Rationale, Design, and Methods for the Sedentary Behavior Reduction in Pregnancy Intervention (SPRING): Protocol for a Pilot and Feasibility Randomized Controlled Trial

Influence of a Sedentary Behavior Intervention on Mood, Sleep, and Quality of Life Outcomes During Pregnancy: The SPRING Study

Background

Psychological symptoms and sleep disturbance are common during pregnancy. Observational data suggest that being physically active during pregnancy is related to better mood and sleep, but whether sedentary behavior reduction interventions provide similar benefits is untested. We aimed to determine whether reducing sedentary behavior across pregnancy improved psychological and sleep parameters.

Methods

Pregnant participants (n = 51) were allocated 2:1 to a sedentary behavior reduction intervention or control in their first trimester. Depressive symptoms, perceived stress, mood disturbance, nausea/vomiting quality of life, and sleep parameters were assessed with validated questionnaires in each trimester. Linear mixed effects regression examined differences between groups across pregnancy. Spearman correlations tested whether changes in sedentary time and physical activity were associated with changes in psychological and sleep outcomes without regard to group.

Results

Despite significant reductions in sedentary behavior (-0.84 hour/day), the intervention had no effect on psychological health outcomes. Further, intervention participants demonstrated significant worsening of sleep efficiency factor scores compared with control (p = 0.038). Small but significant correlations were found between changes in sedentary time and nausea/vomiting quality of life, and between changes in physical activity and nausea/vomiting quality of life, sleep duration, and sleep efficiency.

Conclusions

Reducing sedentary behavior during pregnancy did not improve psychological symptoms and may worsen sleep efficiency. Recommendations for future sedentary behavior reduction research in pregnancy include a larger sample with poorer psychological health and sleep at baseline, targeting reductions in mentally passive sedentary behavior, and including device-based sleep assessments.

The sedentary behavior reduction in pregnancy intervention (SPRING) pilot and feasibility randomized trial

Pregnant individuals rarely achieve moderate-to-vigorous intensity physical activity recommendations.Purpose The sedentary behavior reduction in pregnancy intervention (SPRING) pilot and feasibility randomized trial aimed to demonstrate feasibility, acceptability, and initial efficacy of a lower intensity intervention targeting reduced sedentary behavior and increased standing and steps.Methods First trimester pregnant individuals at risk for high sedentary behavior and adverse pregnancy outcomes (APO) were randomized 2:1 to a multi-component sedentary behavior reduction intervention or no-contact control. Intervention components included biweekly remote health coaching, wearable activity monitor, height-adjustable workstation, and a private Facebook group. Evidence-based behavioral targets included sedentary time < 9 h/day, increasing standing by 2-3 h/day, and ≥ 7500 steps/day. Participants completed all-remote assessments (baseline, second trimester, third trimester) of sedentary behavior and activity (thigh-worn activPAL) along with exploratory pregnancy health outcomes abstracted from medical records. Intervention effects vs. control were evaluated using generalized mixed models and an intention-to-treat approach. Intervention participants also provided feedback on perceived benefits and acceptability.Results Participants (34 intervention; 17 control) had mean age 32 years, were 83% White, with mean pre-pregnancy BMI 28 kg/m2. Retention was high (90% and 83% at second and third trimester follow-up visits). Intervention participants decreased sedentary time (-0.84 h/day, p = 0.019) and increased standing (+0.77 h/day, p = 0.003), but did not increase steps/day (+710, p = 0.257) compared to controls. Intervention participants reported many perceived benefits and identified the wearable, height-adjustable workstation, and behavioral lessons as most useful.Conclusion For pregnant individuals at risk for high sedentary behavior and APOs, a sedentary behavior reduction intervention is feasible, acceptable, and may offer a viable alternative to more intense physical activity recommendations during pregnancy. Further testing in a fully powered clinical trial is warranted.Trial registration NCT05093842 on clinicaltrials.gov.