Estelle D. Watson

The influence of physical activity during pregnancy on maternal, fetal or infant heart rate variability: a systematic review

BackgroundPhysical activity (PA) during pregnancy has been shown to be associated with several positive effects for mother, fetus, and offspring. Heart rate variability (HRV) is a noninvasive and surrogate marker to determine fetal overall health and the development of fetal autonomic nervous system. In addition, it has been shown to be significantly influenced by maternal behavior. However, the influence of maternal PA on HRV has not yet been systematically reviewed. Therefore, the aim of this systematic review was to assess the influence of regular maternal PA on maternal, fetal or infant HRV.MethodsA systematic literature search following a priori formulated criteria of studies that examined the influence of regular maternal PA (assessed for a minimum period of 6 weeks) on maternal, fetal or infant HRV was performed in the databases Pubmed and SPORTDiscus. Quality of each study was assessed using the standardized Quality Assessment Tool for Quantitative Studies (QATQS).ResultsNine articles were included into the present systematic review: two intervention studies, one prospective longitudinal study, and six post-hoc analysis of subsets of the longitudinal study. Of these articles four referred to maternal HRV, five to fetal HRV, and one to infant HRV. The overall global rating for the standardized quality assessment of the articles was moderate to weak. The articles regarding the influence of maternal PA on maternal HRV indicated contrary results. Five of five articles regarding the influence of maternal PA on fetal HRV showed increases of fetal HRV on most parameters depending on maternal PA. The article referring to infant HRV (measured one month postnatal) showed an increased HRV.ConclusionsBased on the current evidence available, our overall conclusion is that the hypothesis that maternal PA influences maternal HRV cannot be supported, but there is a trend that maternal PA might increase fetal and infant HRV (clinical conclusion). Therefore, we recommend that further, high quality studies addressing the influence of maternal PA on HRV should be performed (methodological conclusion).

The relationships of eccentric strength and power with dynamic balance in male footballers

Abstract Unilateral balance is critical to kicking accuracy in football. In order to design interventions to improve dynamic balance, knowledge of the relationships between dynamic balance and specific neuromuscular factors such as eccentric strength and power is essential. Therefore, the aim was to determine the relationships of eccentric strength and power with dynamic balance in male footballers. The Y-balance test, eccentric isokinetic strength testing (knee extensors and flexors) and the countermovement jump were assessed in fifty male footballers (university (n = 27, mean age = 20.7 ± 1.84 years) and professional (n = 23, mean age = 23.0 ± 3.08 years). Spearman Rank Order correlations were used to determine the relationships of eccentric strength and power with dynamic balance. Multiple linear regression, adjusting for age, mass, stature, playing experience and competitive level was performed on significant relationships. Normalised reach score in the Y-balance test using the non-dominant leg for stance correlated with (1) eccentric strength of the non-dominant leg knee extensors in the university group (r = 0.50, P = 0.008) and (2) countermovement jump height in the university (r = 0.40, P = 0.04) and professional (r = 0.56, P = 0.006) football groups, respectively. No relationships were observed between eccentric strength (knee flexors) and normalised reach scores. Despite the addition of potential confounders, the relationship of power and dynamic balance was significant (r = 0.52, P < 0.0002). The ability to generate power correlates moderately with dynamic balance on the non-dominant leg in male footballers.

Validity and responsiveness of the Global Physical Activity Questionnaire (GPAQ) in assessing physical activity during pregnancy

The physiological and biomechanical changes that occur during pregnancy make accurate measurement of physical activity (PA) a challenge during this unique period. The Global Physical Activity Questionnaire (GPAQ) has been used extensively in low-to-middle income countries, but has never been validated in a pregnant population. In this longitudinal study, 95 pregnant women (mean age: 29.5±5.7 years; BMI: 26.9±5.0 kg/m2) completed the GPAQ and were asked to wear an accelerometer for 7 days at two time points during pregnancy (14–18 and 29–33 weeks gestation). There was a significant difference between accelerometry and GPAQ when measuring moderate-to-vigorous physical activity (MVPA) at 29–33 weeks gestation (16.6 vs 21.4 min/day; p = 0.02) as well as sedentary behaviour (SB) at both 14–18 weeks (457.0 vs 300 min/day; p < 0.01) and 29–33 weeks gestation (431.5 vs 300 min/day; p < 0.01). There was poor agreement between the GPAQ and accelerometry for both PA and SB at both time points (ICC: -0.05–0.08). Bland Altman plots indicated that the GPAQ overestimates PA by 14.8 min/day at 14–18 weeks and by 15.8 min/day at 29–33 weeks gestation. It underestimates SB by 127.5 min/day at 14–18 weeks and by 89.2 min/day at 29–33 weeks gestation. When compared to accelerometry, the GPAQ shows poor agreement and appears to overestimate PA and underestimate SB during pregnancy.

Are South African Mothers Moving? Patterns and Correlates of Physical Activity and Sedentary Behavior in Pregnant Black South African Women

BACKGROUND Although physical activity during pregnancy may be beneficial, the prenatal period is a vulnerable time for decreasing physical activity levels and increasing sedentary time. METHODS This longitudinal cohort study measured physical activity using the Global Physical Activity Questionnaire (GPAQ) in singleton, pregnant women in the second (14-18 wk gestation; n = 332) and third trimester (29-33 wk; n = 256). RESULTS There was a significant decrease in total MVPA (MET mins/wk) between the second and third trimester (P = .01). The majority of physical activity time was spent in walking for transport (80%), and less than 2% in recreational activities. In both trimesters, being married was inversely associated with walking for transport (second trimester: β = -0.12 95% CI = -0.31 to -0.02, third trimester: β = -0.17 95% CI = -0.47 to -0.07) and owning a car was positively associated with recreational physical activity (second trimester: β = 0.16 95% CI = 0.02 to 0.32, third trimester: β = 0.17 95% CI = 0.04 to 0.27). The women spent an average of 5 hours per day sitting. CONCLUSIONS The low and declining levels of physical activity during pregnancy in this population are a concern. Interventions that include lifestyle education and provision of accessible recreational physical activity programs for pregnant women are needed.

Do South African general practitioners believe that ‘Exercise is Medicine’?

Background . Physical activity (PA) has been described as medicine, owing to the clear evidence for its role in the prevention and management of various diseases. Objectives . To determine the knowledge, perceptions and attitudes of South African general practitioners (GPs) towards the promotion of PA. Methods . A total of 255 private-sector GPs from various provinces in SA participated in our cross-sectional study, by completing a selfreport questionnaire surveying their knowledge, perceptions and attitudes towards the promotion of PA. Results . The findings indicated that South African GPs in general do promote PA to their patients for treatment and health promotion. The majority of GPs in our study strongly believed that promoting PA is an important part of primary healthcare. The GPs frequently promoted exercise in the treatment of obesity, type 2 diabetes and hyperlipidaemia. Conclusion . South African GPs appear to be recommending PA to their patients at a primary-care level. Clear practice guidelines are needed to promote PA in a way that will have a population-level impact. To aid this, GPs are encouraged to provide written information to promote PA in a way that will have an effect.

Maternal and early life nutrition and physical activity: setting the research and intervention agenda for addressing the double burden of malnutrition in South African children

ABSTRACT Early life is important for later health outcomes, yet there are few studies which adequately address all of the potential early life insults that may affect later life health and growth trajectories. This is particularly evident in low- to middle-income countries such as South Africa, where women of childbearing age are particularly vulnerable to high levels of physical inactivity, malnutrition, and obesity. Pregnancy may therefore be an opportune time to change behaviours and improve maternal and offspring health outcomes, and decrease the inter-generational transfer of risk. We show clear evidence that physical activity and nutrition are important target areas for intervention during pregnancy and in the early years of life, yet that current literature in Africa, and specifically South Africa, is limited. We have outlined the available literature concerning the impact of maternal and early life nutrition and physical activity on the health status of South African children, and have provided some recommendations for future research and policy.

“Just because you’re pregnant, doesn’t mean you’re sick!” A qualitative study of beliefs regarding physical activity in black South African women

BackgroundDespite the benefits of physical activity during pregnancy, the physiological and psychological changes that occur during this unique period may put women at greater risk of being sedentary. Lifestyle and environmental transitions have left black South African women at increased risk of physical inactivity and associated health risks. Therefore, the aim of this qualitative study was to describe the beliefs regarding physical activity during pregnancy in an urban African population.MethodsSemi-structured interviews (n = 13) were conducted with pregnant black African women during their third trimester. Deductive thematic analysis was completed based on the Theory of Planned Behaviour. Coding and analysis was completed with the assistance of ATLAS.ti software.ResultsParticipants had a mean age of 28 (19–41) years, and a mean BMI of 30 (19.6–39.0) kg/m2. Although the majority of women believed that physical activity was beneficial, this did not appear to translate into behaviour. Reported reasons for this included barriers such as pregnancy-related discomforts, lack of time, money and physical activity related education, all of which can contribute to a reduced perceived control to become active. Opportunities to participate in group exercise classes was a commonly reported facilitator for becoming active. In addition, influential role players, such as family, friends and healthcare providers, as well as cultural beliefs, reportedly provided the women with vague, conflicting and often discouraging advice about physical activity during pregnancy.ConclusionsThis study provides new theoretical insight on the beliefs of urban South African pregnant women regarding physical activity. Findings from this study suggest a holistic approach to improve physical activity compliance during pregnancy, inclusive of physical activity education and exercise opportunities within a community setting.This study presents critical formative work upon which contextually and culturally sensitive interventions can be developed.

Cardiovascular Disease Risk Profile and Readiness to Change in Blue- and White-collar Workers

This study provides a health and risk profile of blue- (BCWs) and white-collar workers (WCWs). Health screening data (n = 603; age 38.2 ± 9.7 years) included cholesterol and glucose finger-prick test, blood pressure, body mass index, and self-reported stress levels and readiness to change. Blue-collar workers were significantly older and had higher blood pressure readings and were more likely to develop hypertension (odds ratio [OR]: 1.72; 95% confidence interval [CI]: 1.05-2.81; P = .03), but less likely to present with hypercholesterolemia (OR: 0.50; 95% CI: 0.31-0.81; P = .01) and overweight/obesity (OR: 0.65; 95% CI: 0.42-0.99; P = .047). White-collar workers showed significantly higher cholesterol and stress levels. This study highlights the importance of occupation type in workplace health screening and intervention planning.

The effect of lifestyle interventions on maternal body composition during pregnancy in developing countries: a systematic review

Abstract Optimal maternal body composition during pregnancy is a public health priority due to its implications on maternal health and infant development. We therefore aimed to conduct a systematic review of randomised, controlled trials, and case–control and cohort studies using lifestyle interventions to improve body composition in developing countries. Of the 1 708 articles that were searched, seven studies, representing three countries (Brazil, Iran and Argentina), were included in the review. Two articles suggested that intervention with physical activity during pregnancy may significantly reduce maternal weight gain, and five studies were scored as being of poor quality. This systematic review highlights the lack of research within developing countries on lifestyle interventions for the management of excessive weight gain during pregnancy. Similar reviews from developed countries demonstrate the efficacy of such interventions, which should be confirmed using well-designed studies with appropriate intervention methods in resource-limited environments.Optimal maternal body composition during pregnancy is a public health priority due to its implications on maternal health and infant development. We therefore aimed to conduct a systematic review of randomised, controlled trials, and case-control and cohort studies using lifestyle interventions to improve body composition in developing countries. Of the 1 708 articles that were searched, seven studies, representing three countries (Brazil, Iran and Argentina), were included in the review. Two articles suggested that intervention with physical activity during pregnancy may significantly reduce maternal weight gain, and five studies were scored as being of poor quality. This systematic review highlights the lack of research within developing countries on lifestyle interventions for the management of excessive weight gain during pregnancy. Similar reviews from developed countries demonstrate the efficacy of such interventions, which should be confirmed using well-designed studies with appropriate intervention methods in resource-limited environments.

The prevalence of self-reported neck pain in rugby union players in Gauteng Province

Background. Rugby is a highly demanding sport that carries a high risk of injury, specifically to the neck region. Repetitive loading of the neck during the scrum or tackle phase may increase neck symptoms and pain. Objectives. The objective of this cross-sectional, descriptive study was to determine the prevalence of self-reported neck pain in rugby union players in Gauteng Province, South Africa. Methods. One hundred rugby union players of a mean ± standard deviation age of 22.1±2.4 years, height 1.84±0.07 m and weight 95.3±15.2 kg, completed the four-part questionnaire. Results. We found a 12% prevalence of current neck pain, and 52% of the players reported experiencing previous neck pain. Neck pain was more frequently reported in forwards, with the tackle being the most commonly stated cause. Eighteen players reported mild to moderate disability as a result of neck pain. The players reported that neck strengthening, on-field treatment and coaching could be improved to prevent neck pain. Conclusion. Current and previous neck pain is prevalent in rugby union players. Neck pain may be a sign of underlying pathology; therefore, players presenting with chronic or acute neck pain should be assessed thoroughly by a sports physician. Neck conditioning and strengthening should be encouraged in all players to prevent the deleterious effects that rugby union may have on the cervical spine.