How Do Fitness Club Members Differentiate in Background Characteristics, Exercise Motivation, and Social Support? A Cross-Sectional Study.

Fitness clubs are one of the largest exercise arenas worldwide. Still, membership withdrawal and exercise dropout rates are 40-65% in the first six months. One important approach to retaining members may be to create an environment that feels inclusive, and clusters members with mutual needs and interests. Increased knowledge in this field can provide valuable information that leads to more effective exercise promotion strategies and better retention rates, important to the long-term success of the gym and public health. Thus, we aimed to compare background factors, motivation, and social support between members of multipurpose (wide range of exercise concepts/facilities, middle to high membership fee), fitness-only (low membership fee), and boutique (one or two specialized exercise concepts, high membership fee) fitness clubs. A total of 232 members from multipurpose (n = 107), fitness-only (n = 52), and boutique gyms (n = 73) were recruited for this cross-sectional study. Data included background variables (age, gender, body weight and height, smoking, total household income, occupation, education, and general health), exercise behaviour, exercise motivation, and social support. A one-way between-group ANOVA with Bonferroni correction or a chi-square test was used as appropriate. Multipurpose and fitness-only members were older (mean diff: 9.1 years, p = <0.001) and exercised less (mean diff: 1-1.2 sessions/week, p = <0.001) than members from boutique clubs. Compared with multipurpose and fitness-only members, members from boutique clubs reported the highest autonomous motivation (intrinsic regulation: mean diff: 0.3, p = 0.030), and perceived greater social support from family/friends (mean diff: 6.4 to 6.6, p = <0.001). Boutique members were younger, exercised more, and reported higher autonomous motivation and social support than multipurpose and fitness-only members. Our results suggest that exercise enjoyment and a social community, the "philosophy" of boutique gyms, may be important for regular exercise.

A mixed-methods exploration of attitudes towards pregnant Facebook fitness influencers.

BACKGROUND: Exercise during pregnancy is associated with various health benefits for both mother and child. Despite these benefits, most pregnant women do not meet physical activity recommendations. A known barrier to engaging in exercise during pregnancy is a lack of knowledge about appropriate and safe exercise. In our current era of social media, many pregnant women are turning to online information sources for guidance, including social media influencers. Little is known about attitudes towards pregnancy exercise information provided by influencers on social media platforms. This study aimed to explore attitudes towards exercise during pregnancy depicted by social media influencers on Facebook, and user engagement with posted content. METHODS: A mixed-methods approach was used to analyse data from 10 Facebook video posts of social media influencers exercising during pregnancy. Quantitative descriptive analyses were used to report the number of views, shares, comments and emotive reactions. Qualitative analysis of user comments was achieved using an inductive thematic approach. RESULTS: The 10 video posts analysed were viewed a total of 12,117,200 times, shared on 11,181 occasions, included 13,455 user comments and 128,804 emotive icon reactions, with the most frequently used icon being 'like' (81.48%). The thematic analysis identified three themes associated with attitudes including [1] exercise during pregnancy [2] influencers and [3] type of exercise. A fourth theme of community was also identified. Most user comments were associated with positive attitudes towards exercise during pregnancy and the influencer. However, attitudes towards the types of exercise the influencer performed were mixed (aerobic and body weight exercises were positive; resistance-based exercise with weights were negative). Finally, the online community perceived by users was mostly positive and recognised for offering social support and guidance. CONCLUSIONS: User comments imply resistance-based exercise with weights as unsafe and unnecessary when pregnant, a perception that does not align with current best practice guidelines. Collectively, the findings from this study highlight the need for continued education regarding exercise during pregnancy and the potential for social media influencers to disseminate evidence-based material to pregnant women who are highly receptive to, and in need of reliable health information.

Bone health in Norwegian female elite runners: a cross-sectional, controlled study.

Objective: The primary objective was to compare bone mineral density (BMD) in Norwegian female elite long-distance runners with a control group of inactive females. Secondary objectives were to identify cases of low BMD, to compare the concentration of bone turnover markers, vitamin D and symptoms of low energy availability (LEA) between the groups, and to identify possible associations between BMD and selected variables. Methods: Fifteen runners and fifteen controls were included. Assessments included dual-energy X-ray absorptiometry measurement of BMD in the total body, lumbar spine and dual proximal femur. Blood samples included endocrine analyses and circulating bone turnover markers. The risk of LEA was assessed through a questionnaire. Results: Runners had higher Z-scores in the dual proximal femur (1.30 (0.20 to 1.80) vs 0.20 (-0.20 to 0.80), p<0.021) and total body (1.70 (1.20 to 2.30) vs 0.90 (0.80 to 1.00), p<0.001). The lumbar spine Z-score was similar between groups (0.10 (-0.70 to 0.60) vs -0.10(-0.50 to 0.50), p=0.983). Three runners had low BMD (Z-score <-1) in the lumbar spine. Vitamin D and bone turnover markers showed no differences between the groups. Forty-seven per cent of the runners were at risk of LEA. Dual proximal femur BMD showed a positive correlation to estradiol and a negative correlation to LEA symptoms in runners. Conclusion: Norwegian female elite runners had higher BMD Z-score in the dual proximal femur and total body compared with controls, while no difference was observed in the lumbar spine. The advantages of long-distance running on bone health seem to be site specific, and there is still a need for the prevention of LEA and menstrual disorders in this group.

The Coronavirus pandemic and closed fitness clubs negatively affected members exercise habits.

Introduction: Due to the Coronavirus pandemic, politicians enacted directions to reduce social interactions, including lockdown of fitness clubs. We aimed to investigate how this changed exercise habits of Norwegian gym members. Method: Based on survey data, men and women (≥18 years, n = 233, data collection from Aug. 2020 to Jan. 2021) were recruited to this study by an email-invitation from their fitness club chain or by Facebook advertisement. The participants reported on background variables (e.g., age, gender, total household income, occupation, and education), and exercise habits pre- and during social lockdown. Data were analyzed using independent or student t-test, chi-squared test, or McNemar's test, as appropriate. Results: Home-based exercise (18.0 vs. 72.5%, p = <0.001), walking (49.8 vs. 65.2%, p = <0.001), and cycling (16.7 vs. 24.5%, p = 0.004) was more common during than pre-lockdown. Also, men (4.33 to 3.68 days/week, p =0.013) and women (4.20 to 3.79 days/week, p = 0.001) reported a lower exercise frequency, and a shorter duration. Exercise frequency was lower in those with a BMI ≥25 than in those with BMI <25 (3.95 vs. 4.48 days/week, p = <0.007) pre-lockdown. High exercise attendees (≥3 sessions/week, 66.5%) reported a smaller decrease in exercise frequency (mean change: 0.06 vs. 1.24 days/week, p = <0.001) and duration (>60 min. per session: 33.0 vs. 3.8%, p = <0.001) than low exercise attendees during lockdown. Discussion: Home-based exercise, walking, and cycling were most frequently reported during lockdown. Participants reported a small decrease in exercise duration and frequency compared with pre-lockdown. Closure of fitness clubs impacted low attendees more than high attendees.

Is there an association between total physical activity level and VO2max among fitness club members? A cross-sectional study.

BACKGROUND: Since cardiorespiratory fitness is an important predictor for all-cause mortality, it is of interest to know if meeting the physical activity (PA) recommendations is associated with higher levels of maximal oxygen uptake (VO2max). We aimed to investigate the association between total PA level given as counts per minute (cpm) and minutes in moderate-to-vigorous PA (MVPA), and VO2max in new fitness club members. METHODS: A total of 62 men and 63 women (≥ 18 years), defined as healthy (no disease considered to hinder PA) participated in this study. VO2max (mL kg-1 min-1) was measured with a cardiopulmonary exercise (modified Balke protocol), and total PA level was measured with ActiGraph GT1M for seven consecutive days. All participants accumulating ≥ 10 h of activity recordings ≥ 4 days were included in the data analysis. To examine associations between PA level and VO2max, a Pearson correlation and a multiple linear regression analysis adjusted for covariates were used. RESULTS: VO2max (mL kg-1 min-1) was 40.5 ± 7.2 in men and 35.1 ± 6.0 in women. Total PA level (cpm) and MVPA (min) were 352.4 ± 123.4 and 260.0 ± 132.6 in men and 361.4 ± 103.8 and 273.2 ± 137.0 in women. Total PA level (men: r = 0.346, p < 0.01, women: r = 0.267 p < 0.01) and MVPA (men: r = 0.359, p = < 0.01, women: r = 0.236, p = 0.03) was associated with VO2max. When adjusting for age and body fat percentage, total PA level and MVPA were no longer associated with VO2max (men: p = 0.11 and p = 0.79, women: p = 0.40 and p = 0.61). In men, age (ß = - 0.469 p < 0.01) and body fat percentage (ß = - 0.483, p < 0.01) were the strongest predictor for VO2max. For women, body fat percentage was the strongest predictor for VO2max (ß = - 0.483, p < 0.01). CONCLUSIONS: Total PA level and MVPA were associated with VO2max, but the association was low and diminished when adjusted for age and body fat percentage. Body fat percentage (men and women) and age (men) were more strongly associated with VO2max than total PA level and MVPA.

Weight Cycling and Dieting Behavior in Fitness Club Members.

Background: Along with the rising prevalence of high body-mass index (BMI), there is also increased emphasis on leanness and fitness. Both these trends suggest that many individuals are concerned about weight management and may try to lose weight. Using data from the research project "Fitness clubs - a venue for public health?", we aimed to describe weight cycling and energy-restricted dieting in men and women at start-up of fitness club membership, and to investigate influencing factors [age, BMI, educational level, self-classified overweight/obesity, compliance with nutritional guidelines, unhealthy weight control strategies and self-perceived health (SPH)]. Methods: In a cross-sectional online survey, 250 men and women from 25 fitness clubs in Oslo, reported anthropometrics, self-classified weight group, weight cycling, weight loss/gain, eating habits/dieting, and background/health information. Enrollment was limited to adult (≥18 years) novice exercisers (exercising <60 min/week at a moderate or vigorous intensity or brisk walking <150 min/week, the past six months) with less than four weeks of membership. Factors associated with weight cycling were examined using simple and multiple logistic regression, separated for men and women. Results: In both sexes (mean age: 36.4 ± 11.3, range 18-71 years), a high number reported substantial weight fluctuation (+/-5 kg) the past 12 months (men: 50% and women: 62%, mean difference 12%, 95% CI -0.3 to 23.8, p=0.056) and unhealthy weight control strategies (men: 24.8% and women: 47.2%, mean difference 22.4%, 95% CI 10.5 to 33.4, p<0.001). Weight cyclers had a higher mean BMI compared with non-cyclers (mean difference -1.5, 95% CI -2.6 to - 0.4, p= 0.003). Further, the difference in body weight was 6.7 kg (95% CI 2.2 to 10.8, p=0.004) and 10.8 kg (95% CI 5.8 to 15.8, <0.001) in men and women, respectively. Besides BMI status, self-classified overweight/obesity was the strongest predictor of reporting weight cycling (men: OR 5.54, 95% CI 2.03 to 15.12, p<0.01 and women: OR 7.17, 95% CI 2.48 to 20.68, p<0.001). Conclusion: In novice exercisers, a large proportion reported weight cycling and unhealthy weight control strategies, and both were more prevalent in women than in men. Self-classified overweight was found to be the most important factor influencing weight cycling.

Australian guidelines for physical activity in pregnancy and postpartum.

OBJECTIVES: To develop Australian guidelines on physical activity/exercise during pregnancy and the postpartum period. DESIGN: Critical 'umbrella' reviews of the scientific evidence, combined with adaptation of recently published guidelines. METHODS: A five stage approach included: identification of key source documents (including national physical activity/exercise guidelines and position statements from professional organisations, published since 2010); narrative review of evidence relating to 27 health outcomes; summarising the evidence; development of draft guidelines and supporting information; and review and consultation to finalise the guidelines. RESULTS: Our evidence review found that physical activity/exercise during pregnancy and the postpartum period is safe, has health benefits for the woman and her unborn child, and may reduce the risks of some pregnancy related complications. Four specific guidelines were developed. These encourage all women without pregnancy complications to: (1) meet the Australian Physical Activity and Sedentary Behaviour Guidelines for Adults before, during and after pregnancy; (2) modify activities to accommodate the physical changes that occur as pregnancy progresses; (3) do pelvic floor exercises during and after pregnancy; and (4) take an active role in shared decision-making about their physical activity/exercise during and after pregnancy. The review also identified warning signs and contraindications for physical activity/exercise during pregnancy. CONCLUSIONS: All women who are pregnant or planning a pregnancy should be aware of the benefits of physical activity/exercise, and health professionals should encourage safe levels of activity and be familiar with the contraindications, signs and symptoms which suggest that physical activity/exercise should be modified or avoided.

Does Self-Perception Equal the Truth When Judging Own Body Weight and Height?

BACKGROUND: Data from the research project "Fitness clubs-a venue for public health?" provided an opportunity to evaluate the accuracy of self-reported body weight and height, and subsequent Body Mass Index (BMI), as well as the "trueness" of novice exercisers perception of weight status category, which has not been examined in this population. The aims were to examine self-reported body weight, height, and calculated BMI data from an online survey compared with measured data at fitness club start-up, investigate how accurately novice exercisers place themselves within self-classified weight group (underweight, normal weight, overweight, and obese), and compare this with fitness club attendance at three months follow-up. METHODS: Prior to anthropometric measurements, 62 men and 63 women responded to an online questionnaire, including body weight (kilogram, kg) and height (centimeters, cm), and self-classified weight group ("I think I am … underweight, normal weight, overweight, obese"). We used the following statistical analysis: Paired sample t-tests, a Bland-Altman plot kappa statistics, chi-squared tests, and a logistic regression. RESULTS: Mean difference of BMI calculated from self-reported and measured data was 0.06 (95% CI -0.29 to 0.17, p = 0.593) in men, and 0.16 (95% CI -0.40 to 0.09, p = 0.224) in women, with four participants being outliers of the 95% limits of agreement (Bland-Altman plot). Allowing a difference of 0.5 kg between self-reported and measured weight, we found that 16% reported their weight correctly, 31.2% underreported (-1.89 ± 1.59 kg), and 52.8% overreported (1.85 ± 1.23 kg), with no sex differences (p = 0.870). Further, our results suggest that both sexes may have difficulty recognizing overweight/obesity in themselves, and particularly men are likely to underreport their perceived weight group compared with women. More than half (53.3%) of the overweight men perceived themselves to be normal weight (women: 14%), and only 33.3% of obese men and women correctly classified themselves as being obese. We did not find any difference between participants correctly or incorrectly classifying weight group and fitness club attendance (≥2 times a week) at three months follow-up. CONCLUSION: Both sexes reported body weight and height reasonably accurately, and BMI based on self-report appears to be valid measure. Still, a large proportion of novice exercisers do not recognise their own overweight or obesity status, which may in part explain why public health campaigns do not reach risk populations.

What Makes Individuals Stick to Their Exercise Regime? A One-Year Follow-Up Study Among Novice Exercisers in a Fitness Club Setting.

OBJECTIVES: A fitness club may be an important arena to promote regular exercise. However, authors have reported low attendance rates (10 to 37%) the first months after individuals sign up for membership. It is therefore important to understand the reasons for poor exercise adherence. In this project, we aimed to investigate different psychosocial factors that might increase the likelihood of reporting regular exercise the first year of a fitness club membership, including self-efficacy, motives, social support, life satisfaction, and customer satisfaction. METHODS: New members (≤4 weeks membership, n = 250) classified as novice exercisers (exercise < 60 min/week the last 6 months) from 25 multipurpose gyms were followed for 1 year. Data were collected by an electronic survey including background and health factors, self-efficacy, social support, life satisfaction, motives, customer satisfaction, and exercise attendance, and was answered at start-up and after three (n = 224), six (n = 213), and 12 (n = 187) months. It is well established in the literature that ≥2 exercise sessions/week improve physical fitness in novice exercisers (if adhered to). Hence, we divided the participants into regular exercise attendance (≥2 sessions/week) and non-regular exercise attendance (≤1 session/week, exercise dropout, or membership dropout) in the analysis. RESULTS: A mixed-effects logistic regression model revealed that the strongest predictor for reporting regular exercise attendance was higher levels of the motive "enjoyment" (OR = 1.84, p ≤ 0.001, 95% CI for OR = 1.35, 2.50), followed by self-efficacy "sticking to it" (OR = 1.73, p = 0.002, 95% CI for OR = 1.22, 2.46) and social support from friends and family (OR = 1.16, p ≤ 0.001, 95% CI for OR = 1.09, 1.23). CONCLUSION: In novice exercisers, regular exercise at three, six, and 12 months was associated with higher scores of the motive "enjoyment," self-efficacy ("sticking to it"), and social support compared with non-regular exercise. Our results show that the majority of new fitness club members do not achieve regular exercise behavior.

Stay True to Your Workout: Does Repeated Physical Testing Boost Exercise Attendance? A One-Year Follow-Up Study.

No prospective studies have investigated if repeated testing of physical performance and body composition are associated with exercise attendance or patterns in fitness club members. This study aimed to investigate if repeated physical testing was associated with exercise attendance and patterns in gym members and to report prospective data on use of the fitness club`s facilities and products. Untrained new members were recruited and divided into a test group (n = 125) and as controls (n = 125). All participants answered a survey including exercise involvement, at onset, and after 3, 6, and 12 months follow-up. The test group also measured body composition, maximal oxygen uptake, and maximal muscle strength (onset, and after 3 and 12 months). In total 73.6% answered all surveys, and in the test group, 44.8% completed all physical tests. Regular exercise attendance was defined as ≥2 sessions/week. Repeated testing showed no association with long-term regular exercise attendance (test group: 19.6%, controls: 19.8%; p = 0.638). At 3 months, a lower proportion in the test group reported engagement in resistance exercise (35.3% and 60.2%; p = 0.003) and had lower exercise frequency (2.0 and 2.6 days/week; p = 0.008) than controls. The test group had higher participation in group exercise classes (28.0% and 13.6%; p = 0.040). Exercise frequency decreased from onset to 12 months (from 2.6 to 2.2 days/week; p = 0.025) At 3, 6, and 12 months, 51.8%, 37.6%, and 37.4% reported regular exercise attendance, and 16.9% at all follow-ups. At all time-points, most common workout mode was individual resistance exercise (43.8% to 46.3%). Few attended group exercise classes (7.5% to 13.8%) or used a personal trainer (22.5% to 27.5%). Repeated physical testing did not improve exercise attendance, and we found no changes in members` use of the fitness club`s facilities and products. Only 16.9% reported regular exercise attendance throughout the first year of membership.

Long-term effects of participation in a prenatal exercise intervention on body weight, body mass index, and physical activity level: a 6-year follow-up study of a randomized controlled trial.

BACKGROUND: Growing evidence supports that physical activity and exercise during pregnancy is favorable for the mother, with persisting benefits in the postpartum period. However, there is scant knowledge of the effect of a prenatal exercise program on long-term health and lifestyle habits. OBJECTIVES: This 6-year follow-up study of a randomized controlled trial had two aims: (1) compare body weight, weight retention and body mass index (BMI) in the intervention group and control group, and (2) evaluate effects on physical activity level and recreational exercise. MATERIALS AND METHODS: Out of 105 participants initially randomized to either an intervention group, n = 52 (twice weekly group-exercises and physical activity counselling) or control group, n = 53 (standard prenatal care), 80 women (76.2%) participated in the present long-term follow-up study, performed in a general community in Oslo, Norway. Data were collected through a standardized telephone interview based on the baseline protocol and a modified Physical Activity and Pregnancy Questionnaire (PAPQ). Body weight at 6 years follow-up was self-reported (kg), and calculation of current BMI (kg/m2) was based on self-reported weight and measured height at study inclusion. Investigators were unaware of the original randomization at the time of the interviews. Analyses of covariance were used to examine the difference in change in body weight and BMI between the groups. Even though the MET-values were not normally distributed, differences were examined using a two-sided independent sample t-test due to large sample size (n ≥ 30). RESULTS: At 6 years follow-up there were no differences in mean BMI (kg/m2) (24.0 ± 3.8 versus 24.8 ± 4.0, p = .37), physical activity level (4167 ± 2638 versus 3925 ± 3075 MET-min/week, p = .67) or recreational exercise (630 ± 1290 versus 720 ± 1005 MET-min/week, p = .88) between the intervention and control group, respectively. Subgroup analysis of participants with high adherence during the intervention 6 years ago (≥24 prenatal exercise classes), showed a positive intervention effect at long-term follow up in body weight (kg) (62.8 ± 7.9 versus 70.8 ± 11.8, p = .03) and BMI (kg/m2) (22.5 ± 3.1 versus 24.8 ± 4.0, p = .05), and none (versus 11 in the control group) had gained ≥5 kg compared to prepregnancy weight (p = .02). CONCLUSIONS: Women who adhered to the original prenatal exercise intervention demonstrated significantly lower body weight and BMI at 6-year follow-up. Otherwise, no long-term intervention effect was observed.

MAMMA MIA! Norwegian Midwives' Practices and Views About Gestational Weight Gain, Physical Activity, and Nutrition.

OBJECTIVES: Most studies regarding prevalence of prenatal lifestyle counseling are based on patient report of provider advice. The aim of the present study was to describe midwives' practice and views in promoting three distinct, but importantly related lifestyle factors: gestational weight gain (GWG), regular physical activity (PA), and nutrition. DESIGN: A cross-sectional study. SETTING: Healthcare clinics in Oslo and Akershus County, Norway. PARTICIPANTS: Clinics that expressed interest to participate provided an email list of the midwives. Of 107 midwives invited to participate, 65 completed the 15-min electronic survey (SurveyXact), giving a response rate of 60.7%. OUTCOME MEASURES: We developed a new questionnaire based on questions and results from similar studies, as no validated questionnaires existed when we initiated this project in 2014. The final electronic questionnaire included a mix of close-ended questions, semi-close-ended questions, and 11-point Likert scales and covered demographics, personal health behaviors, counseling practice, views, and self-perceived role in lifestyle counseling. RESULTS: Mean workload in prenatal care was 78%, and mean years practicing was 8.9 (±7.5). Across all three health topics, most (74-95%) reported to give advice on the first meeting, with a mean frequency of 2.2 (±1.4), 2.7 (±1.8), and 2.7 (±2.0) for GWG, PA, and nutrition counseling, respectively. Approximately 40% did not report advice on GWG or give advice discordant with the Institute of Medicine (IOM) recommendations (2009) for at least one prepregnancy body mass index (BMI) category. GWG was rated as more unpleasant to talk about than PA (3.0 ± 2.8 vs. 1.1 ± 2.5, p < 0.001) and nutrition (3.0 ± 2.8 vs. 1.2 ± 2.5, p = 0.002). Also, regarding the importance of giving lifestyle advice, PA (9.6 ± 0.9 vs. 8.3 ± 2.2, p < 0.001) and nutrition (9.9 ± 0.4 vs. 8.3 ± 2.2, p < 0.001) were rated as more important than advice about GWG. Postpartum, nearly 40% gave advice about PA, whereas only two (3.1%) reported to discuss weight/weight retention (p < 0.001). CONCLUSION: While most midwives gave advice on GWG, PA, and nutrition at the first meeting and rated lifestyle counseling as an important topic, the advice on GWG was often discordant with IOM recommendations, and the topic was viewed as more unpleasant to talk about than PA and nutrition.

Motives and barriers to initiation and sustained exercise adherence in a fitness club setting-A one-year follow-up study.

No prospective studies have investigated motives and barriers to exercise in new untrained fitness club members. The aims of the present prospective longitudinal study were to (a) examine proportions reporting regular exercise, non-regular exercise, and exercise dropout; (b) identify motives and barriers to exercise; and (c) compare motives between regular and non-regular exercisers the first year of fitness club membership. New members (n = 250) were followed for 1 year. A questionnaire including demographics, exercise frequency, motives (EMI-2), and barriers (18 common reported barriers) was used, and 184 answered at four time points (onset, and after 3, 6, and 12 months). Participants were categorized into regular exercise: ≥2 sessions/wk or non-regular exercise: ≤1 session/wk, exercise relapse, or dropout. At 3, 6, and 12 months, 63.4%, 59.6%, and 57.2% exercised regularly, whereas 20.1%, 21.1%, and 28.3%, dropped out, respectively. Throughout the follow-up, 37% reported regular exercise. At all time points, motives regarding positive health and strength/endurance were rated highest on a six-point scale. Exercise dropouts rated priority as the greatest barrier. Regular exercisers rated the motives enjoyment (such as "I enjoy the feeling of exerting myself") and challenge (such as "To give me goals to work towards") higher than non-regular exercisers (P = ≤.05). In conclusion, less than half exercised regularly, and most members were motivated by factors such as positive health and physical fitness the first year of fitness club membership. Higher levels of the motives enjoyment and challenge were associated with regular exercise.

Investigating self-perceived health and quality of life: a longitudinal prospective study among beginner recreational exercisers in a fitness club setting.

OBJECTIVES: This study investigated self-perception of overall health (SPH) and quality of life (QoL) at onset and after 3, 6 and 12 months of fitness club membership. Also, we compared SPH and QoL between those who reported regular use of the fitness club (≥2 exercise sessions/week the last month) with those who did not (one exercise session/week or no exercise the last month). DESIGN: Longitudinal prospective study. SETTING: 25 fitness clubs in Oslo, Norway. PARTICIPANTS: In total, 250 newly registered fitness club members (equal numbers of men and women, mean age=36.4±11.3 years, mean body mass index=25.7±4.4) were recruited. At onset (n=250), after 3 (n=224), 6 (n=213) and 12 months (n=187), the participants answered an electronic questionnaire, covering background variables, exercise involvement, perceived SPH and QoL. OUTCOME MEASURES: SPH was measured by a single-item question, rating health status from poor to excellent on a 5-point scale. High SPH was dichotomised as excellent or good, and low SPH as moderate, fair or poor. QoL was measured on a 7-item scale, rating five statements and dichotomised according to a total max sum score of 35, with low QoL ≤25 and high QoL >25. RESULTS: Repeated measurements did not show any changes in SPH. In QoL, we observed an improvement in QoL sum score and a significant increase in mean scores for two out of five statements at 12 months follow-up: 'In most ways, my life is close to my ideal' (p=0.036) and'If I could live my life over, I would change almost nothing' (p<0.001). Regular use of the fitness club was associated with high SPH (OR 3.532 (95% CI 1.60-7.82), p=0.002) and high QoL (OR 1.914 (95% CI 0.95-3.86), p=0.069). The results were unchanged after adjusting for confounders. CONCLUSION: Regular attendance at a fitness club was associated with high SPH and high QoL at 12 months follow-up.

The marathon of labour-Does regular exercise training influence course of labour and mode of delivery?: Secondary analysis from a randomized controlled trial.

OBJECTIVES: Today all pregnant women are recommended to participate in moderate intensity aerobic and resistance-based physical activity/exercise ≥150 min/week. However, there are still controversies and scant knowledge on the role of regular exercise on delivery outcomes, including mode of delivery and length of active labour. In addition, nutritional counselling have often been examined together with exercise, which may independently effect the outcomes. Hence, the aims of the present study were to investigate the sole effect of supervised group exercise, including pelvic floor muscle training on course of labour and mode of delivery. STUDY DESIGN: A single blind, randomized controlled trial, performed in the municipality of Oslo, Norway. Out of 105 healthy, inactive nulliparous women, initially enrolled (gestation week 17.7 ± 4.2) to study the effect regular aerobic exercise (60 min 2/week) on health benefits for both mother and her baby, 90 (85.7%) completed postpartum follow-up (7.7 ± 1.7) on labour outcomes (exercise: 43 and control: 47). Data were collected via standardized interviews and birth partographs from hospital records, reported on the postpartum visit (weeks after labour 7.6 ± 1.6). The primary investigator was unaware of the original randomization at the time of the interviews. The principal analysis was done on an intention to treat basis (ITT). For the planned subgroup analyses (per protocol), acceptable intervention adherence was defined as attending ≥ 80% of the recommended exercise program (≥ 19 exercise sessions). RESULTS: There were no differences between the exercise and control groups in induction of labour, use of analgesia, duration of active labour or prolonged labour, according to ITT. Per protocol analyses, showed a shorter duration of total active labour in the exercise group (6.8 ± 5.5 h) than the control group (9.8 ± 5.4 h), with a mean between group difference of 3.1 h (95% CI 0.31-5.9, p = 0.029). Rate of normal vaginal delivery was 85.7% among adherent participants and 62.3% in the control group (p = 0.051). CONCLUSIONS: Regular exercise during pregnancy decreased duration of total active labour and showed a trend towards more normal vaginal deliveries among participants who adhered to the prescribed program. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00617149.

Urinary incontinence in a fitness club setting-is it a workout problem?

INTRODUCTION: The aims of the present study were to report longitudinal data on the prevalence of urinary incontinence (UI) in a fitness club setting and to investigate whether gym members are educated about and exercise their pelvic floor muscles. METHODS: New members (125 women) from 25 fitness clubs in Oslo, Norway, filled in a 25-min online questionnaire (SurveyXact) at four time points (onset, 3, 6 and 12 months of fitness club membership). The questionnaire covered background/health information, membership dropout and exercise habits, including pelvic floor muscle training (PFMT). A modified Subjective Health Complaints Inventory (SHC Inventory) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were used to gather repeated measures of UI. RESULTS: At onset, 3, 6 and 12 months of fitness club membership, 16.8%, 13.8%, 19.6% and 18.7% reported UI, respectively (p = 0.11). Of these, 57.1% to 76.2% reported leakage during exercise and perceived the UI to be slight. Less than 8% had received information about PFMT by the fitness club staff. Adherence to regular exercise and PFMT throughout the follow-up period (minimum two sessions/week) did not show any association with absent or present UI at 12 months (p = 0.48 and p = 0.63) and was reported by 30% and 22.2% of the participants, respectively. CONCLUSIONS: About 17% reported UI at onset of fitness club membership, with no changes in proportions throughout the first year. Adherence to regular exercise and PFMT did not show any association with absent or present UI at 12 months. Few had been taught PFMT.

Pregnancy and advanced maternal age-The associations between regular exercise and maternal and newborn health variables.

INTRODUCTION: Despite the associations between delayed childbearing and poorer maternal and perinatal outcomes, little is known about these issues in regular exercisers and in women with healthy lifestyles. The aims of the present study were to: (a) compare lifestyle variables and exercise, pregnancy and birth outcomes in women ≥35 years and women <35 years of age, and (b) investigate the associations between regular exercise and maternal health and newborn variables in women of advanced maternal age. MATERIAL AND METHODS: Healthy pregnant women (≥35 years, n = 104 and <35 years, n = 362) were allocated to the study from Rikshospitalet, Oslo University Hospital, Norway. The participants completed a validated self-administered questionnaire, the Physical Activity Pregnancy Questionnaire (PAPQ) in gestational weeks 32-36. Prepregnancy body weight (kg) was self-reported, whereas maternal weight (kg) was measured at gestational weeks 14-16, 22-24, 30-32, and 36-38. Details of the delivery (gestational week at delivery, mode of delivery, Apgar score) and birthweight (g) were obtained from the hospital's medical records. RESULTS: More women <35 than ≥35 years of age reported to have exercised prepregnancy (83.7% vs 74.0%, P = 0.04) and in the 1st trimester (71.2% vs 61.5%, P = 0.05). At gestational week 36, fewer than 50% were exercising regularly, with no group differences (P = 0.74). Current alcohol use (10.5% vs 3.3%, P = 0.02) and tobacco use (5.8% vs 1.7%, P = 0.02) were higher among women ≥35 than women <35 years, whereas for healthy diet the result was reversed (<35 years 67.1% and ≥35 years 80.8%, P = 0.02). There were higher rates of post-term birth (13.5% vs 6.4%, P = 0.02) and induction of labor (40.5% vs 27.9%, P = 0.02) in the ≥35 years group, otherwise no other differences were observed in perinatal outcomes. In women with advanced maternal age, exercising ≥2 times weekly was associated with less pelvic girdle pain (40.0% vs 61.1%, P = 0.02), lower gestational weight gain (12.7 ± 4.0 kg vs 15.5 ± 5.5 kg, P < 0.01), fewer had gestational weight gain ≥16 kg (22.0% vs 51.9%, P < 0.01) and a newborn with macrosomia (10.0% vs 37.0%, P < 0.01). The results were unchanged after adjusting for recognized confounders. CONCLUSIONS: The results indicate that regular exercise is associated with improvement in some of the risks of advanced maternal age.

Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials.

BACKGROUND: High Body Mass Index (BMI) and gestational weight gain (GWG) affect an increasing number of pregnancies. The Institute of Medicine (IOM) has issued recommendations on the optimal GWG for women according to their pre-pregnancy BMI (healthy, overweight or obese). It has been shown that pregnant women rarely met the recommendations; however, it is unclear by how much. Previous studies also adjusted the analyses for various women's characteristics making their comparison challenging. METHODS: We analysed individual participant data (IPD) of healthy women with a singleton pregnancy and a BMI of 18.5 kg/m2 or more from the control arms of 36 randomised trials (16 countries). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to describe the association between GWG outside (above or below) the IOM recommendations (2009) and risks of caesarean section, preterm birth, and large or small for gestational age (LGA or SGA) infants. The association was examined overall, within the BMI categories and by quartile of GWG departure from the IOM recommendations. We obtained aOR using mixed-effects logistic regression, accounting for the within-study clustering and a priori identified characteristics. RESULTS: Out of 4429 women (from 33 trials) meeting the inclusion criteria, two thirds gained weight outside the IOM recommendations (1646 above; 1291 below). The median GWG outside the IOM recommendations was 3.1 kg above and 2.7 kg below. In comparison to GWG within the IOM recommendations, GWG above was associated with increased odds of caesarean section (aOR 1.50; 95%CI 1.25, 1.80), LGA (2.00; 1.58, 2.54), and reduced odds of SGA (0.66; 0.50, 0.87); no significant effect on preterm birth was detected. The relationship between GWG below the IOM recommendation and caesarean section or LGA was inconclusive; however, the odds of preterm birth (1.94; 1.31, 2.28) and SGA (1.52; 1.18, 1.96) were increased. CONCLUSIONS: Consistently with previous findings, adherence to the IOM recommendations seem to help achieve better pregnancy outcomes. Nevertheless, even in the context of clinical trials, women find it difficult to adhere to them. Further research should focus on identifying ways of achieving a healthier GWG as defined by the IOM recommendations.

Are changes in physical fitness, body composition and weight associated with exercise attendance and dropout among fitness club members? Longitudinal prospective study.

OBJECTIVES: The primary aim of the present study was to investigate if changes in physical fitness, body composition and weight are associated with exercise attendance and dropout among fitness club members. Secondary, we wanted to identify motives for fitness club membership and exercise. SETTING: New members at 25 fitness clubs in Oslo, Norway. PARTICIPANTS: In total, 125 new fitness club members were recruited. Eligible criteria were <4 weeks of membership, untrained (exercising <60 min once a week) and ≥18 years. At inclusion, and after 3 (n=87) and 12 months (n=64), participants answered a questionnaire (including motives for membership and exercise, and attendance) and performed measurements of maximum oxygen uptake (VO2max), one repetition maximum (bench press and leg press), body composition and weight. In total, 56 participants underwent measurements at all time points. Based on self-reported attendance, participants were divided into three groups: regular attendance (≥2 sessions per week), low attendance (<2 sessions per week) and exercise dropout (no sessions the last month). RESULTS: At 3 months, regular attendees had significantly higher VO2max than dropout (6.54 mL/min/kg, 95% CI 2.00 to 11.07, p=0.003). At 12 months, a difference in VO2max of 5.32 mL/min/kg (95% CI -0.08 to 10.72, p=0.054) was found between regular attendees and dropout, and between regular and low exercise attendance (6.17 mL/min/kg, 95% CI 0.19 to 12.15, p=0.042). VO2max was the only factor showing an association with attendance. No differences or associations were observed in maximal muscle strength or body composition between the three groups. Primary motive for fitness club membership and exercise was increase in physical fitness (92.8%). CONCLUSIONS: VO2max was the only factor associated with exercise attendance at two time points. Increased physical fitness was primary motive for fitness club membership and exercise.