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The Effects of Exercise on Postpartum Weight Retention in Overweight and Obese Women
Abstract
Obesity is a global phenomenon with unfavourable clinical and economic outcomes. The prevalence of maternal obesity has risen at similar rates to global obesity and has two distinct population pathways. Firstly, pregnancy has been identified as a risk factor for the development of obesity due to extreme gestation gain and/or prolonged postpartum weight retention. Secondly, the number of pre-gravid obese women has increased dramatically over recent years, making this a high-risk medical group. As such, effective interventions are necessary to prevent and reduce the incidence of excessive gestational weight gain and persistent postpartum weight retention, particularly in overweight and obese women. The focus of this review is on the postpartum period, which includes the first twelve months following childbirth. Exercise has many potential benefits for these women, but, despite considerable interest in the effects of physical activity on maternal body mass, few exercise-based randomised controlled trials exist. Two studies have implemented low to moderate intensity walking programmes as weight management interventions, with limited success. Two, more recent studies have used resistance exercises and active videogames to promote weight loss, however while both types of interventions resulted in significant weight loss, these reductions were not significantly different from the corresponding control groups. As such, a proof of principle with regards to exercise and weight retention in overweight and obese women is not available. More investigation is warranted in this important research area and future studies should be based on accessible, progressive, appropriate and effective exercise strategies.
Background
Increasing numbers of UK women have overweight or obese body mass index scores when they become pregnant, or gain excessive weight in pregnancy, increasing their risk of adverse outcomes. Failure to manage postnatal weight is linked to smoking, non-healthy dietary choices, lack of regular exercise and poorer longer-term health. Women living in areas of higher social deprivation are more likely to experience weight management problems postnatally.
Objectives
The objectives were to assess the feasibility of conducting a definitive randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of lifestyle information and access to a commercial weight management group focusing on self-monitoring, goal-setting and motivation to achieve dietary change commencing 8–16 weeks postnatally to achieve and maintain weight management and positive lifestyle behaviour.
Design
The design was a randomised two-arm feasibility trial with a nested mixed-methods process evaluation.
Setting
The setting was a single centre in an inner city setting in the south of England.
Participants
Participants were women with body mass index scores of > 25 kg/m ² at antenatal ‘booking’ and women with normal body mass index scores (18.0–24.9 kg/m ² ) at antenatal booking who developed excessive gestational weight gain as assessed at 36 weeks’ gestation.
Main outcome measures
Recruitment, retention, acceptability of trial processes and identification of relevant economic data were the feasibility objectives. The proposed primary outcome was difference between groups in weight at 12 months postnatally, expressed as percentage weight change and weight loss from antenatal booking. Other proposed outcomes included assessment of diet, physical activity, smoking, alcohol consumption, body image, maternal esteem, mental health, infant feeding and NHS costs.
Results
Most objectives were achieved. A total of 193 women were recruited, 98 allocated to the intervention arm and 95 to the control arm. High follow-up rates (> 80%) were achieved to 12 months. There was an 8.8% difference in weight loss at 12 months between women allocated to the intervention arm and women allocated to the control arm (13.0% vs. 4.2%, respectively; p = 0.062); 47% of women in the intervention arm attended at least one weight management session, with low risk of contamination between arms. The greatest benefit was among women who attended ≥ 10 sessions. Barriers to attending sessions included capability, opportunity and motivation issues. Data collection tools were appropriate to support economic evaluation in a definitive trial, and economic modelling is feasible to quantify resource impacts and outcomes not directly measurable within a trial.
Limitations
The trial recruited from only one site. It was not possible to recruit women with normal body mass index scores who developed excessive pregnancy weight gain.
Conclusions
It was feasible to recruit and retain women with overweight or obese body mass index scores at antenatal booking to a trial comparing postnatal weight management plus standard care with standard care only and collect relevant data to assess outcomes. Approaches to recruit women with normal body mass index scores who gain excessive gestational weight need to be considered. Commercial weight management groups could support women’s weight management as assessed at 12 months postnatally, with probable greater benefit from attending ≥ 10 sessions. Process evaluation findings highlighted the importance of providing more information about the intervention on trial allocation, extended duration of time to commence sessions following birth and extended number of sessions offered to enhance uptake and retention. Results support the conduct of a future randomised controlled trial.
Trial registration
Current Controlled Trials ISRCTN39186148.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research ; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.
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