Walking for Health During Pregnancy: A Literature Review and Considerations for Future Research

Walking is the most commonly chosen type of physical activity (PA) during pregnancy and provides several health benefits to both mother and child. National initiatives have promoted the importance of walking in general, but little emphasis is directed toward pregnant women, the majority of whom are insufficiently active. Pregnant women face a variety of dynamic barriers to a physically active lifestyle, some of which are more commonly experienced during specific times throughout the pregnancy experience. Walking is unique in that it appears resistant to a number of these barriers that limit other types of PA participation, and it can be meaningfully integrated into some transportation and occupational activities when leisure-time options are unavailable. Preliminary intervention work suggests that walking programs can be effectively adopted into a typical pregnancy lifestyle. However, a great deal of work remains to administer successful pregnancy walking interventions, including developing and using validated methods of PA and walking assessment. This narrative review discusses the unique advantages of walking during pregnancy, provides recommendations for future intervention work, and outlines the need for pregnancy-focused community walking initiatives.Standard search procedures were followed to determine sources from the literature specific to walking during pregnancy for use in each section of this review

Cardiovascular Disease Risk Factors and Physical Fitness in Volunteer Firefighters

International Journal of Exercise Science 12(2): 764-776, 2019. Forty-seven percent of volunteer firefighter line of duty deaths are caused by cardiovascular events. Aggressive cardiovascular disease (CVD) risk factor reduction and improved physical fitness could reduce CVD mortality within this population. We assessed CVD risk factors and physical fitness in a large cohort of volunteer firefighters to help establish a health and fitness profile of this population, which may serve as evidence for the need to initiate programs aimed at reducing morbidity and mortality caused by CVD in the volunteer fire service. Seventy-four male volunteer firefighters were assessed for eight CVD risk factors and anthropometric characteristics. Physical fitness was assessed via push-ups, sit-ups, and the YMCA step test. Sixty-eight percent of the firefighters had two or more CVD risk factors. The sample was considered obese via body fat percentage (25.3 ± 5.7%), 27% were hypertensive, 30% had hypercholesterolemia, and 46% were sedentary. The average number of sit-ups performed was 27.3 ± 10.5, which was ranked in the 25thpercentile. The average heart rate after the YMCA step test was 160.2 ± 14.6 bpm, which was ranked very poor. The number of CVD risk factors and poor physical fitness in this cohort of volunteer firefighters was noteworthy. Most volunteer firefighters in our sample were at elevated risk for CVD and had inadequate physical fitness. This evidence conveys the need to initiate physical activity and nutrition outreach programs, led by health and fitness professionals, aimed at reducing firefighter morbidity and mortality within the volunteer fire service

Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome

BACKGROUND Clomiphene is the current first-line infertility treatment in women with the polycystic ovary syndrome, but aromatase inhibitors, including letrozole, might result in better pregnancy outcomes. Full Text of Background... METHODS In this double-blind, multicenter trial, we randomly assigned 750 women, in a 1:1 ratio, to receive letrozole or clomiphene for up to five treatment cycles, with visits to determine ovulation and pregnancy, followed by tracking of pregnancies. The polycystic ovary syndrome was defined according to modified Rotterdam criteria (anovulation with either hyperandrogenism or polycystic ovaries). Participants were 18 to 40 years of age, had at least one patent fallopian tube and a normal uterine cavity, and had a male partner with a sperm concentration of at least 14 million per milliliter; the women and their partners agreed to have regular intercourse with the intent of conception during the study. The primary outcome was live birth during the treatment period. Full Text of Methods... RESULTS Women who received letrozole had more cumulative live births than those who received clomiphene (103 of 374 [27.5%] vs. 72 of 376 [19.1%], P=0.007; rate ratio for live birth, 1.44; 95% confidence interval, 1.10 to 1.87) without significant differences in overall congenital anomalies, though there were four major congenital anomalies in the letrozole group versus one in the clomiphene group (P=0.65). The cumulative ovulation rate was higher with letrozole than with clomiphene (834 of 1352 treatment cycles [61.7%] vs. 688 of 1425 treatment cycles [48.3%], P Full Text of Results... CONCLUSIONS As compared with clomiphene, letrozole was associated with higher live-birth and ovulation rates among infertile women with the polycystic ovary syndrome. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; ClinicalTrials.gov number, NCT00719186.

Postpartum Exercise Intervention Targeting Diastasis Recti Abdominis

International Journal of Exercise Science 14(3): 400-409, 2021. To examine the effectiveness of an online, 12-week exercise intervention on diastasis recti abdominis (DRA) width and negatively associated health outcomes (i.e. weight and core function). Non-pregnant women who were 6-24 months postpartum and ≥ 18 years of age completed the study. Participants (n = 8) were randomized to intervention (exercise) or control groups; with the intervention group completing three exercise sessions per week virtually. Both groups completed three surveys at baseline, 6-weeks, and 12-weeks. DRA width was measured with nylon calipers at baseline and 12-weeks. Repeated measures analysis of covariance examined Group x Time changes in width of DRA, core function, and weight at 12-weeks; effect sizes (i.e. Cohen’s d) were calculated. An alpha level of 0.05 was used to determine statistical significance. There was a significant Group x Time interaction for two DRA width measurement sites, 2 inches above navel (rest) (p = 0.007, d = 0.67) and 2 inches above navel (active) (p = 0.005, d = 0.69). The Group x Time interaction for weight approached significance (p = 0.06), with a small between group effect size (d = 0.23). The Group x Time interaction for core function was not significant (p = 0.83). Exercise interventions delivered in a virtual setting may be effective for decreasing the severity of DRA in postpartum women. Future research should investigate the impact of similar programs on other aspects of postpartum mental and physical health, activities of daily living, and clinical practice

Examining the energy cost and intensity level of prenatal yoga

Context: A popular form of pregnancy physical activity (PA) is prenatal yoga. However, little is known about the intensity and energy cost of this practice. Aims: To examine the energy cost and intensity level of prenatal yoga. Methods: Pregnant women in a prenatal yoga class (n = 19) wore a Sense Wear Armband during eleven 60 min classes each, and self-reported demographic variables, height and weight, prepregnancy weight, and PA behaviors and beliefs. Sense Wear Armband data included kilocalories, metabolic equivalent (MET) values, and time spent in various intensities. Descriptive statistics and frequencies were utilized to describe energy expenditure and intensity. Results: Energy expenditure averaged 109 ± 8 kcals, and the average MET value was 1.5 ± 0.02. On average, 93% and 7% of classes were sedentary and moderate intensity PA, respectively. Conclusions: Time spent in a prenatal yoga class was considered to be primarily a sedentary activity. Future research should utilize larger samples, practice type, and skill level to increase generalizability

Perceptions of Athletic Trainers as a Source of Nutritional Information among Collegiate Athletes: A Mixed-methods Approach

Background: Athletes obtain nutrition information from a number of sources, with some being more accurate than others.  Little is known about athletes’ perceptions of utilizing Certified Athletic Trainers (ATs) as a primary source of information. Objective: We sought to 1) examine the primary sources of nutrition information among a group of United States collegiate athletes and 2) understand athletes’ perceptions regarding utilization of their ATs as primary sources of nutrition information. Methods: Participants (Division II university athletes) completed an online questionnaire (n=155;n=58 males, n=97 females) assessing demographic information and ranked primary sources of nutrition information, and participated in focus groups (n=26;n=18 women, n=8 men) to better understand barriers/perceptions for using their ATs for nutrition information. Mean+SD ranking were calculated for all sources. Mann Whitney-U analyses were used to identify differences in rank order nutrition sources between genders and years of collegiate experience. Semi-structured focus groups were transcribed, coded, and themes were identified regarding barriers to utilizing ATs for nutrition-related information. Results: Parents (3.54±2.38) and the internet (3.69±2.29) had the highest mean ranks.  ATs were least often ranked as the number one nutrition source (7.5%), among all sources provided.  Barriers to utilizing ATs for nutritional information included discomfort, nutrition information not being within the scope of practice, lack of knowledge, the athletic trainer not caring, and lack of time. Conclusions: Participants reported utilizing ATs less than previous research indicates. Continuing education may be needed to improve the efficacy of ATs in addressing nutritional issues and being seen as a credible and accessible source. Keywords: Diet, Athlete perceptions, Barrier