersonal factors (self-efficacy, enjoyment, outcome expectations, behavioural intentions and behavioural skill), social support from friends, neighbourhood cohesion and number of televisions were longitudinally associated with LTPA amongst all mothers. Interaction models showed that findings were generally consistent across groups (i.e., those with both younger and older children compared to those with older children only), with three exceptions. Physical activity enjoyment and social support from family were associated with LTPA only among mothers with older children. Neighbourhood cohesion was associated with screen time only amongst mothers with both younger and older children. No associations were detected for TRPA. Conclusion: Intrapersonal, social and physical environmental factors were longitudinally associated with mother's LTPA, whilst neighbourhood cohesion was longitudinally associated with screen time behaviours amongst mothers. Interventions aimed at increasing LTPA amongst mothers (particularly those from socioeconomically disadvantaged neighbourhoods) may need to target all domains of the social ecological model and may require some tailoring according to the age of children. Further work is needed to identify longitudinal associations with screen time and TRPA in this population group

Social and physical environmental correlates of adults\u27 weekend sitting time and moderating effects of retirement status and physical health

Emerging research suggests that prolonged sedentary behaviour (SB) is detrimental to health. Changes in SB patterns are likely to occur during particular life stages, for example at retirement age (55-65-year-old). Evidence on socio-ecological SB correlates is scarce and inconsistent in this age group. Moreover, the influence of socio-ecological correlates may vary depending on health and retirement status. This study examined social and environment correlates of overall weekend day sitting among adults at or approaching retirement age, and moderating effects of perceived physical health and retirement status. Baseline data from the Wellbeing, Eating and Exercise for a Long Life study in 2839 Australian adults (55-65-year-old) were analysed. Participants self-reported proximal social factors, neighbourhood social and physical environment, physical health and retirement status. MLwiN multilevel regression analyses were conducted. In the multivariable model, only social support from friends/colleagues to discourage sitting (B = -0.891; p = 0.036) was associated with overall weekend day sitting. No moderation of retirement status, nor physical health were found in the multivariable results. Results from this study suggest the importance of social factors in relation to weekend day sitting among 55-65-year-old adults. Health promotion initiatives in this age group should pay special attention to enhancing social interaction opportunities. Moreover, findings suggest that SB-specific correlates may need to be examined in future research

Maternal dietary intake and physical activity habits during the postpartum period: associations with clinician advice in a sample of Australian first time mothers

Background Numerous health benefits are associated with achieving optimal diet and physical activity behaviours during and after pregnancy. Understanding predictors of these behaviours is an important public health consideration, yet little is known regarding associations between clinician advice and diet and physical activity behaviours in postpartum women. The aims of this study were to compare the frequency of dietary and physical activity advice provided by clinicians during and after pregnancy and assess if this advice is associated with postpartum diet and physical activity behaviours. Methods First time mothers (n = 448) enrolled in the Melbourne InFANT Extend trial completed the Cancer Council of Australia’s Food Frequency Questionnaire when they were three to four months postpartum, which assessed usual fruit and vegetable intake (serves/day). Total physical activity time, time spent walking and time in both moderate and vigorous activity for the previous week (min/week) were assessed using the Active Australia Survey. Advice received during and following pregnancy were assessed by separate survey items, which asked whether a healthcare practitioner had discussed eating a healthy diet and being physically active. Linear and logistic regression assessed associations of advice with dietary intake and physical activity. Results In total, 8.6 % of women met guidelines for combined fruit and vegetable intake. Overall, mean total physical activity time was 350.9 ± 281.1 min/week. Time spent walking (251.97 ± 196.78 min/week), was greater than time spent in moderate (36.68 ± 88.58 min/week) or vigorous activity (61.74 ± 109.96 min/week) and 63.2 % of women were meeting physical activity recommendations. The majority of women reported they received advice regarding healthy eating (87.1 %) and physical activity (82.8 %) during pregnancy. Fewer women reported receiving healthy eating (47.5 %) and physical activity (51.9 %) advice by three months postpartum. There was no significant association found between provision of dietary and/or physical activity advice, and mother’s dietary intakes or physical activity levels. Conclusions Healthy diet and physical activity advice was received less after pregnancy than during pregnancy yet no association between receipt of advice and behaviour was observed. More intensive approaches than provision of advice may be required to promote healthy diet and physical activity behaviours in new mothers

The ethos of physical activity delivery in mental health: a narrative study of service user experiences.

Our research into the physical activity experiences of people with severe mental illness has led us to take seriously the social and cultural environment in which physical activity is delivered. In this study, through narrative methodology, we examine service user accounts of physical activity to illuminate the characteristics of physical activity groups that are experienced as positive, helpful, or beneficial. We present several qualities and show how effective leadership and coaching is central to these qualities being present. We conclude that it is not so much what activity is delivered, but how it is delivered that is critical for sustained participation and positive outcomes

Key stakeholder perspectives on the development and real-world implementation of a home-based physical activity program for mothers at risk of postnatal depression: a qualitative study

Background: Physical activity (PA) is a modifiable risk factor for postnatal depression (PND) and programs are needed to enhance PA amongst women at risk of PND. Key stakeholder involvement in informing development and implementation of such programs is vital. However, little research demonstrates key stakeholder insights to inform the design and delivery of PA programs for improving PND. The aim of this study was to explore key stakeholder perspectives on the design and delivery of a home-based PA program for mothers with PND symptoms to inform future real-world implementation and scale-up. Methods: A descriptive qualitative study was undertaken whereby semi-structured interviews were conducted with representatives from various key stakeholder organisations involved in postnatal PA and/or mental health, public health and policy in Australia (n = 11). Interviews were conducted between September to November 2019 and explored stakeholder perceptions on the design and delivery of a home-based PA program for mothers with PND symptoms. The interview schedule was informed by both the Consolidated Framework for Implementation Research (CFIR) and the PRACTical planning for Implementation and Scale-up (PRACTIS) guide. Data were analysed thematically using both deductive and inductive coding. Results: The relative priority of PND and PA was high for most organisations involved, although none implemented PA programs supporting women at risk of PND. Most stakeholders perceived the program as appealing due to addressing barriers to postnatal PA, although identified some feasibility issues regarding funding and delivery mechanisms. Suggestions for program adaptations included an equity focus (e.g. providing socioeconomically disadvantaged women with a greater program dose; translating web-app based content into various languages). Planned components of the program were suggested to align (i.e. relative advantage) with existing initiatives (e.g. equipment hire for nurseries scheme) and screening systems for PND (timing of referral). Perceived barriers to scale-up included logistics/cost of equipment, organisational capacity demands and safety risks/liability. Perceived enablers to scale-up included linking the program with ‘adjunct’ programs and services. Conclusions: While the program was appealing and most organisations could see a role in endorsing and/or referring to the program, funding and delivery mechanisms still need to be identified

Positive and negative well-being and objectively measured sedentary behaviour in older adults: evidence from three cohorts

Background: Sedentary behaviour is related to poorer health independently of time spent in moderate to vigorous physical activity. The aim of this study was to investigate whether wellbeing or symptoms of anxiety or depression predict sedentary behaviour in older adults. Method: Participants were drawn from the Lothian Birth Cohort 1936 (LBC1936) (n = 271), and the West of Scotland Twenty-07 1950s (n = 309) and 1930s (n = 118) cohorts. Sedentary outcomes, sedentary time, and number of sit-to-stand transitions, were measured with a three-dimensional accelerometer (activPAL activity monitor) worn for 7 days. In the Twenty-07 cohorts, symptoms of anxiety and depression were assessed in 2008 and sedentary outcomes were assessed ~ 8 years later in 2015 and 2016. In the LBC1936 cohort, wellbeing and symptoms of anxiety and depression were assessed concurrently with sedentary behaviour in 2015 and 2016. We tested for an association between wellbeing, anxiety or depression and the sedentary outcomes using multivariate regression analysis. Results: We observed no association between wellbeing or symptoms of anxiety and the sedentary outcomes. Symptoms of depression were positively associated with sedentary time in the LBC1936 and Twenty-07 1950s cohort, and negatively associated with number of sit-to-stand transitions in the LBC1936. Meta-analytic estimates of the association between depressive symptoms and sedentary time or number of sit-to-stand transitions, adjusted for age, sex, BMI, long-standing illness, and education, were β = 0.11 (95% CI = 0.03, 0.18) and β = − 0.11 (95% CI = − 0.19, −0.03) respectively. Conclusion: Our findings indicate that depressive symptoms are positively associated with sedentary behavior. Future studies should investigate the causal direction of this association

Is gestational weight gain and early postpartum weight retention associated with clinician advice in first time mothers?

Objective: Excess gestational weight gain (GWG) and postpartum weight retention increase risk for multiple maternal and child health complications. It is necessary to determine factors which influence maternal weight across the perinatal period. The aim of this study was to describe change in maternal body mass index (BMI) from prepregnancy to early postpartum, document weight advice provided by clinicians and assess associations of advice received with maternal weight gain during and following pregnancy.Methods: First-time mothers (n=448) and their newborns who attended first-time parent groups at their local Maternal and Child Health Centres were recruited to the InFANT Extend cluster randomised controlled trial. Baseline data collection occurred when women were approximately three months postpartum. Women completed a written questionnaire assessing their own health and the provision of weight-related advice received by clinicians. Prepregnancy weight and GWG were self-reported. Postpartum height and weight were objectively measured.Results: Mean GWG was 14.0 ± 6.08 kg and 41.0% of women experienced excess gestational weight gain. Mean PPWR was 4.3 ± 5.75 kg and mean BMI increased from 24.8 ± 4.9 kg/m² pre-pregnancy to 26.2 ± 4.9 kg/m² at three months postpartum. The proportion of women classified obese (BMI≥ 30kg/m2) almost doubled from prepregnancy(11.8%) to three months postpartum (21.7%) (p<0.001). 54.4% of all women reported receiving advice regarding how much weight to gain during pregnancy and 42.6% reported receiving advice to avoid excess GWG. During the postpartum period, just 5.8% of women reported receiving advice about how much they should weigh and 8.3% reported receiving advice about programs to support weight loss. No associations were found between provision of clinician advice with gestational weight gain or postpartum weight retention.Conclusion: More intensive approaches are required, opposed to provision of advice alone, to influence healthy maternal weight across the perinatal period in the interest of best maternal and child health outcomes