Exercise interventions for weight management during pregnancy and up to 1 year postpartum among normal weight, overweight and obese women: a systematic review and meta-analysis.

BACKGROUND: The prevalence of excessive gestation weight gain, extended postpartum weight retention and pregravid obese women is increasing and is associated with numerous adverse health outcomes. OBJECTIVE: To review the evidence from studies employing exercise-only interventions for weight management among pregnant and postpartum women. SEARCH STRATEGY: Ten databases were searched for randomised controlled trials conducted during pregnancy or within the 12 months following childbirth and published between 1990 and 2013. SELECTION CRITERIA: There were no restrictions to the type, frequency, duration or intensity of exercise intervention. Interventions not specifically designed to target weight were excluded. The outcomes were a change in body weight (kg) or body mass index (BMI; kg/m(2)). DATA COLLECTION AND ANALYSIS: All data were continuous and were reported as weighted mean differences (WMD), with 95% CIs. Data were analysed with a fixed-effect model and heterogeneity was determined using the I(2) statistic. RESULTS: Five studies were included in this review. Exercise significantly reduced gestational weight gain (WMD=-2.22 kg, CI -3.14 to -1.3, p≤0.00001) and had no significant effect on postpartum weight loss (WMD=-1.74 kg, CI -3.59 to 0.10, p=0.06) or BMI during pregnancy (WMD=-2.8 kg/m(2), CI -5.60 to 0.00, p=0.05) or postpartum (WMD=-0.54 kg/m(2), CI -1.17 to 0.08, p=0.09). CONCLUSIONS: There is currently limited evidence to suggest that exercise can be used to limit maternal gestational weight gain.

Prioritise safety, optimise success! Return to rugby postpartum.

Pregnancy and childbirth involve substantial physical, physiological and psychological changes. As such, postpartum rugby players should be supported and appropriately prepared to return to the demands of rugby alongside the additional demands of motherhood. This review aims to discuss specific perinatal considerations that inform a rugby player's readiness to return-to-sport postpartum and present an approach to rehabilitation. Before engaging in full rugby training and matchplay, postpartum players should have progressed through the initial phases of rehabilitation and graded sports-specific training to prepare them for the loads they will be exposed to. Additional rehabilitation considerations include minimising deconditioning during pregnancy; medical concerns; the abdominal wall; the pelvic floor; perinatal breast changes, breastfeeding and risk of contact breast injury; body mass; nutritional requirements; hormonal considerations; athlete identity and psychological considerations; joining team training; return to contact and tackle training; evaluating player load tolerance and future research, policy and surveillance needs. A whole-systems, biopsychosocial approach following an evidence informed return-to-sport framework is recommended when rehabilitating postpartum rugby players. Health and exercise professionals are encouraged to use the perinatal-specific recommendations in this review to guide the development of postpartum rehabilitation protocols and resources.

The effects of short-term low energy availability, achieved through diet or exercise, on cognitive function in oral contraceptive users and eumenorrheic women.

To date, no research has explored the effects of low energy availability on cognitive performance using dietary and exercise regimens relevant to athletes. Twenty female participants (10 eumenorrheic, 10 oral contraceptive [OC] users) completed three 3-day conditions: 1) controlled-balanced energy availability without exercise (BAL; 45 kcal·kg lean body mass [LBM]-1·day-1); 2) diet-induced low energy availability without exercise (DIET; 15 kcal·kg LBM-1·day-1); and 3) exercise-induced low energy availability (EX; 15 kcal·kg LBM-1·day-1, including 30 kcal·kg LBM-1·day-1 treadmill running at 70% maximal oxygen uptake). A cognitive test battery was completed before and after each 3-day condition. Mental rotation test accuracy improved in the BAL condition, but there was a decline in accuracy in the EX condition (BAL, +2.5%; EX, -1.4%; P = 0.042, d = 0.85). DIET (+1.3%) was not different to BAL or EX (P > 0.05). All other measures of cognitive performance were not affected by condition (P > 0.05) and OC use did not affect cognitive responses (P > 0.05). Accuracy in the mental rotation test was impaired when low energy availability was induced through increased exercise energy expenditure. All other aspects of cognition were unaffected by 3 days of low energy availability through diet or exercise. OC use did not mediate the effect of low energy availability on cognition. Novelty: Cognitive function was not affected by 3 days of diet-induced low energy availability. Only spatial awareness was impaired during 3 days of exercise-induced low energy availability. Reproductive hormones affected spatial awareness independent of energy availability.

Systematic review of randomised controlled trials on exercise interventions for weight management during pregnancy and up to one year postpartum among normal weight, overweight and obese women.

OBJECTIVE: To review the effectiveness of exercise interventions in managing weight among pregnant and postpartum women. METHODS: Ten databases were searched for randomised controlled studies, published between January 1990 and September 2013 that compared an exercise-based weight management intervention with routine care or another type of intervention. There were no restrictions to the type, frequency, duration, intensity or mode of exercise intervention. Interventions not specifically designed to target or affect weight were excluded. Study quality was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomised trials and the Consolidated Standards of Reporting Trials statement. RESULTS: The combined searches yielded 354 articles. Reasons for study exclusion included but were not limited to; non-randomisation, retrospective study design, duplicates, qualitative/baseline studies, not specifically designed to influence weight, combined intervention and study protocols. Five papers were included in this review (three trials with pregnant women and two trials with postpartum women). Two of the three pregnancy-related studies found that exercise interventions significantly reduced gestational weight gain. In addition, postpartum women in the intervention groups lost significantly more body weight than those in the control groups. CONCLUSIONS: There is a paucity of information on the efficacy of exercise-only interventions for the prevention of excessive gestational weight gain and retention. However, there is some limited evidence to suggest that exercise can be used for these groups to alleviate some of the issues associated with maternal obesity.