Danielle Symons Downs

Exercise dependence: a systematic review

Abstract Background and Purpose: The purpose of this paper was to review the equivocal literature examining exercise dependence and deprivation. Method: A comprehensive literature search yielded 77 exercise dependence and 11 exercise deprivation studies, spanning 29 years (range=1970 to 1999), were reviewed. Results and conclusions: The research was characterized by three general approaches: (a) comparing exercisers to eating disorder patients, (b) comparing “excessive” to “less excessive” exercisers, and (c) comparing exercisers to nonexercisers. Study results have been inconclusive due, in part, to a lack of experimental research, inconsistent or nonexistent control groups, discrepant operational criteria for exercise dependence, and/or invalidated or inappropriate measures of exercise dependence. More systematic theory based research is required to understand the precipitating and perpetuating factors associated with exercise dependence, as well as effective treatment regimens.

How Much is Too Much? The Development and Validation of the Exercise Dependence Scale

This paper presents five studies with 2,420 total participants on the development and validation of the Exercise Dependence Scale (EDS), which is conceptualized based on the Diagnostic and Statistical Manual-IV (APA, 1994) criteria for substance dependence, and differentiates among at-risk, nondependent-symptomatic, and nondependent-asymptomatic exercisers. Results of the studies revealed evidence for the a priori hypothesized components, acceptable test-retest and internal consistency reliability, and content and concurrent validity of the EDS. Individuals at-risk for exercise dependence reported more strenuous exercise, perfectionism, and self-efficacy compared to the nondependent groups. The findings provide initial support for the EDS and indicate the need for a multifaceted approach to its conceptualization and measurement.

Comparison of body image between athletes and nonathletes: a meta-analytic review.

Due to the equivocal research examining body image between athletes and nonathletes and the serious negative effects of body image disturbance a metaanalytic review of the literature was undertaken (N = 78 studies, 294 effect sizes). A small effect was found which indicated that athletes had a more positive body image compared to the nonathletes. Examination of the moderator variables revealed that the magnitude of the effect size: (a) for unpublished research was larger compared to published research; (b) for comparison groups which were included within the study was smaller than for comparison groups based on normative data; (c) did not differ between the female athletes compared to the male athletes; (d) did not vary among the aesthetic, endurance, and ball game sport athletes; and (e) did not differ by age or body mass index. Possible explanations for the more positive body image of the athletes than the nonathletes are discussed.

Factorial Validity and Psychometric Examination of the Exercise Dependence Scale-Revised

The research purposes were to examine the factorial and convergent validity, internal consistency, and test-retest reliability of the Exercise Dependence Scale (EDS). Two separate studies, containing a total of 1,263 college students, were undertaken to accomplish these purposes. Participants completed the EDS and measures of exercise behavior and perfectionism. Confirmatory factor analysis in Study 1 reduced the scale from 28 to 21 items (i.e., 3 items per subscale) and it supported a correlated seven-factor model in Study 2 (Tucker-Lewis Index = .96, comparative fit index = .97, root mean square error of approximation = .05, average absolute standardized residual = .02). Adequate internal consistency and test-rest reliability for the scale was evidenced. Consistent with the hypotheses and the EDS classifications for exercise dependence symptoms, individuals at risk for exercise dependence reported more exercise behavior and perfectionistic tendencies, compared to the nondependent-symptomatic and nondependent-asymptomatic groups. These studies provide evidence for the reliability and validity of the EDS. Research in more diverse populations is needed to further examine the general applicability of the EDS-Revised.

Postpartum Anxiety and Maternal-Infant Health Outcomes

OBJECTIVE: Postpartum anxiety screening does not typically occur, despite changes in life roles and responsibility after childbirth. We sought to determine the prevalence of postpartum anxiety during the maternity hospitalization and its associations with maternal and child outcomes. We further aimed to compare correlates of anxiety with correlates of depression. METHODS: For a randomized controlled trial of mothers with “well” newborns ≥34 weeks’ gestation comparing 2 post–hospital discharge care models, mothers completed baseline in-person interviews during the postpartum stay and telephone surveys at 2 weeks, 2 months, and 6 months to assess health care use, breastfeeding duration, anxiety, and depression. All participants intended to breastfeed. State anxiety scores ≥40 on the State Trait Anxiety Inventory (STAI) and depression scores ≥12 on the Edinburgh Postnatal Depression Survey (EPDS) were considered positive. RESULTS: A total of 192 (17%) of 1123 participating mothers had a positive baseline STAI; 62 (6%) had a positive EPDS. Primiparity was associated with a positive STAI (20% vs 15%, P = .02), but not a positive EPDS (4% vs 7%, P = .05). Positive STAI scores were associated with cesarean delivery (22% vs 15%, P = .001), reduced duration of breastfeeding (P = .003), and increased maternal, but not infant total unplanned health care utilization within 2 weeks of delivery (P = .001). Positive STAI scores occurred more frequently than positive EPDS scores at each assessment through 6 months postpartum. CONCLUSIONS: Postpartum state anxiety is a common, acute phenomenon during the maternity hospitalization that is associated with increased maternal health care utilization after discharge and reduced breastfeeding duration. State anxiety screening during the postpartum stay could improve these outcomes.

Determinants of Pregnancy and Postpartum Depression: Prospective Influences of Depressive Symptoms, Body Image Satisfaction, and Exercise Behavior

BackgroundLimited research has prospectively examined women’s exercise and psychological health behaviors before, during, and after pregnancy.PurposeThe purpose of this study was to examine the associations between and the extent to which depressive symptoms (DS), body image satisfaction (BIS), and exercise behavior (EB) prospectively explained trimester-specific and postpartum depression.MethodsParticipants (N = 230 pregnant women) completed self-reported measures midway through their first, second, and third trimesters and at 6-weeks postpartum from 2005 to 2007. Women were also classified based on current activity guidelines as active and somewhat active to examine the moderating influence of pre-pregnancy EB on the contributions of the study variables for explaining DS.ResultsWe found that : (a) DS, BIS, and EB were associated across the three pregnancy time points and postpartum, (b) DS and BIS were main determinants of later depression in pregnancy and postpartum, and (c) the moderating influence of pre-pregnancy EB was evident in early pregnancy.ConclusionsThese preliminary findings suggest that DS and BIS are important psychological factors for intervention to improve women’s pregnancy and postpartum psychological health and that EB in the pre-pregnancy period may offer women protective effects against DS in early pregnancy.

Physical Activity and Pregnancy: Past and Present Evidence and Future Recommendations

Purpose. In this review, we provide researchers and practitioners with an overview of the physical activity and pregnancy literature to promote prenatal physical activity, improve measurement, further elucidate the role of activity in reducing maternal health complications, and inform future research. Method. We examined past and present physical activity and pregnancy studies and highlight key papers with a focus on maternal health outcomes to best inform physical activity promotion efforts. Results. We discuss: (a) historical overview of prenatal physical activity relative to the physical activity guidelines, how they have changed over time, and how evidence of the effect of prenatal activity on maternal/fetal health outcomes has affected clinical recommendations; (b) existing tools and challenges associated with measuring prenatal physical activity; (c) empirical evidence on multilevel determinants of prenatal activity to guide future intervention work; (d) empirical evidence of prenatal activity on adverse maternal outcomes (gestational diabetes mellitus, preeclampsia, excessive gestational weight gain) from observational and intervention studies; and (e) summary/recommendations for future research and practice. Conclusions. The physical activity and pregnancy literature has evolved over the past 50 years, and there is sufficient empirical evidence to support the promotion of moderate-to-vigorous prenatal physical activity for maternal health benefits. Future studies and interventions should be carefully designed, theoretically driven, and include validated and reliable activity measures. Researchers and practitioners should also consider the multifaceted determinants and outcomes of prenatal physical activity and intervene to promote physical activity before, during, and after pregnancy.

Opportunities for the Primary Prevention of Obesity during Infancy

Many parents, grandparents, and clinicians have associated a baby’s ability to eat and gain weight as a sign of good health, and clinicians typically only call significant attention to infant growth if a baby is failing to thrive or showing severe excesses in growth. Recent evidence, however, has suggested that pediatric healthcare providers should pay closer attention to growth patterns during infancy. Both higher weight and upward crossing of major percentile lines on the weight-for-age growth chart during infancy have long term health consequences, and are associated with overweight and obesity later in life. Clinicians should utilize the numerous available opportunities to discuss healthy growth and growth charts during health maintenance visits in the first two years after birth. Further, providers should instruct parents on strategies to promote healthy behaviors that can have long lasting obesity preventive effects.

PRECONCEPTION PREDICTORS OF WEIGHT GAIN DURING PREGNANCY Prospective Findings from the Central Pennsylvania Women's Health Study

OBJECTIVES We examined preconception (prepregnancy) predictors of pregnancy weight gain and weight gain that exceeds the 2009 Institute of Medicine (IOM) recommendations based on pre-pregnancy body mass index (BMI), in a prospective study. METHODS Data are from a population-based cohort study of 1,420 women who were interviewed at baseline and 2 years later. The analytic sample includes 103 women who were not pregnant at baseline and gave birth to full-term singletons during the follow-up period. Preconception maternal weight category as well as health behaviors, psychosocial stress, parity, and age were examined as predictors of pregnancy weight gain and of weight gain in excess of the IOM recommendations using multiple linear and logistic regression analysis. RESULTS Pregnancy weight gain averaged 33.01 pounds, with 51% of women gaining weight in excess of the 2009 IOM recommendations for their preconception weight category. Preconception overweight (BMI = 25-29.9) increased the odds of excessive pregnancy weight gain nearly threefold, whereas preconception physical activity levels meeting activity guidelines reduced the odds of excessive weight gain but was marginally statistically significant. CONCLUSION Although future research examining the role of physical activity in relation to pregnancy weight gain is needed, preconception overweight and physical activity levels are prime targets for interventions to avoid excessive pregnancy weight gain.

Review of Self-reported Physical Activity Assessments for Pregnancy: Summary of the Evidence for Validity and Reliability

BACKGROUND Epidemiological studies and surveillance systems of pregnant women often rely on collection of physical activity through self-report. This systematic review identified and summarised self-reported physical activity assessments with evidence for validity and reliability among pregnant women. METHODS Peer-reviewed articles published through 2011 were included if they assessed validity and/or reliability of an interviewer- or self-administered physical activity questionnaire or diary among pregnant women. RESULTS We identified 15 studies, including 12 studies that assessed questionnaires and 4 studies that assessed diaries, conducted in Australia, Finland, Norway, the U.K., the U.S. and Vietnam. For questionnaires, 92% (11/12) assessed mode, all assessed frequency and/or duration and 58% (7/12) collected information on perceived intensity. All but one study (92%) assessed validity of the questionnaires. Questionnaires compared with objective measures (accelerometers, pedometers) ranged from slight to fair agreement, while comparison with other self-reported measures ranged from substantial to almost perfect agreement. Five studies (42%) assessed test-retest reliability of the questionnaires, ranging from substantial to almost perfect agreement. The four studies on diaries were all assessed for validity against objective measures, ranging from slight to substantial agreement. CONCLUSIONS Selection of valid and reliable physical activity measures that collect information on dose (type, frequency, duration, intensity) is recommended to increase precision and accuracy in detecting associations of physical activity with maternal and fetal outcomes.