Physical Activity and Self-Perception of Mental and Physical Quality of Life during Pregnancy: A Systematic Review and Meta-Analysis

Self-perception of health status (quality of life) is considered one of the best indicators of health and well-being. However, during pregnancy, it could be impacted not only by physiological and anatomical changes, but by poor lifestyle habits like high sedentary behaviour or bad nutrition. This study assesses the effects of physical activity RCT interventions during pregnancy on both mental and physical components of quality of life. A systematic review and two meta-analyses were performed (PROSPERO registration number: CRD42022370467). Of the 207 articles captured both in English and Spanish, seven articles were deemed eligible for inclusion. The two analyses performed found that physically active pregnant women had better scores of mental self-perception of quality of life (z = 2.08, p = 0.04; SMD = 0.34, 95% CI = 0.02, 0.67, I2 = 76%, Pheterogeneity = 0.0004) and in physical self-perceived health status (z = 2.19, p = 0.03; SMD = 0.33, 95% CI = 0.03, 0.63, I2 = 71%, Pheterogeneity = 0.002) compared to control group pregnant women. Physical activity interventions could potentially increase mental and physical self-perception of quality of life during pregnancy.

Children with Cardiomyopathy have Active Lifestyles Despite Reporting Disease-Specific Barriers to Physical Activity: A Mixed-Methods Study

Objectives: This exploratory mixed-methods study explored the barriers to physical activity, daily physical activity and submaximal exercise capacity among children with and at risk for cardiomyopathy and children with atrial septal defects.Methods: The study followed a convergent parallel mixed methodology design. Semi-structured interviews explored physical activity barriers. Seven-day accelerometry assessed moderate-to-vigorous physical activity, and an intermittent cardiopulmonary exercise test measured submaximal exercise capacity.Results: Twenty children, including 5 with cardiomyopathy (n=2 females, 14.2 ± 2.7 years old), 7 who were genotype-positive phenotype-negative for cardiomyopathy (n=5 females, 10.6 ± 3.3 years old) and 8 with atrial septal defects (n=4 females, 9.4 ± 3.8 years old) were recruited. Children with cardiomyopathy reported disease-specific physical activity barriers, while children who were genotype-positive phenotype-negative perceived barriers related to lack of time, parent support or activity motivation. The average daily moderate-to-vigorous physical activity was less than the recommended 60-minutes/day (n=20, mean 48.1 ± 18.0 minutes). Children with cardiomyopathy participated a median of 141.2 [interquartile range (IQR): 98.8) minutes of light-intensity physical activity and a median of 55.6 (IQR: 34.6) minutes of moderate-to-vigorous physical activity. The average submaximal exercise capacity was low (n=16, 25.2 ± 5.7 mL/kg/min). Estimated submaximal exercise capacity, including metabolic equivalent (4.5 ± 3.1 METs), respiratory exchange ratio (median = 1.0, IQR: 0.09) and ratings of perceived exertion (median = 7, IQR: 5) at peak exercise suggest that children with cardiomyopathy appear to have the exercise capacity to participate in low-to-moderate intensity activities.Conclusions: These novel data suggest that a diagnosis of cardiomyopathy may not preclude children from participating in a healthy, active lifestyle. However, they perceive disease-specific physical activity barriers and may require support to optimize their level of participation for optimal health.

Protocol of the Fit-For-Fertility study: a multicentre randomised controlled trial assessing a lifestyle programme targeting women with obesity and infertility

INTRODUCTION

Women with obesity are at a higher risk of infertility as well as gestational and neonatal complications. Lifestyle changes are universally recommended for women with obesity seeking fertility treatments, but such intervention has only been assessed in very few robust studies. This study's objectives are therefore to assess the clinical outcomes and cost-effectiveness of an interdisciplinary lifestyle intervention (the Fit-For-Fertility Programme; FFFP) targeting women with obesity and subfertility in a diverse population.

METHODS AND ANALYSIS

This pragmatic multicentre randomised controlled trial (RCT) will include 616 women with obesity (body mass index ≥30 kg/m² or ≥27 kg/m² with polycystic ovary syndrome or at-risk ethnicities) who are evaluated at a Canadian fertility clinic for subfertility. Women will be randomised either to (1) the FFFP (experimental arm) alone for 6 months, and then in combination with usual care for infertility if not pregnant; or (2) directly to usual fertility care (control arm). Women in the intervention group benefit from the programme up to 18 months or, if pregnant, up to 24 months or the end of the pregnancy (whichever comes first). Women from both groups are evaluated every 6 months for a maximum of 18 months. The primary outcome is live birth rate at 24 months. Secondary outcomes include fertility, pregnancy and neonatal outcomes; lifestyle and anthropometric measures; and cost-effectiveness. Qualitative data collected from focus groups of participants and professionals will also be analysed.

ETHICS AND DISSEMINATION

This research study has been approved by the Research Ethics Board (REB) of Centre intégré universtaire de santé et des services sociaux de l'Estrie-CHUS (research coordinating centre) on 10 December 2018 and has been or will be approved successively by each participating centres' REB. This pragmatic RCT will inform decision-makers on improving care trajectories and policies regarding fertility treatments for women with obesity and subfertility.

TRIAL REGISTRATION NUMBER

NCT03908099.

PROTOCOL VERSION

1.1, 13 April 2019.

Sports and Functional Training Improve a Subset of Obesity-Related Health Parameters in Adolescents: A Randomized Controlled Trial

To investigate the effects of two different modes of physical activity on body composition, physical fitness, cardiometabolic risk, and psychological responses in female adolescents participating in a multi-disciplinary program. The 12-week randomized intervention included 25-adolescents with overweight divided into two groups: sports practice-SPG and functional training-FTG. The SPG intervention was divided into three sports: basketball, handball, and futsal. SPG participants performed one sport 3-times/week, over the course of 1 month. The FTG performed concurrent exercises 3-times/week. This study was registered in Clinical Trials Registry Platform under number: RBR-45ywtg and registered in Local Ethics Committee number: 2,505.200/2018. The intensity of physical exercises-PE was matched between groups by the rating of perceived exertion. The primary outcome was body composition, and secondary outcomes were physical fitness, cardiometabolic risk, and psychological responses. There was a significant time-effect for body mass, body mass index, and low-density lipoprotein (LDL-c), all being reduced. There were increases over time for musculoskeletal mass, aerobic fitness, and high-density lipoprotein (HDL-c) (p < 0.05). There was a group time interaction with body fat percentage being lower post-intervention in the SPG (p < 0.05). No significant differences were observed for the other variables. Both physical activity models were effective in improving a subset of obesity-related health parameters. The findings should be extended by further investigation using more sophisticated measures of energy expenditure. Clinical Trial Registration: https://ensaiosclinicos.gov.br/, identifier: RBR-45ywtg.

Health trajectories of children with severe obesity attending a weight management program

Purpose

The objective of the present study is to examine physical and mental health trajectories of change in youth with severe obesity attending a tertiary care weight management program. It was predicted that younger children would show favourable changes in body mass index (BMI), markers of cardiovascular health, quality of life, and mental health.

Methods

This 2-year longitudinal study examined health trajectories of children referred to a weight management program at a Canadian paediatric tertiary care centre from November 2010 to December 2013. Participants were 209 of 217 consecutive referred paediatric patients (families) aged 3 to 17 years who met criteria for severe obesity and consented to participate. To maximize generalizability of results, there were no exclusion criteria. Primary outcomes were children's quality of life and BMI. Secondary outcomes included anxiety, depression, and non-high-density lipoprotein cholesterol levels.

Results

The findings suggest an improvement in mental health, quality of life, and cardiometabolic health of children and adolescents of all ages over the 2 years of programming. These positive findings were consistent across gender, age, and distance to the program. BMI trajectory changes varied across age cohorts such that younger children showed more favourable outcomes. The retention rate over the 2 years was high at 82.9%.

Conclusions

This is the first study to show improvements in both physical and mental health outcomes beyond 1 year in a tertiary care setting with a high-risk population of children and youth with severe obesity. Findings highlight the need to examine both mental and physical health outcomes beyond 1 year.

Associations of Parenthood with Physical Activity, Sedentary Behavior, and Sleep

OBJECTIVE

We examined the associations of the presence, number, and the age of children living in the household with adult physical activity, sedentary behavior (sitting and screen time), and sleep behaviors in a large representative sample.

METHODS

Participants were 8312 adults aged 20-65 from the 2011-2014 cycles of the National Health and Nutrition Examination Survey (NHANES). Presence (yes/no), the number of children (none, 1, ≥2), the age of the youngest child (none, ≤5 years, 6-17 years) as well as leisure time physical activity, sitting, screen time, and sleep benchmarks were derived from the home interview.

RESULTS

Compared to women with no children in the household, women who reported the presence of a child living in the household were significantly less likely to meet optimal physical activity (OR = 0.69; 95% CI:0.56-0.84) and sleep (OR = 0.73; 95% CI:0.60-0.87) benchmarks, and significantly more likely to meet optimal sitting (OR = 2.08; 95% CI:1.68-2.58) and screen time (OR = 2.42; 95% CI:1.93-3.02) benchmarks. Findings were similar in men for sitting and screen time, however effect sizes were smaller. Findings were mainly consistent regardless of the number of children and the age of the youngest child in the household.

CONCLUSION

Integrated approaches that promote healthy 24-hour behavioral patterns among parents, especially mothers, should be considered.

A role for maternally derived myokines to optimize placental function and fetal growth across gestation

Exercise during pregnancy is associated with improved health outcomes for both mother and baby, including a reduced risk of future obesity and susceptibility to chronic diseases. Overwhelming evidence demonstrates a protective effect of maternal exercise against fetal birth weight extremes, reducing the rates of both large- and small-for-gestational-age infants. It is speculated that this protective effect is mediated in part through exercise-induced regulation of maternal physiology and placental development and function. However, the specific mechanisms through which maternal exercise regulates these changes remain to be discovered. We hypothesize that myokines, a collection of peptides and cytokines secreted from contracting skeletal muscles during exercise, may be an important missing link in the story. Myokines are known to reduce inflammation, improve metabolism and enhance macronutrient transporter expression and activity in various tissues of nonpregnant individuals. Little research to date has focused on the specific roles of the myokine secretome in the context of pregnancy; however, it is likely that myokines secreted from exercising skeletal muscles may modulate the maternal milieu and directly impact the vital organ of pregnancy—the placenta. In the current review, data in strong support of this potential role of myokines will be presented, suggesting myokine secretion as a key mechanism through which maternal exercise optimizes fetal growth trajectories. It is clear that further research is warranted in this area, as knowledge of the biological roles of myokines in the context of pregnancy would better inform clinical recommendations for exercise during pregnancy and contribute to the development of important therapeutic interventions.

Development and Preliminary Validation of a Comprehensive Questionnaire to Assess Women's Knowledge and Perception of the Current Weight Gain Guidelines during Pregnancy

The aim of this study was to develop and validate an electronic questionnaire, the Electronic Maternal Health Survey (EMat Health Survey), related to women's knowledge and perceptions of the current gestational weight gain guidelines (GWG), as well as pregnancy-related health behaviours. Constructs addressed within the questionnaire include self-efficacy, locus of control, perceived barriers, and facilitators of physical activity and diet, outcome expectations, social environment and health practices. Content validity was examined using an expert panel (n = 7) and pilot testing items in a small sample (n = 5) of pregnant women and recent mothers (target population). Test re-test reliability was assessed among a sample (n = 71) of the target population. Reliability scores were calculated for all constructs (r and intra-class correlation coefficients (ICC)), those with a score of >0.5 were considered acceptable. The content validity of the questionnaire reflects the degree to which all relevant components of excessive GWG risk in women are included. Strong test-retest reliability was found in the current study, indicating that responses to the questionnaire were reliable in this population. The EMat Health Survey adds to the growing body of literature on maternal health and gestational weight gain by providing the first comprehensive questionnaire that can be self-administered and remotely accessed. The questionnaire can be completed in 15-25 min and collects useful data on various social determinants of health and GWG as well as associated health behaviours. This online tool may assist researchers by providing them with a platform to collect useful information in developing and tailoring interventions to better support women in achieving recommended weight gain targets in pregnancy.

Acyl-CoA synthetase long-chain 5 genotype is associated with body composition changes in response to lifestyle interventions in postmenopausal women with overweight and obesity: a genetic association study on cohorts Montréal-Ottawa New Emerging Team, and Complications Associated with Obesity

BACKGROUND

Genetic studies on Acyl-CoA Synthetase Long-Chain 5 (ACSL5) demonstrate an association between rs2419621 genotype and rate of weight loss in women with obesity in response to caloric restriction. Our objectives were to (1) confirm results in two different populations of women with overweight and obesity (2) study rs2419621's influence on body composition parameters of women with overweight and obesity following lifestyle interventions.

METHODS

rs2419621 genotype was determined in women with overweight and obesity who participated in the Montréal-Ottawa New Emerging Team (MONET n = 137) and Complications Associated with Obesity (CAO n = 37) studies. Genotyping was done using TaqMan MGB probe-based assay. Multiple linear regression analyses were used to test for associations.

RESULTS

When studying women with overweight and obesity, rs2419621 [T] allele carriers had a significantly greater decrease in visceral fat, absolute and percent fat mass and a greater increase in percent lean mass in response to lifestyle intervention in comparison to non-carriers. Studying only individuals with obesity showed similar results with rs2419621 [T] allele carriers also displaying a significantly greater decrease in body mass index following the lifestyle intervention in comparison to non-carriers.

CONCLUSION

Women with overweight and obesity carrying the ACSL5 rs2419621 [T] allele are more responsive to lifestyle interventions in comparison to non-carriers. Conducting such genetic association studies can aid in individualized treatments/interventions catered towards an individual's genotype.

Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond

OBJECTIVES

To provide health care professionals in Canada with the basic knowledge and tools to provide nutrition guidance to women through their lifecycle.

OUTCOMES

Optimal nutrition through the female lifecycle was evaluated, with specific focus on adolescence, pre-conception, pregnancy, postpartum, menopause, and beyond. The guideline begins with an overview of guidance for all women, followed by chapters that examine the evidence and provide recommendations for the promotion of healthy nutrition and body weight at each life stage. Nutrients of special concern and other considerations unique to each life stage are discussed in each chapter.

EVIDENCE

Published literature, governmental and health agency reports, clinical practice guidelines, grey literature, and textbook sources were used in supporting the recommendations made in this document.

VALUES

The quality of evidence was rated using the criteria described in the report of the Canadian Task Force on Preventive Health Care. CHAPTER 2: GENERAL FEMALE NUTRITION: Summary Statements Recommendations CHAPTER 3: ADOLESCENCE NUTRITION: Summary Statements Recommendations CHAPTER 4: PRE-CONCEPTUAL NUTRITION: Summary Statement Recommendations CHAPTER 5: NUTRITION IN PREGNANCY: Summary Statements Recommendations CHAPTER 6: POSTPARTUM NUTRITION AND LACTATION: Summary Statements Recommendations CHAPTER 7: NUTRITION DURING MENOPAUSE AND BEYOND: Summary Statement Recommendations.

Middle-aged women's decisions about body weight management: needs assessment and testing of a knowledge translation tool

OBJECTIVE

This study aims to assess middle-aged women's needs when making body weight management decisions and to evaluate a knowledge translation tool for addressing their needs.

METHODS

A mixed-methods study used an interview-guided theory-based survey of professional women aged 40 to 65 years. The tool summarized evidence to address their needs and enabled women to monitor actions taken. Acceptability and usability were reported descriptively.

RESULTS

Sixty female participants had a mean body mass index of 28.0 kg/m(2) (range, 17.0-44.9 kg/m(2)), and half were premenopausal. Common options for losing (82%) or maintaining (18%) weight included increasing physical activity (60%), eating healthier (57%), and getting support (40%). Decision-making involved getting information on options (52%), soliciting others' decisions/advice (20%), and being self-motivated (20%). Preferred information sources included written information (97%), counseling (90%), and social networking websites (43%). Five professionals (dietitian, personal trainer, occupational therapist, and two physicians) had similar responses. Of 53 women sent the tool, 27 provided acceptability feedback. They rated it as good to excellent for information on menopause (96%), body weight changes (85%), and managing body weight (85%). Most would tell others about it (81%). After 4 weeks of use, 25 women reported that the wording made sense (96%) and that the tool had clear instructions (92%) and was easy to use across time (88%). The amount of information was rated as just right (64%), but the tool had limited space for responding (72%).

CONCLUSIONS

When making decisions about body weight management, women's needs were "getting information" and "getting support." The knowledge translation tool was acceptable and usable, but further evaluation is required.

Gaming, Adiposity, and Obesogenic Behaviors Among Children

Videogames in general have been maligned for causing obesity because of their inherent sedentariness, whereas exergames have been both maligned for requiring low levels of activity and extolled for requiring physical activity to move game play along. The intensity and duration of physical activity resulting from exergame play have shown varying results, and they have been explored for use in obesity treatment and prevention, primarily among children. Other videogames have been developed and tested to help children change their diet and physical activity practices with various outcomes. As a field of inquiry, we are in the earliest stages of understanding how, or under what circumstances, videogames can influence all these behavioral and health outcomes. To deal with these complexities, we have assembled a group of investigators who have made important, but diverse, contributions to this research agenda and asked them to address five key child obesity-related issues in a Roundtable format. Brief biosketches are presented at the end of this article.

Functional characterization of a promoter polymorphism that drives ACSL5 gene expression in skeletal muscle and associates with diet-induced weight loss

Diet-induced weight loss is affected by a wide range of factors, including genetic variation. Identifying functional polymorphisms will help to elucidate mechanisms that account for variation in dietary metabolism. Previously, we reported a strong association between a common single nucleotide polymorphism (SNP) rs2419621 (C>T) in the promoter of acyl-CoA synthetase long chain 5 (ACSL5), rapid weight loss in obese Caucasian females, and elevated ACSL5 mRNA levels in skeletal muscle biopsies. Here, we showed by electrophoretic mobility shift assay (EMSA) that the T allele creates a functional cis-regulatory E-box element (CANNTG) that is recognized by the myogenic regulatory factor MyoD. The T allele promoted MyoD-dependent activation of a 1089-base pair ACSL5 promoter fragment in nonmuscle CV1 cells. Differentiation of skeletal myoblasts significantly elevated expression of the ACSL5 promoter. The T allele sustained promoter activity 48 h after differentiation, whereas the C allele showed a significant decline. These results reveal a mechanism for elevated transcription of ACSL5 in skeletal muscle of carriers of the rs2419621(T) allele, associated with more rapid diet-induced weight loss. Natural selection favoring promoter polymorphisms that reduced expression of catabolic genes in skeletal muscle likely accounts for the resistance of obese individuals to dietary intervention.

Effects of breastfeeding on weight changes in family-based pediatric obesity treatment

Research indicates that breastfeeding may provide protective effects against the development of obesity; however, breastfed children may still become obese because of the obesogenic environment. This study is designed to examine the effects of retrospective recall of breastfeeding on weight changes in children participating in a 6-month behavioral treatment program for childhood obesity. The independent variable of breastfeeding was defined as children who were exclusively breastfed for 4 weeks (excluding water or medication) versus those who were never breastfed. Child percent overweight and body mass index changes during 6 and 12 months were evaluated for 94 families based on mother report of breastfeeding status using analysis of covariance, controlling for socioeconomic status and initial child weight status. Data were compiled for secondary analysis from pediatric obesity randomized controlled outcome studies evaluating core components of family-based treatments. Results showed that, compared with nonbreastfed (formula) children (n = 28), breastfed children (n = 66) showed significantly larger reductions in (mean +/- SEM) percent overweight at 6 months (-15.2 +/- 1.1 vs -10.2 +/- 1.7, p <.05) and 1 year (-10.3 +/- 1.3 vs -5.9 +/- 1.8, p <.05). Similarly, breastfed children showed greater reductions in body mass index at 6 months (-2.1 +/- 0.19 vs -1.1 +/- 0.28) and 1 year (-0.8 +/- 0.23 vs +0.1 +/- 0.32). Findings suggest the beneficial effects of breastfeeding may extend beyond obesity prevention to include improved outcome in family-based pediatric obesity treatment. Potential mechanisms relating breastfeeding, obesity prevention, and enhanced outcome in pediatric obesity treatment are discussed.

Sex differences in cardiac rehabilitation

OBJECTIVE

To determine and compare the baseline characteristics and outcomes between men and women in a Canadian cardiac rehabilitation program.

DESIGN

Nonrandomized, retrospective, observational study with a before and after research design.

SETTING

The Prevention and Rehabilitation Centre at the University of Ottawa Heart Institute, Ottawa, Ontario, a tertiary cardiac care centre.

PATIENTS

Three hundred and eighty-seven patients, 82% male aged 59+/-10 years and 18% female aged 61+/-4 years, who were enrolled in the on-site cardiac rehabilitation program between November 1, 1995 and April 1, 1997.

INTERVENTION

A three-month, multifactorial cardiac rehabilitation program that incorporates exercise training, risk factor modification, education and psychosocial support.

MAIN RESULTS

Fewer than 20% of all rehabilitation participants (n=70; 18%) were women; most participants were under 65 years of age. More women than men had a primary diagnosis of myocardial infarction (42% versus 28%, respectively), whereas men were more likely than women to have had coronary artery bypass grafting (45% versus 23%, respectively). Men and women had similar mean baseline measures of body mass index, blood pressure and glucose levels, whereas women had significantly higher mean baseline measures of total cholesterol (5.6 mmol/L versus 5.0 mmol/L for men, P 0.001), low density lipoprotein (LDL) cholesterol (3.4 mmol/L versus 3.1 mmol/L, P=0. 012) and high density lipoprotein (HDL) cholesterol (1.2 mmol/L versus 1.0 mmol/L, P 0.001). Baseline LDL to HDL ratios were 3.3 for men and 3.0 for women (not significant), and total cholesterol to HDL ratios were 5.4 and 4.9 for men and women, respectively. Men had a higher exercise capacity than women coming into the program (metabolic equivalent [METs] 6.6 versus 4.9, respectively, P 0.001), had a higher baseline activity level (1114 kcal/week versus 617 kcal/week, P=0.001) and scored higher than women in all health-related quality of life scores. After the program, there were no significant sex differences in improvement in MET level, physical activity or risk factor profile. Although men exercised more than women (increase of 557 kcal/week versus 343 kcal/week, respectively), this was not statistically significant. In health-related quality of life scores, both men and women improved in all scores, although women reported less increase than men in their level of overall vitality (P=0.016).

CONCLUSION

Women are the minority of cardiac rehabilitation patients, although they appear to benefit equally well from the program.

Muscle glycogen accumulation after a marathon: roles of fiber type and pro- and macroglycogen

Muscle glycogen remains subnormal several days after muscle damaging exercise. The aims of this study were to investigate how muscle acid-soluble macroglycogen (MG) and acid-insoluble proglycogen (PG) pools are restored after a competitive marathon and also to determine whether glycogen accumulates differently in the various muscle fiber types. Six well-trained marathon runners participated in the study, and muscle biopsies were obtained from the vastus lateralis of the quadriceps muscle before, immediately after, and 1, 2, and 7 days (days 1, 2, and 7, respectively) after the marathon. During the race, 56 +/- 3.8% of muscle glycogen was utilized, and a greater fraction of MG (72 +/- 3.7%) was utilized compared with PG (34 +/- 6.5%). On day 2, muscle glycogen and MG values remained lower than prerace values, despite a carbohydrate-rich diet, but they had both returned to prerace levels on day 7. The PG concentration was lower on day 1 compared with before the race, whereas there were no significant differences between the prerace PG concentration and the concentrations on days 2 and 7. On day 2 the glycogen concentration was particularly low in the type I fibers, indicating that local processes are important for the accumulation pattern. We conclude that a greater fraction of human muscle MG than of PG is utilized during a marathon and that accumulation of MG is particularly delayed after the prolonged exercise bout. Furthermore, factors produced locally appear important for the glycogen accumulation pattern.