Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial.

OBJECTIVE: To examine whether a lifestyle intervention in pregnancy limits gestational weight gain (GWG) and provides measurable health benefits for mother and newborn. DESIGN: Randomised controlled trial. SETTING: Healthcare clinics of southern Norway. POPULATION: Healthy, non-diabetic, nulliparous women, aged ≥18 years, with a body mass index of ≥19 kg/m2 , and with a singleton pregnancy at ≤20 weeks of gestation. METHODS: Women were randomised to an intervention group (with dietary counselling twice by telephone and access to twice-weekly exercise groups) or to a control group (with standard prenatal care). Participants were measured three times during pregnancy and at delivery, and newborns were measured at delivery. Hospital records were reviewed for outcomes of pregnancy and delivery. Assessors were blinded to group allocation. Analysis was performed by intention to treat, assessing GWG using the Student's t-test and linear mixed models, and comparing proportions using the chi-square test. MAIN OUTCOME MEASURES: GWG, rates of pregnancy complications and operative deliveries, and newborn birthweight. RESULTS: A total of 606 women were randomised. Of these, 591 were analysed, with 296 in the intervention group and 295 in the control group. At term, the mean GWG from pre-pregnancy was 14.4 kg for the intervention group and 15.8 kg for the control group (mean difference 1.3 kg; 95% confidence interval, 95% CI 0.3-2.3 kg; P = 0.009). There was no significant difference between groups in the frequency of pregnancy complications or operative deliveries. The intervention demonstrated no effect on the mean birthweight of term infants, or on the proportion of large newborns. CONCLUSIONS: The Norwegian Fit for Delivery lifestyle intervention in pregnancy had no measurable effect on obstetrical or neonatal outcomes, despite a modest but significant decrease in GWG. TWEETABLE ABSTRACT: Norwegian Fit for Delivery RCT: reduced gestational weight gain, unchanged birthweight and obstetric outcomes.

The effect of prenatal lifestyle intervention on weight retention 12 months postpartum: results of the Norwegian Fit for Delivery randomised controlled trial.

OBJECTIVE: To examine the effect of a prenatal lifestyle intervention on postpartum weight retention (PPWR). DESIGN: Randomised controlled trial. SETTING: Healthcare clinics in southern Norway. POPULATION: Healthy, nulliparous women with body mass index ≥19 kg/m2 , age ≥18 years, and singleton pregnancy of ≤20 gestational weeks. METHODS: Women were randomised to intervention (dietary counselling twice by phone and access to twice-weekly exercise groups during pregnancy) or control group (standard prenatal care). Intervention compliance was defined post-factum as attending dietary counselling and ≥14 exercise classes. MAIN OUTCOME MEASURES: PPWR (weight measured postpartum minus self-reported pre-pregnancy weight) and the proportion of women returning to pre-pregnancy weight. RESULTS: Of 606 women randomised, 591 were included in an intention-to-treat analysis of pregnancy outcomes and 391 (64.5%) were analysed 12 months postpartum. Mean PPWR was not significantly different between groups (0.66 kg for intervention versus 1.42 kg for control group, mean difference -0.77 kg, 95% CI -1.81, 0.28; P = 0.149). An increased proportion of intervention participants achieved pre-pregnancy weight (53% versus 43%, OR 1.50, 95% CI 1.003, 1.471; P = 0.045). However, the difference was not statistically significant when we adjusted for missing data (adjusted odds ratio (OR) 2.23, P = 0.067) using logistic mixed-effects models analysis. Women compliant with intervention had significantly lower PPWR than control participants, also after adjusting for potential confounders (adjusted mean diff -1.54 kg, 95% CI -3.02, -0.05; P = 0.039). CONCLUSIONS: The Norwegian Fit for Delivery intervention had little effect on PPWR, although women who were compliant with the intervention demonstrated significantly lower PPWR at 12 months. TWEETABLE ABSTRACT: Norwegian Fit for Delivery RCT: little effect of lifestyle intervention on weight retention 1 year postpartum.

Vitamin C and E supplementation blunts increases in total lean body mass in elderly men after strength training.

The aim of this study was to investigate the effects of vitamin C and E supplementation on changes in muscle mass (lean mass and muscle thickness) and strength during 12 weeks of strength training in elderly men. Thirty-four elderly males (60-81 years) were randomized to either an antioxidant group (500 mg of vitamin C and 117.5 mg vitamin E before and after training) or a placebo group following the same strength training program (three sessions per week). Body composition was assessed with dual-energy X-ray absorptiometry and muscle thickness by ultrasound imaging. Muscle strength was measured as one-repetition maximum (1RM). Total lean mass increased by 3.9% (95% confidence intervals: 3.0, 5.2) and 1.4% (0, 5.4) in the placebo and antioxidant groups, respectively, revealing larger gains in the placebo group (P = 0.04). Similarly, the thickness of m. rectus femoris increased more in the placebo group [16.2% (12.8, 24.1)] than in the antioxidant group [10.9% (9.8, 13.5); P = 0.01]. Increases of lean mass in trunk and arms, and muscle thickness of elbow flexors, did not differ significantly between groups. With no group differences, 1RM improved in the range of 15-21% (P < 0.001). In conclusion, high-dosage vitamin C and E supplementation blunted certain muscular adaptations to strength training in elderly men.

Musculoskeletal fitness and balance in older individuals (65-85 years) and its association with steps per day: a cross sectional study.

BACKGROUND: There is limited normative, objective data combining musculoskeletal fitness (MSF), balance and physical activity (PA) among older adults. The aims were therefore to; 1) describe MSF and balance in older Norwegian adults focusing on age- and sex-related differences; 2) investigate the associations among MSF, balance and objectively-assessed PA levels. METHODS: This was part of a national multicenter study. Participants (65-85 years) were randomly selected from the national population registry. We used ActiGraph GT1M accelerometers to measure PA. Balance and MSF were assessed using: one leg standing (OLS), handgrip strength (HG), static back extension (SBE), sit and reach (SR), back scratch right, left arm over (BSR, BSL). Univariate analyses of variance were used to assess sex differences within the different MSF and balance tests and for comparisons among multiple age groups. Linear regression analysis was used to investigate how PA (expressed in 1000 steps increments) was associated with MSF and balance. RESULTS: 85 women and 76 men were included. Mean age (standard deviation (SD)) was 73.2 (5.4) years for women and 72.3 (4.8) years for men. The youngest participants (65-69 years) had significantly better mean OLS- and SBE results compared with older participants. Women (65-85 years) had significantly better mean SR, BSR, BSL and SBE results compared with men (65-85 years). Men had significantly better mean HG results compared with women. No sex differences in mean OLS results were observed. A daily increment of 1000 steps was associated with better mean test scores for OLS- and SBE tests (b = 1.88, 95% CI: 0.85 to 2.90 (p ≤ 0.001) and b = 4.63, 95% CI: 1.98 to 7.29 (p = 0.001), respectively). CONCLUSION: The youngest (65-69 years) had better static balance and muscular endurance in trunk extensors compared with older participants. Older women (65-85 years) had better joint flexibility than older men (65-85 years), whereas older men had better handgrip strength than older women. A higher PA level was associated with better static balance and muscular endurance in trunk extensors in older individuals. This study provides important normative data, and further investigation of trunk endurance and static balance as key foci for PA interventions in elderly is warranted.

Preeclampsia and gestational weight gain in the Norwegian Fit for Delivery trial.

OBJECTIVE: Excessive gestational weight gain is linked to risk of preeclampsia, but it is not clear whether the association is causal. The purpose of this paper was to examine gestational weight gain in the Norwegian Fit for Delivery study among women who developed preeclampsia compared to those who did not, and to further explore associations between weight gain and preeclampsia by including data on body composition (bioimpedance) assessed in the last trimester of pregnancy. RESULTS: A total of 550 women were eligible for the study. Women who developed preeclampsia gained more weight than women who did not (difference 3.7 kg, p = 0.004), with a 3.5 kg difference in total body water observed in week 36 (p = 0.040). Adjusted for age, education, pre-pregnancy body mass index (BMI), randomization, and fat mass, a one kg increase in GWG was associated with 1.3 times higher odds of preeclampsia (OR: 1.31, 95% CI 1.15-1.49, p < 0.001). An independent inverse association between fat mass in week 36 and odds of preeclampsia was observed (OR: 0.79, 95% CI 0.68-0.92, p = 0.002). Given the observed difference in total body water, these findings point to excess fluid as the component driving the association between gestational weight gain and preeclampsia in the present study. Trial registration The NFFD trial has the Clinical Trials registration: clinicaltrial.gov NCT0100168.