A Qualitative Exploration of Exercise During Pregnancy.

OBJECTIVE: To explore the experience of women engaging in physical activity during pregnancy. DESIGN: This was the qualitative arm of the Starting Pregnancy With Robustness for Optimal Upward Trajectories (SPROUT) pilot project. Thematic analysis was used to realize patterns of meaning and significance from data on participants' experiences in engaging in physical activity during pregnancy. SETTING: One-on-one structured interviews via video conferencing. PARTICIPANTS: Eighteen women in the first trimester of their pregnancy were recruited from local obstetric practices and randomized into one of three exercise groups. All three groups of women were followed for their entire pregnancy and for 6 months postpartum. METHODS: Interviews were recorded and analyzed using thematic analysis. RESULTS: Six major themes important for clinical practice resulted from the analysis: Physical Activity During Pregnancy Is Desirous for Health Benefits, Activity Monitors Provide Motivation, Human Connection HelpsSupportPhysical Activity, More Guidance Is Needed on How to Be Physically Active During Pregnancy, A Supervised Physical Activity Program Is Preferred if Available and Flexible, and Participants Would Choose to Be Physically Active in Subsequent Pregnancies. CONCLUSION: Human interaction, education on physical activity guidelines, and exercise advice increased motivation, accountability, and confidence in the women. Using a tracking device such as an activity watch provided real-world feedback in addition to fostering motivation.

Muscle function, dynamic loading, and femoral neck structure in pediatric females.

PURPOSE: Muscle forces influence the development of bone mass and structure, but dynamic loading via impact exercise is considered particularly osteogenic. We hypothesized that indices of local muscle function and physical activity exposure would predict femoral neck (FN) structure in premenarcheal females. METHODS: We tested this hypothesis in 76 healthy, premenarcheal girls (46 gymnasts and 30 nongymnasts). Height, weight, Tanner breast stage, and prior year nonaquatic, organized physical activity level (PAL) were recorded semiannually. Hologic dual-energy x-ray absorptiometry scans (whole body, left FN) yielded total body nonbone lean mass and bone outcomes, including narrow neck (NN) hip structural analysis data. Dynamometers assessed nondominant hand grip and left hip flexion/extension indices. Parsimonious regression models tested the following as predictors of bone outcomes: local muscle function, PAL, gymnast status, and lean mass, accounting for Tanner breast stage and height, as appropriate. RESULTS: Hip flexion indices were significantly correlated with indices of FN mass, density, structure, and strength (P < 0.05). However, the entry of PAL, gymnast status, and lean mass into regression models supplanted local muscle function explanatory value. In contrast, for many variables, the significant association of gymnast status persisted after accounting for physical maturity, body size/lean mass, and PAL. For all skeletal indices except FNArea, NNwidth, NN endosteal diameter, and NN buckling ratio, gymnast status was more strongly associated with bone outcomes than PAL. CONCLUSIONS: Greater activity doses and exposure to extreme dynamic loading provide independent benefits to FN structure during growth. Furthermore, weight-bearing activity and high-impact exercise exposure appear superior to local muscle force measures for prediction of FN structure.

Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial.

OBJECTIVE: To compare two forms of device-specific training - body-weight-supported (BWS) ambulation on a fixed track (TRK) and BWS ambulation on a treadmill (TM) - to comprehensive physical therapy (PT) for improving walking speed in persons with chronic, motor-incomplete spinal cord injury (SCI). METHODS: Thirty-five adult subjects with a history of chronic SCI (>1 year; AIS 'C' or 'D') participated in a 13-week (1 hour/day; 3 days per week) training program. Subjects were randomized into one of the three training groups. Subjects in the two BWS groups trained without the benefit of additional input from a physical therapist or gait expert. For each training session, performance values and heart rate were monitored. Pre- and post-training maximal 10-m walking speed, balance, muscle strength, fitness, and quality of life were assessed in each subject. RESULTS: All three training groups showed significant improvement in maximal walking speed, muscle strength, and psychological well-being. A significant improvement in balance was seen for PT and TRK groups but not for subjects in the TM group. In all groups, post-training measures of fitness, functional independence, and perceived health and vitality were unchanged. CONCLUSIONS: Our results demonstrate that persons with chronic, motor-incomplete SCI can improve walking ability and psychological well-being following a concentrated period of ambulation therapy, regardless of training method. Improvement in walking speed was associated with improved balance and muscle strength. In spite of the fact that we withheld any formal input of a physical therapist or gait expert from subjects in the device-specific training groups, these subjects did just as well as subjects receiving comprehensive PT for improving walking speed and strength. It is likely that further modest benefits would accrue to those subjects receiving a combination of device-specific training with input from a physical therapist or gait expert to guide that training.