The association between physical activity and sleep during pregnancy: a systematic review.

OBJECTIVES: Pregnant women frequently report experiencing poor sleep. Poor sleep during pregnancy is associated with negative health outcomes for both mother and baby. Physical activity (PA), including exercise may be an effective non-pharmacological strategy for improving sleep during pregnancy. The aim of this systematic review was to synthesize the current literature on the association between physical activity (including exercise) and sleep during pregnancy. METHOD: A systematic online search was undertaken between 15-16 February 2022 in PsycINFO, CINAHL, Embase and PubMed. To meet the inclusion criteria articles had to; [1] be published in a peer reviewed journal; [2] consist of pregnant participants; and [3] be published in English. Studies were excluded if they were not published in English and did not investigate the association between a type of physical activity (including exercise) and a sleep variable during a trimester of pregnancy. RESULTS: Ten studies were included in this review. Five of the ten studies used observational data collection measures and the remaining five used intervention based methods. Eight of the ten included studies found PA (including exercise) was positively associated with sleep during pregnancy. CONCLUSION: In order to properly establish PA as a strategy to improve sleep during pregnancy, future research should aim to determine the PA characteristics most beneficial to sleep during pregnancy across each trimester.

Assessing the Content and Quality of Digital Tools for Managing Gestational Weight Gain: Systematic Search and Evaluation.

BACKGROUND: Digital health resources have the potential to assist women in optimizing gestational weight gain (GWG) during pregnancy to improve maternal health outcomes. OBJECTIVE: In this study, we aimed to evaluate the quality and behavior change potential of publicly available digital tools (websites and apps) that facilitate GWG tracking. METHODS: Digital tools were identified using key search terms across website search engines and app stores and evaluated using the Mobile App Rating Scale, the App Behavior Change Scale, as well as criteria to evaluate the rigor and safety of GWG information. RESULTS: Overall, 1085 tools were screened for inclusion (162 websites and 923 apps), and 19 were deemed eligible. The mean Mobile App Rating Scale quality score was 3.31 (SD 0.53) out of 5, ranging from 2.26 to 4.39, and the mean App Behavior Change Scale score was 6 (SD 3.4) out of 21, ranging from 19 to 0. Of the 19 items used to evaluate rigor of GWG advice, most tools (n=11, 57.9%) contained ≤3 items. CONCLUSIONS: This review emphasizes the substantial limitations in current digital resources promoting the monitoring and optimization of GWG. Most tools were of low quality, had minimal behavior change potential, and were potentially unsafe, with minimal linkage to evidence-based information or partnership with health care.

A Delphi Study to Identify Research Priorities Regarding Physical Activity, Sedentary Behavior and Sleep in Pregnancy.

This study aimed to produce a list of the top 10 research priorities regarding physical activity, sedentary behavior, and sleep in pregnancy. Using the Delphi methodology, pregnant/postpartum individuals (N = 118), exercise professionals and healthcare providers (N = 55) listed up to 10 questions perceived as unanswered regarding physical activity, sedentary behavior, and sleep in pregnancy (Round 1). Respondents rated the proposed questions on a Likert importance scale (Round 2), and the sum of ratings received were totaled. Questions of priority regarding physical activity among pregnant/postpartum individuals (N = 67), healthcare providers and exercise professionals (N = 22) pertained to exercise prescription, impact of exercise on maternal and fetal outcomes and impact of exercise on pregnancy conditions, special population groups and clinical education and access to information. Sedentary behavior priorities included the impact of sedentary behavior on maternal and fetal outcomes, sedentary recommendations and exercise and sedentary positioning. Sleep research priorities included the impact of pregnancy on sleep, safety, sleeping aids and the effect of exercise on sleep. Pregnant/postpartum women, healthcare providers and exercise professionals prioritized questions that have in part been addressed by existing research, highlighting a need for improved knowledge translation from research to practice. They have also identified novel questions that warrant prioritization within future research.

Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis.

BACKGROUND: Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. OBJECTIVE: This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers. METHODS: Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool. RESULTS: Overall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user's current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials. CONCLUSIONS: Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual's characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps.

The Effectiveness of a Web-Based Computer-Tailored Physical Activity Intervention Using Fitbit Activity Trackers: Randomized Trial.

BACKGROUND: Web-based interventions that provide personalized physical activity advice have demonstrated good effectiveness but rely on self-reported measures of physical activity, which are prone to overreporting, potentially reducing the accuracy and effectiveness of the advice provided. OBJECTIVE: This study aimed to examine whether the effectiveness of a Web-based computer-tailored intervention could be improved by integrating Fitbit activity trackers. METHODS: Participants received the 3-month TaylorActive intervention, which included 8 modules of theory-based, personally tailored physical activity advice and action planning. Participants were randomized to receive the same intervention either with or without Fitbit tracker integration. All intervention materials were delivered on the Web, and there was no face-to-face contact at any time point. Changes in physical activity (Active Australia Survey), sitting time (Workforce Sitting Questionnaire), and body mass index (BMI) were assessed 1 and 3 months post baseline. Advice acceptability, website usability, and module completion were also assessed. RESULTS: A total of 243 Australian adults participated. Linear mixed model analyses showed a significant increase in total weekly physical activity (adjusted mean increase=163.2; 95% CI 52.0-274.5; P=.004) and moderate-to-vigorous physical activity (adjusted mean increase=78.6; 95% CI 24.4-131.9; P=.004) in the Fitbit group compared with the non-Fitbit group at the 3-month follow-up. The sitting time and BMI decreased more in the Fitbit group, but no significant group × time interaction effects were found. The physical activity advice acceptability and the website usability were consistently rated higher by participants in the Fitbit group. Non-Fitbit group participants completed 2.9 (SD 2.5) modules, and Fitbit group participants completed 4.4 (SD 3.1) modules. CONCLUSIONS: Integrating physical activity trackers into a Web-based computer-tailored intervention significantly increased intervention effectiveness. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616001555448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371793 (Archived by WebCite at http://www.webcitation.org/73ioTxQX2).