Heat production during exercise in pregnancy: discerning the contribution of total body weight.

Studies have reported enhanced thermoregulatory function as pregnancy progresses; however, it is unclear if differences in thermoregulation are attributed to weight gain or other physiological changes. This study aimed to determine if total body weight will influence thermoregulation (heat production (Hprod)), heart rate, and perceptual measurements in response to weight-bearing exercise during early to late pregnancy. A cross-sectional design of healthy pregnant women at different pregnancy time points (early, T1; middle, T2; late, T3) performed a 7-stage weight-bearing incremental exercise protocol. Measurements of Hprod, HR, and RPE were examined. Two experimental groups were studied: (1) weight matched and (2) non-weight matched, in T1, T2, and T3. During exercise, equivalent Hprod at T1 (326 ± 88 kJ), T2 (330 ± 43 kJ), and T3 (352 ± 52 kJ) (p = 0.504); HR (p = 0.830); and RPE (p = 0.195) were observed in the WM group at each time point. In the NWM group, Hprod (from stages 1-6 of the exercise) increased across pregnancy time points, T1 (291 ± 76 kJ) to T2 (347 ± 41 kJ) and T3 (385 ± 47 kJ) (p < 0.001). HR increased from T1 to T3 in the warm-up to stage 6 (p = 0.009). RPE did not change as pregnancy time point progressed (p = 0.309). Total body weight, irrespective of pregnancy time point, modulates Hprod and HR during exercise. Therefore, accounting for total body weight is crucial when comparing thermoregulatory function during exercise across pregnancy.

'It's not me, it's them' - a report describing the weight-related attitudes towards obesity in pregnancy among maternal healthcare providers.

BACKGROUND: Occurrences of weight stigma have been documented in prenatal clinical settings from the perspective of pregnant patients, however little is known from the viewpoint of healthcare providers themselves. Reported experiences of weight stigma caused by maternal healthcare providers may be due to negative attitudes towards obesity in pregnancy and a lack of obesity specific education. The objective of this study was to assess weight-related attitudes and assumptions towards obesity in pregnancy among maternal healthcare providers in order to inform future interventions to mitigate weight stigma in prenatal clinical settings. METHODS: A cross-sectional survey was administered online for maternal healthcare providers in Canada that assessed weight-related attitudes and assumptions towards lifestyle behaviours in pregnancy for patients who have obesity. Participants indicated their level of agreement on a 5-point likert scale, and mean scores were calculated with higher scores indicating poorer attitudes. Participants reported whether they had observed weight stigma occur in clinical settings. Finally, participants were asked whether or not they had received obesity-specific training, and attitude scores were compared between the two groups. RESULTS: Seventy-two maternal healthcare providers (midwives, OBGYNs, residents, perinatal nurses, and family physicians) completed the survey, and 79.2% indicated that they had observed pregnant patients with obesity experience weight stigma in a clinical setting. Those who had obesity training perceived that their peers had poorer attitudes (3.7 ± 0.9) than those without training (3.1 ± 0.7; t(70) = 2.23, p = 0.029, Cohen's d = 0.86). CONCLUSIONS: Weight stigma occurs in prenatal clinical environments, and this was confirmed by maternal healthcare providers themselves. These findings support advocacy efforts to integrate weight stigma related content and mitigation strategies in medical education for health professionals, including maternal healthcare providers. Future work should include prospective examination of weight related attitudes among maternal healthcare providers and implications of obesity specific education, including strategies on mitigating weight stigma in the delivery of prenatal care.

Validity of an ultrasound device to measure bone mineral density.

This study aims to examine the validity and reliability of the UltraScan650™, a portable ultrasound device, used to measure BMD at the 1/3rd radius position. Fifty-two female first responders and healthcare providers were assessed using DXA (forearm, femur, lumbar, and total body) and the UltraScan650™. Fat and lean mass were also assessed using the DXA. Pearson correlations, Bland-Altman plots, t-tests, and linear regressions were used to assess validity. Intra-class correlation (ICC) coefficients were used to assess reliability. Inter-rater reliability and repeatability were good (ICC = 0.896 [0.818; 0.942], p < 0.001) and excellent (ICC = 0.917 [0.785; 0.989], p < 0.001), respectively. BMD as measured by the UltraScan650™ was weakly correlated to the DXA (r = 0.382 [0.121; 0.593], p = 0.0052). Bland-Altman plots revealed that the UltraScan650™ underestimated BMD (-0.0569 g/cm2), this was confirmed with a significant paired t-test (p < 0.001). A linear regression was performed (0.4744 × UltraScan650™ + 0.4170) to provide more information as to the issue of agreement. Bland-Altman plots revealed a negligible bias, supported by a paired t-test (p = 0.9978). Pearson's correlation revealed a significant relationship (r = -0.771 [-0.862; -0.631], p < 0.0001) between adjusted UltraScan650™-DXA and the average of the two scans (i.e., adjusted UltraScan650™ and DXA), suggesting a proportional constant error and proportional constant variability in measurements of BMD from the UltraScan650™. The UltraScan650™ is not a valid alternative to DXA for diagnostic purposes; however, the UltraScan650™ could be used as a screening tool in the clinical and research setting given the linear transformation is employed.

Associations Between Rank, Sex, and Parity With Musculoskeletal Injuries Sustained During Annual Military Physical Fitness Test.

ABSTRACT: Edwards, CM, da Silva, DF, Puranda, JL, Souza, SCS, Semeniuk, K, and Adamo, KB. Associations between rank, sex, and parity with musculoskeletal injuries sustained during annual military physical fitness test. J Strength Cond Res 38(2): 367-373, 2024-Musculoskeletal injuries pose a significant threat to the well-being of military personnel. Attempts to use physical employment standard test results as predictors of injury are underway, but little is known about injuries sustained during the tests. This study sought to identify body regions most likely to be reported as injured during the annual Canadian Armed Forces (CAF) physical fitness evaluation. In addition, sex, rank, and parity status are explored as possible associated factors for injury. A total of 1,796 actively serving CAF members were categorized by sex (1,030 male participants; 766 female participants), rank (1,142 Non-Commissioned Members [NCM]; 638 Officers), and parity (314 parous female participants; 435 nulliparous female participants). Sex, rank, and parity were associated with body regions reportedly injured during an annual CAF fitness assessment (significance p ≤ 0.05). When compared with male participants, female participants were more likely to be injured {aOR: 1.797 (95% [confidence interval] CI: 1.45-2.23)} and more prone to injury of the wrist (adjusted odds ratio [aOR]: 1.933 [95% CI: 1.20-3.12]), hip (aOR: 3.445 [95% CI: 2.07-5.728]), or lower back (aOR: 1.55 [95% CI: 1.18-2.04]). Non-Commissioned Members were more likely to injure the neck (aOR: 2.14 [95% CI: 1.18-3.88]) or shoulder (aOR: 2.03 [95% CI: 1.31-3.15]), when compared with Officers. Parous female participants reported pelvis/abdomen injury at a higher rate than the nulliparous group (5 vs. 1.7%, p = 0.019). Injuries sustained during an annual CAF fitness assessment differ based on sex, rank, and parity. Canadian Armed Forces female participants, NCM, and parous female participants may require specific physical fitness support in preparation for the annual physical fitness test.

Characteristics Associated with Pelvic Floor Disorders among Female Canadian Armed Forces Members.

OBJECTIVES: Urinary incontinence (UI) and pelvic organ prolapse (POP) are prevalent pelvic floor disorders (PFDs) among the female population. In the military environment, being a non-commissioned member (NCM), and physically demanding occupations are factors associated with higher PFD risk. This study seeks to characterize the profile of female Canadian Armed Forces (CAF) members reporting symptoms of UI and/or POP. METHODS: Present CAF members (18-65 years) responded to an online survey. Only current members were included in the analysis. Symptoms of UI and POP were collected. Multivariate logistic regressions analyzed the relationships between PFD symptoms and associated characteristics. RESULTS: 765 active members responded to female-specific questions. The prevalence of self-reported POP and UI symptoms were 14.5% and 57.0%, respectively, with 10.6% of respondents reporting both. Advanced age (adjusted odds ratio [aOR]: 1.062, CI 1.038-1.087), a body mass index (BMI) categorized as obese (aOR: 1.909, [1.183-3.081]), parity ≥1 (e.g., aOR for 1: 2.420, [1.352-4.334]) and NCMs (aOR: 1.662, [1.144-2.414]) were factors associated with urine leakage. Parity of ≥2 (aOR: 2.351, [1.370-4.037]) compared to nulliparous and having a perception of a physically demanding job (aOR: 1.933, [1.186-3.148]) were associated with experiencing POP symptoms. Parity of ≥2 increased the odds of reporting both PFD symptoms (aOR: 5.709, [2.650-12.297]). CONCLUSION: Parity was associated with greater odds of experiencing symptoms of UI and POP. Higher age, higher BMI, and being an NCM were associated with more symptoms of UI, and the perception of having a physically demanding role increased the likelihood of reporting POP symptoms.

Exploring weight bias internalization in pregnancy.

BACKGROUND: Recent research has shown that pregnant individuals experience weight stigma throughout gestation, including negative comments and judgement associated with gestational weight gain (GWG). Weight bias internalization (WBI) is often a result of exposure to weight stigma and is detrimental to biopsychological health outcomes. The purpose of this study was to explore WBI in pregnancy and compare scores based on maternal weight-related factors including pre-pregnancy body mass index (BMI), obesity diagnosis and excessive GWG. METHODS: Pregnant individuals in Canada and USA completed a modified version of the Adult Weight Bias Internalization Scale. Self-reported pre-pregnancy height and weight were collected to calculate and classify pre-pregnancy BMI. Current weight was also reported to calculate GWG, which was then classified as excessive or not based on Institute of Medicine (2009) guidelines. Participants indicated if they were diagnosed with obesity by a healthcare provider. Inferential analyses were performed comparing WBI scores according to pre-pregnancy BMI, excessive GWG, and obesity diagnosis. Significance was accepted as p < 0.05 and effect sizes accompanied all analyses. RESULT: 336 pregnant individuals completed the survey, with an average WBI score of 3.9 ± 1.2. WBI was higher among those who had a pre-pregnancy BMI of obese than normal weight (p = 0.04, η2 = 0.03), diagnosed with obesity than not diagnosed (p < 0.001, Cohen's d = 1.3), and gained excessively versus not (p < 0.001, Cohen's d = 1.2). CONCLUSIONS: Pregnant individuals who have a higher BMI, obesity and gain excessively may experience WBI. Given that weight stigma frequently occurs in pregnancy, effective person-oriented strategies are needed to mitigate stigma and prevent and care for WBI.

The impact of new government childcare accreditation standards on children's in-care physical activity and sedentary time.

BACKGROUND: A new physical activity and sedentary behaviour accreditation standard criterion for childcare settings was introduced by the provincial government in Alberta, Canada. The primary objective of this study was to examine if changes for in-care physical activity and sedentary time (ST) differed between centres in and around Edmonton, Alberta after implementing the new accreditation standards and non-accredited control centres in and around Ottawa, Ontario. Secondary objectives were to examine whether baseline age group (toddler, preschooler) or the childcare environment moderated any group differences in change of the primary outcomes. Furthermore, accreditation and control group differences in change of children's body mass index (BMI) Z-scores or cognitive development as well as educators' perceptions of the primary outcomes were explored. METHODS: Participants were 252 toddlers (19-35 months) and preschoolers (36-60 months) in childcare centres from Alberta (n = 11) and Ontario (n = 8) in the supporting Healthy physical AcTive CHildcare setting (HATCH) study. In-care ST, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were accelerometer-derived before and 6 months after the implementation of the new standards. At both time points, cognitive development (working memory, expressive vocabulary), heights, and weights were measured, and BMI Z-scores were calculated. Additionally, the childcare environment was observed using the Environment and Policy Assessment and Observation (EPAO) and Movement Environment Rating Scale (MOVERS) tools. Demographic characteristics were parent-reported and weather variables were derived from Environment Canada data. Mixed models were conducted. RESULTS: In adjusted models (n = 241), change in children's in-care ST (B = -0.07, 95%CI: - 1.43,1.29), LPA (B = 0.08, 95%CI: - 0.89,1.05), and log-transformed MVPA (B = 0.01, 95%CI: - 0.09,0.11) were not significantly different between accreditation and control groups. Age group and the childcare environment were not moderators. Significant increases in BMI Z-score (B = 0.19, 95%CI: 0.03,0.35) and high working memory (OR = 3.24, 95%CI: 1.32,7.97) were observed in the accreditation group and significant increases in expressive vocabulary (B = 3.18, 95%CI: 0.05,6.30) were observed in the control group. CONCLUSIONS: The new accreditation criterion may not significantly change physical activity or ST in childcare settings and therefore may not explain findings for BMI Z-scores and cognitive development. Additional training and resources may be needed.

Change in pre- and in-service early childhood educators' knowledge, self-efficacy, and intentions following an e-learning course in physical activity and sedentary behaviour: a pilot study.

BACKGROUND: Early childhood educators (ECEs) are the primary daytime role models for many young children, and are responsible for facilitating physical activity (PA) opportunities and minimizing sedentary behaviour (SB) in childcare. However, they have reportedly received little related education in their pre-service training. The purpose of the Training pre-service EArly CHildhood educators in physical activity (TEACH) pilot study was to explore changes in pre- and in-service ECEs' knowledge, self-efficacy, behavioural intention, and perceived behavioural control following the TEACH e-Learning course in PA and SB. METHODS: Pre-service ECEs were purposefully recruited from three Canadian colleges, while in-service ECEs were recruited via social media. A pre-post study design was used. ECEs completed two online surveys; one prior to, and one immediately following the completion of the TEACH e-Learning course (~ 5 h). Descriptive statistics were reported, and McNemar Chi-Square tests and paired samples t-tests were used to examine changes in ECEs' question-specific, and total knowledge scores, respectively. Wilcoxon Signed Ranks tests were employed to examine changes in self-efficacy, behavioural intention, and perceived behavioural control. RESULTS: Both pre- (n = 32) and in-service (n = 121) ECEs significantly increased their total knowledge scores from pre- to post-course completion (p < .05*). Significant positive changes in self-efficacy (p < .025*), behavioural intention (p < .007*), and perceived behavioural control (p < .007*) were demonstrated by in-service ECEs following course completion, while only select composite scores within these tools were significant among pre-service ECEs. CONCLUSIONS: These findings provide preliminary evidence of the potential efficacy of the e-Learning course at improving ECEs' knowledge, self-efficacy, behavioural intention, and perceived behavioural control to support PA and minimize SB in childcare. Following the success of the pilot study, testing the effectiveness of the TEACH e-Learning course on a larger scale, with a comparison group, is warranted prior to recommending broader dissemination of the training in pre-service ECE programs and for in-service ECE professional learning.

Physical Activity and Weight Gain Throughout Pregnancy Are Associated With Umbilical Cord Markers.

OBJECTIVE: Maternal serum and umbilical cord (UC) lipid and glucose levels are influenced by a variety of maternal factors over the course of pregnancy, including maternal physical activity (PA) levels and gestational weight gain (GWG). However, previous research has not assessed the interaction of these 2 variables. This study investigated mid-gestation (24-28 weeks) and late gestation (34-38 weeks) maternal and UC serum lipid and glucose profiles in relation to maternal PA status and GWG, independently and in combination. METHODS: This study had a longitudinal design. Pregnant participants (n = 40) were categorized as active or inactive based on the 2019 Canadian Guideline for Physical Activity throughout Pregnancy, and GWG was categorized as insufficient, appropriate, or excessive based on 2009 Institute of Medicine recommendations. Fasting maternal serum was taken in mid- and late gestation, and venous UC serum was taken at birth. RESULTS: No relationship was found between maternal serum values and PA and/or GWG. Infants born to individuals who were physically active across pregnancy, or who were active in mid-pregnancy and had their activity status drop in late gestation, had lower UC total cholesterol levels than those who were inactive throughout pregnancy (P < 0.0001). Participants who had gained weight appropriately at mid-gestation had significantly lower UC glucose levels than those who gained weight insufficiently (P = 0.040) or excessively (P = 0.021). CONCLUSION: In our study, PA, and GWG (independently and in combination) may not have affected maternal serum; however, meeting PA recommendations at mid-gestation may provide prophylactic effects on UC serum, potentially providing long-term health benefits to the newborn.

Population characteristics associated with adherence to prenatal group-based exercise programs.

Community-based supervised group exercise may be an effective option to increase activity levels throughout pregnancy. Previous studies that have explored predictors of low adherence to exercise during pregnancy have not examined group-based settings. We analysed an international cohort of 347 pregnant women who participated in group-based prenatal exercise interventions (from <20 weeks to 34-36 weeks pregnant). Probable adherence predictors informed by previous literature that were assessed included: pre-pregnancy physical activity level and body mass index (BMI) classification, age, number of previous pregnancies, and education level. Adherence was measured by attendance. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated to explore the relationship between the selected predictors and high adherence (≥70%). Post-secondary education level versus only secondary (aOR 5.28; CI 1.67; 16.72) or primary level (aOR 13.82; CI 4.30; 44.45) presented greater likelihood to have high adherence to the exercise intervention than low adherence. Future research and public health initiatives should consider implementing strategies to overcome education-related barriers to improve accessibility to prenatal exercise.

Acute Ingestion of Ketone Monoesters and Precursors Do Not Enhance Endurance Exercise Performance: A Systematic Review and Meta-Analysis.

There has been much consideration over whether exogenous ketone bodies have the capacity to enhance exercise performance through mechanisms such as altered substrate metabolism, accelerated recovery, or neurocognitive improvements. This systematic review aimed to determine the effects of both ketone precursors and monoesters on endurance exercise performance. A systematic search was conducted in PubMed, SPORTDiscus, and CINAHL for randomized controlled trials investigating endurance performance outcomes in response to ingestion of a ketone supplement compared to a nutritive or nonnutritive control in humans. A meta-analysis was performed to determine the standardized mean difference between interventions using a random-effects model. Hedge's g and 95% confidence intervals (CI) were reported. The search yielded 569 articles, of which eight were included in this review (80 participants; 77 men and three women). When comparing endurance performance among all studies, no significant differences were found between ketone and control trials (Hedges g = 0.136; 95% CI [-0.195, 0.467]; p = .419). Subanalyses based on type of endurance tests showed no significant differences in time to exhaustion (Hedge's g = -0.002; 95% CI [-0.312, 0.308]; p = .989) or time trial (Hedge's g = 0.057; 95% CI [-0.282, 0.395]; p = .744) values. Based on these findings, exogenous ketone precursors and monoesters do not exert significant improvements on endurance exercise performance. While all studies reported an increase in blood ketone concentrations after ingestion, ketone monoesters appear to be more effective at raising concentrations than precursors.

Associations between screen time and cognitive development in preschoolers.

Objectives: To examine the cross-sectional associations between screen time and cognitive development in preschoolers. Methods: Participants were 97 preschoolers (36 to 60 months) in Alberta and Ontario, Canada in the supporting Healthy physical AcTive Childcare setting (HATCH) study. The time that children spent watching television, videos or DVDs (television time) or playing video or computer games (video game time) on a television, computer, or portable device was assessed using a parental questionnaire. Television time and video game time were summed to calculate total screen time. Adherence to the screen time recommendation (≤1 hour/day) of the Canadian 24-Hour Movement Guidelines was calculated. Expressive vocabulary and working memory were assessed using the Early Years Toolbox. Due to the distribution of working memory, it was categorized as a binary variable based on the median score. The associations between screen time and cognitive development were examined using mixed models (expressive vocabulary) or generalized mixed models (working memory). Results: Screen time was not associated with expressive vocabulary. Preschoolers who had higher total screen time were less likely to have better working memory (OR=0.52; 95%CI:0.31, 0.88), despite the null associations for television time (P=0.155) and video game time (P=0.079). Preschoolers who met the screen time recommendation were more likely to have higher working memory capacity (OR=3.48; 95%CI:1.06, 11.47), compared to those who did not meet the recommendation. Conclusion: Limiting total screen time to no more than one hour per day may facilitate working memory development in preschoolers. Screen time may be unrelated to expressive language development in this age group.

Maternal and Cord Blood Metabolite Associations with Gestational Weight Gain and Pregnancy Health Outcomes.

Pre-pregnancy obesity and excessive gestational weight gain (GWG) are risk factors for future maternal and childhood obesity. Maternal obesity is potentially communicated to the fetus in part by the metabolome, altering the child's metabolic program in early development. Fasting maternal blood samples from 37 singleton pregnancies at 25-28 weeks of gestation were obtained from mothers with pre-pregnancy body mass indexes (BMIs) between 18 and 40 kg/m2. Various health measures including GWG, diet, and physical activity were also assessed. At term (37-42 weeks), a venous umbilical cord sample was obtained. Serum metabolomic profiles were measured using nuclear magnetic resonance spectroscopy as well as a gut and metabolic hormone panel. Maternal and cord serum metabolites were tested for associations with pre-pregnancy BMI, GWG, health outcomes, and gut and metabolic hormones. While cord blood metabolites showed no significant correlation to maternal obesity status or other measured health outcomes, maternal serum metabolites showed distinct profiles for lean, overweight, and obese women. Additionally, four serum metabolites, namely, glutamate, lysine, pyruvate, and valine, allowed prediction of excessive GWG when pre-pregnancy BMI was controlled. Metabolic biomarkers predictive of GWG are reported and, if validated, could aid in the guidance of prenatal weight management plans as the majority of pregnancy weight gain occurs in the third trimester.

The effects of intervening with physical activity in the early years (ages 3-5) on health-related quality of life: a secondary analysis of the Activity Begins in Childhood (ABC) trial.

PURPOSE: Limited research has measured the effect of physical activity (PA) interventions on health-related quality of life (HRQoL) among pre-school-aged children. This study evaluates the effect of the Activity Begins in Childhood (ABC) cluster-randomized controlled trial designed to increase PA in the ages 3-5 years on HRQoL. METHODS: This was a cluster-randomized controlled trial where the intervention group included PA education delivered to daycare providers only, or daycare providers and parents. In the current study, the two PA intervention groups were combined. The comparator group received standard daycare curriculum (COM). A total of 215 children were included (PA n = 161, COM n = 54). Parents completed the proxy Pediatric Quality of Life Inventory Generic Core Scale (PedsQL™ 4.0) to measure HRQoL at baseline and the end of the 6-month trial. HRQoL scores were analyzed as physical, psychosocial, and total domains. Baseline and 6-months measurements were compared for PA and COM groups, and mean changes in scores (95% confidence intervals) were measured using absolute values. RESULTS: No between-group differences were observed for the physical (p = 0.17), psychosocial (p = 0.95) or total scores (p = 0.20). Paired comparisons showed that only the PA group improved psychosocial- (PA mean difference = 2.18 (0.20, 4.15), p = 0.03; COM mean difference = 2.05 (- 1.03, 5.13), p = 0.19) and total-HRQoL scores (PA mean difference = 2.83 (1.83, 3.84), p < 0.001; COM mean difference = 0.19 (- 1.78, 2.16), p = 0.84) after 6 months. CONCLUSION: Although the within-PA group analysis showed an improvement in psychosocial and total HRQoL scores from baseline, no between-group differences were observed in the HRQoL over time among children aged 3-5 years.

Heat loss responses at rest and during exercise in pregnancy: A scoping review.

BACKGROUND: The teratogenic risk associated with maternal hyperthermia (i.e., core temperature ≥39.0 °C) has been a crucial motive in understanding thermoregulatory responses in pregnancy. To date, a substantial number of studies have focused on core temperature responses in a wide range of exercise intensities, duration, and ambient temperatures. Fortunately, none have reported core temperatures exceeding 39.0 °C. Nonetheless, there are limited studies that have provided substantial insight into both dry and evaporative heat loss mechanisms involved in facilitating the maintenance of core temperature (≥39.0 °C) during heat stress in pregnant women. The purpose of this scoping review was to summarize the available literature that has assessed heat loss responses in studies of human pregnancy. METHODS: A search strategy was developed combining the terms pregnancy, thermoregulation, and adaptation. A systematic search was performed in the following databases: PubMed, Embase, Scopus, and ProQuest. Studies eligible for inclusion included pregnant women between the ages of 18-40 years old, and at least one measurement of the following: sweating, blood flow, skin temperature, and behavioural responses. Retrieved data were categorized as evaporative (sweating), dry or behavioural heat loss responses and summarized narratively. RESULTS: Thirty-three studies were included in this review (twenty-nine measured physiological responses and four measured behavioural responses). Studies suggest that during exercise, evaporative (sweating) and dry (skin blood flow and temperature) heat loss responses increase from early to late pregnancy in addition to greater cardiac output, blood volume and reduced vascular resistance. Behavioural practices related to heat loss responses are also influenced by cultural/religious expectations, personal preferences and sociodemographics. CONCLUSION: The findings from this review suggest that pregnancy modifies evaporative (sweating), dry and behavioural heat loss. However, future studies have an opportunity to compare heat loss measurements accounting for gestational weight gain and thermal sensation/comfort scale to associate physiological responses with perceptual responses across pregnancy.

Eating Habits, Advice from Family/Friends, and Limited Personal Effort May Increase the Likelihood of Gaining Outside Gestational Weight Gain Recommendations.

OBJECTIVES: The present study analyzed the association between (i) eating habits during pregnancy, (ii) advice from family or friends about gestational weight gain (GWG), and iii) personal effort to stay within weight gain limits, and meeting GWG recommendations. METHODS: Participants included pregnant and postpartum women who completed the validated electronic maternal health survey (EMat). Sociodemographic, lifestyle variables, and body mass index were covariates used in the analyses. RESULTS: Among all eligible women (1171), and a subset of women receiving a specific GWG target from HCP (365, 31.2%), participants who considered that their eating habits became less healthy, or could not evaluate if habits changed, had a higher likelihood of gaining above (adjusted odds ratio, aOR = 2.62; 95% CI 1.84; 3.73 for the total sample (TS); aOR = 4.79; CI 2.32;9.88 for the subset) GWG guidelines after adjusting for the covariates. Women who received advice from family or friends about how much weight they should gain while pregnant were more likely to experience GWG below (TS: aOR = 1.49; CI 1.02;2.17; subset: aOR = 1.95; CI 1.03;3.68) and above (TS: aOR = 1.42; CI 1.01;1.99; subset: aOR = 1.92; CI 1.06;3.48) guidelines, when compared to women who did not receive family/friends advice. Moreover, lower personal effort to stay within weight gain limits was associated with gaining below (TS: aOR = 1.77; CI 1.07;2.92; subset: aOR = 2.71; CI 1.30; 5.65) GWG guidelines. CONCLUSIONS FOR PRACTICE: Women self-reporting less healthy eating habits than before pregnancy, receiving advice from family/friends about GWG, and lower personal effort to stay within guidelines, had an increased odds of weight gain discordant with recommendations.

"I really like playing games together": Understanding what influences children with congenital heart disease to participate in physical activity.

BACKGROUND: Participation in physical activity is essential to the long-term health and development of all children. However, children living with cardiac conditions are typically not active enough to sustain positive health outcomes. Understanding the experiences of children living with congenital heart disease in community-based settings could help inform the physical activity counselling practices of clinicians. The current study explored the perceptions of 7- to 10-year-old children with moderate or complex congenital heart disease as they participated in a 10-week multisport programme. METHODS: Detailed field notes recorded the discussions and behaviours of 11 participants (45% female participants) each week during the programme sessions. Among those, four participants (50% female participants) were purposively selected to participate in preprogramme and postprogramme focus groups to gather more detailed accounts of their experiences. RESULTS: Four main themes surrounding physical activity were identified: (a) motivation, (b) self-efficacy, (c) peer influences, and (d) family influences. Although feelings of excitement and enjoyment towards physical activity were prevalent throughout the data ("I'm really excited … because I really like those sports"), participants also often felt frustrated, nervous, and fatigued ("I'm not very good at the skills"). Social inclusion with peers and family influences were meaningful reasons to engage in physical activity ("I really like playing games together"). Following the completion of the programme, participants emphasized their enjoyment of physical activity as a primary source of motivation, demonstrating an important shift from recognizing positive health outcomes ( "… it's good for you") towards more intrinsic sources of motivation ("… because it's fun"). CONCLUSION: Opportunities for physical activity that enhance positive experiences and build intrinsic motivation should be identified and promoted to children with congenital heart disease. Community-based programmes may also be an appropriate context for children with cardiac conditions to engage and maintain participation in physical activity through adolescence.

Health trajectories of children with severe obesity attending a weight management program.

PURPOSE: The objective of the present study is to examine physical and mental health trajectories of change in youth with severe obesity attending a tertiary care weight management program. It was predicted that younger children would show favourable changes in body mass index (BMI), markers of cardiovascular health, quality of life, and mental health. METHODS: This 2-year longitudinal study examined health trajectories of children referred to a weight management program at a Canadian paediatric tertiary care centre from November 2010 to December 2013. Participants were 209 of 217 consecutive referred paediatric patients (families) aged 3 to 17 years who met criteria for severe obesity and consented to participate. To maximize generalizability of results, there were no exclusion criteria. Primary outcomes were children's quality of life and BMI. Secondary outcomes included anxiety, depression, and non-high-density lipoprotein cholesterol levels. RESULTS: The findings suggest an improvement in mental health, quality of life, and cardiometabolic health of children and adolescents of all ages over the 2 years of programming. These positive findings were consistent across gender, age, and distance to the program. BMI trajectory changes varied across age cohorts such that younger children showed more favourable outcomes. The retention rate over the 2 years was high at 82.9%. CONCLUSIONS: This is the first study to show improvements in both physical and mental health outcomes beyond 1 year in a tertiary care setting with a high-risk population of children and youth with severe obesity. Findings highlight the need to examine both mental and physical health outcomes beyond 1 year.

Validation of a child version of the Three-Factor Eating Questionnaire in a Canadian sample: a psychometric tool for the evaluation of eating behaviour.

OBJECTIVE: To examine score validity and reliability of a child version of the twenty-one-item Three-Factor Eating Questionnaire (CTFEQ-R21) in a sample of Canadian children and adolescents and its relationship with BMI Z-score and food/taste preferences. DESIGN: Cross-sectional study. SETTING: School-based. PARTICIPANTS: Children (n 158), sixty-three boys (mean age 11·5 (sd 1·6) years) and ninety-five girls (11·9 (sd 1·9) years). RESULTS: Exploratory factor analysis revealed that the CTFEQ-R21 was best represented by four factors with item 17 removed (CFFEQ-R20), representing Cognitive Restraint (CR), Cognitive Uncontrolled Eating (UE 1), External Uncontrolled Eating (UE 2) and Emotional Eating (EE), accounting for 41·2 % of the total common variance with good scale reliability. ANOVA revealed that younger children reported higher UE 1 and CR scores than older children, and boys who reported high UE 1 scores had significantly higher BMI Z-scores. Children with high UE 1 scores reported a greater preference for high-protein and -fat foods, and high-fat savoury (HFSA) and high-fat sweet (HFSW) foods. Higher preference for high-protein, -fat and -carbohydrate foods, and HFSA, HFSW and low-fat savoury foods was found in children with high UE 2 scores. CONCLUSIONS: The study suggests that the CFFEQ-R20 can be used to measure eating behaviour traits and associations with BMI Z-score and food/taste preferences in Canadian children and adolescents. Future research is needed to examine the validity of the questionnaire in larger samples and other geographical locations, as well as the inclusion of extraneous variables such as parental eating or socio-economic status.

Exploring the physical activity and screen-viewing-related knowledge, training, and self-efficacy of early childhood education candidates.

BACKGROUND: Early childhood educators greatly influence young children's physical activity and screen-viewing behaviours in childcare. However, educators have requested additional training in physical activity programming, and one logical place to provide this education is during their pre-service schooling. This study explored the physical activity and screen-viewing-related knowledge, training, and self-efficacy of early childhood education (ECE) candidates across Canada, to determine their confidence and ability to facilitate physical activity opportunities and limit screen-viewing among young children in childcare. METHODS: Key program personnel at 61 (of 110) Canadian colleges/universities offering an ECE program agreed to participate in this cross-sectional study. An online survey (112 items; 9 domains), developed by experts using the Tailored Design Method, was administered via Qualtrics© to a sample of 1292 ECE candidates. Descriptive statistics, Mann-Whitney U-tests, and chi-square tests were used to report participant demographics and physical activity and screen-viewing-related knowledge (i.e., of physical activity and screen-viewing concepts), training (i.e., physical activity and screen-viewing courses/content received), and self-efficacy (i.e., to facilitate physical activity and limit screen-viewing in childcare) of candidates. RESULTS: ECE candidates exhibited the least amount of knowledge regarding the impact of screen-viewing on physiological outcomes (i.e., blood pressure) in young children. Further, only 32.2 and 26.7% of candidates reported completing physical activity or screen-viewing courses during their post-secondary training, respectively. Candidates who completed one or more physical activity or screen-viewing courses exhibited significantly greater (p <.05) self-efficacy than those without such training related to ensuring children were engaging in adequate moderate-to-vigorous physical activity (MVPA). Confidence to limit screen time did not differ. Candidates reporting meeting national physical activity recommendations (i.e., 150+ minutes of MVPA/week) exhibited significantly greater (p <.05) physical activity-related self-efficacy than those not meeting these guidelines. CONCLUSIONS: Findings from this work highlight both the need for and the potential of supplementary physical activity and screen-viewing content in post-secondary ECE programs to benefit candidates' knowledge and self-efficacy in these areas. Introducing this content at the post-secondary level will ensure that all early childhood educators are appropriately trained regarding physical activity and screen-viewing before entering a childcare-based profession, where they can positively influence young children's health behaviours.