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- Feasibility, clinical efficacy, and maternal outcomes of a remote exercise program in pregnant women with obesity: The GROB randomized control pilot studyPublication . Bernardo, Diana; Bobadilla-Agouborde, Carolina; Festas, Clarinda; Carvalho, Carlos; Abdalla, Pedro Pugliesi; Amezcua-Prieto, Carmen; Naia-Entonado, Zeltia; Mesquita, Cristina; Mota, Jorge; Santos, Paula ClaraObesity is common in women of reproductive age and increases the risk during pregnancy. Exercising during this period reduces health complications. Home e-health programs are effective in overcoming exercise barriers as pregnant women use technology and the internet for health information. Methods: A single-blind randomized controlled feasibility study with pregnant women with obesity (body mass index [BMI] ≥≥30 kg/m22) was conducted in the University Hospital Center of São João between January and April 2023. Pregnant women were randomized to a control group with standard care and to an experimental group with 8-week remote exercise program using a Phoenix® biofeedback device. Feasibility outcome measures were recruitment rate (≥≥35%), loss to follow-up (≤≤15%), and program fidelity (≥≥1 session/week). Secondary outcomes were evaluated through Pregnancy Physical Activity Questionnaire, Oswestry Index on Disability, and weight assessments at baseline and at the end of the program. Results: Of the 63 eligible participants, 24 (38.1%) were successfully randomized and completed the baseline assessment. Of these, 3 (4.8%) from experimental group did not perform the initial onboarding. The control group had 8.3% of follow-up losses and for the experimental group there were no follow-up losses. Program fidelity (mean ≥≥1 session/week) was fulfilled by 66.7% of successfully randomized participants. Regarding secondary outcomes assessed between baseline and the 8th week, experimental group compared to control group had higher levels of physical activity for sports activities, a lower level of inactivity, and lower disability rates caused by low back pain. Conclusions: Based on the recruitment rate, losses to follow-up, and fidelity rate, the GROB (obesity in pregnancy) study was deemed feasible and worthy of consideration for a larger study. Moreover, the GROB study has the potential to improve maternal outcomes by reducing sedentarism and disability caused by low back pain.
- The influence of pre-gestational body mass index and physical activity patterns on maternal, delivery and newborn outcomes in a sample of portuguese pregnant women: a retrospective cohort study.Publication . Bernardo, Diana; Carvalho, Carlos; Mota, Jorge; Ferreira, Margarida; Santos, Paula ClaraThere is a linear association between pregestational body mass index (BMI) and almost all adverse pregnancy outcomes. Pregnancy is “a window of opportunities” in terms of changing behavior and improving awareness of healthy living. The proper assessment of physical activity levels, during pregnancy, determines trends, health benefits, and their effects over time. This study aims to describe maternal physical activity levels, stratified by pregestational BMI, verify the accomplishment of physical activity recommendations in pregnant women, and correlate pregestational BMI and physical activity accomplishment with maternal, delivery, and neonatal parameters. A retrospective cohort study was carried out with 103 pregnant women. Physical activity levels were evaluated using a questionnaire and accelerometry. Pregestational BMI was obtained through the Quetelet formula and used the American College of Sports Medicine’s guidelines were used to determine physical activity accomplishment levels. Continuous data were presented as mean and standard deviation and categorical data as numbers and percentages. The F test was used to examine the differences between groups. Pregnant women in the sample spent 42.9% of their time on household activities, and for pregnant women with obesity, 91.5% of the time was spent on sedentary activities. Women with normative BMI had higher levels of moderate-intensity activities. Only 15.8% of participants with obesity reached the international recommendations for physical activity practice and women who accomplished physical activity recommendations gained less weight during pregnancy. A high percentage of pre-obesity and obese pregnant women exceeded the recommendations for gestational weight gain and the gestational diabetes prevalence was higher in the obesity group (p = 0.03 between groups). Regarding delivery and neonatal parameters (Apgar score 1st, Apgar score 5th, birth weight, length and head circumference), no statistical differences were found when adjusted to a gestational week at birth, between BMI (p = 0.58; p = 0.18; p = 0.60; p = 0.34; p = 0.34, respectively) or physical activity (p = 0.12; p = 0.15; p = 0.83; p = 0.70; p = 0.70, respectively) groups. Pregnant women with obesity, exhibit high levels of sedentary behavior, a high prevalence of gestational diabetes, and exceed recommended gestational weight gain. Healthcare professionals have a crucial role in promoting regular physical activity and lifestyle changes before and during pregnancy.
- Effects of physical activity on quality of life of pregnant women with overweight or obesity: A systematic reviewPublication . Bernardo, Diana; Sousa, Diana Rebelo; Ferreira, Ivo Henriques; Agouborde, Carolina Bobadilla; Soto-Rodriguez, Francisco; Santos, Paula ClaraThere is evidence that the quality of life and mental health of pregnant women change during pregnancy. To evaluate the impact of physical activity on the quality of life and mental health of pregnant women with obesity or overweight, a systematic review was performed using six electronic databases (PubMed, Cochrane (CENTRAL), ScienceDirect, Scielo, BVS and PEDro). In total, 205 articles were collected, and after screening in accordance with the PRISMA declaration, six randomized clinical trials were selected. Methodological quality was assessed using the Cochrane RoB2 tool and a narrative synthesis of the results was performed. Physical activity interventions did not demonstrate statistically significant results on the quality of life and mental health of pregnant women with obesity or overweight. The effects of physical activity during pregnancy for women with obesity or overweight are varied due to the diversity of interventions implemented. Nonetheless, a discernible positive association emerges between stringent adherence to the prescribed physical activity regimen and enhanced physical well-being, weight management, and heightened aerobic capacity. In order to ascertain more definitive conclusions, rigorous clinical trials are needed that take into account the heterogeneity of interventions and ensure adequate adherence to the protocol.
- Comparison of the portuguese version of the Pregnancy Physical Activity Questionnaire (PPAQ) with accelerometry for classifying physical activity among pregnant women with obesityPublication . Bernardo, Diana; Carvalho, Carlos; Leirós-Rodríguez, Raquel; Mota, Jorge; Santos, Paula ClaraIn recent years, the number of pregnant women with obesity has increased exponentially; thus, it is important to evaluate and characterize the physical activity levels of this specific group. The aim of this study is to evaluate the reliability and validity of the Portuguese version of the Physical Activity and Pregnancy Questionnaire and Pregnancy Questionnaire in pregnant women with obesity and to classify physical activity using the Physical Activity and Pregnancy Questionnaire and accelerometry. An analytical observational study was carried out between May and August of 2019 at the University Hospital Center of São João, with a sample of 31 pregnant women with obesity (30.9 ± 4.6 years 36.5 ± 4.6 kg/m2 of BMI and 21.5 ± 9 gestational weeks). The physical activity of participants was evaluated using an accelerometer and Physical Activity and Pregnancy Questionnaire at two time points (the first visit at the moment of consultation and the second seven days after, with accelerometer retest), the interclass correlation coefficient was used to test reliability between the Physical Activity and Pregnancy Questionnaire filled out at visit1 and the Physical Activity and Pregnancy Questionnaire filled out at visit2, and Pearson’s correlation was used to determine validity between the Physical Activity and Pregnancy Questionnaire and accelerometry. The interclass correlation coefficient values for total activity were 0.95, 0.97 for moderate and 0.58 for vigorous intensities. It ranged from 0.74 for sports/exercise to 0.96 for domestic activities. The Pearson’s correlations showed that the Physical Activity and Pregnancy Questionnaire is moderately valid for moderate intensity (r = 0.435). A total of 67.7% of the pregnant women complied with international physical activity recommendations.