do we need evidence based physical activity guidelines and … · 2017-12-21 · systematic review...
TRANSCRIPT
British Heart Foundation Centre on Population Approaches for NCD Prevention
Professor Charlie Foster
Nuffield Department of Population Health
University of Oxford
Do we need evidence based physical activity
guidelines
and infographics for pregnancy?
Presentation Aims
• What are national physical activity guidelines?
• What is their aim?
• CMO Physical activity &
Pregnancy study
• Seeking your input
So what’s in your physical activity
promotion tool box?
Research evidence Communication skills
Strategies
to change
behaviour
Health promotion
Skills – advocacy,
Lobbying, management
PA training, evaluation,
knowledge & skills
Toolbox
Policy
placement
Diagnostic &Clinical Skills
What are national physical activity recommendations?
• They are epidemiological thresholds where optimal behaviour is associated with a significantly reduced risk of disease
Dose-response Curve
p17
Dose-response Curve
p17
Physical activity recommendation
Dose-response & Distribution Curve
p17
Distribution of physical activity across population
Dose response
NO PA
LOW PA
Physical activity Recommendation
Elevate 2016
Supporting health professionals
CHIEF MEDICAL OFFICERS GUIDELINES
Elevate 2016
PHYSICAL ACTIVITY GUIDELINES INFOGRAPHICS
Process – EB to I
Research evidence Communication skills
Strategies
to change
behaviour
Health promotion
Skills – advocacy,
Lobbying, management
PA training, evaluation,
knowledge & skills
Toolbox
Policy
placement
Diagnostic &Clinical Skills
Process – EB to I for Pregnancy
Research evidence Communication skills
Strategies
to change
behaviour
Health promotion
Skills – advocacy,
Lobbying, management
PA training, evaluation,
knowledge & skills
Toolbox
Policy
placement
Diagnostic &Clinical Skills
Scoping Review for Exercise & Pregnancy
Systematic Review of FITTof physical activity
Qualitative studies ofHPs & PW
Web searches forinformation about physical activity& pregnancyMedical charities, NGOs
International & national examples of infographics
Systematic Review of FITTof physical activity - Inclusion criteria
Population: Healthy pregnant women
Interventions: Structured exercise programmes/ exercise and diet
Comparison group: Standard care
ExerciseFrequency - 1-5 sessions/weekIntensity – low, moderate, vigorousTime – 15-70 minutes/sessionType - walking, cycling, aerobics, dance, water gymnastics, strength exercise, toning, climbing stairs, resistance training
Method and reviews includedMethod
• Searched 9 databases of published literature
– CINAHL
– Cochrane Database of Systematic Reviews
– Cochrane Central Register of Controlled Trials
– Database of Abstracts of Reviews of Effects
– Embase
– Epub Ahead of Print, In-Process & Other Non-Indexed Citations
– PsycINFO
– SportDiscus
– Science Citation Index and Conference Citation Index - Science
• Used key words and pre-defined search terms
Total hits from the searches = 1974
Total titles and abstracts screened = 1078
Duplicates excluded = 896
Total included for full text review = 57
Excluded = 1021• Does not include
pregnant women• Exercise not an
intervention• Clinical outcomes not
reported
Total reviews further screened = 48
Excluded= 27Exercise frequency/ duration not reported, only postnatal interventions, includes women with complications or comorbidities, AMSTAR score<3
Excluded = 9
Total systematic reviews finally included = 21
ResultsOutcomes with definite positive effect
Outcomes with definite no significant effect
Outcomes with conflicting evidence [positive or no significant effect]
1. Lower gestational weight gain
2. Reduced risk of gestational diabetes mellitus
3. Cardiorespiratory fitness
1. Mode of delivery
2. Operative vaginal delivery
3. Gestational age at delivery
4. Small for gestational age
5. Apgar score at 5 minutes
1. Pregnancy induced hypertensive disorders including pre-eclampsia
2. Lower risk of preterm birth
3. Lower back pain
4. Shorter duration of labour
1. Small reduction in mean birthweight
2. Lower risk of Macrosomia
3. Small increase in Apgar score at 1 minute
None of the systematics reviews identified any adverse maternal or infant outcomes resulting from physical activity during pregnancy
Method
• Google images search: terms used:– Pregnancy
– Exercise
– Infographics
• Excluded: – Those with Predominantly Nutritional content, not
relevant to exercise and pregnancy
– Those that just contained pure pictures Exercises
– Those just contained pelvic floor exercise
Results
• 16 infographics found (15 during pregnancy and 1 postparum)
• Country of Design
– UK 2, Australia 1, US 11, Canada 2
– Benefits of exercise 81% (13)
– FITT principles (all 12%)
• Frequency (43%), Intensity (37%)
• Type (75%), Time (44%)
– Safety message 63% (10)
– What to avoid 63% (10)
– Presentation of information
Common themes
Web searches – Royal Colleges
• Web search – key messages
Key messages of qualitative papers
POVs of pregnant women
• PW say their HPs don’t mention about
• PW respect HPs and would like advice
• Lack of advice lead PW to seek alternatives of information
POVs of Health Professionals
• Advice is vague and non specific
• HPs happy to recommend type of physical activity with no specifics for FIT
• Undertrained
• Unsure what to say, and they do mention it
Scoping Review for Exercise & Pregnancy
Systematic Review of FITTof physical activity
Qualitative studies ofHPs & PW
Web searches forinformation about physical activity& pregnancyMedical charities, NGOs
International & national examples of infographics
Conclusions
• Yes a need for guidance for HPs and patients• Information must be positive and clear about benefits and
risks of physical activity and pregnancy• Specific guidance should include
– Frequency– Intensity– Time– Type of physical activity – must be appropriate for stage of
pregnancy and current physical activity status– Reduction of sedentary behaviour – Pelvic floor exercises?
• What else matters?
Thanks:
Dr Anne Matthews
Dr Ralph Smith
Dr Hamish Reid
Dr Manisha Nair
Professor Marion Knight
British Heart Foundation Centre on Population Approaches for NCD Prevention
Charlie Foster
Nuffield Department of Population Health
University of Oxford
@CharlieatOxford
Do we need evidence based physical activity
guidelines and infographics for pregnancy?