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

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

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

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

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

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

Is there such a thing as sustainable physical activity?

There is a global need to diminish climate gas emissions, and a simultaneous call for enhanced levels of physical activity. Increased physical activity entails reduced risk for overweight and chronic diseases, as well as a potential to reduce transport's major contribution to global CO2 emissions. However, increased physical activity level also implies increased energy expenditure. Therefore, we aim to introduce the concept of sustainable physical activity, and to suggest certain physical activity habits due to their potentially sustainable properties. Worldwide, a third of adults and four fifths of adolescents ought to be more physically active in order to comply with current physical activity recommendations. Yet, considering upcoming resource challenges, types of physical activity should be taken into account. Active transportation represents carbon-friendly means of transportation as well as an opportunity for enhanced physical activity. Physical activity conducted in the local community is likely to favor sustainability through less use of fossil fuel, as it makes transportation redundant. Moreover, going "back to basic", using less equipment and appliances for everyday tasks could contribute toward energy balance through increased physical activity, and could decrease resource use. Finally, balancing food intake and energy expenditure would require less food production with accompanying energy savings.

Effect of exercises with weight vests and a patient education programme for women with osteopenia and a healed wrist fracture: a randomized, controlled trial of the OsteoACTIVE programme.

BACKGROUND: Exercise programmes have shown to be important for the prevention of fractures in patients with established osteoporosis. However, few studies have evaluated the effect of such programmes for women with low bone mineral density (BMD) (osteoporosis or osteopenia) who have already suffered a fracture. Studies have indicated that exercise programmes concentrating on muscular strength and dynamic balance have a positive effect on significant risk factors for falls such as quadriceps strength and balance. The aim of the present study was to assess the effect of a 6-month exercise programme and a patient education component (OsteoACTIVE) on quadriceps strength, BMD, dynamic balance, walking capacity, physical activity level and quality of life in postmenopausal women with osteopenia and a previous wrist fracture. METHODS: Eighty postmenopausal women with low BMD and a healed wrist fracture were randomized to OsteoACTIVE (n = 42) (age 65.5, range 51.2-79.2 years) or patient education only (control group) (n = 38) (age 63.9, range 52.7-86.8 years). Follow-up was conducted after 6 months (end of intervention) and 1 year. Outcome measures included quadriceps strength, BMD, dynamic balance, walking capacity, physical activity level and quality of life. RESULTS: Thirty-five participants (83 %) completed the OsteoACTIVE programme. Mean adherence to OsteoACTIVE was 87 % (range 48-100 %). Twenty-five participants (72 %) met the a priori goal of 80 % adherence to the program. No adverse events were reported. There were no significant differences between the two groups over the 1-year follow-up for any of the outcome measures. CONCLUSION: The OsteoACTIVE rehabilitation programme revealed no significant effect on quadriceps strength, BMD, dynamic balance, walking capacity or self-reported functional outcomes over the 1-year follow-up. TRIAL REGISTRATION: NCT01357278 at ClinicalTrials.gov (date of registration 2010-04-21).

Obesity prevalence in Norwegian adults assessed by body mass index, waist circumference and fat mass percentage.

The prevalence of obesity presents serious public health challenges worldwide and is most commonly estimated by the categorization of body mass index (BMI). The purpose of this study was (i) to describe the sensitivity of BMI, waist circumference (WC) and fat mass percentage in the classification of overweight and obesity and (ii) to describe the prevalence of overweight and obesity using different measurement methods in a national sample of Norwegians. A total of 904 Norwegians (20-85 years) were randomly enrolled. Body weight, height, WC and skinfold thickness were measured; BMI and fat mass percentage (FP(skf) ) were calculated. The sensitivity and specificity varied from 77.0% to 86.9% and from 60.6% to 82.3%, respectively. Area under the curve was 0.837 (95% confidence interval [CI]: 0.801-0.872) for the ability of BMI to predict obesity by FP(skf) and 0.811 (95% CI: 0.770-0.852) for WC. A total of 12.7% (male: 12.1%, female: 13.4%) were obese based on BMI classifications, 29.1% (male: 36.5%, female: 20.0%) of the sample were obese based on FP(skf) and 24.3% of men and 37.8% of women were abdominally obese by WC. The agreement between selected measuring methods was fair to good, although the variation in obesity prevalence rates between the different assessments methods varied markedly.

Association between short time in bed, health-risk behaviors and poor academic achievement among Norwegian adolescents.

OBJECTIVE: To investigate the prevalence of short time in bed (<8h/day) and to examine the association between time in bed, overweight/obesity, health-risk behaviors and academic achievement in adolescents. METHODS: This study included a sample of adolescents (n=2432) aged 15-17 years in the southern part of Norway (participation rate, 98.7%). A self-report questionnaire was used to assess time in bed, body mass index, dietary habits, physical activity habits, sedentary behavior, smoking and snuffing habits, and academic achievement. RESULTS: A total of 32.3% of the students reported short time in bed (<8h/day) on an average school night. Several health-risk behaviors were associated with short sleep duration, including not being physically active for > or =60 min for > or =5 days/week (adjusted odds ratio, 1.33; 95% confidence interval, 1.05-1.68); using television/computer >2 h/day (1.63; 1.23-2.17); being a current smoker (2.46; 1.80-3.35) or snuffer (2.11; 1.57-2.85); having an irregular meal pattern (1.33; 1.05-1.68); intake of sweets/candy > or =4 times/week (0.51; 0.32-0.83); and poor academic achievement (1.62; 1.26-2.09). All odds ratios were adjusted for sex, age and parental education. CONCLUSIONS: In Norwegian adolescents, short time in bed is associated with several health-risk behaviors and poor academic achievement.

Stress fractures in elite male football players.

The objective was to investigate the incidence, type and distribution of stress fractures in professional male football players. Fifty-four football teams, comprising 2379 players, were followed prospectively for 189 team seasons during the years 2001-2009. Team medical staff recorded individual player exposure and time-loss injuries. The first team squads of 24 clubs selected by UEFA as belonging to the 50 best European teams, 15 teams of the Swedish Super League and 15 teams playing their home matches on artificial turf pitches were included. In total, 51 stress fractures occurred during 1,180,000 h of exposure, giving an injury incidence of 0.04 injuries/1000 h. A team of 25 players can therefore expect one stress fracture every third season. All fractures affected the lower extremities and 78% the fifth metatarsal bone. Stress fractures to the fifth metatarsal bone, tibia or pelvis caused absences of 3-5 months. Twenty-nine percent of the stress fractures were re-injuries. Players that sustained stress fractures were significantly younger than those that did not. Stress fractures are rare in men's professional football but cause long absences. Younger age and intensive pre-season training appear to be risk factors.

Aspects of disordered eating continuum in elite high-intensity sports.

Dieting is an important risk factor for disordered eating and eating disorders. Disordered eating occurs on a continuum from dieting and restrictive eating, abnormal eating behavior, and finally clinical eating disorders. The prevalence of eating disorders is increased in elite athletes and for this group the cause of starting to diet is related to (a) perception of the paradigm of appearance in the specific sport, (b) perceived performance improvements, and (c) sociocultural pressures for thinness or an "ideal" body. Athletes most at risk for disordered eating are those involved in sports emphasizing a thin body size/shape, a high power-to-weight ratio, and/or sports utilizing weight categories, such as in some high-intensity sports. In addition to dieting, personality factors, pressure to lose weight, frequent weight cycling, early start of sport-specific training, overtraining, injuries, and unfortunate coaching behavior, are important risk factors. To prevent disordered eating and eating disorders, the athletes have to practice healthy eating, and the medical staff of teams and parents must be able to recognize symptoms indicating risk for eating disorders. Coaches and leaders must accept that disordered eating can be a problem in the athletic community and that openness regarding this challenge is important.

Prevalence of eating disorders and the predictive power of risk models in female elite athletes: a controlled study.

The purposes of this study were to examine the percentage of female elite athletes and controls with disordered eating (DE) behavior and clinical eating disorders (EDs), to investigate what characterize the athletes with EDs, and to evaluate whether a proposed method of screening for EDs in elite athletes does not falsely classify sport-specific behaviors as indicators of EDs. All athletes representing the national teams at the junior or senior level, aged 13-39 years (n=938), and age-group matched, randomly selected population-based controls (n=900) were invited to participate. From the screening data, a random sample of athletes (n=186) and controls (n=145) were subjects for a clinical interview. More athletes in leanness sports (46.7%) had clinical EDs than athletes in non-leanness sports (19.8%) and controls (21.4%) (P<0.001). Variables predicting clinical EDs, and thus candidates for valid screening procedures, were menstrual dysfunction in leanness athletes, self-reported EDs in non-leanness athletes, and self-reported use of pathogenic weight control methods in controls. Hence, statistically based risk factors are not universally valid, but specifically related to athletes and non-athletes, respectively.

Low bone mineral density is two to three times more prevalent in non-athletic premenopausal women than in elite athletes: a comprehensive controlled study.

OBJECTIVE: To compare bone mineral density (BMD), investigate factors associated with BMD, and examine the prevalence of low BMD in athletes and non-athletic controls. METHODS: The study included a questionnaire (part I), measurement of BMD (part II), and a clinical interview (part III). All Norwegian female athletes on national teams (n = 938) and an aged matched random sample of non-athletic controls (n = 900) were invited to participate. The questionnaire was completed by 88% of athletes and 70% of controls. A random sample of these athletes (n = 300) and controls (n = 300) was invited to participate in parts II and III. All parts were completed by 186 athletes (62%) and 145 controls (48%). RESULTS: Mean (standard deviation) total body (TB) BMD was higher (p<0.001) in athletes (1.21 (0.09) g/cm2) than in controls (1.18 (0.08) g/cm2), and higher (p<0.001) in high impact (HI) sports athletes than in medium impact (MI) and low impact (LI) sports athletes. In athletes, body weight and impact loading sports were positively associated, and percent body fat and eating disorders were negatively associated with TB BMD. Body weight and weight bearing activities were positively associated and menstrual dysfunction was negatively associated with TB BMD in controls. A higher percentage of controls (28.3%) than athletes (10.7%) had low BMD (p<0.001). CONCLUSION: Female elite athletes have 3-20% higher BMD than non-athletic controls and HI sports athletes have 3-22% higher BMD compared with MI and LI sports athletes. Low BMD is two to three times more common in non-athletic premenopausal women than in elite athletes.

Participation in leanness sports but not training volume is associated with menstrual dysfunction: a national survey of 1276 elite athletes and controls.

OBJECTIVE: To examine the prevalence of menstrual dysfunction in the total population of Norwegian elite female athletes and national representative controls in the same age group. METHODS: A detailed questionnaire that included questions on training and/or physical activity patterns, menstrual, dietary, and weight history, oral contraceptive use, and eating disorder inventory subtests was administered to all elite female athletes representing the country at the junior or senior level (aged 13-39 years, n = 938) and national representative controls in the same age group (n = 900). After exclusion, a total of 669 athletes (88.3%) and 607 controls (70.2%) completed the questionnaire satisfactorily. RESULTS: Age at menarche was significantly (p<0.001) later in athletes (13.4 (1.4) years) than in controls (13.0 (1.3) years), and differed among sport groups. A higher percentage of athletes (7.3%) than controls (2.0%) reported a history of primary amenorrhoea (p<0.001). A similar percentage of athletes (16.5%) and controls (15.2%) reported present menstrual dysfunction, but a higher percentage of athletes competing in leanness sports reported present menstrual dysfunction (24.8%) than athletes competing in non-leanness sports (13.1%) (p<0.01) and controls (p<0.05). CONCLUSIONS: These novel data include virtually all eligible elite athletes, and thus substantially extend previous studies. Age at menarche occurred later and the prevalence of primary amenorrhoea was higher in elite athletes than in controls. A higher percentage of athletes competing in sports that emphasise thinness and/or a specific weight reported present menstrual dysfunction than athletes competing in sports focusing less on such factors and controls. On the basis of a comparison with a previous study, the prevalence of menstrual dysfunction was lower in 2003 than in 1993.

Sexual harassment and eating disorders in female elite athletes - a controlled study.

The aims were to examine the percentage of female elite athletes and controls reporting sexual harassment and abuse (SHAB), and whether a higher percentage of female athletes with eating disorders (ED) had experienced SHAB. A questionnaire was administered to the total population of female elite athletes (n = 660) and controls (n = 780) aged 15-39 years. Sexual harassment and abuse were measured through 11 questions, ranging from light to severe SHAB. In addition, questions about dietary-, menstrual- and training-history and the Eating Disorder Inventory were included. The response rate was 88% for athletes and 71% for controls. Athletes (n = 121) and controls (n = 81) classified as "at risk" for ED and non-ED controls participated in a clinical interview. A higher percentage of controls compared with athletes reported experiences of SHAB in general (59% vs. 51%, P < 0.001). A lower percentage of athletes had experienced SHAB inside sports than outside sport (28% vs. 39%, P < 0.001). A higher percentage of ED athletes than non-ED athletes had experienced SHAB (66% vs. 48%, P < 0.01), both inside sport and outside sport. In spite of the fact that a higher percentage of controls compared with athletes had experienced SHAB, it is necessary to formulate clear guidelines, set up educational workshops and implement intervention programs for both ED and SHAB in sport.

Nutritional supplements in Norwegian elite athletes--impact of international ranking and advisors.

UNLABELLED: The aims of this study were to investigate (a) the use of nutritional supplements (NS) (vitamins, minerals, Omega 3, antioxidants, ginseng, amino acids, Creatine and energy supplements) in elite athletes of different international ranking (b) why athletes are using NS, and (c) who recommends the elite athletes to use NS. The total population of elite athletes in Norwegian National Teams (n = 1620, 960 males and 660 females aged 15-39 years) and randomly selected (n = 1681) (916 males and 765 females) controls from the general population, were given a questionnaire including questions about use of nutritional supplements (NS), and from whom athletes had received information about nutrition and recommendations to use NS. The response rate was 76% for male and 92% for female athletes and 75% and 81% for male and female controls, respectively. A similar percentage of female athletes (54%) and controls (52%) reported use of one or more NS, but more male athletes (51%) than male controls (32%) used NS (P < 0.001). However, independent of gender, more athletes as compared to controls used minerals (males 26% vs. 8%; females 42% vs. 20%), amino acids (males 12% vs. 4%; females 3% vs. 0), and Creatine (males 12% vs. 2%; females 3% vs. 0). A lower percentage of NS users were observed in the best female athletes (52%) as compared to female athletes with less experience of international competition (73%) (P < 0.01). In male athletes, NS use was independent of international ranking (49%-53%). The coach was the main advisor for use of NS for both male (58%) and female athletes (52%). For male and female athletes, the main reason for using NS was that they felt it was needed in addition to their daily intake (56% and 67%, respectively). Forty one percent of the male and 37% of the female athletes using NS felt they were well informed about nutrition in general and NS. However, 8% of the NS users did not know whether the NS they used was doping classified or not. IN CONCLUSION: we found that a similar percentage of female elite athletes and controls, but a higher percentage of male elite athletes than controls, reported the use of NS. There was a lower percentage of NS use among the top female athletes, but not the top male athletes as compared to the less successful elite athletes. The coach was the main advisor for NS use both for male and female elite athletes.