Sequential Introduction of Exercise First Followed by Nutrition Improves Program Adherence During Pregnancy: a Randomize
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Sequential Introduction of Exercise First Followed by Nutrition Improves Program Adherence During Pregnancy: a Randomized Controlled Trial Taniya S. Nagpal 1,2,3 & Harry Prapavessis 2,3 & Christina G. Campbell 4 & Barbra de Vrijer 5,6 & Roberta Bgeginski 1,2,5 & Karishma Hosein 1,2 & Stephanie Paplinskie 1,2 & Mollie Manley 1,2 & Michelle F. Mottola 1,2,5,7
# International Society of Behavioral Medicine 2019
Abstract Background Adhering to nutrition and exercise recommendations simultaneously during pregnancy may be challenging. The purpose was to examine adherence to the sequential introduction of nutrition and exercise behaviors during pregnancy in comparison with a simultaneous approach. Method A randomized controlled trial including nutrition and exercise was executed. Using a stratified body mass index (BMI) randomization, participants (n = 88) were allocated to one of three groups at 12–18 weeks gestation. Group A received nutrition and exercise simultaneously. Group B received nutrition first and Group C received exercise first, and the second behavior was added at 25 weeks gestation for both groups. The program included weekly weighing, supervised walking sessions, and/or nutrition counseling. Adherence (primary outcome) was measured by scoring women on meeting the intervention goals (3 nutrition and 3 exercise goals) and converted to a percentage. Secondary health outcomes were gestational weight gain (GWG) and excessive GWG on the program, birthweight, macrosomia (birthweight > 4000 g), and low birthweight (birthweight < 2500 g). Results Group C (n = 23) had the highest adherence to the program (80.2 ± 14.7%) compared with Groups A (n = 17; 60.9 ± 17.9%) and B (n = 20; 66.8 ± 16.7%; p < 0.05, ηp2 = 0.26). There was a significant effect for gestational weight gain (p < 0.05; ηp2 = 0.10) as Group C gained less weight (7.7 ± 2.2 kg) over Group B (9.8 ± 2.8 kg; p = 0.04), however, not Group A (9.1 ± 3.5, p = 0.35). Non-significant small effects favored Group C for the prevention of EGWG (Cramer’s V = 0.13). Conclusion Introducing exercise first followed by nutrition at 25 weeks gestation can improve adherence to multiple behavior change programs and thus have a positive effect on health outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT02804061 Keywords Pregnancy . Adherence . Nutrition . Exercise . Behavior change . Gestational weight gain
Introduction Excessive gestational weight gain (EGWG) significantly increases the risk for pregnancy complications that may impact * Michelle F. Mottola [email protected] 1
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R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, University of Western Ontario, 2245, 3-M Centre, London, Ontario N6A 3K7, Canada School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada Exercise and Health Psychology Laboratory, University of Western Ontario, London, Ontario, Canada
both the mother and baby, including later life obesity [1–3]. Women who gain weight excessively during pregnan
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