The Effectiveness of Regular Exercise Programs in the Prevention of Gestational Diabetes Mellitus-A Systematic Review.

IMPORTANCE: Physical activity is recognized as one of the most important tools in the management of gestational diabetes mellitus (GDM). OBJECTIVE: The aim of this review was to compare and analyze regular prenatal exercise programs and examine their effectiveness in the prevention of GDM. EVIDENCE ACQUISITION: The following databases were used: Academic Search Complete, Health Source-Consumer Edition, Health Source-Nursing/Academic Edition, Master File Premier, MEDLINE, and SportDiscus with full text. The inclusion criteria were as follows: a randomized study, regular training program throughout pregnancy, and supervised by a prenatal activity specialist. RESULTS: The 10 articles selected for the review were divided into 2 groups. The first group comprised 2 studies presenting successful interventions in the prevention of GDM, whereas the second group included 8 articles with no statistically significant effects of the training programs in GDM prevention. Beginning an exercise program at early stages of the pregnancy and high adherence were common features of the effective programs. CONCLUSIONS: When designing and carrying out the program, the beginning of the intervention and adherence should be considered. To increase adherence, the program should be attractive and it should meet the participants' needs. CONCLUSIONS AND RELEVANCE: This review might be used for identifying factors deciding whether an exercise program is an effective intervention to prevent the development of GDM. Moreover, it might also prove useful in the preparation of future guidelines for designing and implementing regular exercise programs effective in preventing GDM in pregnant women by gynecologists, obstetricians, midwives, trainers, and prenatal specialists.

Does the first trimester of pregnancy induce alterations in the walking pattern?

INTRODUCTION: From among many studies observing the walking pattern throughout pregnancy, only two items monitor the influence of pregnancy on the movement system during gait considering the period before gestation. RESEARCH QUESTION: Does the women's gait pattern at the end of the first trimester undergo changes in comparison to body movement pattern before pregnancy? METHODS: All subjects who met the inclusion criteria gave signed and informed consent before the study. Two experimental sessions were arranged according to the same protocol: (P0) before pregnancy and (P1) at the end of the first trimester of pregnancy (12th week of gestation). At first the anthropometric measures were taken. Then, walking trials at a self-selected speed along a walkway were registered with Vicon 250 (Oxford Metrics Ltd.; Oxford, UK) and FreeMED force platform (Sensor Medica, Italy). RESULTS: An analysis of anthropometric parameters in 12th pregnancy week demonstrated significant changes in mean values of waist circumference and waist to hip ratio as well as waist to height ratio indexes compared to the results before pregnancy. No significant differences were found in the basic kinematic gait parameters between experimental conditions. Significant increase of mean inter-ankle distance during double support phase occurred during the first trimester of pregnancy. Also, the ratio of the ankle separation width to the pelvic width was noticeably higher in gestation. Then, angular changes of the pelvis in coronal and transverse planes throughout gait cycle during pregnancy demonstrated significant differences compared to those measured before pregnancy. At the same time in the first trimester of pregnancy no adaptive changes in the pattern of feet loading take place. SIGNIFICANCE: Since our study is of longitudinal character, in the course of pregnancy we expect compensatory mechanisms more clearly demonstrated. Therefore, we hope to identify a strategy of the gravid body progression in space.

Gait assessment of the expectant mothers - Systematic review.

INTRODUCTION: Since pregnant women may have potentially greater difficulty maintaining balance, their stability has been investigated by some researchers. However, there is no consensus considering the results. The purpose of our investigation was to compare all the experimental studies focusing on the analysis of gait that have been conducted over the last years to assess their methodological issues and changes induced by pregnancy. METHODS: The PRISMA Guidelines incorporating a risk of bias and strength of recommendations were used as a methodological template for this review. Literature searches were conducted using the following databases: PubMed, Embase, SPORTDiscus, Scopus. After limiting the search to meet the inclusion criteria, 25 articles remained in the final analysis. RESULTS: Some authors emphasised that adaptations due to pregnancy are recognised to provide safety and stability. Thus, they consistently reported reduced walking velocity as a result of lower frequency and smaller length of the steps. Longer contact times were reflected by the shortened peak forces. Plantar loads were redistributed from the rearfoot (decrease) to the midfoot and forefoot (increase) throughout pregnancy. Another adjustment was an increase of base of support to improve lateral gait stability which allows to compensate increased medio-lateral ground reaction force. During the course of pregnancy the increase of anterior body mass and hormonal changes enhance some realignments of the pelvis and lumbar spine. Methodological approaches varied across the included studies. The critical appraisal identified some areas of weaknesses that should be considered for designing the future investigations. CONCLUSIONS: Since many gait parameters are interrelated, in order to understand the cause-and-effect relationships an integrative and complete analysis of multiple factors is required.

Movement concepts approach in studies on flamenco dancing: A systematic review.

BACKGROUND: Flamenco is a highly emotional and demanding dance form. It is important to understand how the dancer's body works in order to improve fitness levels and reduce injuries. Thus, our investigation reviewed studies on kinesiological aspects of flamenco over recent years. METHODS: The review was restricted to experimental studies. Literature searches were conducted using the following databases: PubMed, Scopus, and Ebsco: SPORTDiscus with Full Text, Medline, Health Source: Nursing/Academic Edition, Health Source - Consumer Edition. After limiting the search, 180 potential articles remained for analysis. RESULTS: A total of 27 papers on different aspects of flamenco dance were finally selected: biomechanics (14), podiatry (6), injury incidence (3), anthropometry (2), and physiology (2). These studies have applied well-established methods from sports studies. However, we noted a number of potential limitations when applied to flamenco. CONCLUSIONS: The evidence from this review shows that flamenco dancing demands high levels of effort. Further research is required to understand how the dancer's body works in order to improve fitness levels and reduce injuries. Most of the results presented here are consistent among studies. However, there is a great scarcity of research addressing flamenco movement in a more comprehensive perspective.

Physical Activity Assessment During Gestation and Its Outcomes: A Review.

BACKGROUND: Physical activity recommendations emphasize a positive influence of exercise on health. It is particularly recognized during pregnancy for both the mother and fetus. AIM: This review aims to identify the main trends of activity undertaken by women during gestation and to find out how it affects the expecting mother and her child. METHODS: Review of the literature comprising the following databases: PubMed, Academic Search Complete, Health Source-Consumer Edition, Health Source: Nursing/Academic Edition, EMBASE (2000 to May 2013), used detailed search strategies. The review was restricted to experimental studies. Trials were excluded if they met any of the following criteria: reviews, letters, commentaries or editorials, only abstracts available, and any kind of pathology during pregnancy. Three assessors reviewed the titles, abstracts, and full articles using standardized data abstraction forms, and they assessed the study quality. A total of 474 potential articles remained for analyses. FINDINGS: Twenty-eight articles were eligible for inclusion in the present review: randomized controlled trials and observational studies that evaluated maternal and offspring outcomes as a result of physical activity during pregnancy. Quasi-randomized trials were excluded. The activities that were most frequently assessed included occupational activity, housework/caregiving, sport/exercise, and active living, as well as habits. The authors evaluated different types of physical activity in the loading conditions. The aerobic activities most frequently used for assessment included treadmill walking program; step aerobics or stair stepper; aerobics; bicycle ergometer; combination of rowing, stationary cycling, and walk jogging; rhythmic calisthenics class and step class; brisk walks; stretching; and relaxation. The benefits following being active during pregnancy are associated with improved maternal psychological well-being, a reduced risk of preterm birth and excessive gestational weight gain, and lower risk of birth-related complications. CONCLUSIONS: Patterns of activity change during pregnancy. Although exercise is safe for both the mother and fetus, most women reduce their activity level during the first weeks of gestation. Specifically, physical activity tends to be of lower duration, frequency, and intensity. Therefore, women should be encouraged by professionals to initiate or continue exercising during a healthy pregnancy.

Three-dimensional analysis of the pelvic and hip mobility during gait on a treadmill and on the ground.

Pelvic girdle combines two units: passenger and locomotor. That is why the importance of this part of the body is emphasized by all researchers in terms of gait economy. The purpose of our research was to determine the changes of pelvic girdle mobility and hip joint in men in three planes of movement (sagittal, frontal and horizontal) during gait at a speed of 5 km/h. The methodology used here aimed at assessing the impact of the surface (ground or treadmill) on the mobility in those planes. To register overground and treadmill locomotion we applied: Vicon 250, Cardionics Treadmill 3113. The sample of the study was the group of 30 men aged between 21 and 23. The analysis of the results revealed the biggest impact of the type of surface on both pelvis and hip joint in the transverse plane. When the subjects moved on the natural ground, the pelvic range of motion (ROM) in this plane was more than twice wider than that in treadmill walking. Whereas in the case of hip joint, significantly higher ROM values occurred in the transverse plane during walking on the treadmill.

Influence of surface on kinematic gait parameters and lower extremity joints mobility.

In biomechanical studies of human locomotion, treadmill is a widely used measuring device. The purpose of this paper was to determine the values of kinematic parameters describing gait with the velocity of 5 km/h, both on the ground and on a treadmill. Besides, the authors assessed the impact of the surface on the mobility of three main joints of lower extremities in the sagittal plane. The measurements were done on a sample of 48 men aged between 21 and 23. The most important element of a measuring set was the Vicon system. Based on kinematic parameters our data indicated that during walking on a treadmill step frequency was slightly higher than that on the ground. Probably, due to that fact there were found some differences in other variables (e.g., single support as well as step and stride time). Besides, the results revealed that the type of surface affects joint range of motion, in particular ankle plantar flexion, the instantaneous values of joint angles and change in dynamics of these values.

Changes of kinematic gait parameters due to pregnancy.

When a woman becomes pregnant her body undergoes tremendous changes hormonally and anatomically. Our survey revealed very little literature on biomechanics of gait in gravidas and lack of consensus among scientists in pregnancy-related mechanisms of body adaptation. That is why the authors felt encouraged to determine the effect of pregnancy on the biomechanical pattern of walking. To investigate alterations in natural locomotion, we used a 3D motion-analysis system Vicon. The inclusion criteria aimed at selecting only healthy subjects (n = 13). Each woman participated in 3 sessions: before pregnancy, during the last trimester of gestation and, finally, half year after delivery. For the purpose of this study, selected kinematic parameters for pregnant and non-pregnant conditions were compared. Gravid women performed lower velocity of their gait and lower frequency of steps. The length of their step decreased in comparison to pre pregnancy state. The results did not reveal any changes in the range of motion of the ankle, knee and hip in different physiological conditions. However, we observed increased base of support and double support phase in gravidas comparing to non pregnant states (by about 10%). This finding indicates that there is a tendency to maximize safety in gait during pregnancy.

An evaluation of symmetry in the lower limb joints during the able-bodied gait of women and men.

For many years, mainly to simplify data analysis, scientists assumed that during a gait, the lower limbs moved symmetrically. However, even a cursory survey of the more recent literature reveals that the human walk is symmetrical only in some aspects. That is why the presence of asymmetry should be considered in all studies of locomotion. The gait data were collected using the 3D motion analysis system Vicon. The inclusion criteria allowed the researchers to analyze a very homogenous group, which consisted of 54 subjects (27 women and 27 men). Every selected participant moved at a similar velocity: approximately 1,55 m/s. The analysis included kinematic parameters defining spatio-temporal structure of locomotion, as well as angular changes of the main joints of the lower extremities (ankle, knee and hip) in the sagittal plane. The values of those variables were calculated separately for the left and for the right leg in women and men. This approach allowed us to determine the size of the differences, and was the basis for assessing gait asymmetry using a relative asymmetry index, which was constructed by the authors. Analysis of the results demonstrates no differences in the temporal and phasic variables of movements of the right and left lower limb. However, different profiles of angular changes in the sagittal plane were observed, measured bilaterally for the ankle joint.

The impact of changes in gait speed and step frequency on the extent of the center of mass displacements.

Center of mass (COM) trajectory plays a crucial role in the analysis of human body movements. This research aimed at studying vertical and transverse COM displacements during gait on a treadmill at a given velocity and step frequency. Locomotion study was accomplished using: Vicon 250, Cardionics Treadmill 3113 and metronome Korg Ma-30. The data achieved for 12 women and 15 men aged 21-22 revealed similarity in vertical COM oscillations in both groups. Lateral COM displacements (L(COM)) were slightly higher in men than in women and they showed tendency to decrease as gait velocity increased. During natural locomotion there was an increasing trend as walking speed increased. At a given velocity of locomotion L(COM) were decreasing as step frequency increased. The only astonishing thing was that the biggest changes of vertical COM oscillations (V(COM)) were noticed at the fastest walking speed (6 km/h). It seems that so large decrease in V(COM) during walking with high velocity and increased step cadency is a consequence of considerable shortening of the movement cycles and performing time of one step.