do we need evidence based physical activity guidelines and … · 2017-12-21 · systematic review...

24
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?

Upload: others

Post on 15-Aug-2020

0 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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?

Page 2: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

Presentation Aims

• What are national physical activity guidelines?

• What is their aim?

• CMO Physical activity &

Pregnancy study

• Seeking your input

Page 3: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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

Page 4: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

What are national physical activity recommendations?

• They are epidemiological thresholds where optimal behaviour is associated with a significantly reduced risk of disease

Page 5: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women
Page 6: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

Dose-response Curve

p17

Page 7: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

Dose-response Curve

p17

Physical activity recommendation

Page 8: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

Dose-response & Distribution Curve

p17

Distribution of physical activity across population

Dose response

NO PA

LOW PA

Physical activity Recommendation

Page 9: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

Elevate 2016

Supporting health professionals

CHIEF MEDICAL OFFICERS GUIDELINES

Page 10: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

Elevate 2016

PHYSICAL ACTIVITY GUIDELINES INFOGRAPHICS

Page 11: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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

Page 12: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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

Page 13: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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

Page 14: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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

Page 15: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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

Page 16: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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

Page 17: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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

Page 18: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

Results

• 16 infographics found (15 during pregnancy and 1 postparum)

• Country of Design

– UK 2, Australia 1, US 11, Canada 2

Page 19: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

– 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

Page 20: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

Web searches – Royal Colleges

• Web search – key messages

Page 21: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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

Page 22: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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

Page 23: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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?

Page 24: Do we need evidence based physical activity guidelines and … · 2017-12-21 · Systematic Review of FITT of physical activity - Inclusion criteria Population: Healthy pregnant women

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

[email protected]

Do we need evidence based physical activity

guidelines and infographics for pregnancy?