A Pedometer-Guided Physical Activity Intervention for Obese Pregnant Women (the Fit MUM Study): Randomized Feasibility Study

Abstract

Background Obesity in pregnancy is a growing problem worldwide, with excessive gestational weight gain (GWG) occurring in the majority of pregnancies. This significantly increases risks to both mother and child. A major contributor to both prepregnancy obesity and excessive GWG is physical inactivity; however, past interventions targeting maternal weight gain and activity levels during the antenatal period have been ineffective in women who are already overweight. Pedometer-guided activity may offer a novel solution for increasing activity levels in this population. Objective This initial feasibility randomized controlled trial aimed to test a pedometer-based intervention to increase activity and reduce excessive GWG in pregnant women. Methods We supplied 30 pregnant women with obesity a Fitbit Zip pedometer and randomized them into 1 of 3 groups: control (pedometer only), app (pedometer synced to patients’ personal smartphone, with self-monitoring of activity), or app-coach (addition of a health coach–delivered behavioral change program). Feasibility outcomes included participant compliance with wearing pedometers (days with missing pedometer data), data syncing, and data integrity. Activity outcomes (step counts and active minutes) were analyzed using linear mixed models and generalized estimating equations. Results A total of 30 participants were recruited within a 10-week period, with a dropout rate of 10% (3/30; 2 withdrawals and 1 stillbirth); 27 participants thus completed the study. Mean BMI in all groups was ≥35 kg/m2. Mean (SD) percentage of missing data days were 23.4% (20.6%), 39.5% (32.4%), and 21.1% (16.0%) in control, app group, and app-coach group patients, respectively. Estimated mean baseline activity levels were 14.5 active min/day and 5455 steps/day, with no significant differences found in activity levels between groups, with mean daily step counts in all groups remaining in the sedentary (5000 steps/day) or low activity (5000-7499 steps/day) categories for the entire study duration. There was a mean decrease of 7.8 steps/day for each increase in gestation day over the study period (95% CI 2.91 to 12.69, P=.002). Conclusions Activity data syncing with a personal smartphone is feasible in a cohort of pregnant women with obesity. However, our results do not support a future definitive study in its present form. Recruitment and retention rates were adequate, as was activity data syncing to participants’ smartphones. A follow-up interventional trial seeking to reduce GWG and improve activity in this population must focus on improving compliance with activity data recording and behavioral interventions delivered. Trial Registration Australian and New Zealand Clinical Trials Registry ACTRN12617000038392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370884

Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial

“…Furthermore, our study and the study by Simmons et al [ 31 ] observed that women in the intervention group also spent less time sitting than women in the control group. In addition, we found that women in the intervention group increased their physical activity at T1 compared with T0, which was derived from the increase in physical activity by walking, as described by Darvall et al [ 17 ]. We observed 4 women with vigorous or high moderate physical activity, 3 (75%) of whom were derived from occupational physical activity and low walking physical activity at T0.…”

“…Pollak et al [ 35 ], based on n=34 (22 women in the chat group and 12 women in the SMS text messaging group) women who were pregnant and had obesity, provided health counseling for the management of GWG through SMS text messaging and a chat with professionals and observed a difference of 2.7 kg, which was similar to the GWG observed in our study. However, a recent RCT that included n=30 (10 per group for control, app, and app-coach) women who were pregnant and had obesity achieved a difference of 5.3 kg between the women who were pregnant and used a smartwatch linked to an app and the women who were pregnant and underwent an in-person coaching intervention or the group that used a smartwatch [ 17 ].…”

“…A recent intervention study on the feasibility of using a pedometer in women who are pregnant and have prepregnancy obesity reported promising results in GWG and increased physical activity [ 17 ]. Despite the growing number of women who are pregnant consulting the internet or using smartbands during pregnancy, few studies have analyzed the impact of their use in women who are pregnant and have prepregnancy obesity [ 15 ].…”

Adipositasprävention in den ersten 1000 Tagen

“…Über die Apps können anschließend Fortschritte angezeigt werden und im Falle eines Über-oder Unterschreitens der Normwerte von Gesundheitsparametern, wie zum Beispiel der Gewichtsentwicklung, die Interventionsintensität angepasst oder Lösungsvorschläge aufgezeigt werden. In einigen Studien wurden gesundheitsbezogene Ziele mit der sogenannten SMART Methode festgelegt [49,52,59]. SMART steht für specific, measurable, achievable und time bound.…”

Application of a Pedometer for the Management of Impaired Glucose Tolerance in Pregnant Women

“…Although the application of a pedometer for the control of gestational weight gain seems controversial based on the abovementioned meta-analysis, one of the most important questions is related to the use of a pedometer by obese women, because they may be reluctant to exercise and that could be one of the reasons why they are obese. Even in a recent multiinstitutional study conducted in Australia which used a randomised controlled trial in order to assess a pedometer-based intervention to increase activity and reduce excessive weight gain in pregnant women, the conclusion of the study showed negative results with the notion that the improvement of compliance with activity data recording and behavioural interventions delivered [30]. However, there are promising reports on the use of a pedometer for the management of overweight and obese pregnant women by active intervention with individualised nutritional support and individual exercise plans.…”