Public health guidelines for physical activity during pregnancy from around the world: a scoping review.

BACKGROUND AND OBJECTIVE: Despite the known health benefits of physical activity (PA), pregnancy is a time of marked decline in PA levels. To provide women with reliable and trustworthy information, and to encourage greater participation in PA during pregnancy, many governments have developed guidelines for PA during pregnancy. Our aim was to synthesise the most recent public health guidelines on PA during pregnancy from different countries in order to understand the nature and extent of advice that is available. DESIGN: Scoping review. DATA SOURCES: Search of the grey literature, direct contact with international experts, screening of relevant academic literature and citation searching. ELIGIBILITY CRITERIA: Public health guidelines developed or endorsed by government departments published since 2010. RESULTS: Our search located 30 eligible guidelines, published in 11 different languages. There is remarkable concordance in the advice offered. For women with uncomplicated pregnancy, guidelines recommend: 150-300 min/week of moderate intensity aerobic activity; pelvic floor and muscle strengthening exercises; modification of some exercises (eg, supine position); and provide lists of warning signs to cease activity (eg, persistent dizziness, vaginal bleeding) and activities that should be avoided (eg, if high risk of falling/collision). Few guidelines offer specific advice for highly active women (eg, athletes), or trimester-specific or culturally specific considerations. CONCLUSIONS: This review provides a summary of public health recommendations for PA during pregnancy around the world. The challenge is now to ensure that all who provide healthcare for women understand the guidelines and encourage safe participation in PA during pregnancy.

A review of public health guidelines for postpartum physical activity and sedentary behavior from around the world.

BACKGROUND: The period following pregnancy is a critical time window when future habits with respect to physical activity (PA) and sedentary behavior (SB) are established; therefore, it warrants guidance. The purpose of this scoping review was to summarize public health-oriented country-specific postpartum PA and SB guidelines worldwide. METHODS: To identify guidelines published since 2010, we performed a (a) systematic search of 4 databases (CINAHL, Global Health, PubMed, and SPORTDiscus), (b) structured repeatable web-based search separately for 194 countries, and (c) separate web-based search. Only the most recent guideline was included for each country. RESULTS: We identified 22 countries with public health-oriented postpartum guidelines for PA and 11 countries with SB guidelines. The continents with guidelines included Europe (n = 12), Asia (n = 5), Oceania (n = 2), Africa (n = 1), North America (n = 1), and South America (n = 1). The most common benefits recorded for PA included weight control/management (n = 10), reducing the risk of postpartum depression or depressive symptoms (n = 9), and improving mood/well-being (n = 8). Postpartum guidelines specified exercises to engage in, including pelvic floor exercises (n = 17); muscle strengthening, weight training, or resistance exercises (n = 13); aerobics/general aerobic activity (n = 13); walking (n = 11); cycling (n = 9); and swimming (n = 9). Eleven guidelines remarked on the interaction between PA and breastfeeding; several guidelines stated that PA did not impact breast milk quantity (n = 7), breast milk quality (n = 6), or infant growth (n = 3). For SB, suggestions included limiting long-term sitting and interrupting sitting with PA. CONCLUSION: Country-specific postpartum guidelines for PA and SB can help promote healthy behaviors using a culturally appropriate context while providing specific guidance to public health practitioners.

"I Felt I Was Actually Inside the Movie" An Exploratory Study into Children's Views of Staging a Physically Active Experience, with Implications for Future Interventions.

Current levels of inactivity suggest novel approaches are needed to engage children in physical activity (PA), and enjoyment is a strong motivator for children's PA engagement. A physically active experience (PAE) was proposed as a way to use entertainment, education, (e)aesthetics and escapist methods to promote PA to children in a way that is immersive and enables them to actively partake whilst enjoying their experience. In this current mixed methods study, three physically active experiences based on popular children's movies were designed and staged, in order to explore children's views on staging a PAE and provide implications for future PA interventions. Seventeen children (boys n = nine, girls n = eight) between the ages of nine and ten years provided feedback on the experiences. The children watched a pre-recorded video presenting the physically active experiences and then completed a survey including affective forecasting responses, which was followed by participation in an online focus group where views on the experiences were explored further. For all three experiences, the mean anticipated affective response for valence was between "fairly good" and "good", and for arousal between "a bit awake" and "awake". Further, when asked, the children reported wanting to take part in the experiences (experience 1: 82.4%, experience 2: 76.5%, experience 3: 64.7%). The qualitative data revealed that children felt that they would enjoy the sessions, feel immersed in their environment, transported away from reality, and that they would be able to learn something new regarding PA. These results support the implementation of a PAE to engage children in enjoyable PA; future interventions should use these findings to engage children in a PAE, examining their actual responses to the activities.

'A Physically Active Experience': Setting the Stage for a New Approach to Engage Children in Physical Activity Using Themed Entertainment Experiences.

Despite the multiple health benefits that result from engaging in physical activity, data suggest that children are moving less. Novel approaches to engaging children in physical activity are needed to address this public health concern. Recently, a new definition of physical activity was proposed that emphasizes, among other things, the fact that physical activity is deeply affective, emotional and situated in spaces that shape the experience. With the need to increase engagement in physical activity and this new proposed definition, this paper presents a more novel approach to addressing this problem through staging a physically active experience. The idea draws upon the well-established area of experience economy, which aims to engage those partaking in an educational, (e)aesthetic, escapist, and entertaining way. When staging something as an experience, the focus is on engagement. By staging physical activity as an experience, it is proposed that children can actively partake in physical activity in a way that is focused on the experience offered. This review explains the notion of experience economy and provides examples of how it could be applied to children's physical activity. By creating an aesthetically pleasing, escapist and entertaining environment where children can learn and engage in physical activity, a more engaging positive experience of physical activity can be offered. Future research should examine the staging of physically active experiences for children and evaluate the practical implementation and effectiveness of this new approach to increasing children's engagement in physical activity.

Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis.

BACKGROUND: Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. OBJECTIVE: This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers. METHODS: Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool. RESULTS: Overall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user's current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials. CONCLUSIONS: Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual's characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps.

Can Earth's Mightiest Heroes Help Children Be Physically Active? Exploring the Immersive Qualities of Les Mills' and Marvel's "Move Like the Avengers" Video.

There have been calls for more enjoyable Physical Activity (PA) interventions which focus on ensuring a positive affective response. This study explored how using a narrative, characters, and music in a video-led PA session might influence the sense of immersion and impact the affective response. One hundred and thirty-six participants (boys n = 65, girls n = 71) were recruited, 85% aged between 7 and 11 years old. Participants completed the "Move Like the Avengers" PA video created by Les Mills and Marvel, then complete a survey answering questions on their post activity affective responses, and the use of immersive elements. Positive average affective responses were found (valence mean score: 3.6 ± 2.2, arousal mean score: 5.1 ± 1.0). Analysis revealed the narrative with characters indirectly mediate the valence response through creating a sense of immersion (ßstd = 0.122 [95%CI 0.013 to 0.231]; p = 0.012). Musical elements had both a direct (ßstd = 0.449 [95%CI 0.264 to 0.634]; p < 0.001), and an indirect (ßstd = 0.122 [95%CI 0.014 to 0.229]; p = 0.011) effect upon valence and a direct effect upon arousal (ßstd = 0.244 [95%CI 0.006 to 0.482]; p = 0.021). These promising results provide justification for future research into children's immersive PA.

A Rapid Review of Communication Strategies for Physical Activity Guidelines and Physical Activity Promotion: A Review of Worldwide Strategies.

BACKGROUND: To support the strategy development for communication of the updated physical activity (PA) guidelines, the UK Chief Medical Officers' Expert Panel for Communication was created. METHODS: To help inform this process, a rapid review was performed to identify and describe how other nations are communicating their PA guidelines and PA generally. Elements of the health-enhancing physical activity policy audit tool created by the World Health Organization were used to investigate all 195 countries. RESULTS: Seventy-seven countries had their own guidelines; 53 used the World Health Organization guidelines, and for 65 countries, no guidelines could be found. For the communication, 27 countries used infographics; 56 had government policies/documents, and 11 used a mass media campaign. Only 6 of these had been evaluated. Although many countries used infographics, there were no associated evaluations. As such, any future communication strategies should incorporate an evaluation. Mass media campaigns had the strongest evidence base, proving to be an effective strategy, particularly when incorporating aspects of social marketing. CONCLUSION: This review provides an insight into strategies countries worldwide have taken to communicate PA guidelines and PA promotion. These should be carefully considered when deciding how best to communicate and promote PA guidelines.

Evaluating the results of resistance training using ultrasound or flexed arm circumference: A case for keeping it simple?

BACKGROUND: The present study aimed to compare changes in muscle size when measured by ultrasound (US) muscle thickness (MT) and arm circumference (AC) using data from young men. METHODS: The investigation involved data from three previous studies involving a total of 67 young men who performed resistance training (RT) for 10-12 weeks. Before and after the training period, elbow flexor MT was evaluated by US and AC was measured. We conducted two-stage individual patient data random-effects meta-analyses using both Frequentist and Bayesian hypothesis testing. One-sample analyses examined the absence or presence of a change in both MT and AC, and paired analyses examined whether these differed from one another or equivalent. RESULTS: One-sample analysis supported that both AC (+4.9%; tp=0.0002; BF10=6,255,759,515) and MT (+3.9%; P<0.0001; BF10=7,958,241,773) suggested that change in muscle size had occurred. Frequentist paired comparisons suggested that the estimates of change between both AC and MT measures did not significantly differ (P=0.1092), but were not statistically equivalent. Bayesian paired comparisons, however, suggested that MT estimates where greater in magnitude than AC estimates for change in muscle size (BF10=16.39174). CONCLUSION: Both MT and AC are able to detect RT-induced changes in muscle size of the upper arm, but that the magnitude of changes may differ. Thus, care should be taken when comparing or combining estimates using either approach. RELEVANCE FOR PATIENTS: The use of AC might be considered as a practical and low-cost alternative to detect changes in muscle size.

Physical Activity, Mental and Personal Well-Being, Social Isolation, and Perceptions of Academic Attainment and Employability in University Students: The Scottish and British Active Students Surveys.

BACKGROUND: Physical activity (PA) promotes health and well-being. For students, university represents a transitional period, including increased independence over lifestyle behaviors, in addition to new stressors and barriers to engaging in PA. It is, therefore, important to monitor PA trends in students to gain a greater understanding about the role it might play in physical and mental well-being, as well as other factors, such as attainment and employability. METHODS: Cross-sectional surveys were conducted in 2016 in Scottish universities and colleges, and in 2017 in universities and colleges across the United Kingdom, and the data were pooled for the present study (N = 11,650). Cumulative ordinal logistic regression was used to model the association between PA levels and mental and personal well-being, social isolation, and perceptions of academic attainment and employability. RESULTS: Only 51% of the respondents met the recommended levels of moderate to vigorous PA per week. There was a linear relationship between PA levels and all outcomes, with better scores in more active students. CONCLUSIONS: UK university students are insufficiently active compared with the general population of 16- to 24-year olds. Yet, students with higher PA report better outcomes for mental and personal well-being, social isolation, and perceptions of academic attainment and employability.

Heart rate, energy expenditure, and affective responses from children participating in trampoline park sessions compared with traditional extra-curricular sports clubs.

BACKGROUND: Lack of physical activity (PA) is becoming an issue in younger populations. Trampoline parks are newly popular environments for PA yet research on their use is scarce. Thus the present study compared heart rate, energy expenditure, and affective responses in children participating in trampoline park sessions compared with extracurricular sports clubs. METHODS: Children (aged 6-11 years; N.=16 females, N.=10 males) participated in 3 trampoline park sessions and 3 extracurricular sports club sessions lasting ~45 minutes over 3 weeks. Heart rate, energy expenditure, and affective responses through the circumplex model, were measured. RESULTS: Both conditions elicited moderate-vigorous PA. Average heart rate (mean difference [95%CIs]=27.6 fc [23.5 to 31.8]), peak heart rate (mean difference [95%CIs]=24.2 fc [20.8 to 27.6]) and energy expenditure (mean difference [95%CIs]=3.2 kcals.min-1 [2.7 to 3.6]) were all significantly higher for the trampoline sessions. Affective responses for both conditions elicited feelings of "excitement." CONCLUSIONS: Both extracurricular sports clubs and trampoline park activities provide moderate-vigorous PA, though the latter may result in higher heart rate and energy expenditure responses. Both however produce similar positive affective responses. As such, both could be valuable options for PA opportunities for children.