Fullfinansiering av "regular exercise during pregnancy. Good for overweight women?"
Aims of this study are to evaluate the effects of regular exercise during pregnancy in the prevention of pregnancy related diseases and complications during labor in overweight and obese women and their fetus/newborn?Objective: The objective of this project is to increase the knowledge of health promoting activities/services for pregnant women and their fetus/newborn. The project addresses translational research - both clinical and basic research and health promotion. This trial is one additional part of an ongoing randomized clinical trial (RCT)(N=860) addressing short and long term effects of training in a general population of pregnant women and their offspring. The present trial is planned and will be carried out in cooperation with researchers at Karolinska Institutet, Stockholm, Sweden and Harvard Medical School,Boston, USA. Main aims are to assess if regular exercise in pregnancy among overweight and obese women can prevent or influence • weight gain • insulin resistance/sensitivity • lumbopelvic pain • urinary and/or fecal incontinence • prolonged labor and other complications • impaired cardiac function in mother and fetus/newborn Methods and materials: Pregnant women (N=150) with pre-pregnancy BMI = 30 will be included and randomized to two groups. Standard dietary advice is given to all women. The training group attend exercise groups led by physiotherapists for 60 minutes once a week in 20 weeks (between 14 and 36 pregnancy weeks) and a 45 minutes home exercise program at least twice a week. Specific attention is given to recruitment and adherence strategies Outcome measures (at 14, 20 and 36 weeks of pregnancy and 3 months post partum) Primary outcome measure is weight increase based on weight measured at 14 weeks and immediately before labor*. Secondary outcome measures are: • Insulin resistance and gestational diabetes: • Body Mass Index (BMI), skin-fold thickness. • Levels of hormones associated with female reproduction and hormones and other factors associated with adiposity and insulin resistance will be investigated in blood samples (full blood and serum are collected following standardized procedures, frozen and stored in a biobank) • Lumbopelvic pain (Disability Rating Index) • Urinary- and fecal incontinence (Urinary severity index, St.Marks fekal incontinence score) • Psychological well-being (Psychological General Well-Being inventory, PGWB) • Postnatal depression (The Edinburgh Postnatal Depression Scale) • Quality of life (generic) (SF-8) • Nutrition (Nord-kost - a quantitative food frequency questionnaire) • Blood pressure (systolic-, diastolic- and mean, using an automated, standardized method) • Physical activity and capacity (Armband, Borg’s Rating Scale of Perceived Exertion) • Cardiac function of mother and fetus/newborn using echocardiography • Peak oxygen uptake The procedures followed will be in accordance with the ethical standards of the responsible regional committee on human experimentation and with the Helsinki declaration. Results will be presented in scientific journals with peer-review, at conferences, through the press and publications in relevant popular science periodicals and integrated in educational courses for health care workers. Relevance: The project is relevant to women in their childbearing period of life, and to health workers meeting women in pregnancy and after delivery. Pregnancy is a well suited time for behaviour modification. Adherence to exercise is inexpensive and has documented effects throughout life. However, the recommendations for physical activity in pregnancy are based on observational studies, and the documentation of positive and adverse effects from high quality RCT’s is lacking. Datacollection starts in 2010.