Promoting stretching exercise to reduce cardiovascular health risk in late pregnant women with obesity

促进伸展运动可降低妊娠晚期肥胖妇女的心血管健康风险

基本信息

批准号：
10166957
负责人：
SEONAE YEO
金额：
$ 45.55万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-08-06 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10166957
关键词：
37 weeks gestation Accelerometer Address Adherence Admission activity American College of Obstetricians and Gynecologists Antioxidants Anxiety Behavior Therapy Behavioral Biological Markers Birth Blood Pressure Body mass index Cardiac Cardiovascular Diseases Cardiovascular Physiology Cardiovascular Pregnancy Complications Cardiovascular system Cesarean section Cessation of life Child Mortality Diastolic blood pressure Effectiveness Emergency Situation Equilibrium Ethnic Origin Exercise Gestational Age Gestational Diabetes Goals Health Health Promotion Incidence Late pregnancy Lead Light Link Long-Term Effects Longevity Low Birth Weight Infant Maternal Mortality Measures Minority Minority Groups Moderate Exercise Morbidity - disease rate Muscle Neonatal Obesity Outcome Overweight Oxidative Stress Physical activity Pilot Projects Population Positioning Attribute Pre-Eclampsia Pregnancy Pregnancy Complications Pregnancy Outcome Pregnant Women Premature Birth Production Protocols documentation Race Randomized Controlled Trials Recommendation Recording of previous events Reporting Research Personnel Risk Sampling Skeletal Muscle Smoking Strenuous Exercise Stretching Superoxide Dismutase Testing Third Pregnancy Trimester Time Transferrin Underserved Population Up-Regulation Ursidae Family Walking Woman arm arterial stiffness blood pressure reduction cardiovascular effects cardiovascular health cardiovascular risk factor cost efficient efficacy testing electric impedance evidence base exercise intervention fetal heart rate variability high risk population improved interest light intensity maternal risk novel obesity management pregnancy hypertension prevent primary outcome protective effect secondary outcome sedentary side effect success treatment as usual vigorous intensity

项目摘要

Project Summary/Abstract Sedentariness can lead to excess risk for maternal and child mortality and morbidity. Most pregnant women, however, become sedentary in the 3rd trimester. In our randomized controlled trial with a high-risk group of sedentary overweight/obese pregnant women with a history of preeclampsia, we found that 10 or more weeks of stretching exercise (SE) reduced the incidence of preeclampsia - a significant risk factor for cardiovascular disease - by lowering blood pressure (BP) and enhancing antioxidant up-regulation and production, compared to walking, to which pregnant women adhered poorly. We plan to test if this effect can be extended to broader populations of pregnant women. From our pilot study of healthy pregnant women, of which 84% were overweight/obese, we reported promising results of the short-term effects of SEs on BP and sympatho-vagal balance. Thus, we propose to test the effects of a novel SE intervention on cardiovascular health in obese pregnant women in the 3rd trimester. We include evidence-based behavioral strategies to enhance adherence. A session of SE includes 30 minutes of sequential static stretching of large skeletal muscle groups for 20 seconds, 3 times per muscle group. Although little is known about cardiovascular effects of SE, our preliminary findings were unexpected yet consistent across our studies. If the findings persist, SE would be an effective, accessible, cost-efficient way for obese pregnant women to promote their health and reduce risk of cardiovascular complications of pregnancy. The study of SE interventions is therefore justified. In this 2-arm RCT we will determine if a SE is superior to a control condition of enhanced usual care (eUC) which includes moderate/vigorous activity, specifically walking, for 30 minutes 5 days/week as recommended by the American College of Obstetricians and Gynecologists. Both the treatment and control arms will receive a supportive behavioral intervention to facilitate adherence. Primary outcomes are BP, sympatho-vagal balance, and arterial stiffness assessed at baseline (27 weeks’ gestation), then at 5 and 10 weeks later, and at 32 and 37 weeks’ gestation. We will compare SE to eUC (n = 306; 153 per arm) and examine selected cardiovascular functions by which SE may be effective. The Aims are: Aim 1: To test the efficacy of SE intervention on improving cardiovascular health compared to eUC with respect to selected indicators of cardiovascular function (BP, sympatho-vagal balance and arterial stiffness), controlling for anxiety, age, race/ethnicity, BMI, and smoking; Aim 2: To test the efficacy of the SE intervention on maternal, fetal, and neonatal composite outcomes compared to eUC. Aim 3: To explore the relationship between adherence and cardiovascular measures and pregnancy complications. Our goals fit NINR’s strategic goal of promoting health and preventing illness across health conditions, settings, the lifespan, and in minority and underserved populations, who bear higher burden of obesity. Stretching exercise may be viable for preventing cardiovascular illness and is known to have high acceptance, better adherence, no known untoward side effects, and promising preliminary evidence of effectiveness.

项目概要/摘要久坐会导致孕产妇和儿童死亡和发病的风险过高。然而，在我们对高危人群进行的随机对照试验中，应在妊娠第三个月保持久坐不动。对于有先兆子痫病史、久坐的超重/肥胖孕妇，我们发现 10 周或更长时间伸展运动（SE）可降低先兆子痫的发生率——子痫前期是心血管疾病的一个重要危险因素疾病 - 通过降低血压 (BP) 和增强抗氧化剂的上调和产生，比较孕妇坚持步行的情况较差，我们计划测试这种效果是否可以推广到更广泛的范围。根据我们对健康孕妇的试点研究，其中 84% 是孕妇。超重/肥胖，我们报告了 SE 对血压和交感迷走神经的短期影响的有希望的结果因此，我们建议测试一种新型 SE 干预措施对肥胖者心血管健康的影响。我们采用基于证据的行为策略来提高依从性。 SE 课程包括 30 分钟的大骨骼肌群连续静态拉伸 20 秒，每个肌肉群 3 次尽管我们对 SE 的心血管影响知之甚少，但我们的初步发现出乎我们的意料，但在我们的研究中是一致的，如果研究结果持续存在，SE 将是一种有效的、易于使用的、肥胖孕妇促进健康并降低心血管风险的经济高效方式因此，在这项 2 组随机对照试验中，SE 干预措施的研究是合理的。确定 SE 是否优于强化常规护理 (eUC) 的控制条件，其中包括按照美国人的建议，每周 5 天进行中等/剧烈的活动，特别是步行 30 分钟妇产科医生学院的治疗组和控制组都将得到支持。促进依从性的行为干预主要结果是血压、交感迷走神经平衡和动脉。在基线（妊娠 27 周）、第 5 周和第 10 周以及第 32 周和第 37 周时评估硬度我们将比较 SE 与 eUC（n = 306；每组 153 例）并检查选定的心血管功能。 SE 可能有效目标是：目标 1：测试 SE 干预对改善的功效。就选定的心血管功能指标（血压、血压、交感迷走神经平衡和动脉僵硬度），控制焦虑、年龄、种族/民族、体重指数和吸烟；目标 2：比较 SE 干预对孕产妇、胎儿和新生儿综合结局的功效 eUC 目标 3：探讨依从性和心血管措施与妊娠之间的关系。我们的目标符合 NINR 促进健康和预防疾病的战略目标。条件、环境、寿命以及承受较高肥胖负担的少数群体和服务不足的人群。伸展运动可能有助于预防心血管疾病，并且被认为具有很高的接受度，更好的依从性，没有已知的不良副作用，并且有希望的有效性初步证据。