Exercise in pregnant women and birth weight: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Birth weight plays an important role in infant mortality and morbidity, childhood development, and adult health. To date there are contradictory results regarding the role of physical activity on birth weight. In addition, it is questioned whether exercise during second and third trimesters of pregnancy might affect gestational age and increase the risk of preterm delivery. Hence, the purpose of this study was to examine the effect of a supervised exercise-program on birth weight, gestational age at delivery and Apgar-score.</p> <p>Methods</p> <p>Sedentary, nulliparous pregnant women (N = 105), mean age 30.7 ± 4.0 years, pre-pregnancy BMI 23.8 ± 4.3 were randomized to either an exercise group (EG, n = 52) or a control group (CG, n = 53). The exercise program consisted of supervised aerobic dance and strength training for 60 minutes, twice per week for a minimum of 12 weeks, with an additional 30 minutes of self-imposed physical activity on the non-supervised week-days.</p> <p>Results</p> <p>There was no statistically significant difference between groups in mean birth weight, low birth weight (< 2500 g) or macrosomia (≥ 4000 g). Per protocol analyses showed higher Apgar score (1 min) in the EG compared with the CG (p = 0.02). No difference was seen in length of gestation.</p> <p>Conclusion</p> <p>Aerobic-dance exercise was not associated with reduction in birth weight, preterm birth rate or neonatal well-being.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00617149">NCT00617149</a></p

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

Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3 - Exercise in the postpartum period

This is Part 3 in the series of reviews from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related complaints experienced by athletes1; Part 2 addressed maternal and fetal perinatal outcomes.2 In this part, we review the implications of pregnancy and childbirth on return to exercise and on common illnesses and complaints in the postpartum period. The postpartum period can be divided into hospital-based (during hospital stay), immediate postpartum (hospital discharge to 6 weeks postpartum) and later postpartum (6 weeks to 1 year, corresponding sometimes to cessation of breast feeding).3 In the literature, the postpartum period is usually defined as the first 6 weeks after pregnancy, during which time women have not typically been encouraged to exercise, except for strength training of the pelvic floor muscles. However, 6 weeks is an arbitrary time point and, anecdotally, many elite athletes report starting exercise inside that period. For the purpose of the present review, we consider the postpartum period to be up to 12 months following birth

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1-exercise in women planning pregnancy and those who are pregnant

BACKGROUND Guidelines on physical activity or exercise and pregnancy encourage pregnant women to continue or adopt an active lifestyle during and following pregnancy.1-3 Two systematic reviews of pregnancy-related guidelines on physical activity found similarities between recommendations from different countries, but noted that the guidelines differed in focus.4 5 The guidelines provided variable guidance on prenatal exercise, or on how pregnant women might approach continuing or adopting sport activities.6 However, most guidelines did not include important topics such as prevalence and known risk factors for common pregnancy-related diseases and complaints, and the role of exercise in preventing and treating them. Importantly, the focus of most previous guidelines has been on healthy pregnant women in the general population, in whom there is almost always a decline in physical activity during pregnancy.7 8 Indeed, a high proportion of pregnant women follow neither physical activity nor exercise guidelines, 9 putting them at increased risk of obesity, gestational diabetes mellitus (GDM), and other pregnancy-related diseases and complaints.1 On the other hand, there are enthusiastic exercisers and elite athletes who often meet and exceed general exercise recommendations for pregnant women, but there are no exercise guidelines specifically for these women. Important questions for such women are unanswered in current guidelines: Which activities, exercises and sports can they perform, for how long and at what intensity, without risking their own health and the health of the fetus? How soon can they return to highintensity training and competition after childbirth? The IOC and most National Sports Federations encourage women to participate in all Olympic sport disciplines. The IOC promotes high-level performance, and it is also strongly committed to promoting lifelong health among athletes10-not just during their competitive sporting careers. With an increasing number of elite female athletes competing well into their thirties, many may wish to become pregnant, and some also want to continue to compete after childbirth. With this background, the IOC assembled an international expert committee to review the literature on physical activity and exercise (1) during pregnancy and (2) after childbirth, using rigorous systematic review and search criteria.11 For efficiency, where sex is not specified, the reader should assume that this manuscript about pregnancy and childbirth refers to females (ie, \u27the elite athlete who wishes to train at altitude\u27 is used in preference to \u27the elite female athlete...\u27). AIMS The September 2015 IOC meeting of 16 experts in Lausanne had three aims. They were to: 1. Summarise common conditions, illnesses and complaints that may interfere with strenuous exercise and competition, during pregnancy and after childbirth; 2. Provide recommendations for exercise training during pregnancy and after childbirth, for highlevel regular exercisers and elite athletes; and 3. Identify major gaps in the literature that limit the confidence with which recommendations can be made. METHODS For each section of the document, a search strategy was performed using search terms such as \u27pregnancy\u27 OR \u27pregnant\u27 OR \u27postpartum\u27 AND \u27exercise\u27 OR \u27physical activity\u27 OR\u27leisure activity\u27 OR\u27leisure\u27 OR \u27recreation\u27 OR \u27recreational activity\u27 or \u27physical fitness\u27 OR \u27occupational activity\u27 AND terms related to the condition under study (eg, \u27gestational diabetes\u27). Available databases were searched, with an emphasis on PubMed, EMBASE, Cochrane, PEDro, Web of Science and SPORTDiscus. In addition, existing guidelines with reference lists were scanned. The review of each topic followed the general order: prevalence of the condition in the general pregnant or postpartum population, prevalence in high-level exercisers or elite athletes, risk factors in the general population and in relation to exercise and sport, and effect of preventive and treatment interventions. Level of evidence and grade of recommendations are according to the Cochrane handbook (table 1) for prevention and treatment interventions only. Each member of the working group was assigned to be the lead author of one or more topics and 1-3 others were assigned to review each topic. A first full consensus draft was reviewed before and during the 3-day IOC meeting (27-29 September 2015), and a new version of each topic was submitted to the meeting chairs (KB and KMK) shortly after the meeting. Each topic leader made amendments before sending a new version for comments to the working group

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2 - The effect of exercise on the fetus, labour and birth

This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes

Study protocol: differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes--individual patient data (IPD) meta-analysis and health economic evaluation.

© 2014 Ruifrok et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Pregnant women who gain excess weight are at risk of complications during pregnancy and in the long term. Interventions based on diet and physical activity minimise gestational weight gain with varied effect on clinical outcomes. The effect of interventions on varied groups of women based on body mass index, age, ethnicity, socioeconomic status, parity, and underlying medical conditions is not clear. Our individual patient data (IPD) meta-analysis of randomised trials will assess the differential effect of diet- and physical activity-based interventions on maternal weight gain and pregnancy outcomes in clinically relevant subgroups of women. METHODS/DESIGN: Randomised trials on diet and physical activity in pregnancy will be identified by searching the following databases: MEDLINE, EMBASE, BIOSIS, LILACS, Pascal, Science Citation Index, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Health Technology Assessment Database. Primary researchers of the identified trials are invited to join the International Weight Management in Pregnancy Collaborative Network and share their individual patient data. We will reanalyse each study separately and confirm the findings with the original authors. Then, for each intervention type and outcome, we will perform as appropriate either a one-step or a two-step IPD meta-analysis to obtain summary estimates of effects and 95% confidence intervals, for all women combined and for each subgroup of interest. The primary outcomes are gestational weight gain and composite adverse maternal and fetal outcomes. The difference in effects between subgroups will be estimated and between-study heterogeneity suitably quantified and explored. The potential for publication bias and availability bias in the IPD obtained will be investigated. We will conduct a model-based economic evaluation to assess the cost effectiveness of the interventions to manage weight gain in pregnancy and undertake a value of information analysis to inform future research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2013: CRD42013003804.This study was funded by the National Institute for Health Research (NIHR) HTA (Health Technology Assessment) UK programme 12/01

Female athlete health domains:A supplement to the International Olympic Committee consensus statement on methods for recording and reporting epidemiological data on injury and illness in sport

The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan; (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) to female athlete health data. In May 2021, five researchers and clinicians with expertise in sports medicine, epidemiology and female athlete health convened to form a consensus working group, which identified key themes. Twenty additional experts were invited and an iterative process involving all authors was then used to extend the IOC consensus statement, to include issues which affect female athletes. Ten domains of female health for categorising health problems according to biological, life stage or environmental factors that affect females in sport were identified: menstrual and gynaecological health; preconception and assisted reproduction; pregnancy; postpartum; menopause; breast health; pelvic floor health; breast feeding, parenting and caregiving; mental health and sport environments. This paper extends the IOC consensus statement to include 10 domains of female health, which may affect female athletes across the lifespan, from adolescence through young adulthood, to mid-age and older age. Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies