Tag: activity

Physical Activity Benefits People With SLE, but Many Do Not Meet WHO Guidelines

Cardio potential and cardiovascular possibility both of those strengthen when people today with systemic lupus erythematosus (SLE) training frequently, according to a new systematic overview.

Actual physical exercise (PA) has apparent and ample gains for folks with systemic lupus erythematosus (SLE), according to a new systematic review printed in Seminars in Arthritis and Rheumatism, but the examine also identified the patient team tends to training at reduced prices than the standard community.

About two-thirds of persons with SLE report important tiredness, and individuals with the autoimmune condition are also at a heightened risk of cardiovascular ailment, spelled out the authors. Sufferers who are sedentary have a tendency to have worse cardiovascular symptoms and better levels of inflammatory markers, they added.

In the typical inhabitants, training has been revealed to significantly lower morbidity and mortality, and in recent a long time, investigators have attempted to quantify regardless of whether and how considerably PA might have an effect on results in persons with SLE. In the new report, they sought to consolidate the present research in buy to make clear the prospective benefits of workout in this patient team.

“These findings will subsequently be used for the improvement of global recommendations on PA in SLE people,” the authors added.

They searched current medical and scientific databases, looking for reports that evaluated training or PA in persons with SLE, and they determined 40 applicable scientific studies that met inclusion requirements they revealed involving 1989 and 2022 and integrated 2291 individuals with SLE. The evaluation manufactured many important themes related to the real amount of PA in people today with SLE and the probable positive aspects of this kind of activity.

To start with, the authors stated, the data counsel exercise is not a priority for many persons with SLE.

“Available evidence implies that SLE clients commonly have low concentrations of PA compared to the standard population and are frequently not reaching the WHO (Earth Wellness Group) recommendations for PA,” they wrote.

The WHO suggests 150 to 300 minutes of reasonable-intensity exercising or 75 to 150 minutes of vigorous PA for each 7 days for grownups in the common populace, the authors pointed out.

The data in the research advise that just 11{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} to 29.8{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of persons with SLE fulfilled the present-day WHO tips. According to self-noted questionnaires employed in scientific studies, men and women with SLE experienced a median of 60 to 132 minutes per 7 days of moderate to vigorous PA—but the median sedentary time was around triple that.

“The most important reasons documented for not performing any PA ended up bad health (65{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}) adopted by pain (41{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}) and fatigue (8{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}),” the authors added.

But, the info also showed that people today with SLE stood to achieve substantially from conference the WHO objectives.

“Aerobic courses had substantial added benefits on international cardio capacity and approximated cardiovascular possibility though resistance teaching systems enhanced strength and function in SLE,” the authors uncovered. In addition, fatigue, melancholy, and overall health-relevant good quality of daily life have been improved amid folks with SLE who exercised.

The reports showed no evidence that PA led to severe adverse activities in folks with SLE.

Though the knowledge about the gains of SLE are regular, the scientists stated a single motive some people today with SLE may possibly prevent training is simply because their medical professionals are hesitant to suggest PA out of dread of adverse functions. The authors said much better schooling about PA and marketing of exercising could assistance in unique, multidisciplinary affected individual instruction systems can be 1 way for experts to promote physical exercise and educate other providers, these as nurses, actual physical therapists, and dieticians.

“Heterogeneity in reports design and outcomes have led doctors not to consider PA between the to start with line of remedy in SLE,” they wrote. “Therefore, focused suggestions informed by this systematic critique are desired to boost PA and its gains in SLE individuals.”

Reference

Blaess J, Goepfert T, Geneton S, et al. Gains & risks of actual physical exercise in sufferers with Systemic Lupus Erythematosus: a systematic evaluate of the literature. Released on line November 19, 2022. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2022.152128

Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality

Sample and design

Figure 1 describes the derivation of the analytic sample. The UK Biobank Study is a prospective cohort study of adults aged between 40 and 69 years whose baseline measurements took place between 2006 and 2010. Participants provided informed consent and ethical approval was provided by the UK’s National Health Service, National Research Ethics Service (Ethics Committee reference number: 11/NW/0382).

Between 2013 and 2015 (median 5.5 years after the baseline measurements), 103,684 UK Biobank participants wore a wrist-worn accelerometer for 7 days24,25. We excluded participants with missing covariates and insufficient valid wear days. Monitoring days were considered valid if wear time was greater than 16 h. To be included in analysis, participants were required to have at least three valid monitoring days, with at least one of those days being a weekend day45,46. We excluded participants who reported that they cannot walk.

To enable examination of VILPA in our study (brief bouts of nonexercise VPA occurring during daily living), we included only participants who reported no leisure time exercise participation and no more than one recreational walk per week. Participation in exercise and recreational walking was measured through a close-ended touch-screen questionnaire that asked participants to report if, how often, and for how long they participate in such activities (Supplementary Table 2). Among the included 14,982 participants who were walking for recreation once a week or less, the average spacing of VILPA bouts was 165.7 (47.0) min within days and 16.7 (5.5) h between days (last session of a day versus first session the day after). The modal median length of the (at most) one and only weekly walking session these participants reported was 30–60 min (32.5{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of the 14,982 participants), effectively eliminating the possibility that the device-recorded VILPA bouts occurred during recreational walking.

To provide a comparison between effects of VILPA and (context-agnostic) VPA we repeated the main analyses among ‘exercisers’, defined as those UK Biobank accelerometry substudy participants who did not meet the above criteria to be considered nonexercisers; that is, those who reported any leisure time exercise or more than one recreational walking session per week (Supplementary Table 1).

Definition of VILPA and choice of bout length

We based the choice of VILPA bout length entered in our analyses on an ongoing study of 58 adults (mean age 55.7 (s.d. 10.1) years) aimed at developing an empirical definition of VILPA (M.N.A., N. Johnson, C.T.-N., M.J.G. and E.S., unpublished data). Participants completed five activities of daily living while wearing an indirect calorimetry unit (Cosmed K5) and Polar heart-rate monitor. The activities included: (1) walking on a flat surface at a self-selected ‘very fast’ pace; (2) walking on a flat surface while carrying shopping-like bags equivalent to 5{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of body weight at a self-defined ‘fast’ pace; (3) walking on a flat surface while carrying shopping-like bags equivalent to 10{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of body weight at a self-defined ‘fast’ pace; (4) walking at a 2.5{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} gradient at a self-defined ‘very fast’ pace (treadmill); and (5) walking at a 7.0{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} gradient at a self-defined ‘very fast’ pace (treadmill). The sequence of activities was randomized for each participant and counterbalanced across participants to prevent biases due to residual fatigue accumulating during the protocol.

Participants performed each activity until vigorous intensity was reached for two of three criteria: (1) {af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}VO2max (percentage of maximal oxygen updake) (≥64{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}); (2) {af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}HRmax (percentage of maximal heart rate) (≥77{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}); and (3) rating of perceived exertion (Borg scale) ≥15. For {af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}VO2max and {af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}HRmax, the threshold had to be met for at least 30 consecutive seconds to minimize the effects of noise. VO2max was calculated using the Ebbeling treadmill test and HRmax was calculated using the Tanaka equation47. Between activities, participants had 5 min of seated recovery, or until heart rate and breathing returned to resting levels. Resting VO2 and heart rate were measured at the beginning of each session with the participant lying supine using 5 min of steady-state (coefficient of variation ≤ 10{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}). The duration to reach vigorous intensity across all five activities is shown in Supplementary Table 7. As the mean time required to reach vigorous intensity in two of the above three physiological intensity indices was 73.5 s (s.d. 26.2 s) across all activities, we decided to test VILPA bouts lasting up to 1 and up to 2 min in the present analyses. As the length of raw bouts within these two VILPA frequency exposures was highly variable, we length-standardized analytic bouts to one minute (for raw bouts lasting up to 1 minute) or two minutes (for raw bouts lasting up to 2 minutes) using a rolling sum on the time-series data until 1 or 2 minutes, respectively, was reached or exceeded. For example, a participant with five consecutive raw bouts lasting up to 1 minute each (20, 30, 20, 40, and 10 seconds long), would be assigned 1.83 analytic bouts: the first three raw bouts would count as one and the rolling sum would be reset; then the last two raw counts would count as 0.83 length-standardised bouts (50 seconds divided by 60). This bout handling has analytic and interpretational advantages: a) it mitigates against the problem of multicollinearity between raw VILPA frequency and daily VILPA duration, and b) permits a more concrete behavioural interpretation of the VILPA frequency findings than raw bouts, as each length-standardised bout can be specifically interpreted as lasting 1 minute or 2 minutes.

Wearable device-based physical activity classification

The methods we describe here were used to classify physical activity intensity in both the nonexercisers (main analyses) and exercisers (additional analyses) strata. Supplementary Fig. 4 summarizes how activity intensity was classified using a previously validated random forest (RF) activity classifier33. RF is an ensemble of multiple decision trees. Each tree is learned on a bootstrap sample of training data and each node in the tree is split using the best among a randomly selected set of acceleration features. The decisions from each tree are aggregated and a final model prediction is based on majority vote. The RF model requires very little preprocessing of the data because the features do not need to be normalized. In addition, the model is resistant to over-fitting the training data because each tree within the forest is independently grown to maximum depth using a randomly selected subset of features.

This two-stage classifier first categorized physical activity in 10-s windows into one of four activity classes: sedentary, standing utilitarian movements (for example, ironing a shirt, washing dishes), walking activities (for example, gardening, active commuting, mopping floors), running/high energetic activities (for example, active playing with children). These activity classes were then assigned to one of four activity intensities: sedentary, light, moderate and vigorous. Walking activities were classified as light (an acceleration value of <100 mg), moderate (≥100 mg) and vigorous (≥400 mg) intensity48. For example, for a VILPA bout lasting up to 2 min, 12 consecutive 10-s windows needed to be classified as vigorous. When there were more than 12 consecutive vigorous activity windows, these bouts counted as long VPA sessions in the corresponding analyses (2.3{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of all VPA bouts). Differentiation between sleep36 and nonwear35 was identified using the change in tilt angle and acceleration standard deviation. Monitors were calibrated49 and corrected for orientation50 using previously published methods, although residual signal and alignment uncertainties may persist.

Activities in an independent sample of 98 participants (age 56.4 ± 15.7 years ; 53.1{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} female) from the US51 (University of California Irvine Center for Machine Learning and Intelligent Systems Physical Activity Monitoring for Aging People study (published data), accessible at https://archive.ics.uci.edu/ml/datasets) and Australia52 (University of Queensland Where and When at Work study (published data) and University of Sydney Intermittent Lifestyle Physical Activity Study (unpublished data)) providing 103,607 activity samples from structured and free-living activities (17,267 min) were used to assess robustness and generalizability of the classifier (Supplementary Tables 8 and 9). For free-living activities participant-worn or researcher-held Go-Pro video-recordings were used to attain ground-truth physical activity. Video files were imported into the Noldus Observer XT software v16.0 for continuous direct observation coding. A two-stage direct observation scheme was implemented in which the participant’s movement behavior was coded for activity type and then activity intensity based on the Compendium of Physical Activities53. The direct observation system generated a vector of date–time stamps corresponding to the start and finish of each movement event, which were used to assign the activity codes to the corresponding time segments of the accelerometer data. Interobserver reliability was assessed by dual coding. The intraclass correlation coefficient for coding activities was 0.91 (0.87–0.94).

Performance was further evaluated in a separate sample of 151 adults (age range 18–91 years, 65.6{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} female; Supplementary Fig. 5) recruited from the UK34 (University of Oxford Capture 24 study (published data), accessible at https://ora.ox.ac.uk/objects/uuid:99d7c092-d865-4a19-b096-cc16440cd001). Participants in this data set wore body cameras that provided pictures every 20 s to annotate ground-truth free-living activity labels. The picture-based activity coding scheme has been previously described34. A total of 172,360 activity samples (28,727 min) were provided by participants.

Outcome ascertainment

Because of the nature of rolling updates for the data linkage, participants were followed up to 31 October 2021, with deaths obtained through linkage with the National Health Service (NHS) Digital of England and Wales or the NHS Central Register and National Records of Scotland. CVD mortality was defined as death attributed to diseases of the circulatory system, excluding hypertension, diseases of arteries and lymph (ICD-10 codes: I0, I11, I13, I20–I51, I60–I69). Cancer mortality was defined as death attributed to any cancer excluded in situ, benign, uncertain, nonmelanoma skin cancer or non-well-defined cancers (ICD-10 codes beginning ‘C0’, ‘C1’, ‘C2’, ‘C3’, ‘C4’ (excluding C49.9), ‘C5’, ‘C6’, ‘C70’, ‘C71’, ‘C72’, ‘C73’, ‘C74’, ‘C75’, ‘C7A’, ‘C8’ or ‘C9’).

Statistical analyses

In our study, the range of VILPA values (and context-agnostic VPA values in exercisers) was capped at the 97.5 percentile to minimize the influence of sparse data. To reduce the possibility of reverse causation through prodromal/undiagnosed disease, all analyses excluded those with an event within the first 2 years of follow-up. We also excluded those with prevalent CVD and prevalent cancer at baseline (CVD and cancer mortality analyses, respectively).

We examined the dose–response of average daily duration and frequency of VILPA bouts lasting up to 1 min and up to 2 min using Cox proportional hazards (all-cause mortality) and Fine–Gray subdistribution hazards to account for competing mortality risks (CVD and cancer mortality)54. In all analyses, we set knots at the 10th, 50th and 90th percentiles. Departure from linearity was assessed by a Wald test. Proportional hazards assumptions were tested using Schoenfeld residuals in the models with all three outcomes and no violations were observed (all P > 0.05). Analyses were adjusted for age, sex, daily duration of light- and of moderate-intensity physical activity, mutual adjustment for daily duration and frequency of vigorous-intensity physical activity bouts lasting more than 1 to 2 min as appropriate, smoking, alcohol, accelerometry-estimated sleep duration35,36, fruit and vegetable consumption, education, parental history of CVD and cancer, medication use (insulin, blood pressure, cholesterol). All-cause mortality analyses were also adjusted for prevalent CVD and cancer, CVD analyses were adjusted for prevalent cancer, and cancer analyses were adjusted for prevalent CVD (Supplementary Table 3 provides full covariate definitions).

In the exercisers stratum of the UK Biobank accelerometry sample, we repeated the above multivariable-adjusted analyses for daily duration and frequency of (context-agnostic) VPA for bouts lasting up to 2 min, and we compared findings with the equivalent VILPA findings using overlay dose–response plots.

To assert the degree to which VILPA and VPA may contribute to mortality beyond the associations of overall movement volume, we also carried out a volume analysis based on energy expenditure using methods analogous to the study by Strain et al.18 We calculated physical activity energy expenditure for all VILPA and VPA bouts lasting up to 2 min.

To provide conservative point estimates we calculated the ‘minimal dose’, defined as VILPA volume/frequency associated with 50{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of the optimal risk reduction37,38. We also present point estimates (HRs and 95{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} CI) associated with the median and maximum volume/frequency VILPA values. We calculated E-values to estimate the plausibility of bias from unmeasured confounding30,55.

We conducted sensitivity analyses of VILPA with additional adjustment for body mass index. To investigate potential reverse causation bias we also excluded participants who had poor self-rated health. In another sensitivity analysis, we tested the influence of applying a conservative definition of ‘nonexercisers’ by restricting analyses to the 10,230 participants who reported no recreational walking and no leisure time exercise.

We performed all analysis using R statistical software v.4.2.1 with RMS v.6.3.0 and survival package v.3.3.1.

We reported this study as per the Strengthening the Reporting of Observational Studies in Epidemiology guidelines (Supplementary Table 10).

Reporting summary

Further information on research design is available in the Nature Portfolio Reporting Summary linked to this article.

Five Key Factors Affect Physical Activity in Multi-ethnic Older Adults

Five Key Factors Affect Physical Activity in Multi-ethnic Older Adults

More mature grownups rarely fulfill the physical activity guidelines of 150 minutes for every week of moderate exercise.

Actual physical activity is significant for healthier aging. It aids prevent practical drop, frailty, falls, and serious disorders this kind of as diabetes and cardiovascular ailment. Common physical action also contributes to good quality of lifetime and reduced despair.

Even with these acknowledged wellbeing gains, more mature grown ups seldom meet up with the bodily activity suggestions of 150 minutes for each 7 days of moderate exercise. Several elements impact bodily action degrees between more mature grown ups. Furthermore, minor is identified about the variations in actual physical exercise amongst numerous racial and ethnic groups.

Scientists from Florida Atlantic University’s Christine E. Lynn Faculty of Nursing, in collaboration with Florida Global University, carried out a unique examine using a robust statistical strategy to evaluate the aspects relevant to physical action in a varied sample of older adults.

The analyze sample provided 601 African People in america, Afro-Caribbeans, European Individuals and Hispanic Us residents ages 59 to 96 residing independently. Whilst prior research have dealt with the issue of components influencing more mature adults’ actual physical exercise degrees, none have employed the substantial assortment of devices/applications used in this research or incorporated more mature adults from many ethnic teams.

Final results of the examine, posted in the journal
Geriatrics

, showed that age, schooling, social community, suffering and melancholy ended up the 5 things that accounted for a statistically substantial proportion of unique variance in physical action in this diverse, community dwelling older inhabitants.

Participants who documented decreased bodily activity tended to be older, have significantly less many years of education and reported reduced social engagement, networking, resilience, psychological well being, self-wellbeing rating, and increased levels of depression, anxiousness, ache, and human body mass index (BMI) in comparison to the reasonable to superior actual physical exercise teams.

A secondary analysis examined aspects related with calculated Satisfied-h/week (ratio of the rate at which a particular person expends energy relative to the mass of that man or woman). Findings confirmed the strongest correlation to Fulfilled-h/7 days was with melancholy.

“Four of the 5 considerable predictors of actual physical action in the more mature adults we studied are at the very least partially modifiable. For case in point, social network, despair and soreness can be ameliorated by actual physical activity,” reported Ruth M. Tappen, Ed.D., RN, FAAN, senior author and the Christine E. Lynn Eminent Scholar and professor in the Christine E. Lynn University of Nursing.

Scientists uncovered that agony was related with fewer time used getting bodily energetic. What is not crystal clear is whether more mature grown ups understand that sedentary lifestyles can boost and/or worsen some types of suffering and actual physical action can enable to decrease suffering or irrespective of whether this know-how on your own is enough to motivate them to come to be far more energetic.  

“Education might be critical each in aiding more mature grownups with depressive signs and symptoms comprehend that physical exercise can assist lessen their signs or symptoms and in assisting them to detect the types of exercise that they may possibly discover pleasurable,” said Tappen.

Analyze results advise that many of these factors could be dealt with by planning and tests specific, group and community stage interventions to boost actual physical exercise in the more mature population. Researchers recommend instruction on the influence of exercise on widespread sources of pain these kinds of as arthritis or back soreness and encouraging health care companies to write a “prescription” for a daily stroll or a workout for all those with melancholy. In addition, neighborhood outreach to isolated more mature older people, improving the walkability of neighborhoods, fixing sidewalks, introducing trails and producing these spots secure to wander and do the job out are other interventions to aid raise actual physical action in the older inhabitants.

“Partnerships between area senior centers, lower cash flow housing developments, areas of worship, YMCAs and overall health treatment vendors are crucial in acquiring tailor-made multi-faceted programs for physically inactive more mature grownups, particularly people experiencing discomfort and/or melancholy,” said Tappen. “These applications can deliver health and fitness-associated training pertinent to the discovered healthcare problems this kind of as ache and depression and aid individuals in conference other individuals and in producing specific actual physical exercise-associated objectives, which are recognized to be involved with sustained involvement.”

Sociodemographic variables incorporated age, sex, years of instruction, ethnic team membership, years dwelling in the United States, and receipt of Medicaid centered upon money amount skills. Cognition was calculated working with the Mini-Mental State Exam. Psychosocial variables bundled social engagement, social community, resilience, character, stress, depression, spirituality and the SF-36 psychological wellbeing summary rating. Physical measures involved agony, BMI, overall body consciousness, practical means and self-rating of wellness. Behavioral variables incorporated adherence to prescribed medications and self-claimed physical activity concentrations.

Analyze co-authors are David Newman, Ph.D., an affiliate professor and statistician Sareen S. Gropper, Ph.D., a professor and Cassandre Horne, a Ph.D. scholar, all in FAU’s Christine E. Lynn College or university of Nursing and Edgar R. Viera, Ph.D., an affiliate professor in FIU’s Nicole Wertheim Higher education of Nursing & Overall health Science. 

This study was funded by the Health and fitness Growing older Analysis Initiative (HARI), FAU sponsored courses (#N11-053) and the Retirement Study Basis (Grant #180250).

-FAU-

More physical activity before a heart attack may reduce risk for a second one

More physical activity before a heart attack may reduce risk for a second one
(Hirurg/E+ by way of Getty Images)

Getting physically energetic in center age – just before getting a coronary heart assault – may perhaps minimize the chance of owning a second heart attack, according to new analysis.

Scientists have lengthy regarded that regular actual physical action assists stop stroke, coronary heart assaults and other forms of cardiovascular disease. But couple of scientific tests have explored no matter if work out shields versus an additional critical cardiovascular occasion following an preliminary heart attack.

Researchers seemed at facts from 1,115 grown ups in Mississippi, North Carolina, Maryland and Minnesota who experienced a coronary heart attack someday amongst the mid-1990s and the conclusion of 2018. Their average age was 73 at the time of the coronary heart assault.

Then the researchers seemed at how substantially research individuals claimed they exercised at two time factors in the many years right before their heart attack. Utilizing a questionnaire that integrated sports, leisure time actions and do the job-connected bodily exercise this kind of as residence chores, individuals been given a whole score.

Just after a median adhere to-up of two many years, these in the maximum bodily exercise team experienced a 34{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} reduce possibility of acquiring a second heart attack when compared with those in the lowest action team.

Possessing a heritage of superior physical exercise was in particular handy in the very first year just after a heart assault, when the hazard of possessing an additional a single was 63{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} reduce than for individuals in the the very least lively group. Also during that initial calendar year put up-heart attack, the chance of dying from any lead to was 39{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} reduced in the most energetic group in comparison with the least energetic.

The review was introduced Saturday at the American Heart Association’s Scientific Sessions. The conclusions are regarded preliminary right up until full outcomes are published in a peer-reviewed journal.

“Our analyze presents extra proof for the value of retaining superior bodily activity levels at center age before you have a coronary heart attack, which can contribute to a far better prognosis afterward,” explained the study’s lead researcher, Yejin Mok.

Nonetheless, she said, it is really vital not to consider of bodily activity as an all-or-practically nothing pursuit.

“The message is to just transfer your system,” mentioned Mok, a exploration affiliate at Johns Hopkins Bloomberg University of General public Health and fitness in Baltimore. “Far more activity is fantastic, but even a small physical action is essential for managing cardiovascular sickness hazard.”

Federal physical exercise pointers suggest adults to get at least 150 minutes per 7 days of average-intensity aerobic activity, 75 minutes for every week of vigorous cardio exercise, or a blend of the two. Muscle-strengthening workouts at minimum two days a week also are encouraged.

Mok reported the examine was limited by its reliance on self-reported questionnaires. She identified as for foreseeable future study that utilizes smartwatches and other health-monitoring products “that objectively evaluate bodily exercise.”

Michael LaMonte, a professor of epidemiology at the University at Buffalo in New York, stated the review was intriguing but had some limitations to take into consideration when deciphering the outcomes. For case in point, the analyze was observational and didn’t account for various factors soon after the preliminary heart assault, together with exercise levels, drugs, cardiac procedures and other therapeutic lifestyle alterations.

Even so, he said, the examine took “a clever solution to comprehend how sturdy the cardiovascular gain conferred by actual physical activity is, in regard to one’s ability to face up to a important bodily insult such as coronary heart attack.”

LaMonte, who was not associated in the new exploration, stated upcoming studies are needed that look at how a improve in regular day-to-day physical exercise following a coronary heart attack impacts long term wellbeing.

Doctors, he mentioned, must advise sufferers to meet the minimum tips for physical action. He also encouraged everybody to try to remember the mantra “Sit fewer, go a lot more.”

“Even standing up periodically or walking a few minutes at function or house will get your skeletal muscle mass, coronary heart and metabolism activated, which we imagine offsets some of the harmful results of prolonged sedentary time, which is so customary in modern environment,” LaMonte explained.

Discover far more information from Scientific Sessions.

If you have thoughts or comments about this American Heart Affiliation Information story, you should electronic mail [email protected].

National strategy puts necessary focus on advancing nutrition, physical activity

Today’s White Home convention an opportunity to adjust the trajectory of wellbeing

WASHINGTON, D.C., September 28, 2022 — Nancy Brown, chief executive of the American Heart Affiliation, issued the subsequent statement in progress of today’s White Residence Convention on Hunger, Diet, and Health and fitness, which will deliver jointly stakeholders to emphasis on addressing meals shortage, nutrition insecurity and insufficient physical action in ways that can obtain equitable wellness for all. The administration issued a National Technique on Hunger, Nutrition, and Well being yesterday in progress of the meeting.

“This conference places a substantially-needed highlight on how we can modernize our nation’s strategy to offer equitable access to nutritious foodstuff and physical exercise. The administration’s countrywide technique unveiled in advance of the conference is a call to motion for switching the trajectory of well being nationwide by earning nutritious food much more obtainable and inexpensive although advertising and marketing physical exercise.

“The American Heart Association has long championed the significant initiatives outlined in the countrywide system as vital to guaranteeing that everyone has an equitable possibility to reside a healthy everyday living. By focusing on foodstuff good quality in addition to food items quantity in our countrywide foods systems, ensuring that all learners have access to university meals at no expense, advancing ‘food is medicine’ plans that enhance access to healthier food among serious condition individuals and growing multi-sector endeavours to really encourage bodily activity, we will boost well being for all.

“We urge governments at all concentrations to consider rapid techniques to set the nationwide strategy into action. This incorporates Congress, which should urgently deal with the scenario confronted by hundreds of thousands of college students who misplaced computerized entry to wholesome college meals this tumble. Congress is extended overdue to reauthorize federal child diet applications that assure youngsters have entry to the healthy foods they need to discover.

“In July, the Home Education and learning and Labor Committee advanced the Healthful Foods, Balanced Young children Act, but the Senate has nonetheless to act. Supplying healthful school meals for college students at no cost is a recipe for success that minimizes food items insecurity, improves children’s diet plans and academic general performance, generates critical profits for educational institutions and decreases stigma. But the Senate’s inaction would be a recipe for catastrophe. Lawmakers ought to act on boy or girl nutrition reauthorization and ensure all learners receive healthy university foods at no cost.”

Brown is attending the meeting alongside with teenage advocates Bella Crowe from Benton, Arkansas and Andre Scott, Jr. from Houston, Texas. They depict the Association’s nationwide network of advocates who are doing the job to carry awareness to the essential issues of youngster diet and nutritious faculty foods for all. The American Coronary heart Affiliation is the world’s main voluntary firm centered on heart and mind wellbeing. 

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About the American Coronary heart Affiliation
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The American Coronary heart Affiliation is a relentless force for a entire world of more time, healthier lives. We are devoted to making certain equitable overall health in all communities. By means of collaboration with many corporations, and run by millions of volunteers, we fund ground breaking investigate, advocate for the public’s overall health and share lifesaving sources. The Dallas-primarily based firm has been a main supply of health data for approximately a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-United states1. 

For Media Inquiries:

Steve Weiss: 202-607-0911 steve.weiss@coronary heart.org

Arielle Beer: 202-785-7902 arielle.beer@coronary heart.org  

For General public Inquiries: 1-800-AHA-Usa1 (242-8721)

heart.org and stroke.org

Workshop on promotion of physical activity in pregnancy

Background

The World Health Organization (WHO) recommends that “women who, before pregnancy, habitually engaged in vigorous-intensity aerobic activity or who were physically active, can continue these activities during pregnancy and the postpartum period”.1 The last three decades produced an increasing amount of scientific evidence on the positive effects of the prenatal physical activity on the maternal and fetal health, as well as in pregnancy outcomes, as shown by recent systematic reviews.2–18 Practice guidelines have become an increasingly popular tool for synthesis of clinical information.19 Clinical guidelines are commonly defined as systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances, which objectives are to enhance appropriateness of practice, improve quality of care, lead to better patient outcomes, improve cost effectiveness, help authorities to decide on the approval of drugs and devices, and identify areas of research needed.20 A profusion of guidelines has been issued over the past 6 years by different national and international obstetrics, gynecology, or sports medicine organizations, which are a trustworthy and comprehensive source of information in terms of safety and health benefits of exercise during pregnancy. Several official guidelines on physical activity during pregnancy have been updated recently.1,21–29 Most of these guidelines were reviewed by other authors30 and in our textbook.31 Moreover, other organizations published these guidelines in a more accessible language to reach pregnant women.32–35 Yet, the physical inactivity epidemic is considered the biggest public health problem of the 21st century.36,37

Challenges for practicing physical activity during pregnancy are numerous and include lack of knowledge about existing recommendations, unawareness of how to engage in physical activity, lack of social support, and unavailability of physical activity offers.38 Despite the above stated scientific evidence, health professionals often lack either knowledge of existing recommendations and pregnancy-related benefits or resources to adequately address the topic.39,40 Among health professionals, midwifes are ideally placed to promote physical activity during pregnancy consultations as part of a wider network of practitioners.40,41 After the assessment of potential contraindications for exercising, health-care providers should provide counseling on an active lifestyle and refer pregnant women to a qualified exercise professional (ie, exercise physiologist or prenatal exercise specialist), with a background and experience in pregnancy and/or postpartum physical activity and/or exercise.42 Interprofessional settings (including health-care providers and exercise experts) can help to reach fitness goals, tailor exercises according to abilities and – most importantly – minimize the risk of injury. Therefore, interprofessional collaboration is essential.43

When exercising during pregnancy, women need to feel safe and professionally guided to ensure proper technique, confidence, and appropriate progression of intensity and complexity.44 The exercise professional should provide proper exercise prescription and selection, along with regular feedback, positive reinforcement, and behavioral strategies to enhance adherence.45,46

The American College of Sports Medicine (ACSM)32,33 recommends that physical activity programs should be individualized for each woman based on situation, experience, and current health status. Exercise professionals can notably support aerobic training, strength training, flexibility, balance, pelvic floor muscle training, during pregnancy and postpartum.32,33,45,46 The National Health Services (NHS) guidelines34 advise pregnant women to make sure that exercise professionals are properly qualified and informed about their pregnancy status. The Sports Medicine Australia (SMA) guidelines21 advise pregnant women to ask for a medical doctor’s recommendation to consult exercise specialists in view of an individually prescribed exercise program including appropriate types of activities and ways to progress at a safe and steady pace. The Canadian guidelines24 and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) guidelines26 highlight fitness professionals and exercise physiologists as target users of their evidence-based guidelines in view of maternal, fetal, and neonatal health outcomes of prenatal physical activity. The Physical Activity Guidelines for Americans23 state that physical activity specialists can encourage to attain and maintain regular physical activity by providing advice on adapted activities and ways to progress at a safe and steady pace, even for individuals with chronic conditions. These statements included in the official position documents highlight the increasing importance of the exercise professional in promoting and implementing adapted effective and safe exercise programs.

In 2016, EuropeActive published the role and standards of the Pregnancy and Postnatal Exercise Specialist, based on the European Qualification Framework.47 According to this professional educational standard, the role of the prenatal exercise specialist is to encourage exercise participation for beginners and already active women at all stages of pregnancy and during the postpartum period47 including the assessment of overall physical fitness, the development of adapted exercise programs, providing feedback on progress, adherence, and outcomes to relevant stakeholders.

The lack of information among women on the exercises during pregnancy, and lack of social support are two of the reasons hindering engagement in a prenatal exercise program.38 However, pregnancy may provide a “teachable moment” for positive health behaviour change,48 and a positive relationship was observed between the mothers’ knowledge about physical activity during pregnancy and their daily physical activity.49 Thus, promoting the guidelines and educational materials providing information about physical activity during pregnancy is expected to help pregnant women to engage in proper exercise programs.48,50

To sum up, the knowledge of health benefits is expected to lead to more favorable attitudes towards exercise during pregnancy, among pregnant women, exercise professionals and health-care providers.

With this background, a one-day workshop on promotion of physical activity in pregnancy for exercise professionals was planned and facilitated by an Associate Professor, coordinator of the master’s in sciences program in Physical Activity and Health, of the Sport Sciences School of Rio Maior (ESDRM), Polytechnic Institute of Santarém, Portugal. The workshop was delivered at the ESDRM and in partnership with other higher schools of the Polytechnic Institutes of Beja and Leiria, Portugal, during 2021, to five groups of exercise professionals.

The main aim of this workshop was to motivate and prepare exercise professionals for promoting physical activity and implementing prenatal exercise programs, in their respective professional fitness center, or in remote settings, in personal training, or group exercise sessions.

The contents of the workshop were focused on six topics: 1) Role and professional development of the Pregnancy Exercise Specialist; 2) General physical and physiological adaptations during pregnancy; 3) Evidence-based benefits of physical activity during pregnancy; 4) Current guidelines for exercise during pregnancy; 5) Pre-exercise assessment and fitness testing; and 6) Exercise prescription and exercise adaptations, based on the “Pregnancy and Postpartum Exercise Specialist” educational standards by EuropeActive47 and on the “Exercise and Physical Activity during Pregnancy and Postpartum” textbook published by Springer.51,52

The following sections will mainly be structured as the report of the workshop event.

Ethical Considerations

Exercise professionals attending advanced higher education programs were invited to participate in the workshop, free of charge. Participants were informed about the objectives and nature of the study, the potential benefits for future programs, that they were free to provide feedback or not, without any consequences, and that the feedback was anonymous. All participants (N = 137) were informed and agreed with the participation in the online questionnaires. Informed consent was checked upon responding to an online questionnaire. All educational materials produced by the research team were made available to the participants, free of charge. The study was conducted in accordance with the Helsinki Declaration. This study is part of the study protocol that was approved by the Ethics Committee of the Polytechnic Institute of Santarém, Portugal (approval number 9-2021-ESDRM).

Report

Objectives of the Workshop

The objectives of the workshop were:

  1. to update participants on the importance and evidence-based knowledge underlying physical activity during pregnancy
  2. to motivate participants for promoting physical activity among pregnant women
  3. to discuss the current guidelines on physical activity during pregnancy
  4. to prepare participants for implementing prenatal exercise programs
  5. to motivate participants for applied multidisciplinary research

Setting

The workshop was delivered in three Portuguese cities (Rio Maior, Beja and Leiria), at the facilities of the higher schools of sports and education of the respective public polytechnic institutes, and online, during 2021, to five groups of exercise professionals. Three workshops were delivered presently, and two workshops were delivered online by means of the zoom platform. The interactive teaching-learning methods were utilized in all sessions of the workshop.

Facilitator

The workshop was facilitated by an Associate Professor, which is the first author of this article, and it was conducted in the Portuguese language. The facilitator academic background includes a BSc in sport sciences, a MSc in exercise and health, a PhD in health and fitness, as well as professional background as exercise physiologist and fitness instructor. Each event was inaugurated by the program coordinator of each of the higher schools where it was delivered.

Participants

Between 23 and 42 persons (61{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} female) participated in each workshop, totaling 137 attendees including graduated exercise professionals, third year exercise science students, and master students, with 1 to 10 years of professional experience in conducting exercise classes and personal training. Only 30{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of the attendees had professional experience in conducting classes for pregnant women. The academic background of all participants was a bachelor’s degree in exercise and sport sciences. The ages of the attendees varied from 21 to 55 years.

Contents

The contents of the workshop were inspired by the EuropeActive’s official document educational standard for the prenatal exercise specialist47 that the three authors of this article produced in 2016, and on the chapters developed in the textbook “Exercise and Physical Activity during Pregnancy and Postpartum” textbook published by Springer in 2019,51 and the second edition in 2022.52

The contents of the workshop were focused on the following six topics, delivered in 3h plus 3 hours (about one hour for each topic). The key points of each content are described as follows:

Role and Professional Development of the Pregnancy Exercise Specialist

Participants were motivated for promoting physical activity, by understanding their role and the barriers and facilitators for exercising during pregnancy. Main points were: The medical and social need for Pregnancy Exercise Specialists (regarding the national laws, in this case, the Portuguese Law nr. 39/2012 of 28-08-2012); The place of the Pregnancy Exercise Specialists in the healthcare system and the cooperation of a multidisciplinary task force of health-care professionals (Obstetrician/Gynecologist, Midwife, Nutritionist, Exercise Physiologist, Exercise Psychologist, Physiotherapist); Specific evidence-based sources related to the benefits of exercise for pregnant women; National legislation, policies and guidance relating to the provision of exercise services to pregnant women; Ethical issues regarding working with pregnant women. Main references for this content: educational standard for the prenatal exercise specialist,47 chapter,43 and national Law nr. 39/2012 of 28-08-2012.

General Physical and Physiological Adaptations During Pregnancy

The main points were to describe the pregnancy-related symptoms and the body adaptations to pregnancy and to physical exercise, which require supervision of technique, adaptations of exercises, and safety considerations: The risk factors and prevalence of discomforts and health conditions associated with pregnancy and postpartum (eg, gestational diabetes, overweight, obesity, edema, low back pain, hypertension, pre-eclampsia, musculoskeletal disorders, diastasis recti abdominis, stress urinary and fecal incontinence and other pelvic-floor disorders, stress and anxiety, oral health, sleep disorders, headache, digestive disorders, etc.); Interactive effects of morphological, physiological and hormonal adaptations to pregnancy phases, and to exercise (eg, adaptation of cardiovascular and thermoregulation systems, metabolic changes); Musculoskeletal changes and biomechanical adaptations of posture and gait in pregnancy; Psychosocial adaptations to pregnancy and the main barriers to participation in exercise. Main references for this content: chapters.38,53–56

Evidence-Based Benefits of Physical Activity During Pregnancy

The main points were to search the recent systematic reviews that support the positive impact of physical activity in the maternal health and fitness parameters, and how to utilize research outcomes when promoting physical activity and planning exercise programs. Participants were updated on the importance and evidence-based knowledge underlying physical activity during pregnancy, and were motivated for multidisciplinary research: The improved sense of well-being and enhanced quality of life as an effect of regular exercise during pregnancy; The acute and long-term effects of exercise in pregnant women and babies, related to all fitness and well-being parameters (eg, cardiovascular, muscular strength and endurance, flexibility, neuromotor, posture, body composition, mental health); The effect of exercise on increased energy expenditure (eg, excess post-exercise oxygen consumption, increased fat loss, preservation of lean body mass, increased metabolic rate, prevention of overweight and obesity in mother and child); The association of exercise with fertility, fetal development, birth outcomes and infant health; The preventative role of exercise in relation to any potential future cardiac health risk related to chronic disease; The preventative role of exercise in relation to gestational diabetes and diabetes mellitus type 2 (eg, lower blood glucose concentration during and after exercise, improved insulin sensitivity and decreased insulin requirement, lower glycated hemoglobin levels); The preventative role of exercise in relation to dyslipidemia (eg, decreased triglycerides, slightly decreased low-density lipoprotein, increased high-density lipoprotein); The preventative role of exercise in relation to hypertension and pre-eclampsia (eg, improvement in mild to moderate blood pressure); The preventative role of exercise in relation to the most prevalent musculoskeletal disorders (eg, low or upper back pain, pelvic floor disorders, osteoporosis and poor posture); The potentially preventative role of exercise in relation to other specific conditions of pregnancy and postpartum (eg, macrosomia, diastasis recti, pelvic girdle pain, postpartum weight retention, coronary heart disease prevention postpartum, etc.). Main references for this content: systematic review studies.2–18

Current Guidelines for Exercise During Pregnancy

The main points were to address and discuss the official position documents of the leading international organizations regarding physical activity and exercise during pregnancy and postpartum, published since 2018 (eg, WHO, US Department of Health and Human Services, UK Department of Health and Social Care, ACOG – American College of Obstetricians and Gynecologists, RANZCOG, CSEP – Canadian Society for Exercise Physiology, ACSM, etc.): Main guidelines for exercise during pregnancy included in the official statements and evidence-based guidelines for exercising during pregnancy and postpartum; Absolute and relative contraindications for exercising during pregnancy and postpartum; Reasons to stop exercising in pregnant and postpartum women; Sports and physical activities to avoid for pregnant and postpartum women; Safety and emergency procedures during a training session for pregnant and postpartum participants. Main references for this content: guidelines1,21–29,32–35 and chapter.31

Pre-Exercise Assessment and Fitness Testing

The main points were to prepare participants for planning prenatal exercise programs by starting with basic assessment tools based on questionnaires of perception of health and readiness for exercising, weekly volume of physical activity, and perception of fitness and quality of life. Basic aspects and importance of fitness testing with pregnant women were addressed: Interviewing of pregnant and postpartum women and building rapport, taking into consideration the medical clearance for exercise; Preliminary screening tools, such as: the PAR-Q+ questionnaire; the new Get Active Questionnaire for Pregnancy (previously the PARMED-X for pregnancy questionnaire), to assess safety or possible contraindications to exercise; Physical activity and lifestyle assessment (eg, pedometers, accelerometers, and/or questionnaires such as the 7-day PAR – 7-day Physical Activity Recall interview and the PPAQ – Pregnancy Physical Activity Questionnaire); Safety considerations in exercise testing for pregnant women; Assessment of the pregnant women’s body composition (eg, body circumferences, body fat distribution markers and other body indexes), heart rate and blood pressure, during rest and exercise; Cardiorespiratory tests (eg, Astrand, Rockport, 6 minutes walking test, Balke and Bruce tests using a treadmill or cycle ergometer); Static and dynamic tests to assess posture, functionality and overall autonomy in pregnant women. Main references for this content: chapter45 and ACSM textbook.57

Exercise Prescription and Exercise Adaptations

The main points were to prepare participants for implementing prenatal exercise programs by following the steps of an exercise prescription plan and workout features which requires adaptations to each trimester of pregnancy. Motivational techniques for starting exercise or keeping adherence to exercise (eg, diary of behavior, active listening and communication, motivational interviewing, giving feedback on fitness tests, available educational resources, etc.); Motivational techniques to be used during exercise sessions (cuing, voice modulation, stressing the goals of exercises, feedback on exercise performance); Prescription of an exercise program (type of exercise, intensity of exercise, duration of the sessions, weekly frequency of sessions) relevant to pregnant women, their goals, medical history and exercise environment; Selection of exercises and their techniques with regard to women’s well-being, functional readiness and the course of pregnancy, in particular the appearance of pregnancy discomforts (eg, back pain, stress urinary incontinence); The structure of the exercise session; The most recommended forms of exercise (eg, walking, low-impact aerobics/step exercise, water exercise, swimming, indoor cycling, strength training, pelvic-floor training, stretching); Adaptation of the so-called risky sports (eg, skiing, skating, cycling, running, etc.); Exercise equipment (eg, fitballs, step, barbells, bands); Monitoring, control and evaluation of all parameters of the exercise program (type, intensity, frequency and duration), and their adaptation to women’s condition and stage of pregnancy; Portable equipment controlling the parameters of the exercise session (eg, heart rate monitor); Reports on the outcomes of an exercise program (including charts, notes and diagrams) to enhance their readability to the client and other health professionals. Main references for this content: chapters45,46 and ACSM textbook.57

Educational Materials

Several educational materials were pointed and/or delivered, as follows:

  • Active Pregnancy Workshop (PowerPoint presentation) [unpublished material]
  • Active Pregnancy Project (PowerPoint presentation) [unpublished material]
  • Systematic reviews studies2–18
  • Official recommendations on physical activity during pregnancy and postpartum1,21–29,32–35
  • Other studies referenced in the presentation, upon request
  • Chapters developed in the textbook “Exercise and Physical Activity during Pregnancy and Postpartum”, published by Springer in 2019,51 and the second edition in 2022.52 To be noted that this is the unique international book addressing this topic, so far.
  • Textbook “ACSM’s Guidelines for Exercise Testing and Prescription”, 11th edition57
  • YouTube channel Active Pregnancy58 including four lists of videos divided into webinars, workshops, workouts, and wikipicks, designed to promote exercise among pregnant women, and to help exercise professionals in planning exercise programs: https://www.youtube.com/channel/UC0Vyookwc0mcQ5T70imtoNA
  • Original educational materials published in the Portuguese language supported by IPDJ – Portuguese Institute of Sport and Youth59–63

Feedback on the Workshop

The feedback of the participants was taken on semi-structured feedback format in order to evaluate effectiveness of the workshop, the satisfaction with the contents, as well as the venue of the event. Thus, an anonymous feedback questionnaire was provided to each participant in google forms, immediately after of the completion of the workshop. The overall response rates from the total number of attendees (in place groups = 74, online groups = 63, total attendees = 137) was 94.1{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} (in place groups = 67, online groups = 62, total respondents n = 129).

The questions and the descriptive analysis of the feedback answers were rated by means of a Likert scale 1–5 (5 = excellent, 4 = very good, 3 = good, 2 = poor, 1 = very poor), as shown in Table 1.

Table 1 Opinions of the Participants on the Quality and Effectiveness of the Workshop

Thus, most of the attendees responded that the objectives of the workshop were obtained, the contents are useful for professional practice, the venue (either school or online) is adequate, the experience of the speaker, the time management and the educational resources are excellent. The best features of the workshop were the contents, speaker, time management and educational resources. Overall, the attendees were enthusiastic about the quality of the workshop, either in person or online, and the topics addressed.

Dissatisfaction About the Workshop

The dissatisfaction about the workshop was obtained by means of an open-ended question format. The categories included in dissatisfaction about the workshop provided by the attendees were: the short length of the workshop (17.1{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}), lack of practical sessions (14.7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}), fewer interactions/group discussions during the workshops (14{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}), lack of specific fitness tests and health questionnaires for pregnancy (7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db}).

Recommendations for Improving Forthcoming Workshops

The various recommendations were obtained for improving future workshops, but only 27 attendees provided feedback. The aim of obtaining the recommendations was to understand the participants’ opinion about future workshops, particularly regarding the organization, the content and objectives of workshop and educational resources (ie, books and YouTube channel).

The answers to the open-ended question format were reported as follows:

  • Organization of more in-person short duration workshops (44.2{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
  • Organization of practical sessions (41.8{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
  • Organization of more online short duration workshops (38.8{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
  • Separation and further development of the contents addressing the postpartum period (33.3{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
  • Organization of workshops with round table discussion (19.4{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
  • Importance of this kind of workshops organized by a higher education school (19.4{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
  • Importance of the accreditation of this workshop as a long-life learning training (14.7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
  • Further development of the free access educational resources (17.7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
  • More time dedicated to fitness assessment procedures (7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
  • More time dedicated to motivational counselling techniques (7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
  • More time dedicated to research procedures regarding the dissertation projects in progress (7{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})
  • Inclusion of contents dedicated to nutrition during pregnancy (2.3{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db})

The main recommendations and demands were the organization of more short duration workshops with round table discussion, the inclusion of practical sessions, and the separation of the contents addressing the postpartum period.

Discussion

The present workshop on promotion of physical activity in pregnancy for exercise professionals was delivered to 137 exercise professionals with similar academic background (ie, graduated exercise professionals with bachelor’s degree in exercise sciences, third year exercise sciences students, and master in exercise sciences students) in the context of a higher education institution. The main aim of this workshop was to motivate and prepare exercise professionals for promoting physical activity and implementing prenatal exercise programs, in their respective private or public fitness centers or in other physical activity settings.

The contents of the workshop were focused on six topics based on the “Pregnancy and postpartum exercise specialist” educational standards by EuropeActive47 and the “Exercise and Physical Activity during Pregnancy and Postpartum” textbook published by Springer.51,52

The most important finding of this work is that the participants rated the content of the training and the achievement of the educational goals very highly. Therefore, the authors believe the knowledge gained could be beneficial for the participants in the future, regarding the promotion of evidence-based knowledge underlying physical activity during pregnancy, the preparation for implementing prenatal exercise programs, and the motivation for applied multidisciplinary research. However, future studies should include knowledge and skill testing, before and after the training, in order to understand how it can improve knowledge and impact practice.

Conducting such workshops is particularly important because exercise professionals play a key role in maintaining an appropriate level and quality of physical activity during pregnancy. In nine guidelines recently published by credible obstetrics, gynecology, or sports medicine institutions, experts recommend pregnant women consult with a physical activity or exercise specialist, or exercise physiologist.1,21–26 This means that this professional group must be well educated and ready to cooperate both with women in the perinatal period and with obstetric care providers.42 Unfortunately, in our survey conducted a few years ago we have shown,64 that although the future exercise professionals are generally aware of the positive impact of prenatal physical activity, they lack detailed knowledge, allowing the implementation of exercise sessions with pregnant clients.

The regular organization of training workshops in this topic is also justified by the fact that in recent years there has been a dynamic increase in scientific evidence about the effectiveness of physical activity during pregnancy and after childbirth. As a result, trends in pre- and postnatal classes are also changing. One example of such a shift is high-intensity interval training (HIIT), which is gaining popularity in a wide variety of populations, including pregnant women.65 As shown by Nagpal et al,66 publicly available sources of information on how to implement HIIT in pregnancy are inconsistent and not evidence-based, which can lead to uncertainty in women and discourage them from continuing their favorite form of exercise. Another example of a significant change in the approach to exercise during pregnancy in some countries is the emphasis on the responsibility of the pregnant woman for her own health and that of the child.67 In Canada, women are encouraged to self-assess their health, pregnancy, and readiness to exercise, eg, based on the Get Active Questionnaire for Pregnancy (GAQ-P).68 Thanks to this, they do not need a doctor’s approval to participate in the prenatal classes. Short workshops on the new trends and tools allow exercise professionals to quickly update their knowledge and skills. The overall workshop evaluations also showed that most of the participants were satisfied with the venue and the speaker with a major recommendation as to the organization of more short duration workshops and the inclusion of practical sessions. However, few complained about the length of the workshop (ie, two sessions of 3 hours, totaling 6 hours), demanding for more workshops in near future with more group discussion and longer duration. These different opinions of participants indicate the need to properly balance the length of training and the volume of educational content. In 2021, our response to this need was the start of the work on updating the EuropeActive’s “Pregnancy and Postpartum Exercise Specialist Standards”.69,70 After careful analysis and based on a global external consultation process, in the new document we have left only those professional competences that are most needed on the labor market to work effectively and safely with pregnant and postpartum woman. This makes the knowledge and skills related to planning and conducting exercise programs for pregnant and postpartum women much more accessible to exercise professionals in less time. Although the training based on these standards should be shorter, we paid a lot of attention to practical competences.

Despite the fact that most participants were graduate exercise professionals, they demanded the organization of more workshops, either in-person or online, including practical sessions, for instances, in two days or 4 slots of 3 hours, balancing theory and practical approaches. Moreover, there is the need to upskill exercise professionals, to work as part of a wider network of professionals (eg, doctors, midwives, physiotherapists, etc.), delivering the same messages, in order to maximize the benefits to pregnant and postpartum women.71,72 These opinions were inspiration to develop an international online workshop – The NEPPE “The New Era of Pre- and Postnatal Exercise” project, supported by the Polish National Academic Exchange Agency (NAWA).73

One-third of the participants recommended the separation of the contents addressing the exercise prescription and adaptations during the pregnancy and postpartum periods. Moreover, participants are aware that, from the perspective of exercise planning and intervention, pregnant and postpartum women are two different populations, which require different skills and expertise from exercise professionals. These opinions were inspiration to develop two separate educational modules in the new EuropeActive’s standards: “Exercise in Pregnancy” and “Exercise in Postpartum”. Based on our experience and observation from this workshop, the training providers should plan a separate time for the educational process aimed at achieving learning outcomes defined for these two modules. These opinions were also an inspiration to develop a new chapter on exercise prescription and selection during the early postpartum period.74

Almost 15{af0afab2a7197b4b77fcd3bf971aba285b2cb7aa14e17a071e3a1bf5ccadd6db} of the participants underlined the importance of the accreditation of this workshop as a lifelong learning (LLL) training. The issue of the recognition of LLL activities undertaken by the exercise professionals has been raised recently by EuropeActive experts.75 From the learner’s perspective it will contribute to professional competitiveness. Moreover, such a system will address skills shortages in the labor market and support the overall professionalization of the sector. It is also in accordance with the Council Recommendation on the European Qualifications Framework for lifelong learning.76 However, in order to enable the recognition of LLL and the accreditation of training workshops, it is necessary to develop appropriate education quality standards. One of the solutions to make the workshops accreditation process more transparent and the educational and vocational programs more comparable, is the use of educational credits. Therefore, in the updated version of the “Pregnancy and Postpartum Exercise” educational standards we decided to use European credit system for vocational education and training (ECVET)77 and the European Credit Transfer and Accumulation System (ECTS).78 We assume it will also facilitate the transferability of the educational modules or individual learning units between vocational education and training (VET) and higher education (HE) systems.79

Conclusion

In conclusion, the workshop on promotion of physical activity in pregnancy for exercise professionals was successfully organized, either in person or online, and the participants are looking forward to future workshops. Most of the workshop attendees were convinced that the participation improved their level of knowledge. Moreover, the feedback gathered during the workshop significantly contributed to updating the European educational standards for Pregnancy and Postpartum Exercise Specialists and the commencement of work on the lifelong learning offer for exercise professionals. Therefore, the updating and improvement of knowledge about the importance of physical activity in pregnancy may be translated into a more effective cooperation between exercise professionals and pregnant women in terms of planning and implementing exercise programs.

Summary

A one-day workshop on promotion of physical activity in pregnancy for exercise professionals was delivered during 2021. The main aim was to motivate and prepare exercise professionals for promoting physical activity and implementing prenatal exercise programs. The contents of the workshop were focused on six topics based on the “Pregnancy and Postpartum Exercise Specialist” educational standards by EuropeActive and the “Exercise and Physical Activity during Pregnancy and Postpartum” textbook published by Springer. The workshop was successfully organized, and the participants are looking forward for future ones.

Acknowledgments

IPDJ – Instituto Português do Desporto e da Juventude (Portuguese Institute of Sport and Youth) for the support in the production of the educational materials. EuropeActive for the support in the production of the educational standards.

Funding

The APC of this article was funded by CCISP (Portugal) – HES-SO (Switzerland) collaborative research: ACTIVE PREGNANCY – PROMOTING PHYSICAL EXERCISE AND A HEALTHY LIFESTYLE DURING PREGNANCY AND POSTPARTUM. IPSANTARÉM – Polytechnic Institute of Santarém, Portugal: ESDRM – Sport Sciences School of Rio Maior; ESSS – Health School of Santarém; ESAS – Agrarian School of Santarém, and University of Applied Sciences and Arts Western Switzerland (HES-SO) – School of Health Sciences, Lausanne (HESAV).

Disclosure

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

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