Karina Tamy Kasawara

Exercise and physical activity in the prevention of pre‐eclampsia: systematic review

Exercise and physical activity have been studied and suggested as a way to reduce or minimize the effects of pre‐eclampsia. Our aim was to evaluate the association between exercise and/or physical activity and occurrence of pre‐eclampsia. We conducted electronic searches without year of publication and language limitations. This was a systematic review designed according to PRISMA. Different databases accessed were as follows: PubMed®; Latin‐American and Caribbean Literature in Health Sciences (LILACS); Scientific Electronic Library On‐line (SciELO); Physiotherapy Evidence Database (PEDro); and ISI web of KnowledgeSM. The Medical Subject Headings (MeSH) were as follows: (“exercise” OR “motor activity” OR “physical activity”) AND (“pre‐eclampsia” OR “eclampsia” OR “hypertension, pregnancy‐induced”). Inclusion criteria were studies conducted in adults who were engaged in some physical activity. The selection and methodological evaluation were carried out by two independent reviewers. Risk assessment was made by the odds ratio (OR) and incidence of pre‐eclampsia in the population who performed physical activity/exercise. A total of 231 articles were found, 214 of which were excluded based on title and full‐text, so that 17 remained. Comparison of six case–control studies showed that physical activity had a protective effect on the development of pre‐eclampsia [OR 0.77, 95% confidence interval (CI) 0.64–0.91, p < 0.01]. The 10 prospective cohort studies showed no significant difference (OR 0.99, 95% CI 0.93–1.05, p= 0.81). The only randomized clinical trial showed a protective effect on the development of pre‐eclampsia in the stretching group (OR 6.34, 95% CI 0.72–55.37, p= 0.09). This systematic review indicates a trend toward a protective effect of physical activity in the prevention of pre‐eclampsia.

Physical Activity Patterns and Factors Related to Exercise during Pregnancy: A Cross Sectional Study.

Objective To assess the physical activity levels of pregnant women and to examine the characteristics associated with the practice of exercise and the activities of daily living during pregnancy. Methods For this cross-sectional study, 1,279 women were recruited within 72 hours postpartum. They were interviewed about their socio-demographic data and obstetric history and were administered self-report questionnaires about exercise and daily physical activities during pregnancy. Data on the current pregnancy, labor, delivery, and newborn outcomes were collected from participants’ medical records. To analyze factors related to the practice of exercise, we used the student t-test, X², and odds ratio (OR), with a corresponding 95% confident interval (CI), followed by a multiple logistic regression. The significance level was 5%. Results Compared to the pre-pregnancy period, the prevalence of physical activity among participants was lower throughout pregnancy (20.1%) (p = 0.01). Half of the women interrupted practicing physical exercise due to pregnancy. The lowest prevalence of exercise was observed in the first (13.6%) and third trimesters (13.4%). Less than half of women received exercise guidance during prenatal care meetings (47.4%). Walking was the most commonly reported exercise, followed by water aerobics. Factors positively associated with exercise practice were higher educational level (OR= 1.82; CI 95% 1.28–2.60), primiparity (OR=1.49; CI 95% 1.07–2.07), exercising before pregnancy (OR= 6.45; CI 95% 4.64–8.96), and exercise guidance during prenatal care (OR=2.54; CI 95% 1.80–3.57). Mildly intense exercise and domestic activities were most frequently reported among pregnant women. There were no differences in maternal and perinatal outcomes between active and sedentary pregnant women. Conclusion The findings indicate that promoting physical activity remains a priority in public health policy, and women of childbearing age, especially those planning a pregnancy, should be encouraged to adopt an exercise routine or maintain an active lifestyle during pregnancy in order to avoid sedentary- and obesity-associated risks.

Effects of Kinesio Taping on breast cancer-related lymphedema: A meta-analysis in clinical trials

ABSTRACT Background: Lymphedema is known as a secondary complication of breast cancer treatment, caused by reduction on lymphatic flow and lymph accumulation on interstitial space. The Kinesio Taping (KT) has become an alternative treatment for lymphedema volume reduction. The objective of the study was to evaluate the literature through a systematic review on KT effects on lymphedema related to breast cancer. Methods: Search strategies were performed by the following keywords: “Kinesio Taping,” “Athletic Tape,” “Cancer,” “Neoplasm,” “Lymphedema,” and “Mastectomy” with derivations and different combinations. The following databases were accessed: SCIELO, LILACS, MEDLINE via PubMed, and PEDro, between 2009 and 2016. Studies published in English, Portuguese, and Spanish were considered for inclusion. The studies’ methodological quality was assessed by the PEDro scale. Results: Seven studies were identified by the search strategy and eligibility. All of them showed positive effect in reducing lymphedema (perimeter or volume) before versus after treatment. However, with no effects comparing the KT versus control group or others treatments (standardized mean difference = 0.04, confidence interval 95%: −0.24; 0.33), the average score of the PEDro scale was 4.71 points. Conclusions: KT was effective on postmastectomy lymphedema related to breast cancer; however, it is not more efficient than other treatments.

Effects of physiotherapy treatment for urinary incontinence in patient with multiple sclerosis

[Purpose] The aim of the study was to evaluate the benefits of physical therapy for urinary incontinence in patients with multiple sclerosis and to verify the impact of urinary incontinence on the patient’s quality of life. [Subject and Methods] A case study of a 55-year-old female patient diagnosed with multiple sclerosis and mixed urinary incontinence was conducted. Physical therapy sessions were conducted once a week, in total 15 sessions, making use of targeted functional electrical vaginal stimulation, along with active exercises for the pelvic floor muscles and electrical stimulation of the posterior tibial nerve, behavioral rehabilitation and exercise at home. [Results] After 15 physical therapy sessions, a patient diagnosed with multiple sclerosis and mixed urinary incontinence showed continued satisfactory results after five months. She showed better quality of life, higher strength of pelvic floor muscle and reduced urinary frequency without nocturia and enuresis. [Conclusion] The physical therapy protocol in this patient with multiple sclerosis and mixed urinary incontinence showed satisfactory results reducing urinary incontinence symptomatology and improving the patient’s quality of life.

Effects of a Knee Brace With a Patellar Hole Versus Without a Patellar Hole in Patients With Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial

The objective of this study was to observe the immediate effect of a knee brace with a patellar hole versus without a patellar hole on pain perception in patients with knee osteoarthritis. To accomplish this, a double-blind, randomized controlled trial enrolled 108 patients divided into two groups (knee brace with a patellar hole or without a patellar hole). Patients were evaluated by the Visual Analogue Scale (VAS) in order to measure their pain sensation, the Timed Up and Go (TUG) test was used to evaluate their ability to walk, and the 8-m walking test (8MWT) was used to estimate their walking speed. Both groups presented significant reduction in pain perception, higher function of the lower extremities, and greater mobility while wearing a knee brace. However, the patients who wore a knee brace without a patellar hole presented more favorable results than those who wore a knee brace with a patellar hole: a 1.6-point reduction was found versus 1.1 points in the VAS, the patients presented 0.7 s less time versus 0.4 s in the TUG, and the speed was reduced by 1.4 s versus 0.8 s in the 8MWT. Therefore, the knee brace without a patellar hole presented more favorable results when compared with the knee brace with a patellar hole.

Early menarche and teenager pregnancy as risk factors for morbid obesity among reproductive-age women: A case-control study

OBJECTIVES: The aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. METHODS: We performed a case-control study with 110 morbidly obese women and 110 women with adequate weight who were matched by age and with a 1:1 case to control ratio. All women were between 20 to 49 years old and non-menopausal. Possible risk factors were evaluated through a self-report questionnaire assessing socio-demographic, obstetric and gynecological characteristics, presence of non-communicable diseases and habits. Multiple logistic regression was used to estimate the odds ratio with respective confidence intervals. RESULTS: Menarche under 12 years old, teenage pregnancy and lower educational level were shown to be risk factors for morbid obesity among women of reproductive age. Incidences of non-communicable diseases (diabetes, hypertension, dyslipidemia, liver disease, lung disease, thyroid dysfunction, and joint pain) were increased in women with morbid obesity. CONCLUSIONS: Early menarche, teenage pregnancy and low education level are risk factors for the occurrence of morbid obesity in women of reproductive age. Some non-communicable diseases were already more prevalent in women with morbid obesity even before 50 years of age.

Translational studies for exercise in high-risk pregnancy: Pre-eclampsia model

ABSTRACT Objective: Reviewed literature regarding exercise effects on pregnancy-related hypertensive disorders, analyzing basic science perspectives and clinical studies. Methods: Scientific databases were accessed by research strategy combining Medical Subject Headings terms. Studies published between 2000 and 2015, in English, Portuguese, and Spanish language, were considered. Results: Studies were classified into: recommendations for exercise on high-risk pregnancy; animal models for hypertension in pregnancy; exercise on hypertensive disorders in animal models and pregnant women. Conclusion: There are several animal models to mimic hypertensive disorders in pregnancy; however, clinical studies are still needed for exercise recommendation in pregnant women with hypertensive disorders.

PP046. Adherence to exercise with bicycle during pregnancy in women with risk of preeclampsia

INTRODUCTION Physical activity (PA) has been proposed as an important part of hypertensions treatment and has been studied as a possibility for the prevention of preeclampsia (PE) and its complications. PA is recommended during pregnancy because it may be beneficial to maternal health. However, some studies relate the difficulty in adherence to exercise during pregnancy. OBJECTIVES The objective of this study was to evaluate the adherence to exercise with bicycle in pregnant women with risk of preeclampsia development and characterize these pregnants. METHODS This is a secondary analysis of a randomized clinical trial at the Womens Hospital Dr. José Aristodemo Pinotti - CAISM/Unicamp, Brazil. We enrolled 116 pregnant women presenting with chronic hypertension (CH), previous PE or both factors associated (risk of PE development). Women from 12 to 20 gestational weeks were selected from the prenatal outpatient clinic and randomly allocated to the study (SG) or non-interventional group (NIG). Women at the SG performed exercise using stationary bicycle (horizontal bench model) during 30min, once a week, under a physical therapist supervision. The HR was maintained at 20% above resting heart rate and up to 140 beats per minute, and the BP was evaluated before and after exercise. The NIG followed regular prenatal routine with weekly returns for HR and BP measurements. We analyzed the adherence of the SG to exercise with bicycle and their sociodemographic and clinical characteristics. RESULTS We invited 152 pregnants to participate and 33 (21.7%) refused. 116 pregnants were randomized and 58 were allocated to the SG. The mean age was 31.7±6.2 and mean of Body Mass Index (BMI) was 34.9±7.9kg/m(2). Previous PE were prevalent in 16 (27.6%) pregnant, CH in 51 (87.9%) pregnant and 9 (15.5(10.5%) pregnants relate to exercise before pregnancy. The average sessions performed by the SG using stationary bicycle were 9.24±7.03. That those who realized less than the mean session of the SG 14 had discontinued, 3 changed the prenatal city, 4 had TPP, 3 had difficulty in controlling blood pressure, 1 had autoimmune hepatitis diagnosis and 1 had fetal malformation. Considering the sociodemographic and clinical characteristics of these 27 the majority were obese and had had CH, they were not used to practice any type of exercise before pregnancy. Most of them were not primiparous, also had more children at home and found difficul to find time for exercise. The majority did not live next to our center. CONCLUSION The majority of our population were obese, sedentary before pregnancy and with CH. In this study exercise, performed once a week, using stationary bicycle in pregnant women of high risk PE, seems to be difficult.

OS020. Effects of exercise on maternal and neonatal outcomes in pregnantwomen with chronic hypertension and/or previous preecampsia: A randomized clinical trial

INTRODUCTION Chronic hypertension (CH) and previous preeclampsia (PE) are considered risk factors for developing PE. Physical activity (PA) has been proposed as an important part of hypertensions treatment and has been studied as a possibility for the prevention of PE and its complications.PA is recommended during pregnancy because it may be beneficial to maternal health.Furthermore, it is considered a safe activity for the mother and fetus. OBJECTIVES The objective of this study was to assess the association between exercise in pregnant women with CH and/or previous PE and type of delivery, maternal and neonatal outcomes. METHODS Randomized clinical trial performed between January, 2008 and November, 2011, at the Womens Hospital Dr.José Aristodemo Pinotti-CAISM/Unicamp, Brazil, enrolled 116 pregnant women presenting CH, previous PE or both factors associated.Women from 12 to 20 gestational weeks were selected from the prenatal outpatient clinic and randomly allocated to the study (SG) or non-interventional group (NIG). Women at the SG performed physical exercise using stationary bicycle (horizontal bench model) during 30min, once a week, under physical therapist supervision.The HR was maintained at 20% above resting heart rate and up to 140 beats per minute.The NIG followed regular prenatal routine.After birth the data related to type of delivery, maternal and neonatal outcomes were collected from medical records and analyzed comparing groups.The statistical analyzes was performed by Chi-square test and Fishersexact test.The program was SAS 9.1 version.Significance was assumed as p<0.5%. RESULTS We had 6 drop-outs and 7 that did not deliver at our hospital and we could not retrieve the data.A total of 103 pregnant women were analyzed (53 in the SG and 50 in the NIG). The mean age was 31.4±5.9 and mean of Body Mass Index (BMI) was 34.9±7.9kg/m(2).Considering the sociodemographic and clinical characteristics the SG and NIG were similar and homogeneous.The average exercise sessions conducted by the SG was 10.11 sessions.The cesarean rate was 69.9% in this study, and the most prevalent indication was cephalopelvic disproportion with 34.3%.However, no statistical differences was observed between groups on type of delivery (p= 0.1901), indications for cesarean delivery and maternal outcomes, including maternal morbidity, rate of PE events and admission in the Intensive Unit Care (ICU). The neonatal outcomes were no significant differences:newborn weigh (p=0.69), adequacy for gestational age (p=0.40), gestational age by recent ultrasound (p=0.20), Apgar 1 min scores (p=0.12), Apgar 5 min score (p=0.24), admission to the ICU (p=0.95) and neonatal morbidity (p=0.39). CONCLUSION Exercise using stationary bicycle in pregnant women of high risk for PE (CH and/or previous PE) performed once a week, under physical therapist supervision does not seem to interfere in the type of delivery or maternal and neonatal outcomes. This study suggests that exercise with controlled intensity is safe, with no additional harm towards newborn health and with possible benefits to womens future health.

Body Mass Index Changes during Pregnancy and Perinatal Outcomes - A Cross-Sectional Study

OBJECTIVE  To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes. METHODS  A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequate weight, overweight, and obese. The BMI was calculated at the first and at the last prenatal care visits, and these values were compared. RESULTS  An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24- 0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetal macrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83). CONCLUSION  Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn.