Lene A.H. Haakstad

Physical activity level and weight gain in a cohort of pregnant Norwegian women

Background. It is generally recommended that healthy, pregnant women should engage in moderate exercise on most days of the week. However, there is scant knowledge about the overall physical activity and exercise levels among pregnant women. Purpose. To assess the total physical activity level of pregnant women, and to investigate the association between weight gain, physical activity and exercise during pregnancy. Methods. Pregnant women (n = 467) answered a questionnaire on total physical activity level in gestation week 36. Results. Some 55% of the participants reported working in a sitting position. Most women drove (52.9%) or used public transport (31.7%) to work. A total of 39% reported sedentary activities of ≥4 h (watching television and reading) daily; 19% were defined as non‐exercisers before pregnancy, 30% in the first trimester, 36% in the second trimester and 53% in the third trimester. Fifty women (10.6%) continued to exercise ≥4 times/week in the third trimester. Mean weight gain was 13.8 kg (SD: 5.2). Of the normal pregestational weight women (pre‐BMI: <26) and overweight women (pre‐BMI: ≥26), 32 and 51% had exceeded weight gain above accepted recommendations, respectively. Women who exercised regularly had significantly lower weight gain than inactive women in the third trimester only. Conclusion. Pregnant women have a low total physical activity level, and a high percentage of women exceed the recommended weight gain during pregnancy.

Why do pregnant women stop exercising in the third trimester

Current exercise guidelines recommend pregnant women to exercise throughout pregnancy. However, a high percentage of pregnant women are sedentary, and there is an increasing decline of physical activity and exercise, especially in the third trimester. Objective. The aim of the present study was to compare demographic and health‐related factors in pregnant women exercising and not exercising in the third trimester. Design. Cross‐sectional design comparing exercisers and non‐exercisers. Setting. Rikshospitalet University Hospital and Norwegian School of Sport Sciences, Oslo, Norway. Population. Healthy pregnant women (n = 467) were successively allocated from the application form for birth at Rikshospitalet University Hospital. Methods. A questionnaire, including questions about demographic variables, physical activity level, common pregnancy complaints, social modeling, attitudes and barriers towards exercise participation was answered between gestation‐week 32 and 36. Main outcome measures. Demographic variables, pregnancy related health factors and social modeling, including exercise counseling by health care providers, were tested using binary logistic regression analysis. Results. Less than 11% were defined as regular exercisers in the third trimester. Having high gestational weight gain and no social role models with respect to exercise behavior during childhood were inversely associated with third trimester exercise. Pre‐pregnancy exercise was the strongest predictor of regular exercise at late gestation. Not receiving advice about exercise from health professionals was borderline significant. Pelvic girdle pain and sick‐leave were not statistically significant factors. Conclusions. Pre‐pregnancy exercise was strongly related to exercise at late gestation. This study indicates a need for more information and motivation for moderate exercise before and throughout pregnancy.

Self-reporting compared to motion monitor in the measurement of physical activity during pregnancy

Most pregnancy‐studies have relied on retrospective, cross‐sectional surveys to measure physical activity level. Questionnaires are cost‐effective, but validity of the data may be questionable. Objective. The aim of the present study was to validate a physical activity and pregnancy questionnaire (PAPQ) with a portable activity monitor (ActiReg®). Design. Prospective comparison study. Setting. Healthy pregnant women recruited in a capital area. Population. Seventy‐seven pregnant women wore the ActiReg® sensors during waking hours for seven consecutive days and answered the PAPQ. Main outcome measures. Agreement between the two methods was analyzed by Bland–Altman plots and Spearman correlation coefficients. Results. The results indicated only small differences between the PAPQ and the ActiReg® in cross‐tabulation of total physical activity level and proportion of participants meeting the current exercise guidelines. The correlation between the methods was good (r = 0.59) for time spent in activities with high intensity (METS > 6), moderate for time spent standing/moving (r = 0.36) and fair for sitting/lying (r = 0.29). The Bland–Altman plot of the activity patterns, showed a mean difference near zero with no apparent trends and wide scatter of individual observations. Conclusions. The PAPQ may be considered an acceptable method for assessing habitual physical activity and exercise among pregnant women at group level. However, as questionnaires and portable activity monitors have their strengths in measuring different aspects of physical activity, there may be advantages in combining these two types of instruments for registrations of physical activity level during pregnancy.

Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials.

CONTEXT Interventions targeting maternal obesity are a healthcare and public health priority. OBJECTIVE The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy. DATA SOURCES A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. STUDY SELECTION Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. DATA SYNTHESIS There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. CONCLUSION This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice.

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

BackgroundPregnant 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/designRandomised 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 registrationPROSPERO 2013:CRD42013003804

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

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 high-intensity 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 …

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

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.

Fitness and physical activity in Norwegian adults

To date there is scant knowledge about cardio-respiratory fitness in the general adult population. The aims of the present study were to assess physical activity and fitness level in adults, and to obtain practical experience with field testing in the adult population. Employees in a rural municipality (n=925) were invited to answer a questionnaire about physical activity and participate in the UKK 2-km Walk Test. Sixty per cent (n=554) answered the questionnaire and 42% (n=388) performed the test. Sixty per cent of the men and 32% of the women had a body mass index ≥25. Twenty-three per cent of the participants were physically active ≥30 min/day. Estimated VO2 max (±SD) was 39.1±8.9 for men and 32.0±5.9 for women. The Walk Test was well received by participants and easy to arrange. The Norwegian adult population was not as fit as expected. The feasibility of the test was good. However, it is important to develop strategies to increase participation rates in future fitness tests and surveillances.

Effects of BodyPump and resistance training with and without a personal trainer on muscle strength and body composition in overweight and obese women—A randomised controlled trial

OBJECTIVES Overweight and obese individuals are recommended to perform regular resistance training, and the health- and fitness industry offer several exercise programs with purpose to improve muscle strength and body composition. This randomised controlled trial aimed to compare 12 weeks (45-60min, 3 sessions/weeks) of popular exercise programs, available at health- and fitness centers worldwide. METHODS Previous untrained women with BMI≥25 were allocated to either BodyPump (a high-repetition group session) (n=25), individual resistance training with a personal trainer (n=25), non-supervised individual resistance training (n=21) and non-exercising control group (n=21). Primary outcome was one repetition maximum (1RM) in squat and bench press, and secondary outcome was body composition (Inbody720). RESULTS The BodyPump group did not improve muscle strength, compared to any of the other groups. In 1RM squat, the personal trainer group increased 17% (95% CI 5.1-23.0), 20% (95% CI 7.5-24.8) and 30% (95% CI 15.8-33.0kg) more than the non-supervised group, BodyPump and controls, respectively. In bench press the personal trainer group increased 10% (95% CI 1.5-7.2) and 16% (95% CI 3.5-9.3kg) more compared to BodyPump and controls. No difference was found compared to the non-supervised group in bench press. There were no between-group differences in body composition. CONCLUSION Twelve weeks of BodyPump did not improve muscle strength in overweight women, but a personal trainer amplified the effects of individual resistance training on maximal strength in squat. None of the intervention groups showed effect in body composition.

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 ≥19kg/m2. METHODS women were randomised 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 60minutes 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 groups 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. FINDINGS of 303 women randomised 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.