Anca Gaston

Exercise during pregnancy: A review of patterns and determinants

The mental and physical health benefits of exercise during pregnancy highlight the importance of understanding the determinants of pregnant womens physical activity. This paper presents a review of the existing research on pregnancy and physical activity, in order to (a) summarize the existing body of literature since 1986 examining changes in physical activity during pregnancy, (b) summarize correlates and predictors of physical activity during pregnancy, and (c) present directions for future research. A literature search yielded 25 articles published from 1986 to 2009 in English peer-reviewed journals. The major findings were categorized into the following: (a) exercise patterns, (b) demographic correlates/predictors, (c) the influence of pre-pregnancy exercise on pregnancy exercise, (d) theory-based predictors and (f) other correlates of exercise (e.g. general health and safety concerns). Results indicated that pregnant women are less active than non-pregnant women and that pregnancy leads to a decrease in physical activity. Consistent demographic predictors of higher exercise participation during pregnancy include higher education and income, not having other children in the home, being white, and being more active prior to becoming pregnancy. Only a few studies used theoretical models to understand physical activity during pregnancy with varied results. The review outlines demographic and theory-based correlates/predictors that should be taken into consideration when developing interventions to increase physical activity among pregnant women.

Maternal-Fetal Disease Information as a Source of Exercise Motivation During Pregnancy

OBJECTIVE A Protection Motivation Theory (PMT) framework was used to examine whether information about the role of exercise in preventing maternal-fetal disease served as a meaningful source of exercise motivation. DESIGN Pregnant women (n = 208) were randomly assigned into one of three conditions: PMT, attention control, and noncontact control. Women in the PMT group read a brochure about the benefits of exercise during pregnancy incorporating the major components of PMT; perceived vulnerability (PV), perceived severity (PS), response efficacy (RE), and self-efficacy (SE). Participants in the attention-control condition read a brochure about diet. Following treatment, all participants completed measures of their beliefs toward maternal-fetal disease and exercise, goal intention (GI), and implementation intention (IMI). One week later, a measure of self-reported exercise behavior was collected. MAIN OUTCOME MEASURES Main outcome measures were PMT variables (PV, PS, RE, and SE), GI, IMI, and follow-up physical activity. RESULTS Participants assigned to the PMT-present group reported significantly higher PS, RE, SE, GI, and increased exercise behavior. PS, RE, and SE predicted GI, GI predicted IMI, and IMI predicted exercise behavior. CONCLUSION Information grounded in PMT is effective in influencing pregnant womens beliefs and intentions as well as changing their initial behavior.

Psychological antecedents of excess gestational weight gain: a systematic review

BackgroundExcess gestational weight gain (GWG), which has reached epidemic proportions, is associated with adverse outcomes during pregnancy and postpartum obesity in women and children. Psychological variables represent potentially modifiable factors. Moreover, previous systematic reviews on GWG interventions have called for the need for a clearer understanding of psychological factors affecting GWG. Hence, a systematic review was conducted to summarize the relation between psychological factors and GWG.MethodsEight databases were searched, and the guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality of the included studies was assessed using a modified Newcastle-Ottawa scale. Two assessors independently reviewed titles, abstracts and full articles, extracted data and assessed quality.ResultsA total of 6198 titles and abstracts were reviewed of which 90 full text articles were retrieved. Thirty-five studies (25 cohort, eight cross-sectional and two case–control) met the inclusion criteria, assessing 26 different psychological constructs in affect, cognitions and personality. Negative affective states such as depression, anxiety and stress were not related to excess GWG. Among weight-related and dietary-related cognitions, risk factors for excess GWG included concern about weight gain, negative body image and attitude towards weight gain, inaccurate perceptions regarding weight, higher than recommended target weight gain, less knowledge about weight gain, higher levels of cognitive dietary restraint, and perceived barriers to healthy eating. Protective factors included an internal locus of control for weight gain, lower than recommended target weight gain and higher self-efficacy for healthy eating. Only one study examined the relation between personality and excess GWG.ConclusionIn this systematic review, a number of cognitive factors were identified that were associated with excess GWG. To address excess GWG, more high quality, adequately powered studies are required examining cognitions, motivation and personality factors.

Tired, moody and pregnant? Exercise may be the answer

Negative psychological states such as depression, fatigue and anxiety are experienced by many women during pregnancy. This study examined whether engaging in an exercise programme during pregnancy is associated with improvements in psychological well-being among previously inactive women (n = 56, M age = 30.34, SD = 4.57; M weeks pregnant = 22.58, SD = 5.32). Participants completed the Profile of Mood States–Short Form and State Trait Anxiety Scale-Trait version at baseline and after four weeks of exercise. Exercise was assessed using accelerometers and these data were used to determine bouts of 30-min of moderate-to-vigorous exercise. Factorial repeated measures ANOVAs demonstrated that participants who met Canadian guidelines for exercise during pregnancy at week four (n = 17) experienced significant decreases in depression (p = .004, η2 = .13), anger (p = .03, η2 = .08), tension (p = .03, η2 = .08), fatigue (p = .01, η2 = .10), trait anxiety (p = .01, η2 = .12) and increases in vigour (p = .001, η2 = .19) compared to those who were not meeting guidelines (n = 39). From a psychological health perspective, these findings highlight the importance of continuing to promote exercise during pregnancy.

The Short Questionnaire to Assess Health-Enhancing (SQUASH) physical activity in adolescents: a validation using doubly labeled water

BACKGROUND Accurate assessment of physical activity energy expenditure (PAEE) among adolescents is important for surveillance, evaluating interventions, and understanding the relation between energy balance and normal physiological and behavioral growth and development. The purpose of this study was to examine the validity of the Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH)13 for measuring PAEE among adolescents. METHODS The participants were seventeen adolescents (9 females; Mean age = 17.53; SD = 0.62). Energy expenditure was measured during a 9-day period with doubly labeled water (DLW). The SQUASH was self-administered on the morning of the 10th day and assessed commuting activities, leisure time activities, household activities, and activities at work and school over the previous 9 days. RESULTS A Bland-Altman plot indicated that the SQUASH underestimated PAEE compared with DLW by a mean difference of 126 kcal·d-1 (95% limits of agreement: -1,207 to 1,459 kcal·d-1), representative of a 10% underestimation. The Spearman rank order correlation coefficient showed there was a significant association between the SQUASH and DLW (r = .50, P = .04), for estimating PAEE. CONCLUSION When using a sample of highly active adolescents, the SQUASH is a valid self-report tool for measuring PAEE at the group and individual rank order level.

Topical vitamin A treatment of recalcitrant common warts

BackgroundCommon warts (verruca vulgaris) are benign epithelial proliferations associated with human papillomavirus (HPV) infection. Salicylic acid and cryotherapy are the most frequent treatments for common warts, but can be painful and cause scarring, and have high failure and recrudescence rates. Topical vitamin A has been shown to be a successful treatment of common warts in prior informal studies.CaseThe subject is a healthy, physically-active 30 old female with a 9 year history of common warts on the back of the right hand. The warts resisted treatment with salicylic acid, apple cider vinegar and an over-the-counter blend of essential oils marketed for the treatment of warts. Daily topical application of natural vitamin A derived from fish liver oil (25,000 IU) led to replacement of all the warts with normal skin. Most of the smaller warts had been replaced by 70 days. A large wart on the middle knuckle required 6 months of vitamin A treatment to resolve completely.ConclusionRetinoids should be further investigated in controlled studies to determine their effectiveness in treating common warts and the broad range of other benign and cancerous lesions induced by HPVs.

Cognitive and Motivational Factors Associated with Sedentary Behavior: A Systematic Review

Excessive time spent in sedentary behavior (SB) is associated with numerous health risks. These associations remain even after controlling for moderate-to-vigorous physical activity (PA) and body mass index, indicating that efforts to promote leisure time physical activity alone are insufficient. Cognitive and motivation variables represent potentially modifiable factors and have the potential of furthering our understanding of sedentary behavior. Hence, a systematic review was conducted to synthesize and critique the literature on the relationship between cognitive and motivational factors and sedentary behaviors. In April 2016, four electronic databases (Psych info, Pub Med, SPORTDiscus, Web of Science) were searched and a total of 4866 titles and abstracts were reviewed. After meeting inclusion criteria, study characteristics were extracted and the methodological quality of each study was assessed according to the Downs and Black Checklist. PRISMA guidelines for reporting of systematic reviews were followed. Twenty-five studies (16 cross-sectional, 8 longitudinal and one examining two populations and employing both a cross-sectional and prospective design) assessed 23 different cognitive and motivational factors. Seventeen studies were theory-based and 8 did not employ a theoretical model. Results showed that among SB-related cognitions, risk factors for greater sedentary time included having a more positive attitude towards SB, perceiving greater social support/norms for SB, reporting greater SB habits, having greater intentions to be sedentary, and having higher intrinsic, introjected, and external motivation towards SB. Protective factors associated with lower sedentary time included having greater feelings of self-efficacy/control over SB and greater intentions to reduce SB. Among PA-related cognitions, protective factors for lower SB included a more positive attitude towards PA, having greater social support/norms for PA, greater self-efficacy/control for PA, higher PA intentions, and higher intrinsic and identified motivation towards PA. In addition, feeling more supported and empowered in general was related with lower levels of SB. The average methodological quality score for included studies was 69% (SD = 9.15%; range 35–80%). In conclusion, a number of cognitive and motivational factors were identified that were associated with sedentarism. These findings have come from reasonably high quality studies. To further extend our understanding of the relation between cognitive and motivational factors and SB, more longitudinal, theory-driven studies examining cognitions and motivation from a sedentary perspective are required.

The effectiveness of a health‐based message on pregnant women’s intentions to exercise postpartum

Background: The benefits of physical activity in the general population are established and research suggests regular physical activity following childbirth is linked with improved health outcomes. However, many women do not resume pre‐pregnancy exercise levels. Objective: The present research used the Theory of Planned Behaviour (TPB) framework to examine whether information about the health benefits of postpartum exercise presented during pregnancy can serve as a meaningful source of exercise motivation. Method: Pregnant women (n = 89) were randomly assigned into one of two conditions: experimental (read a brochure about the health benefits of postpartum exercise) and control (no information). After the intervention, all participants completed measures of attitude, subjective norms (SN), perceived behavioural control (PBC) and intention to exercise postpartum. Results: Independent group t‐tests showed that compared to the control group, participants who received the persuasive message reported significantly more positive attitudes, stronger SN, PBC, and greater intention to exercise (all p’s < .05). Attitudes, SN, and PBC accounted for 51% of the variance in intention. Conclusion: This study demonstrates that exposure to information about the health benefits of exercise during the postpartum period grounded in the TPB can influence pregnant women’s exercise beliefs and intentions.

Health versus appearance messages, self‐monitoring and pregnant women’s intentions to exercise postpartum

Despite the confirmed health benefits of exercise during the postpartum period, many new mothers are not sufficiently active. The present research compared the effectiveness of two types of messages (health versus appearance) and the moderating role of self‐monitoring (SM) on attitudes, subjective norms, perceived behavioral control and intention to exercise after giving birth in two groups of pregnant women (low and high self‐monitors). Participants were 218 pregnant women, 18 years of age and older (M age = 27.9 years, SD = 5.47), in their second or third trimester. Women completed a demographics questionnaire and a SM scale. They next read one of two brochures, describing either the health or appearance benefits of exercise for postpartum women, and then completed measures of attitude, subjective norms, perceived behavioural control, and intentions to exercise postpartum. A MANOVA found no significant effect (all p’s>0.05) for message type, SM, or their interaction. Possible reasons include the fact that the two messages may have been too similar, reading any message about exercise may result in more positive beliefs related to exercise, or a lack of attention given to the brochure.

Psychological factors and trimester-specific gestational weight gain: a systematic review

Abstract Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with numerous adverse pregnancy outcomes. Early pregnancy provides a unique opportunity for counseling pregnant women since many women are motivated to engage in healthy behaviors. A systematic review was conducted to summarize the relation between psychological factors and trimester-specific GWG, i.e. GWG measured at the end of each trimester. Eight databases were searched for affect, cognition and personality factors. The guidelines on meta-analysis of Observational Studies in Epidemiology were followed. The methodological quality of each study was assessed using a modified Newcastle–Ottawa Scale. Of 3620 non-duplicate titles and abstracts, 74 articles underwent full-text review. Two cohort studies met the inclusion criteria. Distress was negatively associated with first trimester GWG among both adolescents and non-adolescents. Body image dissatisfaction was associated with second trimester GWG only among non-adolescents. No association emerged between perceived stress, state and trait anxiety and body image dissatisfaction among adolescents and trimester-specific GWG. The relation between trimester-specific GWG and a number of weight-related and dietary-related cognitions, affective states and personality traits remain unexplored. Given the limited number of studies, further high-quality evidence is required to examine the association between psychological factors and trimester-specific GWG, especially for cognitive and personality factors.