The Association between Weight-related Variables and Postpartum Depressive Symptoms.

Objectives: Postpartum depressive symptoms (PPDS) are common, and weight-related variables may be risk factors. In this study, we examined associations between weight-related variables and PPDS in postpartum women. Methods: Participants who gave birth within the past 12 months completed an online survey assessing various weight-related variables and PPDS. We examined associations between weight-related variables and PPDS using regression models. Results: Participants (N=315) were 30.1±3.9 years of age and 5.6±3.7 months postpartum. A majority were white (96.2%), married (87.9%), and had a bachelor's degree or higher (70.5%). Having a higher pre-pregnancy body mass index (BMI) and current BMI, lower weight loss at 6 months postpartum, and substantial postpartum weight retention were associated with higher PPDS. There was no relationship between total gestational weight gain, IOM weight gain category, excess weight gain, postpartum weight retention, and pre-pregnancy-to-postpartum change in BMI, and postpartum depressive symptoms. Conclusions: Understanding factors associated with postpartum depressive symptoms can help to develop and implement appropriate screenings/follow-ups and interventions among those at greatest risk. Given the potential connection to PPDS, there is a need for interventions aimed at promoting healthy pre-conception weight and helping women to lose excess pregnancy weight during the postpartum period.

Postpartum Exercise Intervention Targeting Diastasis Recti Abdominis.

To examine the effectiveness of an online, 12-week exercise intervention on diastasis recti abdominis (DRA) width and negatively associated health outcomes (i.e. weight and core function). Non-pregnant women who were 6-24 months postpartum and ≥ 18 years of age completed the study. Participants (n = 8) were randomized to intervention (exercise) or control groups; with the intervention group completing three exercise sessions per week virtually. Both groups completed three surveys at baseline, 6-weeks, and 12-weeks. DRA width was measured with nylon calipers at baseline and 12-weeks. Repeated measures analysis of covariance examined Group x Time changes in width of DRA, core function, and weight at 12-weeks; effect sizes (i.e. Cohen's d) were calculated. An alpha level of 0.05 was used to determine statistical significance. There was a significant Group x Time interaction for two DRA width measurement sites, 2 inches above navel (rest) (p = 0.007, d = 0.67) and 2 inches above navel (active) (p = 0.005, d = 0.69). The Group x Time interaction for weight approached significance (p = 0.06), with a small between group effect size (d = 0.23). The Group x Time interaction for core function was not significant (p = 0.83). Exercise interventions delivered in a virtual setting may be effective for decreasing the severity of DRA in postpartum women. Future research should investigate the impact of similar programs on other aspects of postpartum mental and physical health, activities of daily living, and clinical practice.

Preparing for postpartum: health care provider discussions and predictors of patient satisfaction.

Women's health care providers are trusted sources of patient education during pregnancy and postpartum; however, little is known about discussion prevalence or patient satisfaction. The purposes of this study were to describe patient-provider discussion prevalence and identify demographic and pregnancy-related factors associated with discussion occurrence and satisfaction. An electronic survey was completed by 319 postpartum women who received prenatal care for a singleton pregnancy within the last 12 months in the United States. Participants reported demographic and pregnancy-related information, and occurrence and satisfaction with information shared during prenatal and postpartum health care. Descriptive statistics and odds ratios were calculated. During pregnancy and postpartum, college graduates were more likely to report any discussion (pregnancy: OR = 1.70, 95% C.I. 1.01, 2.86; postpartum: OR = 1.94, 95% C.I. 1.16, 3.25). Participants with gestational diabetes were less likely to report any discussion during pregnancy (OR = 0.43, 95% C.I. 0.20, 0.92). Obese participants were less likely to report any postpartum discussion compared to underweight/normal weight participants (OR = 0.51, 95% C.I. 0.29, 0.89). Within postpartum health care, college graduates (p = .01) and those with a cesarean section (p = .01) reported lower satisfaction; multiparous women reported higher satisfaction (p = .03). Findings highlight potential inequities in clinical practice and risk factors for postpartum anticipatory care satisfaction.

Pre-pregnancy body dissatisfaction and weight-related outcomes and behaviors during pregnancy.

To examine relationships among pre-pregnancy body dissatisfaction (BD) and gestational weight gain (GWG), and related attitudes/behaviors. Pre-pregnancy BD was self-reported in early pregnancy. Weight-related attitudes/behaviors were self-reported and physical activity was objectively measured during pregnancy. Overall, 92% of the women reported BD, with 69% desiring a smaller pre-pregnancy size than their actual pre-pregnancy size. Ideal pre-pregnancy weight was 20.7 ± 28 pounds less than self-reported pre-pregnancy weight. Only weight-control strategies used at 35 weeks were associated with BD (p = 0.008). Pre-pregnancy BD may not predict risk for excess GWG and some weight-related issues during pregnancy.

Association of provider advice and gestational weight gain in twin pregnancies: a cross-sectional electronic survey.

BACKGROUND: Little is known about patient-provider communication on gestational weight gain among women pregnant with twins, a growing population at high risk for adverse maternal and neonatal outcomes. We examined if women's report of provider advice on gestational weight gain was consistent with the Institute of Medicine (IOM) weight gain guidelines for twin pregnancies, and the association of provider advice on weight gain with women's weight gain during their twin pregnancy. METHODS: We conducted a cross-sectional survey of 276 women who delivered twins and received prenatal care in the United States. The 2009 IOM provisional weight gain guidelines for twin pregnancies defined whether provider advice on weight gain and women's weight gain were below, within, or above guidelines. Multinomial logistic regression examined associations between provider advice on weight gain with women's weight gain, after adjustment for maternal age, gestational age at delivery, education, parity, twin type, use of assisted reproductive technologies and pre-pregnancy BMI category. RESULTS: Approximately 30% of women described provider advice on weight gain below the IOM guidelines, 60% within, and 10% above guidelines. Compared to women who reported weight gain advice within guidelines, women who reported advice below guidelines or who reported no advice were 7.1 (95% CI: 3.2, 16.0) and 2.7 (95% CI: 1.3, 5.6) times more likely to gain less than recommended, respectively. Women who reported provider advice above guidelines were 4.6 (95% CI: 1.5, 14.2) times more likely to exceed guidelines. CONCLUSIONS: Provider advice on gestational weight gain may be an important predictor of women's weight gain during twin pregnancies, highlighting the critical need for accurate provider counseling to optimize health outcomes.

Associations between prenatal diet quality and gestational weight gain.

BACKGROUND: Improving prenatal diet quality may promote appropriate gestational weight gain (GWG). AIM: To examine relationships between dietary quality in the second and third trimesters of pregnancy and GWG. METHODS: Participants' (n = 41) dietary intake was assessed at 14-20 and 35 weeks gestation via the Automated Self-Administered 24-h recall (ASA-24). Kilocalories and Healthy Eating Index (HEI-2015) scores were calculated and associations with GWG were explored via linear regression. RESULTS: Participants reported consuming 2139 ± 719 and 2085 ± 704 kilocalories at 18 and 35 weeks, respectively. HEI-2015 total scores at 18 (55.6 ±12.6) and 35 weeks gestation (56.6 ± 14.1) indicated a need for improvement. Greens and beans component score at 35 weeks was the only diet quality score associated with GWG. CONCLUSIONS: GWG was not associated with most diet quality indices. However, vegetable intake may help to attenuate GWG. Future research should seek to elucidate relationships between GWG and dietary quality/intake to provide valuable insight for researchers and clinicians.

Examining the Impact of Body Satisfaction and Physical Activity Change on Postpartum Depressive Symptoms.

BACKGROUND: Relationships among moderate to vigorous physical activity (MVPA), body satisfaction, and postpartum depressive symptoms are not well understood. The purpose of this study is to examine the (1) impact of postpartum body satisfaction and changes in MVPA on postpartum depressive symptoms and (2) moderating effect of changes in MVPA over time on the relationship between postpartum body satisfaction and depressive symptoms. METHODS: Participants (N = 269) self-reported body satisfaction, MVPA (prepregnancy through postpartum), and postpartum depressive symptoms. Differences in MVPA at 3 time points (prepregnancy, third trimester, and postpartum) were calculated to create change scores. Main effects and interactions (body satisfaction × MVPA change) were examined using multiple regression. RESULTS: A majority of the sample did not meet MVPA recommendations at all time points. All body satisfaction measures were inversely related to postpartum depressive symptoms (P = .01 to <.001). MVPA change did not predict postpartum depressive symptoms (P = .43-.90) or moderate the relationship between body satisfaction and postpartum depressive symptoms (P = .14-.94). CONCLUSIONS: Given the relationship between postpartum body satisfaction and depressive symptoms, intervention research should include strategies that promote positive postpartum body image; clinicians should consider screening for body dissatisfaction. Although not a predictor or moderator, pregnancy and postpartum MVPA promotion should continue, as it has numerous other benefits.

Provider advice on physical activity and nutrition in twin pregnancies: a cross-sectional electronic survey.

BACKGROUND: Health care providers should counsel pregnant patients on physical activity and nutrition to improve pregnancy outcomes. However, little is known about provider advice on these lifestyle behaviors among women pregnant with twins, a growing population at high risk for pregnancy complications. We examined the prevalence and content of provider advice on physical activity and nutrition among women pregnant with twins. METHODS: A cross-sectional electronic survey was administered to 276 women who delivered twins in the past 3 years and received prenatal care in the United States. The proportion of women reporting provider advice on physical activity and nutrition during prenatal visits (yes/no) was assessed and open-ended questions examined the content of provider advice. Bivariate differences in participant characteristics, stratified by provider advice on physical activity and nutrition (yes/no), were assessed. Responses from open-ended questions were examined using a content analysis approach to identify commonly reported advice on physical activity and nutrition. RESULTS: Approximately 75 and 63% of women reported provider advice on physical activity and nutrition, respectively, during their twin pregnancy. Women who recalled advice on physical activity most commonly reported recommendations to walk at a light to moderate intensity level. However, few women reported physical activity recommendations consistent with current guidelines, and approximately 55% of women reported provider advice to limit or restrict activity during their pregnancy, including bedrest. Nutrition advice was focused on eating a healthy, balanced diet and increasing protein intake. More women reported self-initiating the conversation on physical activity with their provider (40%) compared to nutrition (21%). Despite limited advice, 70% of women reported being satisfied or very satisfied with the information they received from their provider on physical activity or nutrition. CONCLUSIONS: The majority of women reported provider advice on physical activity and nutrition during their twin pregnancies. However, advice was limited in detail, and physical activity levels were commonly restricted, despite the lack of evidence that activity restriction is beneficial during pregnancy. More research is needed to determine the optimal physical activity and dietary patterns in twin pregnancies to facilitate clear and consistent provider counseling on these lifestyle behaviors.

The Feasibility and Efficacy of a Behavioral Intervention to Promote Appropriate Gestational Weight Gain.

INTRODUCTION: Nearly half of all women gain above gestational weight gain (GWG) recommendations. This study assessed the feasibility and efficacy of a pilot behavioral intervention on GWG and physical activity behaviors. METHODS: Women (n = 45) 14-20 weeks gestation enrolled in a behavioral intervention. Physicians 'prescribed' the intervention to low risk patients. The intervention included self-monitoring, support, and optional walking groups. Process evaluation measures regarding usage and acceptability of study components were obtained. Physical activity was objectively measured at baseline and 35 weeks. The percentage of participants with appropriate GWG was calculated. Control data was obtained from the same clinic where participants were recruited. RESULTS: Overall, the intervention was acceptable to participants; attrition was low (6.7%), weekly contact was high (87%), and self-monitoring was high (Fitbit worn on 82% of intervention weeks; weekly weighing on 81%). Facebook (40% of weeks) and study website use (19%) was low, as was walking group attendance (7% attended a single group). Participants reported a lack of discussions about the study with their physician. Results showed no significant difference between intervention and control participants in the percentage who gained excess weight (p = 0.37). There was a significant decrease in moderate-to-vigorous physical activity in intervention participants (p < 0.0001). DISCUSSION: Continued efforts for promoting physical activity and appropriate GWG are needed. Although acceptable, the intervention was not efficacious. Trainings for, or input from prenatal healthcare providers on how to best encourage and support patients' engagement in healthy behaviors, such as PA, are warranted.

Barriers to resistance training among college-aged women.

OBJECTIVE: To examine resistance training (RT) barriers among college-aged women. PARTICIPANTS: Female college students (n = 223) from a Midwestern university. METHODS: Data were collected in September 2014. Participants completed a survey assessing demographics, current and past RT habits, and barriers to resistance training. Descriptive statistics were used to examine barrier agreement. Differences between current and past RT participation, residency, and class standing were analyzed. RESULTS: A majority of participants were Caucasian (78.9%) and, on average, 19.7 ± 1.5 years of age; 52% participated in RT and 46.6% met RT recommendations. Women who did not report current RT participation reported significantly higher mean agreement with all barriers, compared to those who do RT. Highest agreement was observed within socially based barriers. CONCLUSION: A majority of college-aged women are not meeting RT recommendations. Providing educational programs and avenues for finding same-sex RT partners may be most beneficial for overcoming common RT barriers.

The Influence of Life Events and Psychological Stress on Objectively Measured Physical Activity: A 12-Month Longitudinal Study.

BACKGROUND: This study examined how life event occurrences and stressfulness influence objectively measured light through vigorous physical activity (PA) among young adults. METHODS: Every 3 months over a 12-month period, 404 healthy young adults completed questionnaires on the occurrence and stress of 16 life events and wore an accelerometer for 10 days. RESULTS: A modest positive relationship was seen between cumulative life event occurrences [between effect: ß = 22.2 (9.7) min/d, P = .02] and cumulative stress [between effect: ß = 7.6 (2.9) min/d, P = .01] with light through vigorous PA among men. When considering events individually, job change, starting a first job, beginning a mortgage, and changes in a relationship influenced men's PA. For women, mortgage, starting a first job, job change, and engagement had significant associations. Life event stressfulness influenced PA in women more than in men. For men, stress from changes in a relationship or job positively influenced PA. Stress of a mortgage, quitting a job, changing jobs or a first job influenced women's PA. CONCLUSION: Considering each life event individually was more informative than the summation of life events or summation of stress. Specific life events substantially altered PA, and this change varied by gender, direction of association, and PA intensity and duration.

Effects of a Group-Based Behavioral Intervention on Dietary Behaviors in Older Adults.

OBJECTIVE: The aim of this study is to examine the effects of a 12-week, behavioral nutrition intervention on dietary behaviors. METHOD: Inactive older adults ( N = 50) were randomized to a 12-week, behavioral nutrition or physical activity intervention, delivered in a group-based format. Questionnaires assessed fruit and vegetable (FV) consumption, and fat- and fiber-related behaviors at baseline and postintervention. Height and weight were measured. Repeated-measures ANOVAs examined changes in dietary behaviors over time between groups, controlling for age, gender, and education. RESULTS: Participants averaged 64.1 ± 8.4 years of age and had a body mass index (BMI) of 33.3 ± 7.5 kg/m2. Group × Time interactions were significant for FV consumption ( p = .003), and fat- ( p = .02) and fiber-related ( p = .008) behaviors at 12 weeks. At 12 weeks, dietary behaviors improved significantly in the nutrition but not in the physical activity group. Effect sizes were medium to large. DISCUSSION: A 12-week, behavioral nutrition intervention improved dietary behaviors. Behavioral interventions may be a low-cost way to improve dietary behaviors among older adults, potentially affecting population health significantly.

Effects of a Self-Directed Nutrition Intervention Among Adults With Chronic Health Conditions.

Chronic diseases are common among adults. A healthy diet may be beneficial for managing the consequences of such conditions. The purpose of this study was to evaluate the effects of a self-directed nutrition program on dietary behaviors among adults with chronic health conditions. As part of a larger trial examining the effects of a self-directed exercise program, participants with arthritis were randomized to a 12-week self-directed exercise or nutrition intervention. Self-reported fruit and vegetable consumption, fat- and fiber-related behaviors were assessed at baseline, 12 weeks, and 9 months. Repeated measures analyses of covariance examined Group × Time changes in dietary behaviors. Effect sizes were computed. Participants ( n = 321) were, on average, 56.5 ± 10.5 years old, had a mean body mass index of 32.9 ± 8.3 kg/m2, and had 2.0 ± 1.0 chronic health conditions; 88% were female, 65% White, 88% had at least some college education, and 62% married. There were significant Group × Time interactions favoring the nutrition group at 12 weeks for all dietary behaviors ( p < .05) but not at 9 months. Between-group effect sizes were small at 12 weeks and decreased at 9 months. Within-group effect sizes were larger for the nutrition group (small to medium) than the exercise group (none to small) at both time points. A self-directed nutrition intervention can result in meaningful improvements in dietary behaviors among adults with chronic health conditions in the short term.

Patterns of Sedentary Behavior in Older Adults.

OBJECTIVES: We measured the volume and patterns of sedentary behavior (including breaks from sedentary behavior) in a sample of older adults via accelerometry. METHODS: Inactive, older adults (≥50 years of age) were eligible to participate. A cut point of <100 counts/minute was used to estimate: (1) total volume; (2) > 10-, > 30-, and > 60-minute bouts; and (3) patterns of sedentary behavior according to time of day and day of the week were computed. Total breaks in sedentary time also were calculated. RESULTS: Participants (N = 67) were sedentary 62% of the day, engaging in 73.3 total bouts of daily sedentary behavior, and each bout lasted, on average, 7.8 minutes. All participants engaged in >1 daily bout of sedentary behavior > 10 and > 30 minutes. Sedentary time was slightly greater during the evening and on weekdays. Participants averaged 72.9 daily breaks from sedentary behavior, with each break lasting approximately 4.4 minutes. CONCLUSIONS: Our findings add valuable insights into the patterns of sedentary behaviors among older adults. Concentrated research efforts should be made to gain a clearer understanding of patterns and enablers to sedentary behaviors, which will allow for development of targeted interventions for this high-risk population.

Mediators of Social Connection in a Group Teleconference Intervention.

BACKGROUND AND PURPOSE: Social connection has a positive influence on cancer survivorship and has been targeted in intervention work. We examined whether the formation of social connection is influenced by fear, fatalism, and isolation. METHODS: We conducted a mediation analysis on data from an intervention study with African American breast cancer survivors to investigate whether fear, fatalism, and isolation conveyed effects on social connection. RESULTS: Although results indicated that there were no significant mediated effects of the intervention through these variables, we garnered information about action and conceptual theories underlying the program that inform future work. IMPLICATIONS FOR PRACTICE: Our insights can be considered in future interventions conducted for African American women with breast cancer during and following treatment.

An Examination of Personal Health Promotion and Curricular Coverage of Health at US Seminary Schools.

Seminary schools train clergy members, who have significant influence on the health-related environment of their faith-based organizations. The purpose of this study was to examine health promotion in seminary schools, including curriculum coverage of health-related topics. This cross-sectional, mixed methods study used print and online surveys. Seminary schools (n = 57) self-reported approaches to health and health-related curriculum. Most schools emphasized the inclusion of health in clerical practice, and healthy behaviors among students, and covered holistic views of health and self-care issues within their curriculum. This study provides insight into how seminary schools are training future generations of clergy on health-related topics.

"Participation, satisfaction, perceived benefits, and maintenance of behavioral self-management strategies in a self-directed exercise program for adults with arthritis".

A process evaluation was conducted in conjunction with a controlled trial of a self-directed exercise program among people with arthritis to describe the program's reach; self-management behaviors, exposure to materials, program perceptions, satisfaction, and perceived benefits; compatibility with targeted participants' needs; and maintenance. Participants (n=197) were predominantly white, middle-aged, college-educated women. At 12 weeks, 73.2% had read ≥90% of the program materials (at nine months>70% had "occasionally" or "often" looked back over each of the five parts of the materials); 63.3% had set goals (52.5% at nine months), and 83.9% had "some" or "a lot" of success following their plan (64.2% at nine months), while 90.4% rated the program "good" or "excellent" (87.5% at nine months). At 12 weeks, the majority (89.3%) used written logs to self-monitor (mean=9.3 logs); by nine months, >70% never kept logs. Most (>80%) rated twelve of thirteen program components as helpful, and 98.6% would recommend the program. From 38% to 62.4% endorsed each of eight program benefits, with small declines of ≤9% at nine months. Qualitative response identified ways the program met and did not meet expectations. The main program compatibility issue was targeting all adults with arthritis, while featuring older adults in materials.

Neighborhood Attributes Associated With the Social Environment.

PURPOSE: To examine the association between specific attributes of neighborhood environments and four social environment measures. DESIGN: Data were collected as part of a baseline survey among participants enrolling in a walking intervention. SETTING: Participants were recruited from a metropolitan area in a Southeastern state. SUBJECTS: Participants (n = 294) were predominantly African-American (67%) and female (86%), with some college education (79%) and a mean age of 49. MEASURES: The International Physical Activity Questionnaire Environment Module assessed perceptions about neighborhood attributes. The social environment was assessed using three distinct scales: social cohesion, social interactions with neighbors, and social support for physical activity from family and friends. ANALYSIS: Multiple regression models examined associations between neighborhood attributes and social environment measures, adjusting for demographic variables. RESULTS: Having walkable destinations and having access to amenities and transit stops were associated with increased interactions with neighbors (b = 1.32, 1.04, and 1.68, respectively, p < .05). Attributes related to structural support for physical activity (sidewalks, street connectivity, recreation facilities) were associated with increased interactions with neighbors (b = 1.47, 1.34, and 1.13, respectively, p < .05). Bicycling facilities that were maintained (i.e., bike lanes, racks) were associated with social support for physical activity from family and friends (b = .43 and .30, respectively, p < .05). CONCLUSION: The study highlights key attributes of neighborhood environments that may be associated with the social context of such settings.

Body Size Perceptions among Overweight and Obese African American Women.

OBJECTIVE: Understanding body size perceptions and discrepancies among African American women may have implications for effective weight-loss interventions. The purpose of this study is to examine body size perceptions of economically disadvantaged, overweight and obese African American women. DESIGN: Cross-sectional using baseline data from a randomized controlled trial. SETTING: 18 census tracts in a central South Carolina city where ≥ 25% of residents were below poverty income. PARTICIPANTS: 147 economically disadvantaged, overweight and obese African American women. MAIN OUTCOME MEASURES: Using Pulvers' figure rating scale, participants chose the figure: 1) closest to their current figure; 2) they would be satisfied with; and 3) with a body weight that would be a health problem for the average person. Mean body mass indices corresponding to each figure were compared with those in a large sample of White women. RESULTS: Most participants wanted to be smaller (mean=2.6 figures smaller) than their current size. A majority (67%) chose the largest figure as representing a body size that could lead to a health problem, and most (60%) chose a current figure smaller than the figure they believed would be associated with health problems. The mean body mass index for women selecting any given figure as their current size was significantly larger (5.2-10.8 kg/m(2) larger, P<.0001) than those established in the sample of White women. CONCLUSIONS: Although women desired a smaller body size, there nonetheless were misperceptions of body size and the associated health consequences. Body size misperceptions and/or satisfaction may pose barriers for effective weight-loss.

The steps to health randomized trial for arthritis: a self-directed exercise versus nutrition control program.

BACKGROUND: Despite the established benefits of exercise for adults with arthritis, participation is low. Safe, evidence-based, self-directed programs, which have the potential for high reach at a low cost, are needed. PURPOSE: To test a 12-week, self-directed, multicomponent exercise program for adults with arthritis. DESIGN: Randomized controlled trial. Data were collected from 2010 to 2012. Data were analyzed in 2013 and 2014. SETTING/PARTICIPANTS: Adults with arthritis (N=401, aged 56.3 [10.7] years, 85.8% women, 63.8% white, 35.2% African American, BMI of 33.0 [8.2]) completed measures at a university research center and participated in a self-directed exercise intervention (First Step to Active Health(®)) or nutrition control program (Steps to Healthy Eating). INTERVENTION: Intervention participants received a self-directed multicomponent exercise program and returned self-monitoring logs for 12 weeks. MAIN OUTCOME MEASURES: Self-reported physical activity, functional performance measures, and disease-specific outcomes (arthritis symptoms and self-efficacy) assessed at baseline, 12 weeks, and 9 months. RESULTS: Participants in the exercise condition showed greater increases in physical activity than those in the nutrition control group (p=0.01). Significant improvements, irrespective of condition, were seen in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy (p values<0.0001). More adverse events occurred in the exercise than nutrition control condition, but only one was severe and most were expected with increased physical activity. CONCLUSIONS: The exercise program improves physical activity, and both programs improve functional and psychosocial outcomes. Potential reasons for improvements in the nutrition control condition are discussed. These interventions have the potential for large-scale dissemination. This study is registered at Clinicaltrials.gov NCT01172327.