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Exploring the effectiveness of physical activity interventions in women with previous gestational diabetes: A systematic review of quantitative and qualitative studies.

ABSTRACT: Women with previous Gestational Diabetes Mellitus (GDM) have seven times the risk of Type 2 diabetes later in life compared to women without GDM. Physical activity can reduce this risk and most women with previous GDM are not physically active. Aims:To explore: (1) effectiveness of physical activity interventions for women with previous GDM; (2) factors that women with previous GDM perceive influence their physical activity; (3) how these factors are addressed by the interventions. Methods:A systematic review of quantitative (aim 1) and qualitative (aim 2) studies with a mixed-methods synthesis (aim 3) was conducted in October 2017 following Cochrane methodology. Of 8101 articles identified, twenty-eight studies were included in total: 18 in Review 1 and 10 in Review 2. Results:Four interventions significantly increased physical activity and 14 had either mixed effectiveness or no changes in physical activity. Reporting of intervention components and study quality varied greatly. Relevant qualitative factors included accounting for childcare issues, social support and cultural sensitivities. Interventions that incorporated these factors were associated with effectiveness. Education about how to reduce future risk of Type 2 diabetes and using pedometers in interventions were not associated with intervention effectiveness. Other factors that future interventions should address consist of 'putting others before yourself'; 'putting off lifestyle change'; 'lack of support from healthcare professionals' and 'being a healthy role model for families'. Conclusion:Combining the results of qualitative and quantitative studies can provide a nuanced understanding of the effectiveness of physical activity and lifestyle interventions.

SUBMITTER: Buelo AK

PROVIDER: S-EPMC6510702 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Exploring the effectiveness of physical activity interventions in women with previous gestational diabetes: A systematic review of quantitative and qualitative studies.

Buelo A K AK Kirk A A Lindsay R S RS Jepson R G RG

Preventive medicine reports 20190503

Women with previous Gestational Diabetes Mellitus (GDM) have seven times the risk of Type 2 diabetes later in life compared to women without GDM. Physical activity can reduce this risk and most women with previous GDM are not physically active.<h4>Aims</h4>To explore: (1) effectiveness of physical activity interventions for women with previous GDM; (2) factors that women with previous GDM perceive influence their physical activity; (3) how these factors are addressed by the interventions.<h4>Met ...[more]

PMID: 31110933

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Project description:BACKGROUND:Although early detection and management of excess rates of gestational diabetes mellitus (GDM) among Indigenous women can substantially reduce maternal and offspring complications, current interventions seem ineffective for Indigenous women. While undertaking a qualitative study in a rural community in Northland, New Zealand about the complexities of living with diabetes, we observed a common emotional discourse about the burden of diabetic pregnancies. Given the significance of GDM and our commitment to give voice to Indigenous M?ori women in ways that could potentially inform solutions, we aimed to explore the phenomenon of GDM among M?ori women in a rural context marked by high area-deprivation. METHOD:A qualitative and Kaupapa M?ori methodology was utilised. A sub-sample of women (n?=?10) from a broader study designed to improve type 2 diabetes mellitus (T2DM) who had experienced GDM or pre-existing diabetes during pregnancy and/or had been exposed to diabetes in utero were interviewed. Participants in the broader study were recruited via the local primary care clinic. Experiences of GDM, in relation to their current T2DM, was sought. Narrative data was analysed for themes. RESULTS:Intergenerational experiences informed perceptions that GDM was an inevitable heritable illness that "just runs in the family." The cumulative effects of deprivation and living with GDM compounded the complexities of participant' lives including perceptions of powerlessness and mental health deterioration. Missed opportunities for health services to detect and manage diabetes had ongoing health consequences for the women and their offspring. Positive relationships with healthcare providers facilitated management of GDM and helped women engage with self-management. CONCLUSION:M?ori women living with T2DM were clear that health providers had failed to intervene in ways that would have potentially slowed or prevented progression of GDM to T2DM. Participants revealed missed opportunities for appropriate diagnostic testing, treatment and health promotion programmes for GDM. Poor collaboration between health services and social services meant psychosocial issues were rarely addressed and the cycle of intergenerational poverty and disadvantage prevailed. These data highlight opportunities for extended case management to include wh?nau (family) engagement, input from social services, and evidence-based medicine and/or long-term management and prevention of T2DM.

Project description:BackgroundEvidence suggests that Arab migrant populations engage in low levels of physical activity. To our knowledge, there are no reviews that explore the perspectives of Arab migrant populations on the factors influencing physical activity. The aim of this systematic review was to thematically synthesise qualitative literature on the factors influencing physical activity among Arab migrant populations.MethodsFive electronic databases (CINAHL, SPORTDiscus, PsychoInfo, MEDLINE, Embase) were searched in July 2018 and searched again in April 2020. A manual search in Google Scholar was also performed using keywords and the reference lists of included studies were also screened to identify further articles. The eligibility criteria for inclusion were studies that sampled adult (≥18 years) Arab migrant populations, used qualitative methodology, explored the factors influencing physical activity as a primary aim, and were published in English. The 10-item Critical Appraisal Skills Programme (CASP) checklist was used to assess methodological quality of individual studies. The results of the studies were thematically synthesised using the qualitative software Quirkos v1.6.ResultsA total of 15 studies were included, with the largest proportion of studies conducted in Australia, followed by the United States, Netherlands, Sweden, and then Canada. Five studies exclusively sampled Arab migrant populations in their study. A total of 7 major themes influencing physical activity among Arab migrants emerged from the synthesis: culture and religion, competing commitments and time, social factors, health-related influences, accessibility issues, outdoor environment, and the migratory experience.ConclusionsThe findings of this review highlighted the various factors influencing the physical activity levels of Arab migrant adults. While many of the factors influencing physical activity are shared with those experienced by other populations (e.g., time constraints), for Arab migrant populations there are other more unique factors closely associated with culture and religion that appear to influence their levels of physical activity. The findings of this review could be used to inform the design of physical activity interventions targeting Arab migrant populations.

Project description:Increased physical activity (PA) has been associated with a reduction in non-communicable disease risk factors and outcomes. However, interventions to increase childhood PA typically produce small to negligible effects. Recent reviews are limited due to lack of post-intervention follow-up measurement. This review aimed to examine measured effects at least six months post-intervention.We searched PubMed, MEDLINE, EMBASE, PsychINFO, ScienceDirect, SportDiscus and Google Scholar between 1st January 1991 and 1st November 2014 for controlled studies reporting six-month post-intervention measurement for children aged 5 to 18 years. 14 studies met inclusion criteria; 12 reported moderate-to-vigorous PA (MVPA) (n = 5790) and 10 reported total PA (TPA) (n = 4855). We calculated overall effect estimates and 95% CI's using random effects modelling with inverse variance weighting. Mean difference was calculated for MVPA, with standardised mean difference calculated to TPA due to measurement variation. Meta-regression assessed heterogeneity by continuous level variables. Negligible mean difference in MVPA existed in favour of the intervention group, amounting to 1.47 (95% CI -1.88, 4.82) mins/day compared to controls, while no difference was recorded on TPA. Sub-group analyses revealed males (2.65 mins/day: 95% CI 2.03, 3.27) reported higher levels of MVPA than females (-0.42 mins/day: 95% CI -7.77, 6.94), community settings (2.67 mins/day: 95% CI 2.05, 3.28) were more effective than school settings (1.70 mins/day: 95% CI -4.84, 8.25), and that treatment (4.47 mins/day: 95% CI -0.81, 9.76) demonstrated greater effects than population approaches (1.03 mins/day: 95% CI -2.54, 4.60). Meta-regression revealed no significant differences by factor on pooled effects. Significant heterogeneity existed between studies and potential for small study effects was present.Improved PA levels subsequent to intervention were not maintained six month post-intervention. A potentially useful avenue of future research is to specifically explore community treatment of high risk individuals.PROSPERO CRD42014007545.

Project description:Aims/hypothesisLow physical fitness (PF) is a risk factor for type 2 diabetes mellitus (T2D). Women with a history of gestational diabetes (GDM) are at risk for T2D at a young age, but the role of PF in this population is not clear. PF has also been found to correlate inversely with plasma leptin in previous studies. Here, we examine whether women who had GDM have lower PF than women after a normoglycemic pregnancy and, second, whether PF is associated with plasma leptin, independently of body fat mass.MethodsCross-sectional analysis of 236 participants in the PPSDiab Study (cohort study of women 3-16 months after delivery, 152 after gestational diabetes (pGDM), 84 after normoglycemic pregnancy (control subjects); consecutively recruited 2011-16); medical history, physical examination with bioelectrical impedance analysis (BIA), whole body magnetic resonance imaging (MRI) (n = 154), 5-point oral glucose tolerance test, cardiopulmonary exercise testing, clinical chemistry including fasting plasma leptin; statistical analysis with Mann-Whitney U and t -test, Spearman correlation coefficient, multiple linear regression.ResultsWomen pGDM had lower maximally achieved oxygen uptake (VO2peak/kg: 25.7(21.3-29.9) vs. 30.0(26.6-34.1)ml/min/kg; total VO2peak: 1733(1552-2005) vs. 1970(1767-2238)ml/min; p<0.0001 for both), and maximum workload (122.5(105.5-136.5) vs. 141.0(128.5-159.5)W; p<0.0001). Fasting plasma leptin correlated inversely with PF (VO2peak/kg ? = -0.72 p<0.0001; VO2peak ? = -0.16 p = 0.015; max. load ? = -0.35 p<0.0001). These associations remained significant with adjustment for body mass index, or for body fat mass (BIA and MRI).Conclusions/interpretationWomen with a recent history of GDM were less fit than control subjects. Low PF may therefore contribute to the risk for T2D after GDM. This should be tested in intervention studies. Low PF also associated with increased leptin levels-independently of body fat. PF may therefore influence leptin levels and signaling. This hypothesis requires further investigation.

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Exploring the effectiveness of physical activity interventions in women with previous gestational diabetes: A systematic review of quantitative and qualitative studies.

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Exploring the effectiveness of physical activity interventions in women with previous gestational diabetes: A systematic review of quantitative and qualitative studies.

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