Knowledge into action: proposing an evidence-based group prenatal exercise prescription

AIMS

In accordance with the American College of Obstetricians and Gynaecologists recommendations for exercise during pregnancy, this article provides an evidence-based prescription for a group-based prenatal exercise programme.

METHODS

This prescription has been tested in 21 randomized controlled trials. This short report outlines in detail the seven components included in each session (warm-up, aerobic training, resistance training, coordination and balance, pelvic floor training, cool-down, and final discussion).

RESULTS

Using the 26-item behaviour change taxonomy proposed by Abraham and Michie, we identified common techniques that are employed in each session to provide a rationale for the high-programme adherence.

CONCLUSIONS

This session model can be replicated to design prenatal exercise programmes with high adherence and that can be offered by trained exercise professionals.

¿CÓMO PREVENIR EL DOLOR DE HOMBRO EN BALONCESTO EN SILLA DE RUEDAS?

Las lesiones del hombro suponen un problema en el baloncesto en silla de ruedas (BSR). El objetivo de este estudio fue determinar la eficacia de un programa de ejercicio para el dolor del hombro en jugadoras de máximo nivel de BSR para tras 12 semanas de intervención a lo largo del proceso preparatorio de una competición internacional. Participaron 13 jugadoras de BSR de la Pre-Selección Española Femenina (edad 26.6 ±6.1 años), respondiendo a un cuestionario de DH antes y después del programa de ejercicio, evaluando también el rango de movimiento (RM) y aplicando pruebas funcionales. El DH se redujo significativamente después de la intervención (Z=-2.93, p?0.05, d=0.67), pero sin cambios significativos ni en las pruebas funcionales (p?0.05) ni en el RM (p?0.05). El programa de ejercicio resultó efectivo para la reducción del DH durante el proceso de preparación, lo que influyó de manera positiva en rendimiento deportivo de las jugadoras.

Does exercise during pregnancy impact on maternal weight gain and fetal cardiac function? A randomized controlled trial

OBJECTIVE

To evaluate the association between physical exercise during pregnancy and maternal gestational weight gain and fetal cardiac function.

METHODS

This was a randomized controlled trial of women with a singleton pregnancy managed from the first trimester at the Hospital de Torrejón, Madrid, between November 2014 and June 2015. Women were randomized to either follow a supervised physical conditioning program, consisting of a 60-min session 3 days per week for the duration of pregnancy, or not attend any exercise program (controls). The primary outcome was maternal weight gain during pregnancy. Secondary outcomes included fetal cardiac function parameters evaluated at 20, 28 and 36 weeks' gestation, Cesarean section, preterm delivery, induction of labor and birth weight. A sample size of 45 in each group was planned to detect differences in maternal weight gain of at least 1 kg, with a power of > 80% and α of 0.05.

RESULTS

During the study period, 120 women were randomized into the exercise (n = 75) and control (n = 45) groups. Following exclusions, the final cohort consisted of 42 women in the exercise group and 43 in the control group. Baseline characteristics (maternal age, prepregnancy body mass index, parity, conception by in-vitro fertilization, Caucasian ethnicity, physical exercise prior to pregnancy and smoker) were similar between the two groups. No differences were found between the groups in maternal weight at 20, 28, 36 and 38 weeks' gestation or in weight gain at 38 weeks. However, the proportion of women with weight loss ≥ 9 kg at 6 weeks postpartum was higher in the exercise compared with the control group (68.2% vs 42.8%; relative risk 1.593; P = 0.02). The ductus arteriosus pulsatility index (DA-PI) at 20 weeks (2.43 ± 0.40 vs 2.26 ± 0.33, P < 0.05) and the ejection fraction (EF) at 36 weeks (0.85 ± 0.13 vs 0.81 ± 0.11, P < 0.05) were higher in the exercise compared with the control group. All other evaluated fetal cardiac function parameters were similar between the two groups.

CONCLUSIONS

Performing exercise during pregnancy is not associated with a reduction in maternal weight gain but increases weight loss at 6 weeks postpartum. Physical exercise during pregnancy is associated with increased fetal DA-PI at 20 weeks and EF at 36 weeks, which could reflect adaptive mechanisms. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Abstract P1-10-10: An integrative intervention to change breast cancer patients' lifestyle: A medical challenge. A randomize controlled trial

Background. Physical exercise increases breast cancer (BC) patients' survival. However, only about two thirds of them follow the American Guidelines of Exercise to cancer survivors. The aim of this study was to examine the effect of an exercise intervention in breast cancer patients' lifestyle.

Methods. A randomized clinical trial evaluated an intervention (EXE) vs. a control (CON) group in early stage BC patients who recently finished the chemo and radio (neo) adjuvant. Intervention consists on exercise group classes combining aerobic and resistance activities designed specially for the necessities of these patients. Intensity was increasing gradually and intervention was controlled by a qualified in oncologic exercise specialist. CON group maintained their lifestyle without changes. Leisure-time exercise levels (LTEL), quality of life (QoL), grip strength index (GSI), physical capacity (VO2max) and fatigue, were assessed at baseline and after 3 months in both groups. Women who had been participated in the intervention group were followed up after six months to know if lifestyle levels were maintained.

ANCOVA and Pearson Test were used to analyze the continuous variables of baseline and final data and ANOVA test was used to analyze the follow-up data. A 95% of CI was calculated and p &lt; 0.05 was determined as statistically significant.

Results 89 women, aged 49.06±8.75, completed the study, 44 in EXE group and 45 in CON group. Adherence rate was on average of 89%. Main results are presented in the Table.

Main ResultsMEASUREEXE GroupEXE GroupEXE GroupCON GroupCON Group BLFFUBLFQoL*+107.53±17.99112.88±17.74110.96±14.40104.94±17.65103.11±19.26LTEL*+18.73±20.5345.11±14.6134.56±19.5116.02±8.5215.04±4.75GSI*+2.07±1.082.60±0.832.48±0.582.03±0.722.12±0.69VO2max*+26.99±4.3532.58±4.9632.11±7.1027.73±4.8227.08±3.73Fatigue *+130.09±19.68135.94±18.20138.24±17.49124.83±24.66124.00±24.20BL=baseline; F= Final; FU= Follow-Up. *Significant differences between EXE and CON. + Significant differences between BL and FU.

There was a significant improvement in LTEL (p=0.0001) and in QoL (p=0.0001) comparing EXE vs. CON group. In addition, results showed a correlation between this two variables in EXE group (r=0.22; p=0.013). These significant improvements, as well as the mentioned correlation, were maintained in the 6-months follow-up assessment in EXE group.

Significant differences between groups were observed in GSI (p=0.004), and in VO2max levels (p=0.001). EXE group showed a significant improvement in fatigue levels compared with CON group (p=0.0001). All these significant improvements were maintained in the 6-months follow-up assessment in EXE group, as well as previous variables.

Conclusion. These results suggest that an exercise intervention increases LTEL correlated to a better QoL, improving patients' lifestyle that could be long lasting. These changes may ameliorate psychological and physical BC treatments side effects, such as fatigue, in patients with early breast cancer that has recently finished adjuvant treatments.

Citation Format: Casla S, López-Tarruella S, Jerez Y, Marquez-Rodas I, Barakat R, Martín M. An integrative intervention to change breast cancer patients' lifestyle: A medical challenge. A randomize controlled trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-10.

Re-laparotomy after caesarean deliveries: risk factors and how to avoid?

The aim of this study was to explore the risk factors for and how to avoid re-laparotomy after caesarean delivery and to present the experience of a university tertiary care referral hospital. The study comprised of 2,000 caesarean deliveries, among which re-laparotomy was needed in 18 patients (0.9). The study found that 16 of the 18 cases that needed re-laparotomy had previous caesarean sections (CS) and 9/18 had placenta praevia. The main indication for the procedure was internal haemorrhage (haemoperitoneum) (12/18, 66.6%). Significant haemoperitoneum of > 2 litres was reported in six cases (33.3%). Maternal mortality occurred in 3/18 (16.6%) patients. The uterus was preserved in most patients (15 patients, 83.3%). A total of 12 patients needed re-suturing of the uterine incision; 10 patients had bilateral uterine artery ligation; and four patients had bilateral internal iliac artery ligation. Uterine compression B-Lynch suturing was needed in five patients with uterine atony. Six patients (33.3%) were admitted to the intensive care unit (ICU) and were discharged well. Re-laparotomy after caesarean delivery has many risk factors leading to postoperative haemorrhage. Early signs, such as tachycardia and hypotension must be closely monitored to allow early intervention and to avoid morbidity and mortality related to late re-laparotomy.

Exercise During Pregnancy Attenuates Prenatal Depression

Recent studies have estimated the prevalence of depression during pregnancy to be between 10% and 30%, which is higher than that in the postpartum period. Pharmacological treatment during pregnancy is difficult because of the possible side effects of antidepressants on the mother and the fetus. The aim of this study was to examine whether a supervised exercise program (EP) reduces depressive symptoms in pregnant women. A randomized controlled trial was designed. One hundred eighty four healthy pregnant women from Fuenlabrada Hospital were included (31.37 ± 3.62 years). Women from the exercise group (EG) participated in a supervised EP consisting of three, 55- to 60-min sessions per week throughout pregnancy. The main outcome measure was the patients’ depression level assessed by means of the Center for Epidemiologic Studies Depression Scale (CES-D). A total of 167 pregnant women were analyzed; 90 were allocated to the EG and 77 to the control group (CG). Significant differences were found between groups at the end of the study in CES-D scores (EG: 7.67 ± 6.30 vs. CG: 11.34 ± 9.74, p = .005) and in percentages of pregnant women depressed (EG: n = 11/12.2% vs. CG: n = 19/24.7%, p = .04). Our results show that supervised physical exercise during pregnancy reduces the level of depression and its incidence in pregnant women.

Subfertility treatment in women with systemic lupus erythematosus

This study comprised of 65 infertile patients with systemic lupus erythematosus (SLE). The aim was to study causes and different modalities used for the management of subfertile patients with SLE. All patients were diagnosed to have SLE according to the standard criteria of diagnosis. All patients were scheduled to expectant treatment, ovulation induction and timed intercourse, intrauterine insemination (IUI), intracytoplasmic sperm injection (ICSI). Anovulation was in 20 patients (20%), due to PCOS in 10 cases and due to other causes in three patients. A total of 28 patients (43.1%) needed laparoscopy for their work-up of infertility. Male factor for infertility was present in nine couples (16.7%). Ovulation induction and timed intercourse was adopted for a maximum 6 cycles and IUI for 3 cycles. In vitro fertilisation (IVF)/ICSI was needed in five cases using standard long agonist protocol. Four cases were complicated by significant ovarian hyperstimulation syndrome after conventional ovarian stimulation and cycles were cancelled. Pregnancy occurred in 20 women. Ovarian stimulation for ovulation induction and IVF seems to be safe and successful in well selected women with non-complicated SLE.