A socio-ecological model of factors influencing physical activity in pregnant women: a systematic review

Physical activity (PA) is safe for most pregnant women, improving both maternal fitness and birth outcomes. Despite evidence of benefits, most pregnant women eliminate or reduce PA during pregnancy. This systematic review aimed to analyze the factors affecting maternal PA during pregnancy with reference to a socio-ecological model. A systematic search of relevant published studies between 2001 and 2022 was conducted through PubMed, Scopus, Web of Science, Academic Search Ultimate, Medline, and SPORTDiscus with full text via the EBSCO platform. A total of 32 studies that met the inclusion criteria were reviewed. The findings revealed that various study designs can lead to different outcomes in terms of what is identified as a PA facilitator or barrier. The factors that positively influenced PA in pregnant women were: higher levels of education, knowledge, and skills, as well as access to mass media. Conversely, lower levels of education, lack of knowledge and skills, low income, pregnancy discomforts, limited time, safety concerns, and societal perceptions of PA in pregnancy acted as barriers. Additionally, family, colleagues/friends, and partners could either support or hinder PA. Factors affecting overall maternal PA were somewhat different from those affecting the moderate-to-vigorous intensity of PA. Pregnant women receive little organizational and policy support. There is an urgent need to provide accessible information and resource systems for pregnant women. Since most pregnant women are motivated to engage in PA and susceptible to family advice, interventions should not be limited only to pregnant women, but should involve a family member, especially partners. There is a need to take global, systemic actions to promote an active lifestyle in pregnancy. Addressing safety concerns related to PA during pregnancy should be a significant part of these promotional activities.

How to HIIT while pregnant? The protocol characteristics and effects of high intensity interval training implemented during pregnancy – A systematic review

There is strong scientific evidence that prenatal physical activity of moderate-to-high in-tensity is a prerequisite of the proper course of pregnancy, childbirth and fetus development. How-ever, to date little data have been available on high intensity interval training (HIIT) performed during pregnancy. Following the PRISMA guidelines, this systematic review aimed at: first, to characterize HIIT protocols used or planned to be implemented during pregnancy; second, to determine their training effects on participant’s health and obstetric outcomes. We included nine original works and three clinical trials in the analysis. The HIIT protocols substantially differed in terms of the training components (type, intensity, frequency, duration and progression) and the structure of intervals (intensity and time of workout and recovery intervals). Our most important finding is that performing HIIT during pregnancy is safe in terms of obstetric outcomes and well tolerated by pregnant participants, while providing them with the enjoyment of exercise. HIIT interventions either led to an improvement in selected maternal and fetal health parameters or had no impact. No adverse effects were observed. Pregnant women may benefit from HIIT programs in the same way as other populations. Evidence-based recommendations on prenatal HIIT should be developed and promoted worldwide among pregnant women, exercise and health professionals.

High-Low Impact Exercise Program Including Pelvic Floor Muscle Exercises Improves Pelvic Floor Muscle Function in Healthy Pregnant Women - A Randomized Control Trial

Background: Pregnancy and high-impact activity are considered as risk factors for pelvic floor dysfunctions, including urinary incontinence.

Aim: To investigate whether a structured exercise program, including high- and low-impact aerobics and supported by pelvic floor muscle exercises, improves the neuromuscular activity of the pelvic floor and does not reduce the quality of life in terms of urinary incontinence in healthy pregnant women.

Methods: This was a randomized control trial among 97 Caucasian healthy nulliparas in uncomplicated pregnancies (age 30 ± 4 years, 21 ± 5 weeks of gestation; mean ± SD). Women were assessed for pelvic floor muscle functions with surface electromyography (EMG) using vaginal probes and using the Incontinence Impact Questionnaire (IIQ). Only women able to contract pelvic floor muscles and with good quality of life based on IIQ were included for the study. Seventy women in the experimental group took part in a supervised exercise program including high-low impact aerobics and pelvic floor muscle exercises three times a week. Twenty-seven controls did not receive any exercise intervention. After 6 weeks both groups were re-tested with EMG and IIQ. Post- and pre-exercise program changes in each group were analyzed using a repeated-measures ANOVA.

Results: Women in the experimental group improved the neuromuscular activity of the pelvic floor in some motor tasks without any adverse outcomes of the intervention. After the exercise program we observed in the experimental group significantly higher EMG amplitude in the pelvic floor muscles during 3-s contractions (p = 0.014). We also noticed a beneficial trend in the increase of neuromuscular activity during 10- and 60-s contractions, but the changes were not statistically significant. The exercising women substantially improved their abilities for relaxation following 3- and 10-s contractions (p = 0.013 and p < 0.001). In controls, we reported no statistically significant improvement in either of the motor tasks. All study participants maintained good quality of life related to urinary incontinence.

Conclusion: Prenatal exercise programs that include high- and low-impact aerobics and are supported by pelvic floor muscle exercises should be recommended for pregnant women, especially those who are accustomed to higher exercise intensity before pregnancy. Nevertheless, these recommendations can be directed to continent women who can properly contract pelvic floor muscles.

ISRCTN. DOI: 10.1186/ISRCTN92265528: “Pelvic floor muscle training with surface electromyography”, retrospectively registered on the 25th of July, 2016.

Acute Postexercise Change in Circulating Irisin Is Related to More Favorable Lipid Profile in Pregnant Women Attending a Structured Exercise Program and to Less Favorable Lipid Profile in Controls: An Experimental Study with Two Groups

INTRODUCTION

The blood irisin concentrations may be affected both by exercise and pregnancy. We aimed to determine acute responses in serum irisin after a single exercise session and relationships between exercise-induced changes in this hormone and lipid profile in pregnancy.

MATERIAL AND METHODS

It was an experimental study in 20 Caucasian women in normal pregnancy (age 30 ± 3 years, 28 ± 6 weeks of gestation; mean ± SD). Participants were assigned to training (n = 8) and control groups (n = 12). Before the experiment, women from the training group attended a structured exercise program 3 times a week for 6 weeks. Blood samples were collected before and 30 minutes after a single bout of 60-minute moderate- to high-intensity exercise to determine serum levels of irisin, insulin, glucose concentration, and lipid profile.

RESULTS

At baseline, we recorded slightly lower irisin levels in the training group compared to controls (12.2 ± 2.4 and 13.9 ± 3.3 ng · ml^-1, respectively). Only in the training group all women presented increase in irisin levels after exercise (on average by 14%); and this change was statistically significant (p = 0.002). In the controls, we found positive significant relationships between postexercise irisin change and low-density lipoproteins (R = 0.594; p = 0.04) and total cholesterol (R = 0.734; p = 0.006). Surprisingly, in the training group, these relationships were also significant but inverse (R = -0.738 and p = 0.036; R = -0.833 and p = 0.01, respectively).

CONCLUSIONS

Training and control pregnant women responded differently to a single exercise session, both in the postexercise change in irisin and its relationship to the blood lipids. Only in the training group we observed the postexercise increase in irisin, which was related to more favorable lipid profile. Systematic prenatal physical activity may optimize the postexercise irisin response and lipid metabolism regulated by this hormone. Therefore, exercise programs should be promoted in pregnant women and obstetric care providers.

Six-Week Pelvic Floor Muscle Activity (sEMG) Training in Pregnant Women as Prevention of Stress Urinary Incontinence

BACKGROUND Pelvic floor muscle exercises are a widely used and well-established form of stress incontinence treatment, with success rates varying from 21% to 84%, although with a better subjective than objective outcome. MATERIAL AND METHODS "Incontinence Impact Questionnaire" (IIQ), PFM EMG assessment was done at the beginning and after the 6-week training program. RESULTS Statistically significant differences appeared in the BASE and R values. In the symptomatic group (with SUI symptoms), the value of BASE was 3.26 µV, and after training it was 3.95 µV. The R values before and after training were 4.55 µV and 4.25 µV. In the symptomatic group (without SUI symptoms), the value of BASE was 2.88 µV and 3.52 µV and R values were 7.16 µV and 3.92 µV. In the control group, BASE was 3.05 µV and 4.11 µV and R was 7.82 µV and 4.39 µV. CONCLUSIONS The results indicate that a 6-week training process influences PFM EMG activity in pregnant women. During Q, the value of PFM activity after a training session tended to increase in the symptomatic and control groups, but in the symptomatic group it remains practically unchanged. Our results show the probable process of decreasing control of PFM activity during long-lasting contractions in symptomatic and control women. The comparison of BASE before and after training averaged the values of R after five 10-s contractions and showed an increase in the Base and decrease in the R.

Summary of Guidelines for Exercise in Pregnancy–are they Comprehensive Enough for Designing the Contents of a Prenatal Exercise Program?

Background:

Regular physical activity during pregnancy has a positive effect on the psychophysical condition of the pregnant woman, pregnancy and fetal development, parturition and the postpartum period. However, its level in pregnant women is insufficient in most countries. For an exercise program to be effective it must take into account four training components: intensity, frequency, duration and its content - through a proper selection of the type of exercises and their technique. In this work we aimed to answer the question what information on the contents of prenatal exercises is provided in the current guidelines for exercise during pregnancy in different countries.

Methods and Results:

We have analyzed 11 documents, that were the official position of national obstetrics, gynecology, or sports medicine institutions from 7 countries. The guidelines provide little information on the contents of prenatal exercise and on the adaptation of sports activities to pregnancy.

Conclusions:

The guidelines for exercise in pregnancy should be updated based on high-quality research and in collaboration with practitioners in the field of prenatal physical activity, which could increase the chances of their implementation. Trustworthy and comprehensive guidelines created on the basis of international and interdisciplinary initiatives should be disseminated among all interested in prenatal physical activity: pregnant women and their families, obstetrics care providers and exercise professionals to enable them an effective cooperation and to globally promote exercise in pregnancy.