A 12-Week Exercise Program for Pregnant Women with Obesity to Improve Physical Activity Levels: An Open Randomised Preliminary Study

Michèle Bisson, Natalie Alméras, Sébastien S Dufresne, Julie Robitaille, Caroline Rhéaume, Emmanuel Bujold, Jérôme Frenette, Angelo Tremblay, Isabelle Marc, Michèle Bisson, Natalie Alméras, Sébastien S Dufresne, Julie Robitaille, Caroline Rhéaume, Emmanuel Bujold, Jérôme Frenette, Angelo Tremblay, Isabelle Marc

Abstract

Objective: To evaluate whether a 12-week supervised exercise program promotes an active lifestyle throughout pregnancy in pregnant women with obesity.

Methods: In this preliminary randomised trial, pregnant women (body mass index ≥ 30 kg/m2) were allocated to either standard care or supervised training, from 15 to 27 weeks of gestation. Physical activity was measured by accelerometry at 14, 28 and 36 weeks, while fitness (oxygen consumption (VO2) at the anaerobic threshold), nutrition (caloric intake and macronutrients percentage) and anthropometry were assessed at 14 and 28 weeks of gestation. Analyses were performed using repeated measures ANOVA.

Results: A total of fifty (50) women were randomised, 25 in each group. There was no time-group interaction for time spent at moderate and vigorous activity (pinteraction = 0.064), but the exercise group's levels were higher than controls' at all times (pgroup effect = 0.014). A significant time-group interaction was found for daily physical activity (p = 0.023); similar at baseline ((22.0 ± 6.7 vs 21.8 ± 7.3) x 10(4) counts/day) the exercise group had higher levels than the control group following the intervention ((22.8 ± 8.3 vs 19.2 ± 4.5) x 10(4) counts/day, p = 0.020) and at 36 weeks of gestation ((19.2 ± 1.5 vs 14.9 ± 1.5) x 10(4) counts/day, p = 0.034). Exercisers also gained less weight than controls during the intervention period despite similar nutritional intakes (difference in weight change = -0.1 kg/week, 95% CI -0.2; -0.02, p = 0.016) and improved cardiorespiratory fitness (difference in fitness change = 8.1%, 95% CI 0.7; 9.5, p = 0.041).

Conclusions: Compared with standard care, a supervised exercise program allows pregnant women with obesity to maintain fitness, limit weight gain and attenuate the decrease in physical activity levels observed in late pregnancy.

Trial registration: ClinicalTrials.gov NCT01610323.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flowchart.
Fig 1. Flowchart.
*One participant withdrew after randomization (lack of time); †Two participants withdrew after randomization (unsatisfied with group allocation).
Fig 2. Objectively measured physical activity levels…
Fig 2. Objectively measured physical activity levels throughout pregnancy.
Black lozenge: exercise group. White square: control group. Fig 2a. Daily time spent at moderate and vigorous physical activity in bouts of at least 10 min; Fig 2b. Total activity per day, expressed as the daily number of accelerometry counts; Fig 2c. Number of steps per day. P-value is for time-group interaction significance; * Indicates a significant difference (p

Fig 3. Self-reported physical activity and rate…

Fig 3. Self-reported physical activity and rate of weekly weight gain throughout pregnancy.

Black section:…

Fig 3. Self-reported physical activity and rate of weekly weight gain throughout pregnancy.
Black section: exercise group. White section: control group. Fig 3a. Energy expenditure spent at sports and exercise in the previous month, from the PPAQ; Fig 3b. Energy expenditure spent at vigorous intensity activity in the past month, from the PPAQ; Fig 3c. Rate of weekly gestational weight gain, in kg. P-value is for time-group interaction significance; * Indicates a significant difference (p
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References
    1. Kramer MS, McDonald SW. Aerobic exercise for women during pregnancy. Cochrane Database Syst Rev. 2006;19(3):CD000180. - PMC - PubMed
    1. Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Duda W, Borowiack E, et al. Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health Technol Assess. 2012;16(31):iii–iv, 1–191. 10.3310/hta16310 - DOI - PMC - PubMed
    1. Aune D, Saugstad OD, Henriksen T, Tonstad S. Physical activity and the risk of preeclampsia: a systematic review and meta-analysis. Epidemiology. 2014;25(3):331–43. 10.1097/EDE.0000000000000036 - DOI - PubMed
    1. Renault K, Norgaard K, Secher NJ, Andreasen KR, Baldur-Felskov B, Nilas L. Physical activity during pregnancy in normal-weight and obese women: compliance using pedometer assessment. J Obstet Gynaecol. 2012;32(5):430–3. 10.3109/01443615.2012.668580 - DOI - PubMed
    1. Bisson M, Almeras N, Plaisance J, Rheaume C, Bujold E, Tremblay A, et al. Maternal fitness at the onset of the second trimester of pregnancy: correlates and relationship with infant birth weight. Pediatr Obes. 2013;8(6):464–74. 10.1111/j.2047-6310.2012.00129.x - DOI - PubMed
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Fig 3. Self-reported physical activity and rate…
Fig 3. Self-reported physical activity and rate of weekly weight gain throughout pregnancy.
Black section: exercise group. White section: control group. Fig 3a. Energy expenditure spent at sports and exercise in the previous month, from the PPAQ; Fig 3b. Energy expenditure spent at vigorous intensity activity in the past month, from the PPAQ; Fig 3c. Rate of weekly gestational weight gain, in kg. P-value is for time-group interaction significance; * Indicates a significant difference (p

References

    1. Kramer MS, McDonald SW. Aerobic exercise for women during pregnancy. Cochrane Database Syst Rev. 2006;19(3):CD000180.
    1. Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Duda W, Borowiack E, et al. Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health Technol Assess. 2012;16(31):iii–iv, 1–191. 10.3310/hta16310
    1. Aune D, Saugstad OD, Henriksen T, Tonstad S. Physical activity and the risk of preeclampsia: a systematic review and meta-analysis. Epidemiology. 2014;25(3):331–43. 10.1097/EDE.0000000000000036
    1. Renault K, Norgaard K, Secher NJ, Andreasen KR, Baldur-Felskov B, Nilas L. Physical activity during pregnancy in normal-weight and obese women: compliance using pedometer assessment. J Obstet Gynaecol. 2012;32(5):430–3. 10.3109/01443615.2012.668580
    1. Bisson M, Almeras N, Plaisance J, Rheaume C, Bujold E, Tremblay A, et al. Maternal fitness at the onset of the second trimester of pregnancy: correlates and relationship with infant birth weight. Pediatr Obes. 2013;8(6):464–74. 10.1111/j.2047-6310.2012.00129.x
    1. Holowko N, Mishra G, Koupil I. Social inequality in excessive gestational weight gain. Int J Obes (Lond). 2014;38(1):91–6.
    1. Oostdam N, van Poppel MNM, Wouters M, Eekhoff EMW, Bekedam DJ, Kuchenbecker WKH, et al. No effect of the FitFor2 exercise programme on blood glucose, insulin sensitivity, and birthweight in pregnant women who were overweight and at risk for gestational diabetes: results of a randomised controlled trial. Bjog-an International Journal of Obstetrics and Gynaecology. 2012;119(9):1098–107. 10.1111/j.1471-0528.2012.03366.x
    1. Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jorgensen JS. The LiP (Lifestyle in Pregnancy) Study A randomized controlled trial of lifestyle intervention in 360 obese pregnant women. Diabetes Care. 2011;34(12):2502–7. 10.2337/dc11-1150
    1. Mottola MF. Exercise prescription for overweight and obese women: pregnancy and postpartum. Obstet Gynecol Clin North Am. 2009;36(2):301–16, viii 10.1016/j.ogc.2009.03.005
    1. Exercise Prescription for Healthy Populations and Special Considerations: Pregnancy In: Thompson WR, Gordon NF, Pescatello LS, editors. ACSM's Guidelines for Exercise Testing and Prescription, 8th edition Philadelphia: Lippincott, Williams & Wilkins; 2010. p. 183–7.
    1. Richards J, Hillsdon M, Thorogood M, Foster C. Face-to-face interventions for promoting physical activity. Cochrane Database Syst Rev. 2013;9:CD010392 10.1002/14651858.CD010392.pub2
    1. PARmed-X. PARmed-X for pregancy, Physical activity readiness medical examination. 2002; Available: .
    1. Wilson RC, Jones PW. A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise. Clin Sci (Lond). 1989;76(3):277–82.
    1. Kino-Québec. Active pour la vie: L'activité physique pendant et après la grossesse. In: Québec Gd, editor.: Ministère de l'Éducation, du Loisir et du Sport; 2012.
    1. US. Physical Activity Guidelines for Americans. Washington, DC: US Department of Health and Human Services; 2008. p. 76.
    1. Matthew CE. Calibration of accelerometer output for adults. Med Sci Sports Exerc. 2005;37(11 Suppl):S512–22.
    1. Chandonnet N, Saey D, Almeras N, Marc I. French Pregnancy Physical Activity Questionnaire compared with an accelerometer cut point to classify physical activity among pregnant obese women. PLoS One. 2012;7(6):e38818 10.1371/journal.pone.0038818
    1. Matthews CE, Chen KY, Freedson PS, Buchowski MS, Beech BM, Pate RR, et al. Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol. 2008;167(7):875–81. 10.1093/aje/kwm390
    1. Evenson KR, Terry JW Jr. Assessment of differing definitions of accelerometer nonwear time. Res Q Exerc Sport. 2009;80(2):355–62.
    1. Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, Freedson PS. Development and validation of a Pregnancy Physical Activity Questionnaire. Med Sci Sports Exerc. 2004;36(10):1750–60.
    1. Bell R, Tennant PW, McParlin C, Pearce MS, Adamson AJ, Rankin J, et al. Measuring physical activity in pregnancy: a comparison of accelerometry and self-completion questionnaires in overweight and obese women. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):90–5. 10.1016/j.ejogrb.2013.05.018
    1. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9 Suppl):S498–504.
    1. Jackson AS, Pollock ML, Ward A. Generalized equations for predicting body density of women. Med Sci Sports Exerc. 1980;12(3):175–81.
    1. Bisson M, Rheaume C, Bujold E, Tremblay A, Marc I. Modulation of blood pressure response to exercise by physical activity and relationship with resting blood pressure during pregnancy. J Hypertens. 2014;32(7):1450–7. 10.1097/HJH.0000000000000185
    1. Kaminsky LA, Whaley MH. Evaluation of a new standardized ramp protocol: the BSU/Bruce Ramp protocol. J Cardiopulm Rehabil. 1998;18(6):438–44.
    1. Wasserman K, Stringer WW, Casaburi R, Koike A, Cooper CB. Determination of the anaerobic threshold by gas exchange: biochemical considerations, methodology and physiological effects. Zeitschrift fur Kardiologie. 1994;83 Suppl 3:1–12.
    1. Bohannon RW. Dynamometer measurements of hand-grip strength predict multiple outcomes. Percept Mot Skills. 2001;93(2):323–8.
    1. Harbo T, Brincks J, Andersen H. Maximal isokinetic and isometric muscle strength of major muscle groups related to age, body mass, height, and sex in 178 healthy subjects. Eur J Appl Physiol. 2012;112(1):267–75. 10.1007/s00421-011-1975-3
    1. Danneskiold-Samsoe B, Bartels EM, Bulow PM, Lund H, Stockmarr A, Holm CC, et al. Isokinetic and isometric muscle strength in a healthy population with special reference to age and gender. Acta Physiol (Oxf). 2009;197 Suppl 673:1–68.
    1. Goulet J, Nadeau G, Lapointe A, Lamarche B, Lemieux S. Validity and reproducibility of an interviewer-administered food frequency questionnaire for healthy French-Canadian men and women. Nutr J. 2004;3:13
    1. Catalano PM, Thomas AJ, Avallone DA, Amini SB. Anthropometric estimation of neonatal body-composition. American Journal of Obstetrics and Gynecology. 1995;173(4):1176–81.
    1. Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M, et al. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics. 2001;108(2):E35
    1. ACOG. ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;77(1):79–81.
    1. Choi J, Fukuoka Y, Lee JH. The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and meta-analysis of randomized controlled trials. Prev Med. 2013;56(6):351–64. 10.1016/j.ypmed.2013.02.021
    1. Sanabria-Martinez G, Garcia-Hermoso A, Poyatos-Leon R, Alvarez-Bueno C, Sanchez-Lopez M, Martinez-Vizcaino V. Effectiveness of physical activity interventions on preventing gestational diabetes mellitus and excessive maternal weight gain: a meta-analysis. BJOG. 2015.
    1. Wiebe HW, Boule NG, Chari R, Davenport MH. The effect of supervised prenatal exercise on fetal growth: a meta-analysis. Obstet Gynecol. 2015;125(5):1185–94. 10.1097/AOG.0000000000000801
    1. Bessinger RC, McMurray RG, Hackney AC. Substrate utilization and hormonal responses to moderate intensity exercise during pregnancy and after delivery. Am J Obstet Gynecol. 2002;186(4):757–64.
    1. Hawkins M, Braun B, Marcus BH, Stanek E 3rd, Markenson G, Chasan-Taber L. The impact of an exercise intervention on C—reactive protein during pregnancy: a randomized controlled trial. BMC Pregnancy Childbirth. 2015;15:139 10.1186/s12884-015-0576-2
    1. van Poppel MN, Peinhaupt M, Eekhoff ME, Heinemann A, Oostdam N, Wouters MG, et al. Physical activity in overweight and obese pregnant women is associated with higher levels of proinflammatory cytokines and with reduced insulin response through interleukin-6. Diabetes Care. 2014;37(4):1132–9. 10.2337/dc13-2140
    1. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59. 10.1249/MSS.0b013e318213fefb
    1. Halse RE, Wallman KE, Newnham JP, Guelfi KJ. Home-based exercise training improves capillary glucose profile in women with gestational diabetes. Med Sci Sports Exerc. 2014;46(9):1702–9. 10.1249/MSS.0000000000000302
    1. Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012;344:e2088 10.1136/bmj.e2088
    1. Weight Gain During Pregnancy: Reexamining the Guidelines. Rasmussen KM, Yaktine AL, editors. Washington (DC): Institute of Medicine and National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines; 2009.
    1. Santos IA, Stein R, Fuchs SC, Duncan BB, Ribeiro JP, Kroeff LR, et al. Aerobic exercise and submaximal functional capacity in overweight pregnant women: a randomized trial. Obstet Gynecol. 2005;106(2):243–9.
    1. Sisson SB, Katzmarzyk PT, Earnest CP, Bouchard C, Blair SN, Church TS. Volume of exercise and fitness nonresponse in sedentary, postmenopausal women. Med Sci Sports Exerc. 2009;41(3):539–45. 10.1249/MSS.0b013e3181896c4e
    1. Bouchard C, Rankinen T. Individual differences in response to regular physical activity. Med Sci Sports Exerc. 2001;33(6 Suppl):S446–51; discussion S52-3.
    1. Robic T, Benedik E, Fidler Mis N, Bratanic B, Rogelj I, Golja P. Challenges in determining body fat in pregnant women. Ann Nutr Metab. 2013;63(4):341–9. 10.1159/000358339
    1. Fuller NJ, Jebb SA, Goldberg GR, Pullicino E, Adams C, Cole TJ, et al. Inter-observer variability in the measurement of body composition. Eur J Clin Nutr. 1991;45(1):43–9.

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