A concurrent prenatal exercise program increases neonatal and placental weight and shortens labor: The GESTAFIT project.

OBJECTIVE: To explore the influence of a supervised concurrent exercise-training program during pregnancy on maternal and neonatal birth-related outcomes and type of birth. METHODS: One hundred and fifty-nine Caucasian pregnant women from the GESTAFIT project participated in this quasi-experimental study and were allocated into control [(n = 86), (age 33.1 ± 4.8 years old, BMI 24.8 ± 4.1 kg/m2 )] or exercise group [(n = 50) (age 33.1 ± 4.1 years old, BMI: 24.7 ± 4.1 kg/m2 )]. The exercise group followed a 60-min 3 days/week concurrent (aerobic and strength) training program from the 17th gestational week until birth. Maternal and neonatal birth-related outcomes (i.e., gestational age at birth, duration of labor, placental and neonatal weight and type of birth) were collected from obstetric medical records. Umbilical arterial and venous blood gas analysis were assessed after birth. RESULTS: The exercise group increased average duration of the first stage of labor [between-group differences (B): 80.8 min, 95% confidence interval (CI), 4.18, 157.31, p = 0.03] and decreased duration of the second stage of labor [between-group differences (B): 29.8 min, 95% CI: -55.5, -4.17, p = 0.02] compared to the control group. The exercise group showed greater placental [between-group differences (B): 53.3 g (95% CI: 9.99, 96.7, p = 0.01)] and neonatal [between-group differences (B): 161.8 g (95% CI: 9.81, 313.8, p = 0.033)] weight compared to the control group. No differences between groups were found regarding type of birth (p > 0.05). CONCLUSIONS: A concurrent and supervised physical exercise program during pregnancy is safe and could promote better maternal and neonatal birth-related outcomes. More studies are needed to clarify the mechanisms by which physical exercise increases neonatal and placenta weight.

Effects of a concurrent exercise training program on low back and sciatic pain and pain disability in late pregnancy.

OBJECTIVE: The aim of the present study was to explore the influence of a concurrent exercise (aerobic + resistance) training program, from the 17th gestational week (g.w.) until birth on low back and sciatic pain, and pain disability. A total of 93 pregnant women divided into exercise (n = 49) and control (n = 44) groups followed a 60-min, 3 days/week, concurrent exercise training. METHODS: Low back and sciatic pain were measured with a Visual Analogic Scale (VAS). The disability resulting from pain was assessed with the Oswestry Disability Index (ODI). Measures were performed at the 16th and 34th g.w. RESULTS: The exercise group increased 21.9 mm less the VAS low back (between-group differences (B): 95% CI: -33.6 to -10.2; p < 0.001) and 12.9 mm less the VAS sciatica score (between-group differences: 95% CI (B): -21.8 to -4.0; p = 0.005) than the control group. Regarding the ODI questionnaire, the exercise group increased 0.7, 0.5, and 0.7 less than the control group in pain while sleeping (between-group differences (B): 95% CI: -1.4 to -0.01; p = 0.025), pain while lifting weight (between-group differences (B): 95% CI: -0.9 to -0.01; p = 0.016), and limitations of the social life due to pain (between-group differences(B): 95% CI: -1.3 to -0.06; p = 0.032). Furthermore, the exercise group suffered 6.9% less pain than the control group in the ODI total score (between-group differences (B): 95% CI: -13.9 to 0.053; p = 0.052). CONCLUSION: This concurrent exercise training program adapted to pregnant women improved pain compared to controls.

The Influence of Exercise, Lifestyle Behavior Components, and Physical Fitness on Maternal Weight Gain, Postpartum Weight Retention, and Excessive Gestational Weight Gain.

This study examines (a) the influence of exercise, lifestyle behavior components (sedentary time, physical activity, and sleep and dietary patterns), and physical fitness on maternal weight gain, postpartum weight retention, and excessive gestational weight gain and (b) whether exercise protects against the adverse effects of impaired metabolism and nonoptimal body composition related to excessive gestational weight gain. Subjects were assigned to either a supervised concurrent (aerobic + resistance) exercise program followed 3 days/week (n = 47) or a control group (n = 54). Sedentary time, physical activity, sleep and dietary patterns (assessed by accelerometry and questionnaires), muscle strength (handgrip test), and cardiorespiratory fitness (Bruce test) were determined at gestational Weeks 16 and 33 (early-middle and late pregnancy, respectively), and at 6 weeks postpartum. Weight gain and weight retention were calculated using recorded weights at prepregnancy, early-middle, and late pregnancy, and at 6 weeks postpartum. Birth complications, maternal postpartum body composition, cardiometabolic, and inflammatory markers in maternal and umbilical cord arterial and venous blood, and in colostrum, and mature milk were also recorded. The exercise intervention reduced late weight gain (B = -2.7, SE = 0.83, p = .003) and weight retention (B = -2.85, SE = 1.3, p = .03), independent of any lifestyle behavior component or physical fitness, but did not prevent excessive weight gain. Increasing cardiorespiratory fitness, muscle strength, and sleep duration were associated with a smaller mean weight gain and lower excessive weight gain values (p < .05). Among the participants who experienced excessive weight gain, those who were exercisers had a lower body mass index and systemic tumor necrosis factor-alpha concentration, lower umbilical cord venous tumor necrosis factor-alpha and arterial interferon gamma levels, higher cord arterial interleukin-10 levels, and improved placental function compared with controls (p < .05). In summary, exercise may help optimize gestational weight gain and weight retention, and may attenuate the impaired phenotype related to excessive weight gain. Increasing cardiorespiratory fitness, muscle strength, and sleep duration might help to prevent excessive weight gain during pregnancy.

Association of sedentary time and physical activity levels with immunometabolic markers in early pregnancy: The GESTAFIT project.

OBJECTIVES: To analyze the association of sedentary time and physical activity (PA) intensity levels with immunometabolic markers during early pregnancy; and to examine if meeting the PA recommendations is associated with the immunometabolic profile of pregnant women. METHODS: Fifty Caucasian pregnant women (age: 32.8 ± 4.7 years old, body mass index: 24.2 ± 4.1kg/m2 , gestational age: 17 ± 1.5weeks) participated in this cross-sectional study (from September 2015 through May 2016). Sedentary time and PA intensity levels were objectively measured with triaxial accelerometer (seven consecutive valid days). Fasting serum glucose, total cholesterol, phospholipids, and triglycerides were assessed with standard methods. Serum pro-inflammatory and anti-inflammatory cytokines (fractalkine, interleukin-1ß, interleukin-6, interleukin-8, interleukin-10, interferon-γ, and tumor necrosis factor-α) were measured using Luminex xMAP technology. RESULTS: Sedentary time and PA were not correlated with any glycemic or lipid marker (P > .05). After adjusting for the potential confounders, vigorous PA showed a positive non-significant association with interleukin-6 (P = .06), and bouts of moderate-vigorous PA was inversely associated with interleukin-1ß and interferon-γ (P = .02 and P = .04, respectively). Meeting the PA guidelines was inversely associated with interleukin-1ß and positively associated with interleukin-8 (P = .01 and P = .04, respectively). These associations disappeared after controlling for multiplicity. CONCLUSIONS: Increasing the time spent in moderate-vigorous PA, or meeting the PA recommendations, is associated with the cytokine profile of women without metabolic disruptions in early pregnancy. However, sedentary time and PA do not seem to be associated with glucose or lipid levels. These results should be interpreted cautiously in view of the discrepancies after adjusting for multiple comparisons. Future studies in this novel field of research are warranted before reaching any conclusion.

International Fitness Scale-IFIS: Validity and association with health-related quality of life in pregnant women.

This study aimed (a) to examine the construct validity of the International Fitness Scale (IFIS) to discriminate between different objectively measured physical fitness levels in pregnant women and (b) to assess the extent to which IFIS is able to discriminate between pregnant women with different levels of health-related quality of life (HRQoL). A total of 159 pregnant women were involved in the GESTAtion and FITness project: 106 pregnant women (mean age 32.7, SD 4.4 years) were included. Self-reported physical fitness-that is, cardiorespiratory fitness, muscular strength, flexibility, and overall fitness-was assessed with the IFIS. Physical fitness was objectively measured using the Bruce test, the handgrip strength test and the back-scratch test. The HRQoL was assessed with the 36-item Short Form Health Survey (SF-36). Higher self-reported physical fitness measured with IFIS was associated with higher objectively measured physical fitness (P < .05). There was a linear association so that higher self-reported physical fitness (ie, IFIS; regardless of the fitness component) was related to greater General Health dimension scores (P < .05). Moreover, higher self-reported physical fitness (all components except muscular strength) was associated with better Physical Functioning, lower Bodily Pain and higher Vitality scores (ie, SF-36 components). This linear trend was not seen for objectively measured physical fitness. The results of this study suggest that IFIS might be a useful tool for identifying pregnant women with low or very low physical fitness and with low quality of life health-related. Further research should elucidate whether IFIS can identify women with pregnancy complications before it can be implemented in clinical practice.

Aerobic interval exercise improves renal functionality and affects mineral metabolism in obese Zucker rats.

Obesity, metabolic syndrome, and renal injury are considered risk factors for type 2 diabetes, as well as kidney disease. Functional and structural changes in the kidney as consequence of obesity and metabolic syndrome may lead to impaired mineral metabolism in what is known as chronic kidney disease-mineral and bone disorder. Lifestyle interventions such as physical activity are good strategies to manage these pathologies and therefore, prevent the loss of kidney functionality and related complications in mineral metabolism. In this study, we have used 40 male Zucker rats that were randomly allocated into four different experimental groups, two of them (an obese and a lean one) performed an aerobic interval training protocol, and the other two groups were sedentary. At the end of the experimental period (8 wk), urine, plasma, and femur were collected for biochemical and mineral composition analysis, whereas the kidney was processed for histological studies. The obese rats exhibited albuminuria, glomerulosclerosis, and hypertrophy in glomeruli and renal tubule in some areas, together with alterations in mineral content of plasma but not of femur. The training protocol prevented the generation of albuminuria and glomerulosclerosis, showing a significant action on plasma and bone mineral levels. Therefore, the specific training protocol used in this study was able to prevent the development of diabetic nephropathy and affected the metabolism of certain minerals.

Association of self-reported physical fitness with pain during pregnancy: The GESTAFIT Project.

AIMS: To explore the association of self-reported physical fitness with bodily, lumbar and sciatic pain, and pain disability during pregnancy. METHODS: The present study sample comprised 159 pregnant women (32.9 ± 4.7 years old). Self-reported physical fitness was assessed with the International Fitness Scale (IFIS), where higher scores indicate greater physical fitness. Bodily pain was assessed with the 36-Item Short Form Health Survey (SF-36), where higher scores indicate lower pain. Lumbar and sciatic pain were measured with a visual analogue scale (VAS). The Oswestry Disability Index (ODI) questionnaire was employed to assess the disability resulting from pain. Measures were assessed at 16th and 34th gestational weeks (g. w.). RESULTS: Pregnant women showed low-moderate pain during pregnancy course. Most of them showed medium self-reported overall physical fitness. At 16th g. w., greater self-reported overall physical fitness and cardiorespiratory fitness were associated with less bodily and lumbar pain, and pain disability (all, P < 0.05). Greater muscular strength was associated with less bodily pain and pain disability (both, P < 0.05). Greater speed-agility was associated with less bodily pain (P < 0.01) and less pain disability (P < 0.05). Self-reported flexibility was not associated with any outcome (P > 0.05). At 34th g. w., greater overall physical fitness and its components were associated with less bodily and sciatic pain (all, P < 0.05). CONCLUSION: Greater self-reported overall physical fitness and its components are associated with less bodily, lumbar and sciatic pain, and reduced pain disability during pregnancy. Future studies are needed to explore whether increasing physical fitness before and during pregnancy could decrease pain in this relevant stage.

Association of sedentary time and physical activity during pregnancy with maternal and neonatal birth outcomes. The GESTAFIT Project.

AIM: (a) To analyse the association of objectively measured sedentary time (ST) and physical activity (PA) during early second trimester of pregnancy with maternal and neonatal birth outcomes; (b) to explore if ST and PA differ between women with vaginal or caesarean section deliveries. METHODS: Ninety-four Caucasian pregnant women (32.9 ± 4.6 years old) participated in this prospective longitudinal study. Triaxial accelerometers were used to assess ST and PA intensity levels for seven consecutive days during second trimester of pregnancy. Birth data were collected from the obstetric medical records. Umbilical cord arterial and venous blood gas (pH, partial pressure of carbon dioxide and oxygen, and oxygen saturation) were analysed after birth. RESULTS: After adjusting for potential confounders, greater ST was associated with higher arterial and venous cord blood partial pressure of carbon dioxide and more acidic arterial and venous pH (all, P < 0.01). Moderate PA, moderate-to-vigorous PA (MVPA), total PA and steps per day were positively associated with arterial cord blood oxygen saturation (all P < 0.05). Steps per day were inversely associated with gestational age at birth (P < 0.01), and duration of first stage of labor (P < 0.05). Total and light PA were associated with a more alkaline pH in umbilical vein (all, P < 0.01). Vigorous PA was inversely associated with the Apgar score (P < 0.01). No significant differences were observed in ST and PA levels between women with vaginal and women with caesarean section deliveries (all, P > 0.10). CONCLUSION: Increasing PA and decreasing ST during pregnancy might promote better maternal and neonatal birth markers.

Association of physical fitness, body composition, cardiometabolic markers and adherence to the Mediterranean diet with bone mineral density in perimenopausal women. The FLAMENCO project.

This study aimed to analyse the association of different components of physical fitness, body composition, cardiometabolic markers and the Mediterranean diet with bone mineral density (BMD) in perimenopausal women, and to test which of these components are independently associated with BMD. The sample comprised 197 perimenopausal women (52.6 ± 4.5 years). Physical fitness was assessed with the "Senior Fitness Test" battery and the handgrip strength and Bruce tests. Fat and lean mass and BMD were measured using dual-energy X-ray absorptiometry. We analysed the markers of metabolic syndrome, C-reactive protein, and components of the Mediterranean diet. Handgrip muscle strength (ß = 0.212, P = 0.005), body weight (ß = 0.244, P = 0.001), BMI (ß = 0.180, P = 0.011) and lean mass (ß = 0.379, P < 0.001) were positively associated with BMD. No associations were observed between cardiometabolic markers or the Mediterranean diet with BMD (all P > 0.05). When all relevant indicators of BMD were simultaneously considered, lean mass was the only 1 showing an independent association with BMD (ß = 0.392, P < 0.001), explaining 14% of the BMD variability. In conclusion, muscle strength might be a marker of BMD in perimenopausal women. However, lean mass was the only factor independently associated with BMD. Future research to determine whether increasing lean mass through specific exercise-based interventions contributes to increasing BMD is warranted.

Effects of supervised aerobic and strength training in overweight and grade I obese pregnant women on maternal and foetal health markers: the GESTAFIT randomized controlled trial.

BACKGROUND: During pregnancy, a sedentary lifestyle may have negative consequences on maternal and foetal health status. The main objective of this project is to assess the effects of an exercise intervention in overweight and grade I obese pregnant on maternal and foetal health markers. METHODS/DESIGN: The present study aims to recruit 60 overweight and grade I obese women interested in participating in an exercise intervention program from the 17th gestational week until delivery. Women will be randomized to either an exercise (three 60-min sessions/week of combined aerobic and strength training and pelvic floor exercises), or usual care (control) group (30 women per group). The primary outcome measures are maternal weight gain, and maternal and neonatal glycaemic profile. Secondary outcome measures are: i) perinatal obstetric records; i) body composition; iii) dietary patterns; iv) physical fitness; v) low-back pain; vi) objectively measured physical activity and sedentary behaviour; vii) haematology and biochemical analyses; viii) oxidative stress; ix) pro- and anti-inflammatory markers; x) bone health biomarkers; xi) sleep quality; xii) mental health, quality of life and positive health. DISCUSSION: The findings of this project will help to identify strategies for primary prevention and health promotion based on this exercise-based intervention program among overweight and grade I obese pregnant women. TRIAL REGISTRATION: NCT02582567 ; Date of registration: 20/10/2015.

Effects of interval aerobic training combined with strength exercise on body composition, glycaemic and lipid profile and aerobic capacity of obese rats.

The purpose of this study was to investigate the effects of interval aerobic training combined with strength exercise in the same training session on body composition, and glycaemic and lipid profile in obese rats. Sixteen lean Zucker rats and sixteen obese Zucker rats were randomly divided into exercise and sedentary subgroups (4 groups, n = 8). Exercise consisted of interval aerobic training combined with strength exercise in the same training session. The animals trained 60 min/day, 5 days/week for 8 weeks. Body composition, lipid and glycaemic profiles and inflammatory markers were assessed. Results showed that fat mass was reduced in both lean and obese rats following the exercise training (effect size (95% confidence interval (CI)) = 1.8 (0.5-3.0)). Plasma low-density lipoprotein-cholesterol and fasting glucose were lower in the exercise compared to the sedentary groups (d = 2.0 (0.7-3.2) and 1.8 (0.5-3.0), respectively). Plasma insulin was reduced in exercise compared to sedentary groups (d = 2.1 (0.8-3.4)). Some exercise × phenotype interactions showed that the highest decreases in insulin, homeostatic model assessment-insulin resistance, fasting and postprandial glucose were observed in the obese + exercise group (all, P < 0.01). The findings of this study suggest that interval aerobic training combined with strength exercise would improve body composition, and lipid and glycaemic profiles, especially in obese rats.

Association between Flexibility, Measured with the Back-Scratch Test, and the Odds of Oxytocin Administration during Labour and Caesarean Section.

Objective: This study explored whether assessing flexibility levels in clinical settings might predict the odds of oxytocin administration and caesarean section to stimulate labour. Methods: Pregnant women from the GESTAFIT Project (n = 157), participated in this longitudinal study. Maternal upper-body flexibility was assessed at 16 gestational weeks (g.w.) through the Back-scratch test. Clinical data, including oxytocin administration and type of birth, were registered from obstetric medical records. Results: Pregnant women who required oxytocin administration or had caesarean sections showed lower flexibility scores (p < 0.05 and p < 0.01, respectively). The receiver operating characteristic curve analysis showed that the Back-scratch test was able to detect the need for oxytocin administration ((area under the curve [AUC] = 0.672 (95% confidence interval [CI]: 0.682 (95% CI: 0.59-0.78, p = 0.001)). The AUC to establish the ability of flexibility to discriminate between vaginal and caesarean section births was 0.672 (95% CI: 0.60-0.77, p = 0.002). A Back-scratch test worse than 4 centimetres was associated with a ~5 times greater increased odds ratio of requiring exogenous oxytocin administration (95% CI: 2.0-11.6, p = 0.001) and a ~4 times greater increased odds ratio of having a caesarean section (95% CI: 1.7-10.2, p = 0.002). Conclusions: These findings suggest that lower flexibility levels at the 16th g.w. discriminates between pregnant women who will require oxytocin and those who will not, and those with a greater risk of a caesarean section than those with a vaginal birth. Pregnant women below the proposed Back-scratch test cut-offs at 16th g.w. might specifically benefit from physical therapies that include flexibility training.

Physical fitness and maternal body composition indices during pregnancy and postpartum: the GESTAFIT project.

We explored the association of physical fitness (PF) during pregnancy with maternal body composition indices along pregnancy and postpartum period. The study comprised 159 pregnant women (32.9 ± 4.7 years old). Assessments were carried out at the 16th and 34th gestational weeks (g.w.) and six weeks postpartum. Cardiorespiratory fitness (CRF), muscular strength (absolute and relative values) and flexibility were measured. Body composition indices were obtained by using dual-energy X-ray absorptiometry at postpartum. The results, after adjusting for potential covariates at the 16th g.w., indicated that greater CRF was associated with lower postpartum indices total fat mass, android and gynoid fat mass (all, p < 0.05). Greater absolute upper-body muscular strength was associated with greater pre-pregnancy body mass index (BMI), gestational weight gain (GWG); and postpartum indices body weight, BMI, lean mass, fat free mass, fat mass, gynoid fat mass, T-score and Z-score bone mineral density (BMD) (all, p < 0.05). Greater upper-body flexibility was associated with lower pre-pregnancy BMI; and postpartum indices body weight, BMI, lean mass, fat free mass, fat mass, android fat mass and gynoid fat mass, and with greater GWG (all, p < 0.05). At the 34th g.w., greater CRF was additionally associated with greater postpartum T-score and Z-score BMD (both, p < 0.05). In conclusion, this study reveals that greater PF levels, especially during early pregnancy, may promote a better body composition in the postpartum period. Therefore, clinicians and health promoters should encourage women to maintain or improve PF levels from early pregnancy.

Given that obesity is on the rise today, it is important to find strategies to cope with it, especially during pregnancy.The results of the present study suggest that greater physical fitness during early pregnancy is key to promoting better body composition in the postpartum period.It should be of clinical interest to encourage pregnant women to maintain or improve their physical fitness levels.

Influence of a Concurrent Exercise Training Program on Health-Related Quality of Life During Advanced Pregnancy: The GESTAFIT Project.

BACKGROUND: Health-related quality of life (HRQoL) may be altered during pregnancy due to pregnancy-related changes in all domains of women's health. HYPOTHESIS: A supervised concurrent exercise-training program from the 17th gestational week until birth positively influences HRQoL. STUDY DESIGN: Randomized controlled trial. LEVEL OF EVIDENCE: Level 1. METHODS: Eighty-six pregnant women (age, 33.1 ± 4.6 years; prepregnancy body mass index, 23.5 kg/m2), divided into exercise (n = 41) and control (n = 45) groups, participated in this study (per-protocol basis). The exercise group followed a 60-min, 3 days/week, concurrent (aerobic + resistance) exercise training program. HRQoL was assessed with the 36-Item Short Form Health Survey (SF-36), where higher scores (0-100) indicate better HRQoL. RESULTS: After adjusting for potential confounders, the exercise group decreased 16.1 points less than the control group in the SF-36 physical functioning domain [between-group differences (B): 95% confidence interval (CI), 9.02 to 23.22; P < 0.01], and 4.5 points less in the SF-36 physical component summary than the control group (between-group differences (B): 95% CI, 0.65 to 8.28; P = 0.02). Intention-to-treat basis analyses depicted similar results, where the exercise group decreased 10.03 points less than the control group the in the SF-36 social functioning domain (between-group differences (B): 95% CI, 0.39 to 19.68; P = 0.04). CONCLUSION: A supervised concurrent exercise training program ameliorates HRQoL decreases along gestation. Although HRQoL decreased throughout pregnancy in both groups, this impact was less in the exercise group, especially in the SF-36 physical functioning, the SF-36 social functioning, and the SF-36 physical component summary. CLINICAL RELEVANCE: Healthcare providers may encourage pregnant women to exercise in this physiological stage for a better HRQoL throughout pregnancy. CLINICALTRIALS.GOV IDENTIFIER: NCT02582567; Date of registration: 20/10/2015.

The influence of an exercise program in middle-aged women on dietary habits. The FLAMENCO project.

OBJECTIVE: To determine the extent to which following an exercise training program can modify dietary habits and adherence to the Mediterranean diet (MD) compared with a counseling group. METHODS: These are secondary analyses from the FLAMENCO (Fitness League Against MENopause COst) project. The present randomized controlled trial included 150 perimenopausal women who were randomized into counseling (n = 75) or exercise (n = 75) groups. The counseling group attended conferences on a healthy lifestyle. The exercise group followed concurrently a 4-month (60 min/session, 3 d/wk) training and did not take part in the conferences. A validated food frequency questionnaire and the Mediterranean diet score were used to assess dietary habits and adherence to the MD, respectively. RESULTS: The fish/shellfish intake was reduced in the counseling group and increased in the exercise group, with a difference between groups of 1.16 servings/wk ( P < 0.01). The counseling group reduced their beer intake, and the exercise group increased it, with a difference between groups of 1.07 servings/wk ( P < 0.01). CONCLUSION: The exercise intervention did not have a significant impact on dietary habits or MD adherence scores in perimenopausal women. Notwithstanding, women in the exercise group increased their beer consumption, which might have been promoted by the social meetings after the exercise training.

A 16-week concurrent exercise program improves emotional well-being and emotional distress in middle-aged women: the FLAMENCO project randomized controlled trial.

OBJECTIVE: To analyze the influence of a supervised concurrent exercise program on emotional well-being and emotional distress in middle-aged women. METHODS: This randomized controlled trial included 150 middle-aged women recruited for the FLAMENCO project. Participants were allocated into counseling (n = 75) or exercise (n = 75) groups. The counseling group attended conferences on healthy lifestyle (including diet and physical activity topics). The exercise group followed a 60-min concurrent (aerobic + resistance) exercise training 3 days/wk for 16 weeks. Emotional health was assessed with the Positive and Negative Affect Schedule (PANAS) in two diverse timeframes, state (PANAS-S) and trait (PANAS-T) ranging from 10 to 50, where higher scores reflect greater affective emotional health/experience (positive affect subscale) and greater emotional distress (negative affect subscale). The differences between the counseling and exercise groups in PANAS were analyzed by linear regression. RESULTS: The total number of women for the per-protocol analyses was 111 divided into the counseling (n = 53) and exercise (n = 58) groups. After adjusting for body mass index and Mediterranean diet adherence, PANAS-S and PANAS-T-positive affect scores increased by 3.81 and 3.02, respectively, in the exercise group whereas they decreased by 0.15 and increased by 0.51 in the counseling group (both, P < 0.05). PANAS-T negative affect decreased by 4.10 in the exercise group whereas only decreased by 0.9 in the counseling group (P < 0.05). CONCLUSION: A 16-week concurrent exercise program improved emotional experience in middle-aged women. Specifically, women in the exercise group significantly improved their emotional well-being and emotional distress through greater changes in positive affect and negative affect compared with the counseling group.

Associations of physical activity, sedentary time, and physical fitness with mental health during pregnancy: The GESTAFIT project.

PURPOSE: This study was aimed to analyze the associations of objectively measured physical activity (PA), sedentary time, and physical fitness with mental health in the early second trimester (16 ± 2 gestational weeks) of pregnancy. METHODS: From 229 women initially contacted, 124 pregnant women participated in the present cross-sectional study. Data were collected between November 2015 and March 2017. The participants wore Actigraph GT3X+ Triaxial accelerometers for 9 consecutive days to objectively measure their PA levels and sedentary time. A performance-based test battery was used to measure physical fitness. Self-report questionnaires assessed psychological ill-being (i.e., negative affect, anxiety, and depression), and psychological well-being (i.e., emotional intelligence, resilience, and positive affect). Linear regression analyses were adjusted for age, educational level, accelerometer wear time, miscarriages, and low back pain. RESULTS: Moderate-to-vigorous PA was negatively associated with depression (ß = -0.222, adjusted R2 = 0.050, p = 0.041). Higher levels of sedentary time were negatively associated with positive affect (ß = -0.260, adjusted R2 = 0.085, p = 0.017). Greater upper-body flexibility was positively associated with better emotional regulation (ß = 0.195, adjusted R2= 0.030, p = 0.047). The remaining associations were not significant (all p > 0.05). CONCLUSION: An active lifestyle characterized by higher levels of moderate-to-vigorous PA and lower levels of sedentary time during pregnancy might modestly improve the mental health of pregnant women. Although previous research has focused on the benefits of cardiorespiratory exercise, the present study shows that only upper-body flexibility is related to emotional regulation in early pregnant women. If the present findings are corroborated in further experimental research, physical exercise programs should focus on enhancing flexibility to promote improvements in emotional regulation during early second-trimester of pregnancy.

Association of Self-Reported Physical Fitness with Pregnancy Related Symptoms the GESTAFIT Project.

We explored the association of physical fitness (PF) with pregnancy-related symptoms, at the 16th and 34th gestational weeks (g.w.). The International Fitness Scale and the Pregnancy Symptoms Inventory were employed to assess self-reported PF and pregnancy-related symptoms, respectively. At the 16th g.w. greater self-reported overall PF was associated with lower incidence of urinary frequency (p = 0.020); greater overall PF, cardiorespiratory fitness (CRF), muscular strength and speed-agility were associated with lower incidence of tiredness-fatigue (all, p < 0.05); greater overall PF and speed-agility were associated with lower incidence of poor sleep (both, p < 0.05); greater CRF and flexibility were associated with lower limitations by tiredness-fatigue (both, p < 0.05); and greater flexibility was associated with lower limitations by poor sleep (p = 0.021). At the 34th g.w. greater self-reported overall PF, CRF and muscular strength were associated with lower incidence of tiredness-fatigue (all, p < 0.05); greater CRF was associated with lower incidence of poor sleep (p = 0.019); and, greater flexibility was associated with lower incidence of increased vaginal discharge (p = 0.023). Adequate levels of PF, especially CRF, may help women to cope with the most endorsed pregnancy-related symptoms and its limitations, especially tiredness-fatigue and poor sleep.

Influence of dietary habits and Mediterranean diet adherence on menopausal symptoms. The FLAMENCO project.

OBJECTIVE: To explore the association of dietary habits and Mediterranean diet adherence with menopausal symptoms. METHODS: The present study included 172 women recruited from the FLAMENCO project. Menopausal symptoms were assessed with the Kupperman Menopausal Index and the Cervantes Menopause and Health Subscale from the validated Cervantes Scale. A food frequency questionnaire was employed to evaluate dietary habits. Adherence to the Mediterranean diet was assessed with the Mediterranean diet score. RESULTS: Intake of poultry and skimmed dairy products was associated with a worse Kupperman Menopausal Index score (ß: 0.17, P = 0.03 and ß: 0.18, P = 0.01, respectively). On the contrary, soy milk consumption was associated with a better Kupperman Menopausal Index score (ß: -0.17, P = 0.02). Poultry and skimmed dairy were associated with worse scores in the total Cervantes Menopause and Health Subscale score (ß: 0.22, P = <0.01 and ß: 0.19, P = 0.01, respectively), whereas soy milk and vegetables were associated with a better total Cervantes Menopause and Health Subscale score (ß: -0.20, P = 0.01 and ß: -0.17, P = 0.03, respectively). Regarding vasomotor symptoms, a greater consumption of poultry was associated with worse symptomatology (ß: 0.18, P = 0.02), and soy milk consumption was associated with fewer vasomotor symptoms (ß: -0.15, P = 0.04). In addition, women with numerous or severe vasomotor symptoms showed a greater consumption of skimmed dairy products (P < 0.05). CONCLUSIONS: This study seems to indicate that some women with mild menopausal symptoms may derive benefit from lower consumption of poultry and skimmed dairy products and a greater consumption of vegetables and soy milk.

Correction: Association of objectively measured physical fitness during pregnancy with maternal and neonatal outcomes. The GESTAFIT Project.

[This corrects the article DOI: 10.1371/journal.pone.0229079.].