Home-based active video games to promote weight loss during the postpartum period

Are Malaysians Exercising? A Psychometric Analysis of Their Physical Activity Habits, Physical Literacy and Exercise Participation Rates among Adults with and without Disability

BACKGROUND

Physical activity levels of adults worldwide have reported a rising trend in sedentarism. This study's main objective is to analyze and understand the current tendency in this field and in physical literacy among Malaysian adults in order to improve physical performance.

METHODS

The sample from which the data were collected corresponded to 352 Malaysian participants (N = 176 non-disabled, N = 176 physical disability) using The Physical Activity Scale for Individuals with Physical Disabilities questionnaire.

RESULTS

Four factors were extracted, consisting of leisure activities, home maintenance, household chores, and career. The group with physical disability reported higher physical activity levels (14.30 MET h/day) compared to non-disabled (12.77 MET h/day), performing higher in leisure activities and light exercise. The compliance rate to health-beneficial exercise was 12.8% and was significantly higher among those with physical disability. Self-reported physical activity level correlated moderately well to overall MET performed p < 0.000, (r = 0.57). Only 2.8% of the respondents were aware of the recommendations outlined by health guidelines.

CONCLUSION

The results indicated that the population surveyed was moderately active but had low compliance to exercise habits as recommended by international health guidelines. Non-participation in prescribed exercises was linked to higher education, urban dwellers, and higher income. The study also highlighted very low physical literacy among respondents in health recommended exercise guidelines.

Ethnic Differences in Preferences for Lifestyle Intervention among Women after Childbirth: A Multi-Methods Study in Australia

Postpartum weight retention contributes to maternal obesity and varies by ethnicity. Despite the well-established benefits of lifestyle intervention on weight management, little is known about how to engage postpartum women effectively, especially among ethnic minority groups. This multi-methods study aimed to explore ethnic differences in women's preferences for lifestyle intervention after childbirth. Women within five years of childbirth and living with their youngest child in Australia were recruited in an online survey (n = 504) and semi-structured interviews (n = 17). The survey and interview questions were structured based on the Template for Intervention Description and Replication (TIDieR) framework. Ethnic groups were categorized as Oceanian, Asian and Other according to the Australian Bureau of Statistics. Chi-square tests were used to compare the preferred intervention characteristics between groups. Qualitative data were thematically analysed. The survey showed that most women across all ethnic groups were interested in receiving lifestyle support in the early postpartum period (from 7 weeks to 3 months postpartum). All ethnic groups preferred a regular lifestyle intervention delivered by health professionals that promotes accountability and provides practical strategies. However, Asian women had a higher desire for infant care and a lower desire for mental health in the intervention content compared with Oceanian women. Moreover, Asian women were more likely to favour interventions that are initiated in a later postpartum period, over a shorter duration, and with less intervention frequency, compared with Oceanian women. The interviews further indicated the need for intervention adaptations in the Asian group to address the cultural relevance of food and postpartum practices. These ethnic-specific preferences should be considered in the development of culturally appropriate intervention strategies to optimize engagement in healthy lifestyles among the targeted ethnic groups.

Home-based exergaming training effects for two individuals with spinal cord injury: A case report

INTRODUCTION

Exergaming is a type of serious game that requires active bodily movements for video gameplay. This game-based exercise is gaining interest as a form of leisure activity of moderate-vigorous dose intensity.

OBJECTIVE

This case report sought to assess the effects of exergaming training (i.e. Move Boxing, Move Tennis, and Move Gladiator Duel) on aerobic capacity, feasibility, enjoyment and motivation in two individuals with spinal cord injury (SCI).

CASE DESCRIPTIONS

Two males with SCI at the level of L4 and T10, aged 32 and 39, respectively, underwent home-based exergaming training sessions over a period of 12-18 weeks, conducted within moderate-vigorous intensity training zones for health improvements as recommended by health guidelines. Their peak oxygen consumption (VO₂), physical activity levels and perceived enjoyment were evaluated before, during and after the completion of the training.

OUTCOMES

Participant peak VO₂ improved (effect size g = 2.7) from their baseline values (Participant A: 16.0 ± 0.7 mL/kg/min to 41.7 ± 8.1 mL/kg/min; Participant B: 13.5 ± 0.8 mL/kg/min to 32.7 ± 5.2 mL/kg/min), with an increase in overall weekly physical activity levels. Both participants maintained a relatively high level of enjoyment scores throughout their training period (mean: 31.9 ± 3.2, p = .56, 95% CI 0.22-1.0).

CONCLUSION

A home-based exergaming training program improved aerobic capacity and level of physical activity, while maintaining adherence to the exercise within a relatively high perception of enjoyment for these two participants. The relatively high enjoyment scores maintained throughout the duration of the exergaming training period suggested its feasibility as a home-based exercise program and perceived as enjoyable by these individuals.

Comparative Lipidomic and Metabolomic Analyses Reveal the Mystery of Lacquer Oil from Toxicodendron vernicifluum for the Treatment of “Yuezi” Disease in Nujiang, China: From Anti-Inflammation and Anti-Postpartum Depression Perspective

Background: In southwest China, especially in Nujiang, lacquer oil from the drupes of Toxicodendron vernicifluum (Stokes) F. A. Barkley, including black lacquer oil (BLO) and white lacquer oil (WLO), is one of the most important edible oils for the local people. Through the field investigation, the locals believe that lacquer oil has benefits for parturient women and for the treatment of “Yuezi” disease. However, studies on bioactivities and the chemical compositions of lacquer oil are limited.

Purpose: This study was designed to reveal the mystery of lacquer oil for the treatment of “Yuezi” disease by testing its anti-inflammatory and anti-postpartum depressant activities and related bioactive compounds.

Methods: The anti-inflammatory effects of lacquer oil were examined by establishing a lipopolysaccharide (LPS)-induced RAW264.7 cell inflammation model and detecting the level of pro-inflammatory factors such as NO, IL-6 and TNF-α. The antidepressant effects of lacquer oil were studied by building a mouse model of postpartum depression (PPD), and the animal behavior changes of PPD model mice were assessed by open field test (OFT), forced swimming test (FST) and tail suspension test (TST). The chemical profiles of BLO and WLO were detected by lipidomic and the untargeted metabolomic research methods based on UPLC-MS/MS.

Results: The results showed that BLO and WLO exerted anti-inflammatory effects by reducing the release of pro-inflammatory factors and BLO had better anti-inflammatory effects than WLO. While only BLO had anti-postpartum depressant activities, as evidenced by the significantly reduced the immobility time of the BLO-treated PPD mice in TST and FST compared to the PPD model mice. The comparative lipidomic analysis revealed that BLO contained high levels of Diacylglycerols (DAG) and Diacylglyceryl trimethylhomoserines (DGTS) but low level of ceramides (Cer), sphingomyelines (SM), phosphatidylcholines (PC) and phosphatidylethanolamines (PE) compared with WLO. Metabolomics analysis showed that there were 57 chemical markers between BLO and WLO, of which 17 potential biomarkers have been declared to possess anti-inflammatory and/or antidepressant activities.

Conclusion: The findings of this study furnish a scientific support for the traditional uses of lacquer oil for the treatment of “Yuezi” disease from anti-inflammation and anti-postpartum depression perspective.

Exercise Interventions for Weight Management During Pregnancy and up to 1 year Postpartum Among Normal Weight Women and Women with Overweight and Obesity: An Updated Systematic Review

Background

Given the increased occurrence of pre‐gravid obesity in recent years, and the implications of maternal obesity for maternal and offspring health, it is evident that there is a continued need to investigate antenatal and postnatal weight management strategies and to provide evidence‐based advice for exercise‐based interventions. Given the small number of studies (n = 5) included in an original systematic review by our group in 2015, it was important to add to the dataset by assessing data published since 2015, in order to provide a more in‐depth view of current knowledge.

Objective

To provide an updated systematic review on studies employing exercise interventions for weight management in pregnant and postpartum women.

Methods

A systematic review of randomised controlled trials evaluating the effects of an exercise intervention on gestational weight gain and postpartum weight management in normal weight women, and women with overweight and obesity was conducted. PubMed, Scopus, Central Register of Controlled Trials and Web of Science were searched for studies published between September 2013 and June 2021. No restrictions were set on type, intensity, duration, or frequency of exercise intervention. Only studies that targeted body weight or mass as a primary outcome were included.

Results

Thirteen studies were included in this review: 11 during and two following pregnancy. Exercise significantly reduced gestational weight gain in five of the pregnancy studies and induced significant weight loss in one of the postpartum studies. Across studies, there were large disparities in exercise modality, frequency, and duration, although moderate intensity exercise was consistently employed.

Conclusions

Some studies showed positive effects of exercise on weight management during and following pregnancy. While there is still no consensus on effective exercise intervention approaches, it is crucial that physical activity, of any safe form, is recommended to encourage healthy weight management during this time.

Postnatal exercise interventions: a systematic review of adherence and effect

OBJECTIVE

To evaluate adherence to and effect of postnatal physical activity (PA) interventions.

DESIGN

Systematic review of PA intervention randomised controlled trials in postnatal women. The initial search was carried out in September 2018, and updated in January 2021.

DATA SOURCES

Embase, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases, hand-searching references of included studies. The 25 identified studies included 1466 postnatal women in community and secondary care settings.

ELIGIBILITY CRITERIA

Studies were included if the PA interventions were commenced and assessed in the postnatal year.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using a prespecified extraction template and assessed independently by two reviewers using Cochrane ROB 1 tool.

RESULTS

1413 records were screened for potential study inclusion, full-text review was performed on 146 articles, 25 studies were included. The primary outcome was adherence to PA intervention. The secondary outcomes were the effect of the PA interventions on the studies' specified primary outcome. We compared effect on primary outcome for supervised and unsupervised exercise interventions. Studies were small, median n=66 (20-130). PA interventions were highly variable, targets for PA per week ranged from 60 to 275 min per week. Loss to follow-up (LTFU) was higher (14.5% vs 10%) and adherence to intervention was lower (73.6% vs 86%) for unsupervised versus supervised studies.

CONCLUSIONS

Studies of PA interventions inconsistently reported adherence and LTFU. Where multiple studies evaluated PA as an outcome, they had inconsistent effects, with generally low study quality and high risk of bias. Agreement for effect between studies was evident for PA improving physical fitness and reducing fatigue. Three studies showed no adverse effect of PA on breast feeding. High-quality research reporting adherence and LTFU is needed into how and when to deliver postnatal PA interventions to benefit postnatal physical and mental health.

PROSPERO REGISTRATION NUMBER

CRD42019114836.

Practice nurse-supported weight self-management delivered within the national child immunisation programme for postnatal women: a feasibility cluster RCT

BACKGROUND

Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies.

OBJECTIVE

The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable.

DESIGN

The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up.

SETTING

The trial took place in Birmingham, UK.

PARTICIPANTS

Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women's Hospital or general practices. Nine intervention participants and seven nurses were interviewed.

INTERVENTIONS

The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child's health record ('red book') or using the online programme. The behavioural goal was for women to lose 0.5-1 kg per week. The usual-care group received a healthy lifestyle leaflet.

MAIN OUTCOME MEASURES

The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop-go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme).

RESULTS

The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight.

LIMITATIONS

Fewer participants were recruited than planned.

CONCLUSIONS

Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention.

FUTURE WORK

Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN12209332.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 49. See the NIHR Journals Library website for further project information.

The effects of exergames on muscle strength: A systematic review and meta-analysis

This systematic review and meta-analysis examined studies on the chronic effects of exergames on muscle strength in humans. PubMed, Scopus, CENTRAL, Web of Science, SciELO, Biblioteca Virtual em Saúde, and Google Scholar were searched, and manual searches of the reference lists of included studies and hand-searches on Physiotherapy Evidence Database and ResearchGate were conducted from inception to August 10, 2020. Randomized and non-randomized exergame intervention studies with or without a non-exercise group and/or a "usual care intervention group" (any other intervention that did not incorporate exergames), which evaluated muscle strength through direct measurements, were included. Forty-seven and 25 studies were included in the qualitative review and meta-analysis, respectively. The between-groups meta-analyses showed no significant differences between exergames and non-exercise control groups for handgrip strength in heathy/unhealthy middle-aged/older adults or knee extension maximum voluntary isometric contraction (MVIC) in healthy older adults. However, exergames provided a greater increase in handgrip strength, knee flexion MVIC, and elbow extension MVIC, but not knee extension MVIC or elbow flexion MVIC, in individuals with different health statuses when compared to usual care interventions. Also, there was a greater increase in handgrip strength in children with hemiplegic cerebral palsy favouring usual care plus exergames compared to usual care interventions. These results suggest that exergames may improve upper and lower limb muscle strength in individuals with different heath statuses compared to usual care interventions, but not muscle strength in middle age/older adults after accounting for random error. Also, exergames appear to be a useful tool for improving handgrip strength in children with hemiplegic cerebral palsy when added to usual care. However, as the exergame interventions were applied in different populations and there currently are many different approaches to perform exergames, future randomized controlled trials with high methodological quality and large sample sizes are needed to provide more compelling evidence in favour of a specific exergame protocol, or to elucidate exergame protocol design principles that appear to strongly influence outcomes.

The Role of Health Literacy in Postpartum Weight, Diet, and Physical Activity

Background: Postpartum weight retention is a significant contributor to obesity in women, adverse perinatal events in subsequent pregnancies, and chronic disease risk. Health literacy is known to impact health behaviors. The study aimed to identify the health literacy domains utilized in postpartum weight management interventions and to determine their impact on weight, diet and physical activity in postpartum women. Methods: We searched MEDLINE, CINAHL, EMBASE, PSYCINFO, and EBM databases. We included random control trials of lifestyle intervention in postpartum women (within two years post-delivery) published up to 3 May 2019. Subgroup analyses were performed to determine the effect of health literacy domains on outcomes. Results: Out of 5000 studies, 33 studies (n = 3905) were included in the systematic review and meta-analysis. The health literacy domain self-care (skills and knowledge) was associated with a significant reduction in body weight (mean difference (MD) −2.46 kg; 95% confidence interval (CI) from −3.65 to −1.27) and increase in physical activity (standardized mean difference (SMD) 0.61; 95% CI 0.20 to 1.02). No other health literacy domain was associated with significant outcomes in weight, energy intake, or physical activity. Conclusions: Health literacy skills such as knowledge of self-care are effective in improving weight and in increasing physical activity in postpartum women. The efficacy of other health domains was not supported.

Mila Blooms: A Mobile Phone Application and Behavioral Intervention for Promoting Physical Activity and a Healthy Diet Among Adolescent Survivors of Childhood Cancer

Objectives: Smartphone applications ("apps") can be used to promote health behavior change and expand the reach of behavioral interventions. To date, only a few existing apps have been developed for health promotion among adolescent survivors of childhood cancer. To address this gap, we developed an app-based intervention, using game design characteristics, theory-based behavioral strategies, and assistance from a health coach to motivate health behavior change for adolescent survivors of childhood cancer. This article describes the development and initial feasibility evaluation of the intervention. Methods: Using a theoretical framework and an extensive formative process, we developed an app-based game ("Mila Blooms") that promotes healthy eating and physical activity among adolescent survivors of childhood cancer. A single-arm 8-week intervention, using this app-based game, with assistance from a health coach, was conducted among a sample of pediatric cancer survivors (n = 15) to evaluate its initial feasibility for promoting health behavior change. Results: Results from the feasibility evaluation were encouraging. The majority of enrolled participants were retained throughout the 8-week intervention (93.8%). Participant satisfaction feedback indicated positive experiences, related to ease of use and enjoyment of the app. Although there was little evidence for behavior change attributable to the app in this first stage of development, there was a solid demonstration of the viability and appeal of the game features, and there were no adverse side effects. Conclusions: Results provide insights into how gamification can be used to promote health behaviors through an app-based intervention. Mila Blooms holds promise for promoting health behavior change. Lessons learned from our experiences could be useful for the future development and implementation of app-based adolescent health interventions.

Effects of Exergames on Physical Fitness in Middle-Aged and Older Adults in Taiwan

Using exergaming for exercise training was found to improve physical fitness. Yet, few studies have used the "Xbox Kinect" to examine its effects on physical fitness in healthy middle-aged and older adults. The purpose of this study was to investigate the effect of 10-weeks of Xbox Kinect training on physical fitness in healthy middle-aged and older adults. Forty participants (average 64.00 ± 4.44 years old, eight males and 32 females) were randomized to either intervention (n = 20) or control group (n = 20). The intervention group played Xbox Kinect three times per week, for an average of 50 min per session for 10 weeks. The control group was instructed to maintain their levels of physical activity. All the participants completed assessments of body composition, muscle strength, flexibility, balance and cardiopulmonary endurance at baseline and after 10-week intervention. After 10 weeks of training, the intervention group showed significant improvements in cardiopulmonary endurance and leg muscle strength. Moreover, there were significant differences between the intervention and control group in changes in aerobic fitness and leg muscle strength. The exergame program effectively improved cardiopulmonary endurance and leg muscle strength in healthy middle-aged and older adults. It could be an alternative to conventional exercise.

An evaluation of the impact of lifestyle interventions on body weight in postpartum women: A systematic review and meta-analysis

The established efficacy in postpartum lifestyle interventions has not been translated into better outcomes. This systematic review and meta-analysis assess the penetration (the proportion of women invited within the target population), implementation (fidelity), participation (the proportion of those invited who enrolled), and effect (weight loss compared to controls) (PIPE) of randomized controlled trials of lifestyle interventions in postpartum women (within two years after birth). MEDLINE, EMBASE, Pubmed, and other databases and clinical trial registries were searched up to the 3rd of May 2019. Data was extracted from published reports and missing data was obtained from study authors. The quality of the studies was appraised using the Cochrane Risk of Bias tool (2·0). Main outcomes were the PIPE impact metrics and changes in body weight. Thirty-six trials (49 publications) were included (n=5,315 women). One study provided sufficient information to calculate the population penetration rate (2·5%). All studies provided implementation (fidelity) information, but over half had low program fidelity. The participation rate was calculated for nine studies (0·94% to 86%). There was significant change in body weight (mean difference (MD) (95% confidence interval, CI) of -2·33 (-3·10 to -1·56). This highlights the inadequacy of conventional RCTs to inform implementation. Future research should broaden methods to pragmatic trials.

What Are the Most Effective Behavioural Strategies in Changing Postpartum Women's Physical Activity and Healthy Eating Behaviours? A Systematic Review and Meta-Analysis

Successful implementation of postpartum lifestyle interventions first requires the identification of effective core components, such as strategies for behavioural change. This systematic review and meta-analysis aimed to describe the associations between behavioural strategies and changes in weight, diet, and physical activity in postpartum women. Databases MEDLINE, CINAHL, EMBASE, and PsycINFO were searched for randomised controlled trials of lifestyle interventions in postpartum women (within 2 years post-delivery). Strategies were categorised according to the Behaviour Change Technique Taxonomy (v1). Forty-six articles were included (n = 3905 women, age 23-36 years). Meta-analysis showed that postpartum lifestyle interventions significantly improved weight (mean difference -2.46 kg, 95%CI -3.65 to -1.27) and physical activity (standardised mean difference 0.61, 95%CI 0.20 to 1.02) but not in energy intake. No individual strategy was significantly associated with weight or physical activity outcomes. On meta-regression, strategies such as problem solving (β = -1.74, P = 0.045), goal setting of outcome (β = -1.91, P = 0.046), reviewing outcome goal (β = -3.94, P = 0.007), feedback on behaviour (β = -2.81, P = 0.002), self-monitoring of behaviour (β = -3.20, P = 0.003), behavioural substitution (β = -3.20, P = 0.003), and credible source (β = -1.72, P = 0.033) were associated with greater reduction in energy intake. Behavioural strategies relating to self-regulation are associated with greater reduction in energy intake.

Lifestyle interventions to maternal weight loss after birth: a systematic review

BACKGROUND

Over the past decades, there has been an increase in overweight and obesity in women of childbearing age, as well as the general population. Overweight and obesity are related to a later, increased risk of type 2 diabetes and cardiovascular diseases. Increasing weight between pregnancies has a negative impact on the development of the fetus in a subsequent pregnancy. It is also related to long-term obesity and overweight for the woman. Accordingly, weight control in women of the childbearing age is important for both women and their offspring. Information and communication technology (ICT) has become an integrated part of many peoples' lives, and it has the potential to prevent disease. In this systematic review, we summarize the evidence from randomized controlled trials to compare effects of different ICT-based interventions to support postpartum women to achieve weight loss.

METHODS

A systematic search was performed in PubMed, Embase, PsycInfo, CINAHL, Web of Science, Scopus, and Cochrane, searching on terms, such as postpartum, weight loss, telemedicine, and randomized controlled trials. Two independent researchers undertook study selection and data extraction. Results were reported narratively. The systematic review only included studies that were randomized controlled trials.

RESULTS

Eight studies were included in the systematic review. All of them were characterized by applying one or more ICT components to assist postpartum women in weight control, and had weight loss as an outcome measure. A significant difference was found in weight loss between control group and intervention group in the majority of the studies. However, five of the studies had a relatively short follow-up period (40 days to 16 weeks), six of the studies had a relatively small sample size (18 to 66 women), and half of the studies indicated challenges with adherence to the interventions over time.

CONCLUSION

ICT-based interventions can support postpartum women to achieve a healthy lifestyle and weight control. Future studies should focus on larger sample sizes, longer follow-up periods, and adherence to the interventions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018080731.

A systematic review and meta-analysis of intervention characteristics in postpartum weight management using the TIDieR framework: A summary of evidence to inform implementation

Postpartum weight retention is a significant contributor to obesity in reproductive-aged women, but the key implementation characteristics of postpartum weight management interventions have not been systematically identified to inform policy and practice. This study aimed to evaluate the intervention characteristics associated with weight loss in postpartum women using the Template for Intervention Description and Replication (TIDieR) framework. We searched MEDLINE, CINAHL, EMBASE, PSYCINFO, and EBM databases to identify lifestyle intervention RCTs in postpartum women (within 2 years after birth) published up to January 2018. From 4512 studies, 33 studies were included in the systematic review and meta-analysis (n = 4960 women). Health professional-delivered interventions had significantly greater weight loss than those delivered by nonhealth professionals (mean difference, 95% confidence interval: (-3.22 kg [-4.83, -1.61] vs -0.99 kg [-1.53, -0.45], P = 0.01 for subgroup differences)). Diet and physical activity combined had significantly greater weight loss compared with physical activity-only interventions (-3.15 kg [-4.34, -1.96] vs -0.78 kg [-1.73, 0.16], P = 0.009 for subgroup differences). The extent of weight loss was not influenced by intervention intensity (duration, number of sessions) and setting (individual or group).

Targeting the postpartum period to promote weight loss: a systematic review and meta-analysis

Context

Many international clinical guidelines recommend that overweight and obese women lose weight prior to pregnancy to reduce the risk of adverse pregnancy outcomes. Women who have recently given birth and plan future pregnancies are an important target population for preconception weight-loss interventions.

Objective

A systematic review to evaluate postpartum dietary and/or physical activity interventions to promote weight loss and improve health in a subsequent pregnancy was conducted.

Data Sources

Five databases-the Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), Embase, the Australian New Zealand Clinical Trials Registry, and the International Clinical Trials Registry-were searched using the following terms: preconception, pregnancy, postpartum, pregnancy outcomes, body mass index, weight gain, weight loss, weight change, postpartum weight retention, dietary or lifestyle intervention, and randomiz(s)ed controlled trial. The date of last search was November 2017.

Data Extraction

Data were extracted from each identified study using a standard form. The primary outcomes were weight loss at the completion of the intervention and at follow-up assessments. Secondary endpoints included maternal and infant outcomes in a subsequent pregnancy.

Data Analysis

Mean differences (MDs) were calculated for continuous data and risk ratios for dichotomous data, both with 95%CIs.

Results

A total of 235 abstracts (193 after duplicates were excluded) were identified, from which 37 manuscripts were selected for full-text review. In total, 27 trials were identified for inclusion. Outcome data were available for approximately 75% of participants (n = 3485). A combined dietary and physical activity intervention provided post partum produced greater postpartum weight loss (MD, -2.49 kg; 95%CI, -3.34 to -1.63 kg [random-effects model]; 12 studies, 1156 women), which was maintained at 12 months post partum (MD, -2.41 kg; 95%CI, -3.89 to -0.93 kg [random-effects model]; 4 studies, 405 women), compared with no intervention. No studies reported maternal or infant health outcomes in a subsequent pregnancy.

Conclusions

Providing a postpartum intervention is associated with weight loss after birth, but effects on maternal and infant health in a subsequent pregnancy are uncertain.

A pilot intervention to reduce postpartum weight retention and central adiposity in first-time mothers: results from the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) study

BACKGROUND

Postpartum weight retention (PPWR) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour.

METHODS

A subsample of first-time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n = 28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n = 48; n = 43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self-reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum.

RESULTS

Mean PPWR decreased in the (I) group (-1.2 kg) and the C2 group (-1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (-6.4 cm) compared to C1 (-1.1 cm; P = 0.002) and C2 (-3.3 cm; P = 0.001). Changes in diet, physical activity or sedentary behaviour were not significant.

CONCLUSIONS

The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.

The contribution of Nintendo Wii Fit series in the field of health: a systematic review and meta-analysis

Background

Wii Fit was originally designed as a health and fitness interactive training experience for the general public. There are, however, many examples of Wii Fit being utilized in clinical settings. This article aims to identify the contribution of Wii Fit in the field of health promotion and rehabilitation by: (1) identifying the health-related domains for which the Wii Fit series has been tested, (2) clarifying the effect of Wii Fit in those identified health-related domains and (3) quantifying this effect.

Method

A systematic literature review was undertaken. The MEDLINE database and Games for Health Journal published content were explored using the search term “Wii-Fit.” Occurrences resulting from manual searches on Google and material suggested by experts in the field were also considered. Included articles were required to have measurements from Wii Fit activities for at least one relevant health indicator. The effect of Wii Fit interventions was assessed using meta-analyses for the following outcomes: activity-specific balance confidence score, Berg balance score (BBC) and time-up-and-go test (TUG).

Findings

A total of 115 articles highlighted that the Wii Fit has been tested in numerous healthy and pathological populations. Out of these, only a few intervention studies have focused on the prevention of chronic diseases. A large proportion of the studies focus on balance training (N = 55). This systematic review highlights several potential benefits of Wii Fit interventions and these positive observations are supported by meta-analyses data (N = 25). For example, the BBC and the TUG respond to a similar extend to Wii Fit interventions compared with traditional training.

Conclusion

Wii Fit has the potential to be used as a rehabilitation tool in different clinical situations. However, the current literature includes relatively few randomized controlled trials in each population. Further research is therefore required.

Comparing a telephone- and a group-delivered diabetes prevention program: Characteristics of engaged and non-engaged postpartum mothers with a history of gestational diabetes

AIMS

To explore the acceptability of a telephone- or a group-delivered diabetes prevention program for women with previous gestational diabetes and to compare the characteristics associated with program engagement.

METHODS

Postpartum women participated in a lifestyle modification program delivered by telephone (n=33) or group format (n=284). Semi-structured interviews on barriers and enablers to program engagement (defined as completing≥80% sessions) were conducted before (Group) and after (Group and Telephone) interventions. The Health Action Process Approach theory was used as the framework for inquiry. Psychological measures were compared between engagement subgroups before and after group-delivered intervention.

RESULTS

In the telephone-delivered program 82% participants met the engagement criteria compared with 38% for the group-delivered program. Engaged participants (Group) had significantly higher risk perception, outcome expectancy, and activity self-efficacy at baseline (P<0.05). There was a greater decrease in body weight (-1.45±3.9 vs -0.26±3.5, P=0.024) and waist circumference (-3.56±5.1 vs -1.24±5.3, P=0.002) for engaged vs non-engaged participants following group program completion.

CONCLUSIONS

Telephone delivery was associated with greater engagement in postpartum women. Engagement was associated with greater reduction in weight and waist circumference. Further studies are required to confirm the effectiveness of telephone-delivered program for diabetes prevention in postpartum women.

The use of commercial video games in rehabilitation: a systematic review

The aim of this paper was to investigate the effect of commercial video games (VGs) in physical rehabilitation of motor functions. Several databases were screened (Medline, SAGE Journals Online, and ScienceDirect) using combinations of the following free-text terms: commercial games, video games, exergames, serious gaming, rehabilitation games, PlayStation, Nintendo, Wii, Wii Fit, Xbox, and Kinect. The search was limited to peer-reviewed English journals. The beginning of the search time frame was not restricted and the end of the search time frame was 31 December 2015. Only randomized controlled trial, cohort, and observational studies evaluating the effect of VGs on physical rehabilitation were included in the review. A total of 4728 abstracts were screened, 275 were fully reviewed, and 126 papers were eventually included. The following information was extracted from the selected studies: device type, number and type of patients, intervention, and main outcomes. The integration of VGs into physical rehabilitation has been tested for various pathological conditions, including stroke, cerebral palsy, Parkinson's disease, balance training, weight loss, and aging. There was large variability in the protocols used (e.g. number of sessions, intervention duration, outcome measures, and sample size). The results of this review show that in most cases, the introduction of VG training in physical rehabilitation offered similar results as conventional therapy. Therefore, VGs could be added as an adjunct treatment in rehabilitation for various pathologies to stimulate patient motivation. VGs could also be used at home to maintain rehabilitation benefits.

Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis

Post-partum weight loss is critical to preventing and managing obesity in women, but the results from lifestyle interventions are variable and the components associated with successful outcomes are not yet clearly identified. This study aimed to identify lifestyle intervention strategies associated with weight loss in post-partum women. MEDLINE, EMBASE, PubMed, CINAHL and four other databases were searched for lifestyle intervention studies (diet or exercise or both) in post-partum women (within 12 months of delivery) published up to July 2014. The primary outcome was weight loss. Subgroup analyses were conducted for self-monitoring, individual or group setting, intervention duration, intervention types, the use of technology as a support, and home- or centre-based interventions. From 12,673 studies, 46 studies were included in systematic review and 32 randomized controlled trials were eligible for meta-analysis (1,892 women, age 24-36 years). Studies with self-monitoring had significantly greater weight lost than those without (-4.61 kg [-7.08, -2.15] vs. -1.34 kg [-1.66, -1.02], P = 0.01 for subgroup differences). Diet and physical activity when combined were significantly more effective on weight loss compared with physical activity alone (-3.24 kg [-4.59, -1.90] vs. -1.63 kg [-2.16, -1.10], P < 0.001 for subgroup differences). Lifestyle interventions that use self-monitoring and take a combined diet-and-exercise approach have significantly greater weight loss in post-partum women.

High-tech tools for exercise motivation: use and role of technologies such as the internet, mobile applications, social media, and video games

IN BRIEF The majority of patients with type 2 diabetes are not active at recommended levels, and many do not have access to behavior change programs to support lifestyle change. Thus, tools and programs designed to promote the adoption and maintenance of physical activity using technology may be helpful. This article reviews the evidence regarding the use of technology tools such as the Internet, mobile applications, social media, and video games and provides suggestions for evaluating the potential benefit of such tools for behavior change.

Nintendo related injuries and other problems: review

OBJECTIVE

To identify all reported cases of injury and other problems caused by using a Nintendo video gaming system.

DESIGN

Review.

DATA SOURCES AND REVIEW METHODS

Search of PubMed and Embase in June 2014 for reports on injuries and other problems caused by using a Nintendo gaming system.

RESULTS

Most of the 38 articles identified were case reports or case series. Injuries and problems ranged from neurological and psychological to surgical. Traditional controllers with buttons were associated with tendinitis of the extensor of the thumb. The joystick on the Nintendo 64 controller was linked to palmar ulceration. The motion sensitive Wii remote was associated with musculoskeletal problems and various traumas.

CONCLUSIONS

Most problems are mild and prevalence is low. The described injuries were related to the way the games are controlled, which varies according to the video game console.

Optimizing Weight for Maternal and Infant Health - Tenable, or Too Late?

Obesity in pregnancy is the leading cause of maternal and fetal morbidity, and gestational weight gain (GWG) is one modifiable risk factor that improves pregnancy outcomes. Most pregnant women gain more than the 2009 Institute of Medicine recommendations, particularly overweight and obese women. GWG even less than the 2009 IOM guidelines in obese women may improve pregnancy outcomes and reduce large-for-gestational-age (LGA) infants, an independent risk factor for childhood obesity, without increasing small-for-gestational-age (SGA) infants. Unfortunately, despite the fact that over 50 interventional trials designed to decrease excess GWG have been conducted, these interventions have been only modestly effective, and interventions designed to facilitate weight postpartum weight loss have also been disappointing. Successful interventions are of paramount importance not only to improve pregnancy outcomes but also for the future metabolic health of the mother and her infant, and may be key in attenuating the trans-generational risk on childhood obesity.

A pilot crossover study: effects of an intervention using an activity monitor with computerized game functions on physical activity and body composition

BACKGROUND

Wearing an activity monitor as a motivational tool and incorporating a behavior-based reward system or a computerized game element might have a synergistic effect on an increase in daily physical activity, thereby inducing body fat reduction. This pilot crossover study aimed to examine the effects of a short-term lifestyle intervention using an activity monitor with computerized game functions on physical activity and body composition.

METHODS

Twenty healthy volunteers (31 ± 3 years) participated in a 12-week crossover study. The participants were randomly assigned to either Group A (a 6-week game intervention followed by a 6-week normal intervention) or Group B (a 6-week normal intervention followed by a 6-week game intervention). The participants wore both a normal activity monitor (Lifecorder EX) and an activity monitor with computerized game functions (Yuuhokei) during the game intervention, whereas they only wore a normal activity monitor during the normal intervention. Before, during, and after the intervention, body composition was assessed.

RESULTS

Significantly more daily steps were recorded for the game intervention than for the normal intervention (10,520 ± 562 versus 8,711 ± 523 steps/day, P < 0.01). The participants performed significantly more physical activity at an intensity of ≥ 3 metabolic equivalents (METs) in the game intervention than in the normal intervention (3.1 ± 0.2 versus 2.4 ± 0.2 METs · hour/day, P < 0.01). Although body mass and fat were significantly reduced in both periods (P < 0.01), the difference in body fat reduction was significantly greater in the game intervention than in the normal intervention (P < 0.05).

CONCLUSIONS

A short-term intervention using an activity monitor with computerized game functions increases physical activity and reduces body fat more effectively than an intervention using a standard activity monitor.

Wii Fit U intensity and enjoyment in adults

Background

The Wii Fit series (Nintendo Inc., Japan) provides active video games (AVGs) to help adults to maintain a sufficient level of daily physical activity (PA). The second generation of home AVG consoles is now emerging with new game modalities (including a portable mini screen in the case of the new Wii U). The present study was performed to investigate the intensity and enjoyment of Wii Fit U games among adults.

Findings

Metabolic equivalent (METs, i.e., intensity) of the Wii Fit U activities were evaluated using metabolic chambers in 16 sedentary adults (8 women and 8 men). A short version of the physical activity enjoyment scale was completed for each activity. Wii Fit U activities were distributed over a range from 2.2  ±  0.4 METs (Hula dance) to 4.7  ±  1.2 (Hip-hop dance). Seven activities were classified as light-intensity PA (<3 METs) and 11 activities as moderate-intensity PA (3 – 6 METs). The new portable mini screen game modality does not induce higher METs. Men exercised at higher intensities than women. There was no correlation between enjoyment and MET values in women or men.

Conclusions

More and more moderate-intensity activities are available through video gaming, but the average intensity (3.2  ±  0.6) is still low. Users should be aware that AVGs alone cannot fulfill the recommendations for PA, and the video games industry still must innovate further to enhance gaming intensity and make the tool more attractive to health and fitness professionals.