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PLoS One ; 14(6): e0211442, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31246953


BACKGROUND: Objective methods to measure physical activity (PA) can lead to better cross-cultural comparisons, monitoring temporal PA trends, and measuring the effect of interventions. However, when applying this technology in field-work, the accelerometer data processing is prone to methodological issues. One of the most challenging issues relates to standardizing total wear time to provide reliable data across participants. It is generally accepted that at least 4 complete days of accelerometer wear represent a week for adults. It is not known if this same assumption holds true for pregnant women. AIM: We assessed the optimal number of days needed to obtain reliable estimates of overall PA and moderate-to-vigorous physical activity (MVPA) during the 2nd trimester in pregnancy using a raw triaxial wrist-worn accelerometer. METHODS: Cross-sectional analyses were carried out in the antenatal wave of the 2015 Pelotas (Brazil) Birth Cohort Study. Participants wore the wrist ActiGraph wGT3X-BT accelerometer for seven consecutive days. The daily average acceleration, which indicated overall PA, was measured as milli-g (mg), and time spent in MVPA (minutes/day) was analyzed in 5-minute bouts. ANOVA and Kruskal-Wallis tests were used to compare variability across days of the week. Bland-Altman plots and the Spearman-Brown Prophecy Formula were applied to determine the reliability coefficient associated with one to seven days of measurement. RESULTS: Among 2,082 pregnant women who wore the accelerometer for seven complete days, overall and MVPA were lower on Sundays compared to other days of the week. Reliability of > = 0.80 to evaluate overall PA was reached with at least three monitoring days, whereas seven days were needed to estimate reliable measures of MVPA. CONCLUSIONS: Our findings indicate that obtaining one week of accelerometry in adults is appropriate for pregnant women, particularly to obtain differences on weekend days and reliably estimate overall PA and MVPA.

JAMA Netw Open ; 2(1): e186861, 2019 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-30646198


Importance: Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited. Objective: To assess the efficacy of regular exercise during pregnancy on the prevention of postpartum depression. Design, Setting, and Participants: This randomized clinical trial examines a prespecified secondary outcome of the Physical Activity for Mothers Enrolled in Longitudinal Analysis (PAMELA) Study, a parallel-group, randomized clinical trial. This trial was nested in the 2015 Pelotas (Brazil) Birth Cohort Study. Between August 27, 2014, and March 14, 2016, pregnant women between 16 and 20 weeks of gestation with no contraindications to exercise were randomized 1:2 to the intervention group or control group via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018. Interventions: Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week. Main Outcomes and Measures: Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary analysis was performed on a complete case basis (90% of participants who had the primary end point ascertained). Results: A total of 639 participants (mean [SD] age, 27.1 [5.1] years; mean gestational age, 16.5 [1.5] weeks) were randomly assigned to the intervention group (n = 213) or control group (n = 426). Compliance with the protocol, defined as having engaged in at least 70% of exercise sessions, was low (40.4%). There was no significant difference in mean (SD) scores for postpartum depression between the intervention group (4.8 [3.7]) and the control group (5.4 [4.1]) (mean difference, -0.6; 95% CI, -1.3 to 0.1). There was also no significant difference in rates of postpartum depression between the intervention group (12 of 192 [6.3%]) and the control group (36 of 387 [9.3%]) (odds ratio, 0.65; 95% CI, 0.33-1.28). Instrumental variable analysis indicated that noncompliance may have attenuated the effect estimates obtained in the primary analysis. Conclusions and Relevance: Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise. The point estimates for this study are in the same direction as the previous randomized clinical trial on this topic. Future studies on how to promote regular exercise during pregnancy to improve compliance, particularly targeting young and less educated women, are warranted before further trials are undertaken. Trial Registration: Identifier: NCT02148965.

Int J Behav Nutr Phys Act ; 14(1): 175, 2017 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-29273044


BACKGROUND: Women are encouraged to be physically active during pregnancy. Despite available evidence supporting antenatal physical activity to bring health benefits for both the mother and child, the most effective way to prevent some maternal and fetal outcomes is still unclear. The purpose of this study was to evaluate the efficacy of an exercise intervention to prevent negative maternal and newborn health outcomes. METHODS: A randomized controlled trial (RCT) nested into the 2015 Pelotas (Brazil) Birth Cohort Study was carried-out with 639 healthy pregnant women, 213 in the intervention group (IG) and 426 in the control (CG) group. An exercise-based intervention was conducted three times/week for 16 weeks from 16-20 to 32-36 weeks' gestation. The main outcomes were preterm birth and pre-eclampsia. Gestational age was calculated based on several parameters, including routine ultrassounds and/or last menstrual period and categorized as < 37 weeks and ≥ 37 weeks for evaluation of preterm birth. Pre-eclampsia was self-reported. Secondary outcomes were gestational weight gain, gestational diabetes, birth weight, infant length, and head circumference. Analyses were performed by intention-to-treat (ITT) and per protocol (70% of the 48 planned exercise sessions). Odds ratio were derived using unconditional logistic regression. RESULTS: The IG and CG did not differ at baseline regarding their mean age (27.2 years ± 5.3 vs. 27.1 years ± 5.7) and mean pre-pregnancy body mass index (25.1 ± 3.9 vs. 25.2 ± 4.1 kg/m2). The mean adherence to the exercise intervention was 27 ± 17.2 sessions (out of a potential 48) with 40.4% attending > = 70% of the recommended exercise sessions. A total of 594 participants (IG:198; CG: 396) were included in the ITT and 479 (IG: 83; CG: 396) were included in the per protocol analyses. There were no significant differences in the incidence of preterm birth and pre-eclampsia between groups in the ITT and per protocol analysis. There were also no differences between the two groups in mean gestational weight gain, gestational diabetes, birth weight, infant length, and head circumference. CONCLUSIONS: While the RCT did not support the benefits of exercise performed during pregnancy on preeclampsia and preterm birth, the exercise program also did not present adverse impacts on newborn health. Our findings may contribute to promote intervention strategies that motivate health providers to encourage pregnant women to be more physically active. TRIAL REGISTRATION: identifier: NCT02148965 , registered on 22 May 2014.

Exercício , Pré-Eclâmpsia/epidemiologia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Adulto , Peso ao Nascer , Índice de Massa Corporal , Brasil , Estudos de Coortes , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/prevenção & controle , Feminino , Idade Gestacional , Humanos , Incidência , Lactente , Cooperação do Paciente , Pré-Eclâmpsia/prevenção & controle , Gravidez , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal , Tamanho da Amostra , Ganho de Peso , Adulto Jovem
Trials ; 16: 227, 2015 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-26003406


BACKGROUND: Preterm birth is associated with most cases of neonatal deaths and negative health outcomes, and hypertensive disorders. Hypertension is influenced by maternal behavior, such as physical activity. Physical activity is associated with better outcomes for mother and fetus, besides healthier weight gains during pregnancy. Few women are physically active during pregnancy and few clinical trials have been carried out with pregnant women. The aim of this paper is to describe the protocol of a controlled trial evaluating whether regular exercise during pregnancy may result in improved maternal-child health and neonatal outcomes. METHODS/DESIGN: The PAMELA (Physical Activity for Mothers Enrolled in Longitudinal Analysis) trial is a randomized controlled trial nested in a birth cohort study. Eligible women belonging to the birth cohort will be invited (between the 16th and 20th week of gestation) to enroll in the trial. Baseline data (blood and urine samples, anthropometry and pulmonary function) will be collected at enrollment. The same assessments will be repeated eight and 16 weeks after baseline. After randomization, women will be allocated into either one of these groups: control, 426 women who will be advised to keep their usual daily activities; and intervention, 213 women who will engage in an exercise program, three sessions a week. At least 70 % attendance over 16 weeks will be required to be considered compliant to the intervention. Exercise protocol will include aerobics, strength and flexibility training. Maternal and child outcomes will be measured at the 36th week of gestation, at birth and at three, 12, 24 and 48 months postpartum. An intention-to-treat analysis will be performed. DISCUSSION: Few women are active during pregnancy and a vast majority decrease their activities or even quit exercising. We present a population-based regular exercise intervention focused on the prevention of hypertension, pre-eclampsia and preterm birth. Data on the underlying cohort will allow future analysis using different outcomes with low probability of recall bias or misclassification of exposure status. Results will potentially influence prenatal care counseling in regards to physical activity. TRIAL REGISTRATION: identifier: NCT02148965 , registered on 22 May 2014.

Saúde da Criança , Terapia por Exercício , Comportamentos Relacionados com a Saúde , Saúde do Lactente , Comportamento Materno , Saúde Materna , Atividade Motora , Complicações na Gravidez/prevenção & controle , Atividades Cotidianas , Adolescente , Adulto , Brasil , Pré-Escolar , Protocolos Clínicos , Feminino , Idade Gestacional , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Análise de Intenção de Tratamento , Cooperação do Paciente , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Projetos de Pesquisa , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
J Phys Act Health ; 12(9): 1264-71, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25494097


BACKGROUND: Physical inactivity in each domain (leisure, work, commuting, and household) is not completely independent. This study aimed to describe the clustering of physical inactivity in different domains and its association with sociodemographic factors among Brazilian industrial workers. METHODS: This was a cross-sectional, population-based study using data from 23 Brazilian states and the Federal District collected via questionnaires between 2006 and 2008. Physical inactivity in each domain was defined as nonparticipation in specific physical activities. Clustering of physical inactivity was identified using the ratio of the observed (O) and expected (E) percentages of each combination. Multinomial logistic regression was used to identify sociodemographic factors with the outcome. RESULTS: Among the 44,477 interviewees, most combinations exceeded expectations, particularly the clustering of physical inactivity in all domains among men (O/E = 1.37; 95% CI: 1.30; 1.44) and women (O/E = 1.47; 95% CI: 1.36; 1.60). Physical inactivity in 2 or more domains was observed more frequently in women, older age groups, individuals living without a partner, and those with higher education and income levels. CONCLUSIONS: Physical inactivity tends to be observed in clusters regardless of gender. Women and workers with higher income levels were the main factors associated with to be physically inactive in 2 or more domains.

Características da Família , Atividades de Lazer , Atividade Motora , Comportamento Sedentário , Transportes , Trabalho , Adulto , Brasil , Análise por Conglomerados , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários
J Phys Act Health ; 11(8): 1458-67, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24384577


BACKGROUND: Commuting reflects an important opportunity for youth to engage in physical activity. This study aimed to compare modes of commuting to school and to work and to identify sociodemographic factors associated with various modes of transportation. METHODS: Epidemiologic study with a repeated cross-sectional design. Participants included high school students (15-19 years of age) from Santa Catarina state, Brazil, in 2001 (n = 5028) and 2011 (n = 6529). A questionnaire containing information on the type of transport used to commute to school and to work was administered. RESULTS: Walking/bicycling and the use of the bus to commute to school and to work remained stable after a decade; however, the use of car/motorcycle to school (6.4% versus 12.6%) and to work (10.2% versus 19.7%) increased significantly. In both cases, females more frequently used buses, whereas males commuted to work by car/bus. Students from rural areas more commonly commuted to school by car/motorcycle, whereas those from urban areas traveled to work more by bus. There was a greater use of cars/motorcycles by young people from higher-income families. CONCLUSIONS: The use of cars/motorcycles to commute to school/work has almost doubled in the last decade. Sex, residential area and income were associated with passive commuting.

Estudantes/estatística & dados numéricos , Transportes/métodos , Transportes/estatística & dados numéricos , Adolescente , Adulto , Ciclismo/estatística & dados numéricos , Brasil , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Atividade Motora , Veículos Automotores/estatística & dados numéricos , Instituições Acadêmicas , Fatores Sexuais , Classe Social , Inquéritos e Questionários , Caminhada/estatística & dados numéricos , Trabalho , Adulto Jovem