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Effects of supervised exercise training during pregnancy on psychological well-being among overweight and obese women: secondary analyses of the ETIP-trial, a randomised controlled trial.

ABSTRACT: OBJECTIVES:Women with high body mass index (BMI) have increased risk for symptoms of anxiety and depression during pregnancy and postpartum. In this prespecified secondary analysis from the exercise training in pregnancy trial, our aim was to examine effects of supervised exercise during pregnancy on psychological well-being in late pregnancy and postpartum among women with a prepregnancy BMI ?28?kg/m2. DESIGN:Single-centre, parallel group, randomised controlled trial. SETTING:University Hospital, Norway. PARTICIPANTS:Ninety-one women (age 31.2±4.1 years, BMI 34.5±4.2?kg/m2), 46 in the exercise group, 45 in the control group, were included in the trial. INTERVENTION:The exercise group was offered 3?weekly supervised exercise sessions (35?min of moderate intensity walking/running and 25?min of resistance training), until delivery. PRIMARY AND SECONDARY OUTCOMES MEASURES:Primary analyses were based on intention to treat, with secondary perprotocol analyses. To assess psychological well-being, we used the 'Psychological General Well-Being Index' (PGWBI) at inclusion (gestational week 12-18), late pregnancy (gestational week 34-37) and 3?months postpartum. We assessed postpartum depression using the 'Edinburgh Postnatal Depression Scale' (EPDS). RESULTS:Numbers completed data collection: late pregnancy 72 (exercise 38, control 36), postpartum 70 (exercise 36, control 34). In the exercise group, 50% adhered to the exercise protocol. Baseline PGWBI for all women was 76.4±12.6. Late pregnancy PGWBI; exercise 76.6 (95% CI 72.2 to 81.0), control 74.0 (95% CI 69.4 to 78.5) (p=0.42). Postpartum PGWBI; exercise 85.4 (95% CI 81.9 to 88.8), control 84.6 (95% CI 80.8 to 88.4) (with no between-group difference, p=0.77). There was no between-group difference in EPDS; exercise 2.96 (95% CI 1.7 to 4.2), control 3.48 (95% CI 2.3 to 4.7) (p=0.55). CONCLUSIONS:We found no effect of supervised exercise during pregnancy on psychological well-being among women with high BMI. Our findings may be hampered by low adherence to the exercise protocol. TRIAL REGISTRATION NUMBER:NCT01243554.

SUBMITTER: Garnæs KK

PROVIDER: S-EPMC6886967 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Effects of supervised exercise training during pregnancy on psychological well-being among overweight and obese women: secondary analyses of the ETIP-trial, a randomised controlled trial.

Garnæs Kirsti Krohn KK Helvik A S AS Stafne Signe N SN Mørkved Siv S Salvesen Kjell K Salvesen Øyvind Ø Moholdt Trine T

BMJ open 20191121 11

<h4>Objectives</h4>Women with high body mass index (BMI) have increased risk for symptoms of anxiety and depression during pregnancy and postpartum. In this prespecified secondary analysis from the exercise training in pregnancy trial, our aim was to examine effects of supervised exercise during pregnancy on psychological well-being in late pregnancy and postpartum among women with a prepregnancy BMI ≥28 kg/m<sup>2</sup>.<h4>Design</h4>Single-centre, parallel group, randomised controlled trial.< ...[more]

PMID: 31753866

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Project description:BackgroundThe effectiveness of exercise training for preventing excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) is still uncertain. As maternal obesity is associated with both GWG and GDM, there is a special need to assess whether prenatal exercise training programs provided to obese women reduce the risk of adverse pregnancy outcomes. Our primary aim was to assess whether regular supervised exercise training in pregnancy could reduce GWG in women with prepregnancy overweight/obesity. Secondary aims were to examine the effects of exercise in pregnancy on 30 outcomes including GDM incidence, blood pressure, blood measurements, skinfold thickness, and body composition.Methods and findingsThis was a single-center study where we randomized (1:1) 91 pregnant women with a prepregnancy body mass index (BMI) ≥ 28 kg/m2 to exercise training (n = 46) or control (standard maternity care) (n = 45). Assessments were done at baseline (pregnancy week 12-18) and in late pregnancy (week 34-37), as well as at delivery. The exercise group was offered thrice weekly supervised sessions of 35 min of moderate intensity endurance exercise and 25 min of strength training. Seventeen women were lost to follow-up (eight in the exercise group and nine in the control group). Our primary endpoint was GWG from baseline testing to delivery. The principal analyses were done as intention-to-treat analyses, with supplementary per protocol analyses where we assessed outcomes in the women who adhered to the exercise program (n = 19) compared to the control group. Mean GWG from baseline to delivery was 10.5 kg in the exercise group and 9.2 kg in the control group, with a mean difference of 0.92 kg (95% CI -1.35, 3.18; p = 0.43). Among the 30 secondary outcomes in late pregnancy, an apparent reduction was recorded in the incidence of GDM (2009 WHO definition) in the exercise group (2 cases; 6.1%) compared to the control group (9 cases; 27.3%), with an odds ratio of 0.1 (95% CI 0.02, 0.95; p = 0.04). Systolic blood pressure was significantly lower in the exercise group (mean 120.4 mm Hg) compared to the control group (mean 128.1 mm Hg), with a mean difference of -7.73 mm Hg (95% CI -13.23, -2.22; p = 0.006). No significant between-group differences were seen in diastolic blood pressure, blood measurements, skinfold thickness, or body composition in late pregnancy. In per protocol analyses, late pregnancy systolic blood pressure was 115.7 (95% CI 110.0, 121.5) mm Hg in the exercise group (significant between-group difference, p = 0.001), and diastolic blood pressure was 75.1 (95% CI 71.6, 78.7) mm Hg (significant between-group difference, p = 0.02). We had planned to recruit 150 women into the trial; hence, under-recruitment represents a major limitation of our results. Another limitation to our study was the low adherence to the exercise program, with only 50% of the women included in the intention-to-treat analysis adhering as described in the study protocol.ConclusionsIn this trial we did not observe a reduction in GWG among overweight/obese women who received a supervised exercise training program during their pregnancy. The incidence of GDM in late pregnancy seemed to be lower in the women randomized to exercise training than in the women receiving standard maternity care only. Systolic blood pressure in late pregnancy was also apparently lower in the exercise group than in the control group. These results indicate that supervised exercise training might be beneficial as a part of standard pregnancy care for overweight/obese women.Trial registrationClinicalTrials.gov NCT01243554.

Project description:BackgroundPregnant women with depression and/or anxiety prior to pregnancy are at higher risk of preterm birth, breastfeeding problems, postpartum depression, and disruption of the mother-infant attachment. It is well documented that exercise improves psychological well-being in nonpregnant subjects with symptoms of depression. However, in only a few small studies have researchers examined the effect of exercise on symptoms of depression among pregnant women. We hypothesize that physiotherapist-supervised group exercise for pregnant women at risk of antenatal depression increases their psychological well-being. This paper describes the study protocol of a randomized controlled trial (RCT) on a supervised group exercise intervention for pregnant women with a current or previous history of depression and/or anxiety.Methods/designThe RCT is being carried out at the Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, in the period 2016-2019. The inclusion criteria are pregnant women ≥18 years of age with depression and/or anxiety requiring treatment by a psychiatrist or a psychologist within the last 10 years and/or intake of antidepressants in the 3 months prior to conception and/or during pregnancy. The women must have appropriate Danish language skills, be pregnant with a single fetus, give written informed consent, and be at 17-22 gestational weeks when the intervention begins. The primary outcome is psychological well-being (the five-item World Health Organization Well-being Index). Secondary outcomes are symptoms of depression (Edinburgh Postnatal Depression Scale), functional ability (General Health Questionnaire), clinical symptoms of anxiety (State-Trait Anxiety Inventory), sleep quality and sleep disturbances (Pittsburgh Sleep Quality Index), and pregnancy and delivery outcomes. The intervention is supervised group exercise twice weekly for 12 weeks. The control group will receive standard antenatal care. On the basis of sample size calculation, a total of 300 women will be randomly assigned to either the intervention or the control group in a ratio of 1:1.DiscussionThe trial is expected to contribute to the body of knowledge used in planning antenatal care for pregnant women at risk of depression.Trial registrationClinicalTrials.gov, NCT02833519 . Registered on 19 May 2016.

Project description:In the context of physical activity and sport, perfectionism and the regular practice of physical activity are related to psychological well-being and the regulation of psychological resources necessary for adaptation to effort and satisfaction. At the same time, the most active students are also those who show greater appetites for physical education classes. The goal of this work was to identify the influence of perfectionist beliefs and the regularity of the practice of physical exercise on psychological well-being. The participants were adolescents (n = 436) aged between 14 and 19 years (M = 16.80, SD = .77). They were administered the Multidimensional Perfection Scale, the Psychological Wellbeing Scale, the Global Physical Activity Questionnaire (GPAQv2), and a sociodemographic questionnaire. The results showed, under a non-random and transversal design, that the participants gave important value to physical exercise because they feel both active and vigorous. Regarding perfectionism, the functional aspects of perfectionism (expectations of achievement and organization) correlated positively, while the dysfunctional aspects (fear of committing errors and external expectations) did so negatively with the importance given to physical exercise performed by adolescents; this in turn positively predicted psychological well-being. In this way, the hypothesized model contemplated the relevance of the included variables and reflected the mediation of the degree of importance given to the practice of physical exercise on perfectionist beliefs and psychological well-being. Currently, most physical activity practice proposals for adolescents focus on federated and structured environments for competition, and those that deal with recreational and health-oriented sports are far less common. Hence, "the perfect way of doing sports" for a teenager should be accompanied by cognitive schemes aimed at strengthening psychological resources that allow the regulation of beliefs, attitudes, and behaviors.

Dataset Information

Effects of supervised exercise training during pregnancy on psychological well-being among overweight and obese women: secondary analyses of the ETIP-trial, a randomised controlled trial.

Publications

Effects of supervised exercise training during pregnancy on psychological well-being among overweight and obese women: secondary analyses of the ETIP-trial, a randomised controlled trial.

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