Støtte til laboratoriekostnader for "Trening i svangerskapet"
Training in pregnancy (TRIP)
The primary objectives of this project are to study effects of regular exercise in pregnancy by following women and their children throughout the first 18 months after delivery.
Pregnancy and the postpartum period are risk periods for development of excessive weight gain, gestational diabetes, urinary and fecal incontinence and musculo-skeletal problems such as lumbopelvic pain. Exercise is recommended to reduce negative physical and psychological symptoms. Most published studies indicate that women with normal, uncomplicated pregnancies are fit for exercise with few restrictions, without any risk of harm to the mother or fetus.
Today’s knowledge about the importance of regular exercise in pregnancy is mainly based on results from observational studies. There is a lack of results from randomised clinical trials (RCT) with high methodological quality, assessing short and long term effects of exercise in pregnancy on mothers and offspring.
Main aims of the study are to assess if regular exercise in pregnancy can prevent/influence
• gestational diabetes (or insulin resistance/sensitivity)
• excessive weight gain
• lumbopelvic pain
• urinary and/or fecal incontinence
• psychological well-being and quality of life
• prolonged labor
The RCT started in 2007 in Trondheim and Stavanger, Norway. Measurements are done with validated instruments before and after the intervention period during pregnancy (20 and 36 weeks of pregnancy), and 3 months after delivery. The women (N=860) were randomly allocated to training and control groups.
Pregnant women from an unselected population attending the routine ultrasound examination at 18 weeks of pregnancy were invited to participate. Women were eligible if they were 18 years or older, with a singleton live fetus at the routine ultrasound scan. Exclusion criteria were pregnancy complications, high risk for preterm labor or diseases that could interfere with participation.
The training group followed a specially designed exercise program including aerobic activity, specific exercises for stabilization of the lower back and pelvis, the pelvic floor muscles, and general exercises including balance exercises. They attended training groups led by physiotherapists for 60 minutes once a week in 12 weeks (between 20 and 36 weeks of pregnancy). In addition, they followed a 45 minutes home exercise program at least twice a week (30 minutes endurance training and 15 min. strength/balance exercises) and daily pelvic floor muscle exercises. Adherence were strongly emphasized and registered in the women's personal training diary and the reports from the physiotherapists leading the training groups. Women in the control group received the customary information provided by their midwife or general practitioner.
Outcome measures (at 20 and 36 weeks of pregnancy and 3 months post partum)
Primary outcome measures were insulin resistance and gestational diabetes: Peroral glucose tolerance tests were done at 20 and 36 weeks of pregnancy. HOMA-IR is measured at 20 and 36 weeks of pregnancy and 3 months post partum. Gestational diabetes is diagnosed according to standard criteria.
Secondary outcome measures are:
• Weight, BMI, Levels of hormones (full blood and serum are collected following standardized procedures, frozen and stored in a biobank), Lumbopelvic pain, Urinary- and fecal incontinence, Psychological well-being, Postnatal depression, Quality of life (generic), Nutrition, Blood pressure, Physical activity and capacity, Control of deep abdominal- and pelvic floor muscles by ultrasound.
Datacollection finish i February 2010.
Onset of exercise training 14 days after uncomplicated myocardial infarction: a randomized controlled trial.
Eur J Cardiovasc Prev Rehabil 2010 Aug;17(4):387-92.
Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: A systematic review.
Neurourol Urodyn 2009;28(5):368-73.
To do or not to do? Is there evidence to advice pelvic floor muscle training to prevent and treat urinary incontinence during p
European Urology review 2009; 2 (3):1-6.
Tverrfaglig poliklinisk behandling for pasienter med sykelig overvekt.
Fysioterapeuten 2009 ;Volum 76.(11) s. 21-26