Promoting physical activity among postnatal women: the More Active Mums in Stirling (MAMMiS) study

ABSTRACT BACKGROUND: Adults benefit from participating in physical activity (PA) for chronic disease prevention and treatment. Postnatal women are encouraged to commence a gradual return to PA 4-6 weeks after giving birth, with participation in line with PA guidelines. The potential benefits of postnatal PA include weight management, improvements in cardiovascular fitness and psychological wellbeing. There has been limited high-quality information about the efficacy, feasibility and acceptability of PA interventions in postnatal women and few studies in the UK. Behavioural counselling interventions informed by behaviour change theory have been shown to successfully increase PA in low-active adults. Physical activity consultations (PACs) use structured and individualised behavioural counselling to enhance individuals’ motivation for change, and improve self-management skills. This approach may support adoption of PA in low-active postnatal women with research demonstrating that modifiable socio-cognitive factors influence PA behaviour. This thesis reports on the efficacy of a postnatal PA intervention, the More Active MuMs in Stirling (MAMMiS) study on change in PA behaviour. Efficacy of the intervention was tested in a randomised controlled trial. The effect on secondary health and wellbeing outcomes and PA cognitions targeted by the intervention and feasibility results are also reported. METHODS: The intervention comprised a face-to-face PAC of around 35-45 minutes and 10-week group pramwalking programme. Non-attenders to the pramwalking group received a support telephone call. A follow-up PAC (15-20 minutes) was delivered after three month assessments. The first PAC involved raising awareness about benefits of PA, developing self-efficacy for change, setting goals and action planning PA, developing strategies for overcoming barriers, encouraging self-monitoring, prompting social support and selecting/changing the environment to support PA. The second PAC involved feedback about changes and preventing a return to sedentary habits. The pramwalking group met weekly for 6 walks of 30-55 minutes at a brisk pace, providing opportunities to demonstrate moderate-intensity walking and to encourage and support PA behaviour change. The control group received an NHS leaflet, which encouraged PA after childbirth. Postnatal women (six weeks to 12 months after childbirth) were identified through a variety of NHS-based and community-based strategies plus local advertisements and word-of-mouth. The primary outcome measure was evaluation of PA behaviour change using the Actigraph GT3X/GT3X+ accelerometer, an objective measure of PA behaviour; self-reported moderate-vigorous physical activity (MVPA) was measured using a recall questionnaire (Seven-Day Physical Activity Recall) and cardiovascular fitness using a submaximal step-test (Chester step-test). Secondary health and wellbeing measures were; anthropometric (i.e. weight and body mass index (BMI)) and body composition (measured using a bioelectrical impedance), psychological wellbeing (measured using the Adapted General Wellbeing Index) and fatigue (measured on a 100-point visual analogue scale). PA cognitions were measured via a questionnaire with constructs adapted from previous studies. All were taken at baseline (prior to randomisation), three and six months follow-up from baseline. Process measures were used to investigate intervention fidelity and feasibility. Acceptability was investigated in a post-trial interviews, conducted by a researcher not involved in the trial. RESULTS: Sixty-five postnatal women (average 33 years old with an infant 24 weeks old) were recruited (77% of those eligible). There was a 91% rate of retention at six months; participants who missed a follow-up assessment were younger (30 versus 34 years old) and had younger infants (21 versus 34 weeks old). Participants were less deprived and older compared with postnatal women in Scotland. Objectively measured PA behaviour did not change in response to the intervention. There was no between-groups difference in change in mean counts/minute from baseline to three months (p=0.35, 95% CI -73.50, 26.17, d=0.22) or three to six months (p=0.57, 95% CI -39.46, 71.18, d=0.13). There was no change in MVPA 7 minutes/day in either group from baseline to three (intervention =-0.70, IQR -9.86, 8.36; control =1.65, IQR -4.79, 8.21) or three to six months (intervention =0, IQR -1.13, 1.10; control =0, IQR -9.86, 8.23), with no between-groups difference baseline to three (p=0.43; r=0.10) or three to six months (p=0.75, r=0.09). Results for relative MVPA were similar. Median steps/day from baseline to three months did not change in the intervention group (0, IQR –1619.44, 1047.94) and increased by 195.95 (IQR -1519.55, 1691.03) among controls. The between-groups difference was non-significant (p=0.37, r=0.18). From three to six month follow-up steps/day increased in the intervention group and not in controls (0, IQR -1147.50, 1303.52), this between-groups difference was also non-significant (p=0.35, r=0.16). From baseline to three months self-reported MVPA declined in the intervention group (15 minutes/week; IQR -111, 15) and increased in the control group (30 minutes/week; IQR –68, 75): a non-significant between-groups difference, with a small effect size (p=0.71, r=0.22). From three to six months a decline in self-reported MVPA was found in controls (53 minutes/week; IQR -41,-101) and no change among the intervention group (0, IQ range -26, 71); a significant between-groups difference with a small effect size (p=0.04, r=0.26). There were no differences between the groups for the change in aerobic capacity from baseline to three months or three to six months with no evidence for change over time in aerobic capacity or fitness category in either group. Change in secondary outcomes did not differ between the groups from baseline to three or three to six months (although fatigue did improve in the intervention group relative to controls from baseline to three months). Considering PA cognitions, outcome expectancies declined in both groups from baseline to three months and continued to decline only in the intervention group from three to six months, a between-groups difference with a small effect size (p=0.03, r=0.26). Self-efficacy increased in the intervention group from baseline to three months and declined in the control group with a small effect size for the between-groups difference (p=0.03, r=-0.27). An increase in action 8 planning was seen among the intervention group but not controls from baseline to three months (p<0.01, r=-0.34). Both groups showed an increase in coping planning and action control; the change was larger among the intervention group relative to controls (i.e. p<0.01, r=0.44, r=0.43, respectively). Increased self-efficacy and action control were maintained from three to six months in the intervention group. Coping planning increased relative to controls (p<0.01, r=0.41) and action planning increased among controls from three to six months (p<0.01, r=0.39). Intervention fidelity and feasibility was good. All intervention participants received the initial PAC and adoption of self-management strategies was high for ‘thinking about the benefits of PA’, ‘action planning’ and ‘self-monitoring’, between baseline and three months. Most participants attended at least one walk (61% attended five or more), 89% of planned walks were conducted with no evidence of poor attendance due to season. Walks were conducted at a brisk pace and met moderate-intensity thresholds. DISCUSSION: MAMMiS aimed to recruit low-active healthy postnatal women to test the efficacy of a PAC and group pramwalking intervention. There was no evidence for an intervention effect on PA or on secondary health and wellbeing outcomes. Compared to previous postnatal studies the study sample were relatively active at baseline, there was large variability in accelerometer-measured PA and evidence for fluctuating PA habits. There were positive impacts of the intervention on PA cognitions, which published studies have shown mediate PA behaviour change and postnatal women perceived benefits from taking part. The intervention was feasible, although due to the sample being older and more affluent compared with the general population of postnatal women in Scotland, this would need to be considered if implementing the intervention. Given the importance of PA for health and the challenges of both engaging postnatal women and for postnatal women wanting to be physically active, the findings from MAMMiS provides important evidence to inform future choices about trial design and intervention approach in postnatal PA promotion trials.

The Role of Fish Predation and Spatial Heterogeneity in Determining Benthic Community Structure

The effects of predation and spatial heterogeneity on the benthic macroinvertebrates in the littoral zone of a pond were investigated in a year-long caging experiment. Bluegill sunfish stocked at three densities within the cages were used as the predator. Heterogeneity was manipulated using artificial macrophytes. The presence of plants led to increases both in species richness and in density of most macroinvertebrates. Uncovered benthic sediments had greater species richness and higher macroinvertebrate densities than did sediments covered by macrophytes, suggesting that certain ben- thic species, notably several chironomid groups, migrate onto the macrophytes when this habitat becomes available. Fish predation had a significant impact on both the number of benthic species and the densities of certain benthic macroinvertebrate groups. The predatory chironomid Clinotanypus pinguis showed a strong negative response to bluegill predation, with fish exclusion resulting in higher densities throughout the year. A group of herbivorous chironomids exhibited a response to fish predation that varied over the year, with predation resulting in elevated densities in the fall and winter but reduced densities in the summer. Many of the other species found in the littoral zone showed no significant response to bluegill predation. In addition, fish predation had no significant effect on densities of most macroinvertebrates occurring on the macrophytes. These complex responses of the various macroinvertebrates to fish predation are explainable in terms of seasonal changes in predation intensity and the importance of invertebrate vs. vertebrate predation. In the fall and winter bluegill feeding is often reduced. By concentrating on a few preferred prey (predaceous chironomid species), their feeding might alleviate competitive or predatory rela- tionships among the macroinvertebrates and thus lead to increased densities of many species. The high bluegill feeding intensity known to occur during the summer is severe enough to limit the numbers of most invertebrate prey. As fish predation was not effective on invertebrates in the macrophytes, it seems that the added physical complexity serves as a refuge fro

Decay of bound muons

The decay rate of bound muons from the K shell is calculated for elements up to lead. The muon is represented by a relativistic wave function for a point nucleus with parameters adjusted for finite-nuclear-size effects. The outcoming electron is represented by a Sommerfeld-Maue wave function. The decay rate is found to be a monotonically decreasing function of the atomic number. An estimate of the error is obtained by comparing with an exact calculation for the lowest electron angular state. The spectrum and angular distribution of the electrons are also presented

Whistling Bird Winery

The Whistling Bird Winery has experienced above-industry-average growth in new revenues over the past five years. Although operating with a heavy debt position, the firm, owned and managed by Laurie Johnson, has developed award winning premium table wines that have been enthusiastically accepted by consumers in the northeastern United States. The firm currently has expansion plans that include grape growing land, expanding capacity at its winery, and increasing its fledgling retail operations. Laurie has quickly realized that private equity funding is her only viable option and is evaluating her position at the winery, from both an owner and a manager perspective. With the cost of equity capital quite expensive, is her current expansion proposal worthwhile

Wine World Estates

Wine World Estates has been a wholly owned subsidiary of the Nestle Company for a quarter of a century. This rapidly growing business unit has been put up for sale, and Walter Klenz, its CEO, is leading a management inspired leveraged buyout in competition with two other large potential buyers. His challenge is to arrange for a financing package of more than $350 million to successfully achieve his objective

The Globalization of Beringer Blass Wine Estates

The Beringer Blass Wine Estates Corporation was created by the $1.5 billion purchase of U.S. based Beringer Wines Estates by Australia based Foster\u27s Brewing Group. Each firm, operating independently up to the time of their deal, had expanded in their industries through both internal growth via development of premium wine brands and external growth via acquisitions of new brands. In September, 2002, Walt Klenz, President of the wine operations of the firm, privately contemplated how to guide Beringer Blass towards its strategic goals in an industry that was rapidly consolidating on a global basis

Start Up Research Effort in Fluid Mechanics. Advanced Methods for Acoustic and Thrust Benefits for Aircraft Engine Nozzle

In accordance with the project plan for the report period in the proposal titled above, HU and FML teams investigated two sets of concepts for reduction of noise and improvement in efficiency for jet exhaust nozzles of aircraft engines and screws for mixers, fans, propellers and boats. The main achievements in the report period are: (a) Publication of the paper in the AIAA Journal, which described our concepts and some results. (b) The Award in the Civil Research and Development Foundation (CRDF) competition. This 2 year grant for Hampton University (HU) and Central AeroHydrodynamic Institute (TSAGI, Moscow, Russia) supports the research implementation under the current NASA FAR grant. (c) Selection for funding by NASA HQ review panel of the Partnership Awards Concept Paper. This two year grant also will support our current FAR grant. (d) Publication of a Mobius Strip concept in NASA Technical Briefs, June, 1996, and a great interest of many industrial companies in this invention. Successful experimental results with the Mobius shaped screw for mixers, which save more than 30% of the electric power by comparison with the standard screws. Creation of the scientific-popular video-film which can be used for commercial and educational purposes. (e) Organization work, joint meetings and discussions of the NASA LARC JNL Team and HU professors and administration for the solution of actual problems and effective work of the Fluid Mechanics Laboratory at Hampton University. In this report the main designs are enumerated. It also contains for both concept sets: (1) the statement of the problem for each design, some results, publications, inventions, patents, our vision for continuation of this research, and (2) present and expected problems in the future

Does My Business Need a Human Resources Function? A Decision-Making Model for Small and Medium-Sized Firms

The questions of when and what types of human resource (HR) support are needed tend to be unanswerable for small and medium-sized enterprises (SMEs). This article addresses this gap in the strategic HR literature. Hiring, training, employee retention/satisfaction, wages and benefits programs, and worker’s compensation insurance are important to SMEs seeking to build strong capabilities and resources and to increase their competitive advantage. This article presents an analysis of the existing HR literature for SMEs. It introduces a decision model to help SMEs choose a cost-effective HR strategy, listing a range of options from hiring the HR function to electronic HR (eHR) and outsourcing

Lifestyle interventions for type 2 diabetes prevention in women with prior gestational diabetes : a systematic review and meta-analysis of behavioural, anthropometric and metabolic outcomes

Purpose. To systematically review lifestyle interventions for women with prior Gestational Diabetes Mellitus (GDM) to report study characteristics, intervention design and study quality and explore changes in 1) diet, physical activity and sedentary behaviour; 2) anthropometric outcomes and; 3) glycaemic control and diabetes risk. Methods. Databases (Web of Science, CCRCT, EMBASE and Science DIRECT) were searched (1980 to April 2014) using keywords for controlled or pre–post design trials of lifestyle intervention targeting women with previous GDM reporting at least one behavioural, anthropometric or diabetes outcome. Selected studies were narratively synthesized with anthropometric and glycaemic outcomes synthesized using meta-analysis. Results. Three of 13 included studies were rated as low bias risk. Recruitment rates were poor but study retention good. Six of 11 studies reporting on physical activity reported favourable intervention effects. All six studies reporting on diet reported favourable intervention effects. In meta-analysis, significant weight-loss was attributable to one Chinese population study (WMD = − 1.06 kg (95% CI = − 1.68, − 0.44)). Lifestyle interventions did not change fasting blood glucose (WMD = − 0.05 mmol/L, 95% CI = − 0.21, 0.11) or type 2 diabetes risk. Conclusions. Lack of methodologically robust trials gives limited evidence for the success of lifestyle interventions in women with prior GDM. Recruitment into trials is challenging

Mixing, Noise and Thrust Benefits Using Corrugated Designs

This project was conducted as a support for effective research, training and teaching of Hampton University students in Fluid Mechanics and Acoustics. Basically, this work is organized and implemented by the new Fluid Mechanics and Acoustics Laboratory (FM & AL) which was established at Hampton University in the School of Engineering and Technology (E & T) in 1996. In addition, FM & AL in cooperation with NASA LaRC jointly conducts research with the Central AeroHydrodynamics Institute (TSAGI, Moscow) in Russia under a 2 year Civilian Research and Development Foundation (CRDF). This project is also conducted under control of NASA HQ. For fulfillment of the current project, several researchers were involved as was shown in the proposal to NASA in 1996. This work is the development and support for projects solve problems with the goal of reducing jet noise and increasing nozzle thrust