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Objective: During pregnancy, international guidelines recommend ≥150 min of moderate-intensity aerobic physical activity per week, with an intensity perceived as fairly light to somewhat hard on the Borg Rating of Perceived Exertion (RPE) scale (ranging from 6 'no exertion' to 20 'maximal exertion', corresponding to 60% to 80% of maximum heart rate). However, the determination and monitoring of exercise intensity seem to be a particular source of confusion, and the most effective method to monitor exercise intensity remains uncertain. This study aimed to examine existing research on the correlation between the Borg RPE scale and maternal heart rate (MHR) for monitoring exercise intensity during pregnancy., Design: Scoping review using the mixed methods appraisal tool (MMAT) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach., Data Sources: PubMed, Web of Science and SPORTDiscus were searched from 16-17 April 2023, with a subsequent search on 1 November 2023., Eligibility Criteria: We included studies investigating the correlation between perceived intensity on the Borg RPE scale (6-20) and MHR during exercise in pregnant individuals and written in English/Scandinavian language. There were no restrictions on publication year or study design., Data Extraction and Synthesis: Two independent reviewers screened the articles based on title and abstract. Selected articles were read in full text and reference lists of screened articles were also checked. Out of 120 studies screened, six articles met the inclusion criteria after removing one duplicate. The results were qualitatively summarised to provide an overview of common themes and variations between studies. MMAT and GRADE assessed the risk of bias and the certainty of the evidence., Results: The six studies involved a total of 260 healthy pregnant individuals (gestational week: from 16 to 38), with various exercise protocols (cycling, walking, running and resistance exercise) and intensities (from light to moderate). Three studies supported the Borg RPE scale to estimate exercise intensity during pregnancy, while three found no correlation between this scale and MHR. The certainty of the evidence was graded as low to moderate, with a potential risk of bias due to small sample sizes, incomplete outcome data and inconsistencies across studies., Conclusion: The mixed results highlight the complexity of monitoring exercise intensity during pregnancy. Using both the Borg RPE scale and MHR might be better than using them separately for monitoring exercise intensity during pregnancy. Due to limited and inconsistent research, more extensive studies are needed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Regular exercise during pregnancy is beneficial, but athletes often exceed the recommended 150 min of moderate-intensity activity, incorporate high-intensity exercises. The upper limit for exercise intensity and duration on fetal and maternal safety remains uncertain. A concern is a maternal core body temperature of >39.0 °C, potentially increase the risk of heat-related fetal malformations and complications during pregnancy. Blood flow redirection for thermoregulation could compromise fetal cardiovascular function, increasing the risk of miscarriage and preterm labor. This study evaluated whether pregnant women (gestational weeks 25-35) were at risk of exceeding a core body temperature of 39.0 °C during high-intensity running. We also investigated effects on skin temperature, fluid loss, and thermal sensation, comparing pregnant athletes to non-pregnant controls., Methods: In this comparative cross-sectional study, 30 elite and recreational athletes (pregnant n = 15) completed up to five high-intensity treadmill-intervals. Core and skin temperature were continuously measured. Body weight was utilized to calculate the amount of fluid loss., Results: Highest core body temperature were 38.76 °C and 39.56 °C in one pregnant and non-pregnant participant, respectively. Pregnant participants had lower core body temperatures (mean difference -0.47 °C, p ≤ 0.001) initially and a smaller increase (0.10 °C, p ≤ 0.003) during later intervals compared with the non-pregnant controls. Pregnant participants also showed a greater increase in skin temperature (4.08 ± 0.72 °C vs. 3.25 ± 0.86 °C, p = 0.008) and fluid loss (0.81 ± 0.19 L vs. 0.50 ± 0.12 L, p˂0.001)., Conclusion: Physiological changes in pregnancy may enhance thermoregulation, indicating that high-intensity interval runs are unlikely to pose a risk of exceeding a core body temperature of 39 °C for pregnant athletes., Competing Interests: The authors declare there are no conflicts of interest. The source of funding did not have any role in the study's design, conduct, data collection, management, analysis, or interpretation, nor did it influence the manuscript's preparation, review, approval, or the decision to submit it for publication., (© 2024 The Society of Chinese Scholars on Exercise Physiology and Fitness. Published by Elsevier (Singapore) Pte Ltd.)

Background: Accessible health information during pregnancy is important to positively affect maternal and fetal health. However, the quality and accuracy of health information can greatly vary across numerous sources. This narrative review is aimed at summarizing the literature on pregnant individuals' information sources and how these sources influence their habits toward GWG, PA, and nutrition. Such data will highlight preferences and needs, reveal challenges, and identify opportunities for improvement. Methods: We searched PubMed for studies published in the last decade. Out of 299 studies initially identified, 20 (16 quantitative and four qualitative) met the eligibility criteria (investigating information sources and their influence on health habits toward GWG, PA, nutrition, pregnant participants, adequate data reporting, and being available in full text). Results: Primary sources of health information varied. The Internet (26%-97%) and healthcare providers (HCPs) (14%-74%) predominated, followed by family/friends (12%71%), books/magazines (49%-65%), and guidelines/brochures (25%-53%). Despite the widespread use of the Internet, HCPs were considered the most reliable source. The use of the Internet to retrieve health information was reported to be 2-4 h a week, and < 50% discussed the online information with their HCP. The Internet was also used as a supplementary resource on topics raised by HCPs. Regarding the influence on health habits, the Internet, HCPs, media, and family positively influenced GWG and promoted adherence to recommended guidelines (OR = 0.55-15.5). Only one study showed a positive association between Internet use and PA level. The Internet, media, HCPs, and information brochures were associated with better adherence to nutritional recommendations. Conclusions: Pregnant individuals relied on the Internet and HCP, with a preference for the Internet despite trust in midwives. Several sources of health information were positively associated with adherence to GWG and nutrition recommendations. Improving the quality of online information should be a priority for policymakers and health authorities., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Christina Gjestvang and Lene Annette Hagen Haakstad.)

Fitness clubs are one of the largest exercise arenas worldwide. Still, membership withdrawal and exercise dropout rates are 40-65% in the first six months. One important approach to retaining members may be to create an environment that feels inclusive, and clusters members with mutual needs and interests. Increased knowledge in this field can provide valuable information that leads to more effective exercise promotion strategies and better retention rates, important to the long-term success of the gym and public health. Thus, we aimed to compare background factors, motivation, and social support between members of multipurpose (wide range of exercise concepts/facilities, middle to high membership fee), fitness-only (low membership fee), and boutique (one or two specialized exercise concepts, high membership fee) fitness clubs. A total of 232 members from multipurpose (n = 107), fitness-only (n = 52), and boutique gyms (n = 73) were recruited for this cross-sectional study. Data included background variables (age, gender, body weight and height, smoking, total household income, occupation, education, and general health), exercise behaviour, exercise motivation, and social support. A one-way between-group ANOVA with Bonferroni correction or a chi-square test was used as appropriate. Multipurpose and fitness-only members were older (mean diff: 9.1 years, p = <0.001) and exercised less (mean diff: 1-1.2 sessions/week, p = <0.001) than members from boutique clubs. Compared with multipurpose and fitness-only members, members from boutique clubs reported the highest autonomous motivation (intrinsic regulation: mean diff: 0.3, p = 0.030), and perceived greater social support from family/friends (mean diff: 6.4 to 6.6, p = <0.001). Boutique members were younger, exercised more, and reported higher autonomous motivation and social support than multipurpose and fitness-only members. Our results suggest that exercise enjoyment and a social community, the "philosophy" of boutique gyms, may be important for regular exercise., (© Journal of Sports Science and Medicine.)

Background: Exercise during pregnancy is associated with various health benefits for both mother and child. Despite these benefits, most pregnant women do not meet physical activity recommendations. A known barrier to engaging in exercise during pregnancy is a lack of knowledge about appropriate and safe exercise. In our current era of social media, many pregnant women are turning to online information sources for guidance, including social media influencers. Little is known about attitudes towards pregnancy exercise information provided by influencers on social media platforms. This study aimed to explore attitudes towards exercise during pregnancy depicted by social media influencers on Facebook, and user engagement with posted content., Methods: A mixed-methods approach was used to analyse data from 10 Facebook video posts of social media influencers exercising during pregnancy. Quantitative descriptive analyses were used to report the number of views, shares, comments and emotive reactions. Qualitative analysis of user comments was achieved using an inductive thematic approach., Results: The 10 video posts analysed were viewed a total of 12,117,200 times, shared on 11,181 occasions, included 13,455 user comments and 128,804 emotive icon reactions, with the most frequently used icon being 'like' (81.48%). The thematic analysis identified three themes associated with attitudes including [1] exercise during pregnancy [2] influencers and [3] type of exercise. A fourth theme of community was also identified. Most user comments were associated with positive attitudes towards exercise during pregnancy and the influencer. However, attitudes towards the types of exercise the influencer performed were mixed (aerobic and body weight exercises were positive; resistance-based exercise with weights were negative). Finally, the online community perceived by users was mostly positive and recognised for offering social support and guidance., Conclusions: User comments imply resistance-based exercise with weights as unsafe and unnecessary when pregnant, a perception that does not align with current best practice guidelines. Collectively, the findings from this study highlight the need for continued education regarding exercise during pregnancy and the potential for social media influencers to disseminate evidence-based material to pregnant women who are highly receptive to, and in need of reliable health information., (© 2023. The Author(s).)

Objective: The primary objective was to compare bone mineral density (BMD) in Norwegian female elite long-distance runners with a control group of inactive females. Secondary objectives were to identify cases of low BMD, to compare the concentration of bone turnover markers, vitamin D and symptoms of low energy availability (LEA) between the groups, and to identify possible associations between BMD and selected variables., Methods: Fifteen runners and fifteen controls were included. Assessments included dual-energy X-ray absorptiometry measurement of BMD in the total body, lumbar spine and dual proximal femur. Blood samples included endocrine analyses and circulating bone turnover markers. The risk of LEA was assessed through a questionnaire., Results: Runners had higher Z-scores in the dual proximal femur (1.30 (0.20 to 1.80) vs 0.20 (-0.20 to 0.80), p<0.021) and total body (1.70 (1.20 to 2.30) vs 0.90 (0.80 to 1.00), p<0.001). The lumbar spine Z-score was similar between groups (0.10 (-0.70 to 0.60) vs -0.10(-0.50 to 0.50), p=0.983). Three runners had low BMD (Z-score <-1) in the lumbar spine. Vitamin D and bone turnover markers showed no differences between the groups. Forty-seven per cent of the runners were at risk of LEA. Dual proximal femur BMD showed a positive correlation to estradiol and a negative correlation to LEA symptoms in runners., Conclusion: Norwegian female elite runners had higher BMD Z-score in the dual proximal femur and total body compared with controls, while no difference was observed in the lumbar spine. The advantages of long-distance running on bone health seem to be site specific, and there is still a need for the prevention of LEA and menstrual disorders in this group., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Pregnancy-related lumbopelvic pain is a frequently reported musculoskeletal disorder, but few studies have compared data between countries., Objectives: Examine prevalence, severity, and sick leave and explore potential risk factors associated with pregnancy-related lumbopelvic pain in Italian women and compare the results to a similar study in Norway, utilizing the same questionnaire., Design: Cross-sectional., Methods: Italian ( n  = 481) and Norwegian women ( n  = 435) were allocated from two public hospitals in Rome (Fatebenefratelli San Giovanni Calibita-Isola Tiberina) and Oslo (Oslo University Hospital), as well as four antenatal clinics in Modena (Italy). The questionnaire was completed between gestation weeks 32 and 36, addressing women's experiences of pregnancy-related lumbopelvic pain and sick leave in current week, and retrospectively for prepregnancy, first and second trimesters., Results: In Italy and Norway, 39% and 57% of pregnant women reported pregnancy-related lumbopelvic pain, respectively, with 11% and 25% experiencing severe pregnancy-related lumbopelvic pain. Pregnancy-related lumbopelvic pain was associated with sick leave in Norway ( p  < 0.01), but not in Italy ( p  = 0.66) at late gestation. In both countries, women with pregnancy-related lumbopelvic pain versus those with no pregnancy-related lumbopelvic pain were more likely to be multiparous (Italy: 40% versus 31%, p  = 0.06 and Norway: 53% versus 38%, p  < 0.01), and have gestational weight gain above guidelines (Italy: 21% versus 13%, p  = 0.02% and Norway: 27% versus 14%, p  < 0.01) and previous experience of pregnancy-related lumbopelvic pain (Italy: 15% versus 2%, p  < 0.01 and Norway: 31% versus 4%, p  < 0.01). Maternal exercise (⩾2 times weekly) was associated with less pregnancy-related lumbopelvic pain (Italy: odds ratio = 0.33, 95% confidence interval = 0.11-1.0, p  = 0.05 and Norway: odds ratio = 0.55, 95% confidence interval = 0.29-1.0, p  = 0.06)., Conclusion: We observed high rates of pregnancy-related lumbopelvic pain in Italy and Norway, with Norwegian women reporting the highest prevalence and severity level. While both countries had similar rates of sick leave in late gestation, an association between pregnancy-related lumbopelvic pain and sick leave was observed among Norwegian women only. Health care providers should be proactive in addressing pregnancy-related lumbopelvic pain through open communication and seeking input from pregnant individuals. However, it is essential to acknowledge that the current evidence on effective treatments remains limited and inconclusive, highlighting the need for further research in this field.

Few studies have explored the associations between body satisfaction and physical activity and weight gain during pregnancy, and none have been conducted in Scandinavia. Hence, the aim of the present study was to evaluate changes in body satisfaction from pre-pregnancy to late pregnancy and investigate whether this differed according to parity. We also wanted to explore the association between body satisfaction and physical activity and weight gain among pregnant women in Norway. This cross-sectional survey used an electronic questionnaire to assess physical activity level, weight gain and women's satisfaction with body weight and size. In total, 150 pregnant women answered the questionnaire. Related-samples Wilcoxon signed rank tests, Mann-Whitney U tests and chi-square tests were used to answer our research questions. The proportion of women who were dissatisfied with their body weight and shape increased from pre-pregnancy to late gestation (body weight p = 0.030 and body shape p = 0.040). Body dissatisfaction before and during pregnancy was linked to weight gain above recommendations. Characterising oneself as physically active prior to pregnancy was associated with satisfaction with body shape pre-pregnancy. Given that mothers strongly influence how a child will judge their body later in life, the results of this study underline the importance of addressing these issues during pregnancy.

Introduction: Due to the Coronavirus pandemic, politicians enacted directions to reduce social interactions, including lockdown of fitness clubs. We aimed to investigate how this changed exercise habits of Norwegian gym members., Method: Based on survey data, men and women (≥18 years, n = 233, data collection from Aug. 2020 to Jan. 2021) were recruited to this study by an email-invitation from their fitness club chain or by Facebook advertisement. The participants reported on background variables (e.g., age, gender, total household income, occupation, and education), and exercise habits pre- and during social lockdown. Data were analyzed using independent or student t -test, chi-squared test, or McNemar's test, as appropriate., Results: Home-based exercise (18.0 vs. 72.5%, p = <0.001), walking (49.8 vs. 65.2%, p = <0.001), and cycling (16.7 vs. 24.5%, p = 0.004) was more common during than pre-lockdown. Also, men (4.33 to 3.68 days/week, p =0.013) and women (4.20 to 3.79 days/week, p = 0.001) reported a lower exercise frequency, and a shorter duration. Exercise frequency was lower in those with a BMI ≥25 than in those with BMI <25 (3.95 vs. 4.48 days/week, p = <0.007) pre-lockdown. High exercise attendees (≥3 sessions/week, 66.5%) reported a smaller decrease in exercise frequency (mean change: 0.06 vs. 1.24 days/week, p = <0.001) and duration (>60 min. per session: 33.0 vs. 3.8%, p = <0.001) than low exercise attendees during lockdown., Discussion: Home-based exercise, walking, and cycling were most frequently reported during lockdown. Participants reported a small decrease in exercise duration and frequency compared with pre-lockdown. Closure of fitness clubs impacted low attendees more than high attendees., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gjestvang, Tangen and Haakstad.)

Background: Since cardiorespiratory fitness is an important predictor for all-cause mortality, it is of interest to know if meeting the physical activity (PA) recommendations is associated with higher levels of maximal oxygen uptake (VO 2max ). We aimed to investigate the association between total PA level given as counts per minute (cpm) and minutes in moderate-to-vigorous PA (MVPA), and VO 2max in new fitness club members., Methods: A total of 62 men and 63 women (≥ 18 years), defined as healthy (no disease considered to hinder PA) participated in this study. VO 2max (mL kg -1  min -1 ) was measured with a cardiopulmonary exercise (modified Balke protocol), and total PA level was measured with ActiGraph GT1M for seven consecutive days. All participants accumulating ≥ 10 h of activity recordings ≥ 4 days were included in the data analysis. To examine associations between PA level and VO 2max , a Pearson correlation and a multiple linear regression analysis adjusted for covariates were used., Results: VO 2max (mL kg -1  min -1 ) was 40.5 ± 7.2 in men and 35.1 ± 6.0 in women. Total PA level (cpm) and MVPA (min) were 352.4 ± 123.4 and 260.0 ± 132.6 in men and 361.4 ± 103.8 and 273.2 ± 137.0 in women. Total PA level (men: r = 0.346, p < 0.01, women: r = 0.267 p < 0.01) and MVPA (men: r = 0.359, p =  < 0.01, women: r = 0.236, p = 0.03) was associated with VO 2max . When adjusting for age and body fat percentage, total PA level and MVPA were no longer associated with VO 2max (men: p = 0.11 and p = 0.79, women: p = 0.40 and p = 0.61). In men, age (β = - 0.469 p < 0.01) and body fat percentage (β = - 0.483, p < 0.01) were the strongest predictor for VO 2max . For women, body fat percentage was the strongest predictor for VO 2max (β = - 0.483, p < 0.01)., Conclusions: Total PA level and MVPA were associated with VO 2max , but the association was low and diminished when adjusted for age and body fat percentage. Body fat percentage (men and women) and age (men) were more strongly associated with VO 2max than total PA level and MVPA., (© 2022. The Author(s).)

Objectives: To develop Australian guidelines on physical activity/exercise during pregnancy and the postpartum period., Design: Critical 'umbrella' reviews of the scientific evidence, combined with adaptation of recently published guidelines., Methods: A five stage approach included: identification of key source documents (including national physical activity/exercise guidelines and position statements from professional organisations, published since 2010); narrative review of evidence relating to 27 health outcomes; summarising the evidence; development of draft guidelines and supporting information; and review and consultation to finalise the guidelines., Results: Our evidence review found that physical activity/exercise during pregnancy and the postpartum period is safe, has health benefits for the woman and her unborn child, and may reduce the risks of some pregnancy related complications. Four specific guidelines were developed. These encourage all women without pregnancy complications to: (1) meet the Australian Physical Activity and Sedentary Behaviour Guidelines for Adults before, during and after pregnancy; (2) modify activities to accommodate the physical changes that occur as pregnancy progresses; (3) do pelvic floor exercises during and after pregnancy; and (4) take an active role in shared decision-making about their physical activity/exercise during and after pregnancy. The review also identified warning signs and contraindications for physical activity/exercise during pregnancy., Conclusions: All women who are pregnant or planning a pregnancy should be aware of the benefits of physical activity/exercise, and health professionals should encourage safe levels of activity and be familiar with the contraindications, signs and symptoms which suggest that physical activity/exercise should be modified or avoided., (Copyright © 2022 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: Along with the rising prevalence of high body-mass index (BMI), there is also increased emphasis on leanness and fitness. Both these trends suggest that many individuals are concerned about weight management and may try to lose weight. Using data from the research project "Fitness clubs - a venue for public health?", we aimed to describe weight cycling and energy-restricted dieting in men and women at start-up of fitness club membership, and to investigate influencing factors [age, BMI, educational level, self-classified overweight/obesity, compliance with nutritional guidelines, unhealthy weight control strategies and self-perceived health (SPH)]., Methods: In a cross-sectional online survey, 250 men and women from 25 fitness clubs in Oslo, reported anthropometrics, self-classified weight group, weight cycling, weight loss/gain, eating habits/dieting, and background/health information. Enrollment was limited to adult (≥18 years) novice exercisers (exercising <60 min/week at a moderate or vigorous intensity or brisk walking <150 min/week, the past six months) with less than four weeks of membership. Factors associated with weight cycling were examined using simple and multiple logistic regression, separated for men and women., Results: In both sexes (mean age: 36.4 ± 11.3, range 18-71 years), a high number reported substantial weight fluctuation (+/-5 kg) the past 12 months (men: 50% and women: 62%, mean difference 12%, 95% CI -0.3 to 23.8, p=0.056) and unhealthy weight control strategies (men: 24.8% and women: 47.2%, mean difference 22.4%, 95% CI 10.5 to 33.4, p<0.001). Weight cyclers had a higher mean BMI compared with non-cyclers (mean difference -1.5, 95% CI -2.6 to - 0.4, p= 0.003). Further, the difference in body weight was 6.7 kg (95% CI 2.2 to 10.8, p=0.004) and 10.8 kg (95% CI 5.8 to 15.8, <0.001) in men and women, respectively. Besides BMI status, self-classified overweight/obesity was the strongest predictor of reporting weight cycling (men: OR 5.54, 95% CI 2.03 to 15.12, p<0.01 and women: OR 7.17, 95% CI 2.48 to 20.68, p<0.001)., Conclusion: In novice exercisers, a large proportion reported weight cycling and unhealthy weight control strategies, and both were more prevalent in women than in men. Self-classified overweight was found to be the most important factor influencing weight cycling., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Haakstad, Stensrud, Rugseth and Gjestvang.)

Introduction and Hypothesis: Urinary incontinence (UI) is common in women who exercise. We aimed to investigate new onset UI in formerly inactive, overweight or obese women (BMI > 25) participating in three different strength training modalities compared with a non-exercising control group., Methods: This was a secondary analysis of an assessor blinded randomized controlled trial investigating the effect of 12 weeks of three strength training concepts for women on muscle strength and body composition. None of the programs included pelvic floor muscle training. International Consensus on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was used to investigate primary outcome; new onset UI, and secondary outcome; ICIQ-UI-SF sum score. Suissa and Shuster's exact unconditional test was used to analyze difference in new onset UI. Difference in ICIQ-UI-SF sum score is presented as mean with 95% CI., Results: At baseline 40 out of 128 (31.2%) participants reported UI. Three out of 27, 2 out of 17, 2 out of 23, and 0 out of 21 women in the three training and control groups respectively had new onset UI. There were no statistically significant differences in new onset UI across the groups or when collapsing new onset UI in the intervention groups compared with the controls (7 out of 67 vs 0 out of 21), p = 0.124. After the intervention the control group reported worse ICIQ-UI-SF sum score than any of the training groups; mean difference - 6.6 (95% CI: -11.9, -1.27), p = 0.012, but there was no difference in change from baseline to 12 weeks between the groups p = 0.145)., Conclusions: There was no statistically significant change in UI after strength training., (© 2021. The Author(s).)

Background: Data from the research project "Fitness clubs-a venue for public health?" provided an opportunity to evaluate the accuracy of self-reported body weight and height, and subsequent Body Mass Index (BMI), as well as the "trueness" of novice exercisers perception of weight status category, which has not been examined in this population. The aims were to examine self-reported body weight, height, and calculated BMI data from an online survey compared with measured data at fitness club start-up, investigate how accurately novice exercisers place themselves within self-classified weight group (underweight, normal weight, overweight, and obese), and compare this with fitness club attendance at three months follow-up., Methods: Prior to anthropometric measurements, 62 men and 63 women responded to an online questionnaire, including body weight (kilogram, kg) and height (centimeters, cm), and self-classified weight group (" I think I am … underweight, normal weight, overweight, obese "). We used the following statistical analysis: Paired sample t -tests, a Bland-Altman plot kappa statistics, chi-squared tests, and a logistic regression., Results: Mean difference of BMI calculated from self-reported and measured data was 0.06 (95% CI -0.29 to 0.17, p = 0.593) in men, and 0.16 (95% CI -0.40 to 0.09, p = 0.224) in women, with four participants being outliers of the 95% limits of agreement (Bland-Altman plot). Allowing a difference of 0.5 kg between self-reported and measured weight, we found that 16% reported their weight correctly, 31.2% underreported (-1.89 ± 1.59 kg), and 52.8% overreported (1.85 ± 1.23 kg), with no sex differences ( p = 0.870). Further, our results suggest that both sexes may have difficulty recognizing overweight/obesity in themselves, and particularly men are likely to underreport their perceived weight group compared with women. More than half (53.3%) of the overweight men perceived themselves to be normal weight (women: 14%), and only 33.3% of obese men and women correctly classified themselves as being obese. We did not find any difference between participants correctly or incorrectly classifying weight group and fitness club attendance (≥2 times a week) at three months follow-up., Conclusion: Both sexes reported body weight and height reasonably accurately, and BMI based on self-report appears to be valid measure. Still, a large proportion of novice exercisers do not recognise their own overweight or obesity status, which may in part explain why public health campaigns do not reach risk populations.

Objectives: A fitness club may be an important arena to promote regular exercise. However, authors have reported low attendance rates (10 to 37%) the first months after individuals sign up for membership. It is therefore important to understand the reasons for poor exercise adherence. In this project, we aimed to investigate different psychosocial factors that might increase the likelihood of reporting regular exercise the first year of a fitness club membership, including self-efficacy, motives, social support, life satisfaction, and customer satisfaction., Methods: New members (≤4 weeks membership, n = 250) classified as novice exercisers (exercise < 60 min/week the last 6 months) from 25 multipurpose gyms were followed for 1 year. Data were collected by an electronic survey including background and health factors, self-efficacy, social support, life satisfaction, motives, customer satisfaction, and exercise attendance, and was answered at start-up and after three ( n = 224), six ( n = 213), and 12 ( n = 187) months. It is well established in the literature that ≥2 exercise sessions/week improve physical fitness in novice exercisers (if adhered to). Hence, we divided the participants into regular exercise attendance (≥2 sessions/week) and non-regular exercise attendance (≤1 session/week, exercise dropout, or membership dropout) in the analysis., Results: A mixed-effects logistic regression model revealed that the strongest predictor for reporting regular exercise attendance was higher levels of the motive "enjoyment" (OR = 1.84, p ≤ 0.001, 95% CI for OR = 1.35, 2.50), followed by self-efficacy "sticking to it" (OR = 1.73, p = 0.002, 95% CI for OR = 1.22, 2.46) and social support from friends and family (OR = 1.16, p ≤ 0.001, 95% CI for OR = 1.09, 1.23)., Conclusion: In novice exercisers, regular exercise at three, six, and 12 months was associated with higher scores of the motive "enjoyment," self-efficacy ("sticking to it"), and social support compared with non-regular exercise. Our results show that the majority of new fitness club members do not achieve regular exercise behavior., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Gjestvang, Abrahamsen, Stensrud and Haakstad.)

Background: Growing evidence supports that physical activity and exercise during pregnancy is favorable for the mother, with persisting benefits in the postpartum period. However, there is scant knowledge of the effect of a prenatal exercise program on long-term health and lifestyle habits., Objectives: This 6-year follow-up study of a randomized controlled trial had two aims: (1) compare body weight, weight retention and body mass index (BMI) in the intervention group and control group, and (2) evaluate effects on physical activity level and recreational exercise., Materials and Methods: Out of 105 participants initially randomized to either an intervention group, n  = 52 (twice weekly group-exercises and physical activity counselling) or control group, n  = 53 (standard prenatal care), 80 women (76.2%) participated in the present long-term follow-up study, performed in a general community in Oslo, Norway. Data were collected through a standardized telephone interview based on the baseline protocol and a modified Physical Activity and Pregnancy Questionnaire (PAPQ). Body weight at 6 years follow-up was self-reported (kg), and calculation of current BMI (kg/m 2 ) was based on self-reported weight and measured height at study inclusion. Investigators were unaware of the original randomization at the time of the interviews. Analyses of covariance were used to examine the difference in change in body weight and BMI between the groups. Even though the MET-values were not normally distributed, differences were examined using a two-sided independent sample t -test due to large sample size ( n  ≥ 30)., Results: At 6 years follow-up there were no differences in mean BMI (kg/m 2 ) (24.0 ± 3.8 versus 24.8 ± 4.0, p  = .37), physical activity level (4167 ± 2638 versus 3925 ± 3075 MET-min/week, p  = .67) or recreational exercise (630 ± 1290 versus 720 ± 1005 MET-min/week, p  = .88) between the intervention and control group, respectively. Subgroup analysis of participants with high adherence during the intervention 6 years ago (≥24 prenatal exercise classes), showed a positive intervention effect at long-term follow up in body weight (kg) (62.8 ± 7.9 versus 70.8 ± 11.8, p  = .03) and BMI (kg/m 2 ) (22.5 ± 3.1 versus 24.8 ± 4.0, p  = .05), and none (versus 11 in the control group) had gained ≥5 kg compared to prepregnancy weight ( p  = .02)., Conclusions: Women who adhered to the original prenatal exercise intervention demonstrated significantly lower body weight and BMI at 6-year follow-up. Otherwise, no long-term intervention effect was observed.

No prospective studies have investigated if repeated testing of physical performance and body composition are associated with exercise attendance or patterns in fitness club members. This study aimed to investigate if repeated physical testing was associated with exercise attendance and patterns in gym members and to report prospective data on use of the fitness club`s facilities and products. Untrained new members were recruited and divided into a test group (n = 125) and as controls (n = 125). All participants answered a survey including exercise involvement, at onset, and after 3, 6, and 12 months follow-up. The test group also measured body composition, maximal oxygen uptake, and maximal muscle strength (onset, and after 3 and 12 months). In total 73.6% answered all surveys, and in the test group, 44.8% completed all physical tests. Regular exercise attendance was defined as ≥2 sessions/week. Repeated testing showed no association with long-term regular exercise attendance (test group: 19.6%, controls: 19.8%; p = 0.638). At 3 months, a lower proportion in the test group reported engagement in resistance exercise (35.3% and 60.2%; p = 0.003) and had lower exercise frequency (2.0 and 2.6 days/week; p = 0.008) than controls. The test group had higher participation in group exercise classes (28.0% and 13.6%; p = 0.040). Exercise frequency decreased from onset to 12 months (from 2.6 to 2.2 days/week; p = 0.025) At 3, 6, and 12 months, 51.8%, 37.6%, and 37.4% reported regular exercise attendance, and 16.9% at all follow-ups. At all time-points, most common workout mode was individual resistance exercise (43.8% to 46.3%). Few attended group exercise classes (7.5% to 13.8%) or used a personal trainer (22.5% to 27.5%). Repeated physical testing did not improve exercise attendance, and we found no changes in members` use of the fitness club`s facilities and products. Only 16.9% reported regular exercise attendance throughout the first year of membership., (© Journal of Sports Science and Medicine.)

No prospective studies have investigated motives and barriers to exercise in new untrained fitness club members. The aims of the present prospective longitudinal study were to (a) examine proportions reporting regular exercise, non-regular exercise, and exercise dropout; (b) identify motives and barriers to exercise; and (c) compare motives between regular and non-regular exercisers the first year of fitness club membership. New members (n = 250) were followed for 1 year. A questionnaire including demographics, exercise frequency, motives (EMI-2), and barriers (18 common reported barriers) was used, and 184 answered at four time points (onset, and after 3, 6, and 12 months). Participants were categorized into regular exercise: ≥2 sessions/wk or non-regular exercise: ≤1 session/wk, exercise relapse, or dropout. At 3, 6, and 12 months, 63.4%, 59.6%, and 57.2% exercised regularly, whereas 20.1%, 21.1%, and 28.3%, dropped out, respectively. Throughout the follow-up, 37% reported regular exercise. At all time points, motives regarding positive health and strength/endurance were rated highest on a six-point scale. Exercise dropouts rated priority as the greatest barrier. Regular exercisers rated the motives enjoyment (such as "I enjoy the feeling of exerting myself") and challenge (such as "To give me goals to work towards") higher than non-regular exercisers (P = ≤.05). In conclusion, less than half exercised regularly, and most members were motivated by factors such as positive health and physical fitness the first year of fitness club membership. Higher levels of the motives enjoyment and challenge were associated with regular exercise., (© 2020 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Introduction: The aims of the present study were to report longitudinal data on the prevalence of urinary incontinence (UI) in a fitness club setting and to investigate whether gym members are educated about and exercise their pelvic floor muscles., Methods: New members (125 women) from 25 fitness clubs in Oslo, Norway, filled in a 25-min online questionnaire (SurveyXact) at four time points (onset, 3, 6 and 12 months of fitness club membership). The questionnaire covered background/health information, membership dropout and exercise habits, including pelvic floor muscle training (PFMT). A modified Subjective Health Complaints Inventory (SHC Inventory) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were used to gather repeated measures of UI., Results: At onset, 3, 6 and 12 months of fitness club membership, 16.8%, 13.8%, 19.6% and 18.7% reported UI, respectively (p = 0.11). Of these, 57.1% to 76.2% reported leakage during exercise and perceived the UI to be slight. Less than 8% had received information about PFMT by the fitness club staff. Adherence to regular exercise and PFMT throughout the follow-up period (minimum two sessions/week) did not show any association with absent or present UI at 12 months (p = 0.48 and p = 0.63) and was reported by 30% and 22.2% of the participants, respectively., Conclusions: About 17% reported UI at onset of fitness club membership, with no changes in proportions throughout the first year. Adherence to regular exercise and PFMT did not show any association with absent or present UI at 12 months. Few had been taught PFMT.

Objectives: Today all pregnant women are recommended to participate in moderate intensity aerobic and resistance-based physical activity/exercise ≥150 min/week. However, there are still controversies and scant knowledge on the role of regular exercise on delivery outcomes, including mode of delivery and length of active labour. In addition, nutritional counselling have often been examined together with exercise, which may independently effect the outcomes. Hence, the aims of the present study were to investigate the sole effect of supervised group exercise, including pelvic floor muscle training on course of labour and mode of delivery., Study Design: A single blind, randomized controlled trial, performed in the municipality of Oslo, Norway. Out of 105 healthy, inactive nulliparous women, initially enrolled (gestation week 17.7 ± 4.2) to study the effect regular aerobic exercise (60 min 2/week) on health benefits for both mother and her baby, 90 (85.7%) completed postpartum follow-up (7.7 ± 1.7) on labour outcomes (exercise: 43 and control: 47). Data were collected via standardized interviews and birth partographs from hospital records, reported on the postpartum visit (weeks after labour 7.6 ± 1.6). The primary investigator was unaware of the original randomization at the time of the interviews. The principal analysis was done on an intention to treat basis (ITT). For the planned subgroup analyses (per protocol), acceptable intervention adherence was defined as attending ≥ 80% of the recommended exercise program (≥ 19 exercise sessions)., Results: There were no differences between the exercise and control groups in induction of labour, use of analgesia, duration of active labour or prolonged labour, according to ITT. Per protocol analyses, showed a shorter duration of total active labour in the exercise group (6.8 ± 5.5 h) than the control group (9.8 ± 5.4 h), with a mean between group difference of 3.1 h (95% CI 0.31-5.9, p = 0.029). Rate of normal vaginal delivery was 85.7% among adherent participants and 62.3% in the control group (p = 0.051)., Conclusions: Regular exercise during pregnancy decreased duration of total active labour and showed a trend towards more normal vaginal deliveries among participants who adhered to the prescribed program., Trial Registration: ClinicalTrials.gov: NCT00617149., Competing Interests: Declaration of Competing Interest The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper. The manuscript contains original material only, and has not previously been reviewed elsewhere before this submission. We have followed the CONSORT 2010 checklist of information to include when reporting a randomized trial. No organization or persons have any financial interest in the study or findings presented in this article, and all participants gave written consent to participate and the procedures followed the World Medical Association Declaration of Helsinki. We sincerely hope that the manuscript will be of interest to a broad audience and all the readers of European Journal of Obstetrics Gynecology and Reproductive Biology, and to hear from you in the very near future., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: Most studies regarding prevalence of prenatal lifestyle counseling are based on patient report of provider advice. The aim of the present study was to describe midwives' practice and views in promoting three distinct, but importantly related lifestyle factors: gestational weight gain (GWG), regular physical activity (PA), and nutrition., Design: A cross-sectional study., Setting: Healthcare clinics in Oslo and Akershus County, Norway., Participants: Clinics that expressed interest to participate provided an email list of the midwives. Of 107 midwives invited to participate, 65 completed the 15-min electronic survey (SurveyXact), giving a response rate of 60.7%., Outcome Measures: We developed a new questionnaire based on questions and results from similar studies, as no validated questionnaires existed when we initiated this project in 2014. The final electronic questionnaire included a mix of close-ended questions, semi-close-ended questions, and 11-point Likert scales and covered demographics, personal health behaviors, counseling practice, views, and self-perceived role in lifestyle counseling., Results: Mean workload in prenatal care was 78%, and mean years practicing was 8.9 (±7.5). Across all three health topics, most (74-95%) reported to give advice on the first meeting, with a mean frequency of 2.2 (±1.4), 2.7 (±1.8), and 2.7 (±2.0) for GWG, PA, and nutrition counseling, respectively. Approximately 40% did not report advice on GWG or give advice discordant with the Institute of Medicine (IOM) recommendations (2009) for at least one prepregnancy body mass index (BMI) category. GWG was rated as more unpleasant to talk about than PA (3.0 ± 2.8 vs. 1.1 ± 2.5, p < 0.001) and nutrition (3.0 ± 2.8 vs. 1.2 ± 2.5, p = 0.002). Also, regarding the importance of giving lifestyle advice, PA (9.6 ± 0.9 vs. 8.3 ± 2.2, p < 0.001) and nutrition (9.9 ± 0.4 vs. 8.3 ± 2.2, p < 0.001) were rated as more important than advice about GWG. Postpartum, nearly 40% gave advice about PA, whereas only two (3.1%) reported to discuss weight/weight retention ( p < 0.001)., Conclusion: While most midwives gave advice on GWG, PA, and nutrition at the first meeting and rated lifestyle counseling as an important topic, the advice on GWG was often discordant with IOM recommendations, and the topic was viewed as more unpleasant to talk about than PA and nutrition., (Copyright © 2020 Haakstad, Mjønerud and Dalhaug.)

Purpose: High-repetition, low-load resistance exercise in group class settings has gained popularity in recent years, with BodyPump as a prime example. For individuals using exercise for body-weight management, the energy expenditure during exercise is of interest. Therefore, we herein aimed to estimate the energy expenditure during a session of BodyPump and a time-matched session of heavy load resistance training in overweight women (BMI ≥ 25.0)., Methods: Eighteen women participated in the study (mean age 35.4 years ± 10.2, BMI 30.4 kg/m 2 ± 4.8), 10 exercising BodyPump (50-100 repetitions each muscle group) and eight performed a heavy load session (eight repetition maximum × three sets). The energy expenditure was assessed with indirect calorimetry during the sessions and for two intervals at rest during the recovery phase: 0-20 and 120-140 min after the sessions., Results: The BodyPump group lifted significantly more loads than the heavy load group (19,485 kg ± 2258 vs 15,616 kg ± 2976, p = 0.006), while energy expenditure was similar with 302 kcal ± 67 and 289 kcal ± 69 in BodyPump and heavy load group, respectively ( p = 0.69). With no group differences, the resting metabolic rate (RMR) was elevated with 15-22% 2 h after exercise., Conclusion: Overweight women achieved an energy expenditure of approximately 300 kcal (4.7 kcal per min) during a single session of BodyPump, which was similar with the women performing a single session of heavy load resistance exercise., (Copyright © 2020 Rustaden, Gjestvang, Bø, Haakstad and Paulsen.)

Objectives: This study investigated self-perception of overall health (SPH) and quality of life (QoL) at onset and after 3, 6 and 12 months of fitness club membership. Also, we compared SPH and QoL between those who reported regular use of the fitness club (≥2 exercise sessions/week the last month) with those who did not (one exercise session/week or no exercise the last month)., Design: Longitudinal prospective study., Setting: 25 fitness clubs in Oslo, Norway., Participants: In total, 250 newly registered fitness club members (equal numbers of men and women, mean age=36.4±11.3 years, mean body mass index=25.7±4.4) were recruited. At onset (n=250), after 3 (n=224), 6 (n=213) and 12 months (n=187), the participants answered an electronic questionnaire, covering background variables, exercise involvement, perceived SPH and QoL., Outcome Measures: SPH was measured by a single-item question, rating health status from poor to excellent on a 5-point scale. High SPH was dichotomised as excellent or good, and low SPH as moderate, fair or poor. QoL was measured on a 7-item scale, rating five statements and dichotomised according to a total max sum score of 35, with low QoL ≤25 and high QoL >25., Results: Repeated measurements did not show any changes in SPH. In QoL, we observed an improvement in QoL sum score and a significant increase in mean scores for two out of five statements at 12 months follow-up: 'In most ways, my life is close to my ideal ' (p=0.036) and'If I could live my life over, I would change almost nothing ' (p<0.001). Regular use of the fitness club was associated with high SPH (OR 3.532 (95% CI 1.60-7.82), p=0.002) and high QoL (OR 1.914 (95% CI 0.95-3.86), p=0.069). The results were unchanged after adjusting for confounders., Conclusion: Regular attendance at a fitness club was associated with high SPH and high QoL at 12 months follow-up., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Despite the associations between delayed childbearing and poorer maternal and perinatal outcomes, little is known about these issues in regular exercisers and in women with healthy lifestyles. The aims of the present study were to: (a) compare lifestyle variables and exercise, pregnancy and birth outcomes in women ≥35 years and women <35 years of age, and (b) investigate the associations between regular exercise and maternal health and newborn variables in women of advanced maternal age., Material and Methods: Healthy pregnant women (≥35 years, n = 104 and <35 years, n = 362) were allocated to the study from Rikshospitalet, Oslo University Hospital, Norway. The participants completed a validated self-administered questionnaire, the Physical Activity Pregnancy Questionnaire (PAPQ) in gestational weeks 32-36. Prepregnancy body weight (kg) was self-reported, whereas maternal weight (kg) was measured at gestational weeks 14-16, 22-24, 30-32, and 36-38. Details of the delivery (gestational week at delivery, mode of delivery, Apgar score) and birthweight (g) were obtained from the hospital's medical records., Results: More women <35 than ≥35 years of age reported to have exercised prepregnancy (83.7% vs 74.0%, P = 0.04) and in the 1st trimester (71.2% vs 61.5%, P = 0.05). At gestational week 36, fewer than 50% were exercising regularly, with no group differences (P = 0.74). Current alcohol use (10.5% vs 3.3%, P = 0.02) and tobacco use (5.8% vs 1.7%, P = 0.02) were higher among women ≥35 than women <35 years, whereas for healthy diet the result was reversed (<35 years 67.1% and ≥35 years 80.8%, P = 0.02). There were higher rates of post-term birth (13.5% vs 6.4%, P = 0.02) and induction of labor (40.5% vs 27.9%, P = 0.02) in the ≥35 years group, otherwise no other differences were observed in perinatal outcomes. In women with advanced maternal age, exercising ≥2 times weekly was associated with less pelvic girdle pain (40.0% vs 61.1%, P = 0.02), lower gestational weight gain (12.7 ± 4.0 kg vs 15.5 ± 5.5 kg, P < 0.01), fewer had gestational weight gain ≥16 kg (22.0% vs 51.9%, P < 0.01) and a newborn with macrosomia (10.0% vs 37.0%, P < 0.01). The results were unchanged after adjusting for recognized confounders., Conclusions: The results indicate that regular exercise is associated with improvement in some of the risks of advanced maternal age., (© 2019 Nordic Federation of Societies of Obstetrics and Gynecology.)

Background: High Body Mass Index (BMI) and gestational weight gain (GWG) affect an increasing number of pregnancies. The Institute of Medicine (IOM) has issued recommendations on the optimal GWG for women according to their pre-pregnancy BMI (healthy, overweight or obese). It has been shown that pregnant women rarely met the recommendations; however, it is unclear by how much. Previous studies also adjusted the analyses for various women's characteristics making their comparison challenging., Methods: We analysed individual participant data (IPD) of healthy women with a singleton pregnancy and a BMI of 18.5 kg/m 2 or more from the control arms of 36 randomised trials (16 countries). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to describe the association between GWG outside (above or below) the IOM recommendations (2009) and risks of caesarean section, preterm birth, and large or small for gestational age (LGA or SGA) infants. The association was examined overall, within the BMI categories and by quartile of GWG departure from the IOM recommendations. We obtained aOR using mixed-effects logistic regression, accounting for the within-study clustering and a priori identified characteristics., Results: Out of 4429 women (from 33 trials) meeting the inclusion criteria, two thirds gained weight outside the IOM recommendations (1646 above; 1291 below). The median GWG outside the IOM recommendations was 3.1 kg above and 2.7 kg below. In comparison to GWG within the IOM recommendations, GWG above was associated with increased odds of caesarean section (aOR 1.50; 95%CI 1.25, 1.80), LGA (2.00; 1.58, 2.54), and reduced odds of SGA (0.66; 0.50, 0.87); no significant effect on preterm birth was detected. The relationship between GWG below the IOM recommendation and caesarean section or LGA was inconclusive; however, the odds of preterm birth (1.94; 1.31, 2.28) and SGA (1.52; 1.18, 1.96) were increased., Conclusions: Consistently with previous findings, adherence to the IOM recommendations seem to help achieve better pregnancy outcomes. Nevertheless, even in the context of clinical trials, women find it difficult to adhere to them. Further research should focus on identifying ways of achieving a healthier GWG as defined by the IOM recommendations.

Background: Regular physical activity (PA), adequate gestational weight gain (GWG), and healthy eating are important for the long-term health of both mother and baby. Hence, it is important that women receive current and updated advice on these topics and are encouraged to adopt a healthy lifestyle during pregnancy., Objective: The aim of this study was to investigate the main information sources among pregnant women regarding PA, GWG, and nutrition as well as to evaluate how these information sources may affect their health behaviors., Methods: A cross-sectional study design, comprising an electronic questionnaire, was distributed to 2 antenatal clinics, as well as pregnancy-related online chat forums and social media. The inclusion criteria were ≥18 years, ≥20 weeks gestation, and able to read and write Norwegian. In total, 150 pregnant women answered the questionnaire, which was a mix of 11-point Likert scales, close-ended questions, and semi-close-ended questions with the option to elaborate. The relationship between information sources and selected variables, including health behaviors and descriptive variables, were assessed by logistic regression, linear regression, or chi-square as appropriate (P<.05)., Results: Mean age (years), gestation week, and prepregnancy body mass index (kg/m 2 ) were 31.1 (SD 4.3), 30.6 (SD 5.9), and 24.2 (SD 4.2), respectively. More than eight out of 10 had received or retrieved information about nutrition (88.7%, 133/150) and PA (80.7%, 121/150), whereas 54.0% (81/150) reported information on GWG. When combining all 3 lifestyle factors, 38.5% had retrieved information from blogs and online forums and 26.6%, from their midwife or family physician. Women who reported the internet and media as their primary source of information on weight gain had increased odds of gaining weight below the Institute of Medicine (IOM) guidelines compared with gaining within the guidelines (odds ratio [OR] 15.5, 95% CI 1.4-167.4; P=.02). Higher compliance with nutritional guidelines was seen among those who cited the internet and media as their main source of information on nutrition (beta=.7, 95% CI 0.07-1.3; P=.03). On the other side, receiving advice from friends and family on weight gain was significantly associated with gaining weight above the IOM guidelines compared with gaining within the guidelines (OR 12.0, 95% CI 1.3-111.7; P=.03). No other associations were found between information sources and health behaviors., Conclusions: The small number of health professionals giving information and the extensive use of internet- and media-based sources emphasize the need to address the quality of internet advice and guide women toward trustworthy sources of information during pregnancy. The association between information sources and PA, GWG, and nutrition requires further research., (©Emilie Mass Dalhaug, Lene Annette Hagen Haakstad. Originally published in the Interactive Journal of Medical Research (http://www.i-jmr.org/), 05.07.2019.)

Objectives: The primary aim of the present study was to investigate if changes in physical fitness, body composition and weight are associated with exercise attendance and dropout among fitness club members. Secondary, we wanted to identify motives for fitness club membership and exercise., Setting: New members at 25 fitness clubs in Oslo, Norway., Participants: In total, 125 new fitness club members were recruited. Eligible criteria were <4 weeks of membership, untrained (exercising <60 min once a week) and ≥18 years. At inclusion, and after 3 (n=87) and 12 months (n=64), participants answered a questionnaire (including motives for membership and exercise, and attendance) and performed measurements of maximum oxygen uptake (VO 2max ), one repetition maximum (bench press and leg press), body composition and weight. In total, 56 participants underwent measurements at all time points. Based on self-reported attendance, participants were divided into three groups: regular attendance (≥2 sessions per week), low attendance (<2 sessions per week) and exercise dropout (no sessions the last month)., Results: At 3 months, regular attendees had significantly higher VO 2max than dropout (6.54 mL/min/kg, 95% CI 2.00 to 11.07, p=0.003). At 12 months, a difference in VO 2max of 5.32 mL/min/kg (95% CI -0.08 to 10.72, p=0.054) was found between regular attendees and dropout, and between regular and low exercise attendance (6.17 mL/min/kg, 95% CI 0.19 to 12.15, p=0.042). VO 2max was the only factor showing an association with attendance. No differences or associations were observed in maximal muscle strength or body composition between the three groups. Primary motive for fitness club membership and exercise was increase in physical fitness (92.8%)., Conclusions: VO 2max was the only factor associated with exercise attendance at two time points. Increased physical fitness was primary motive for fitness club membership and exercise., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Overweight and obesity are associated with musculoskeletal pain, particularly in the female population. However, regular resistance training may positively affect these complaints., Objective: The present study aimed to investigate between group differences in musculoskeletal pain in previously inactive women, allocated to three different resistance-training modalities available in health- and fitness clubs., Methods: This is secondary analysis from a single-blinded randomized controlled trial, including healthy women (aged 18-65) with a BMI (kg/m 2 ) ≥25. The participants were allocated to 12 weeks (3 times/weekly) of either BodyPump (high-repetition low-load group session) (n=24), heavy load resistance training with a personal trainer (n=28), non-supervised heavy load resistance training (n=19) or non-exercising controls (n=21). Primary outcome was self-reported musculoskeletal pain in ten different body parts, measured with the Standardized Nordic Pain Questionnaire, at baseline and post-test. In addition, the study included sub-analyses of the participants when they were divided into high (≥28 of 36 sessions, n=38) and low (≤27 of 36 sessions, n=22) exercise adherence., Results: The analysis revealed no between group differences in musculoskeletal pain in any of the ten body parts. The results did not change when the participants were divided into high versus low adherence., Conclusions: Twelve weeks of BodyPump, heavy load resistance training with a personal trainer and non-supervised heavy load resistance training did not show any effect on self-reported musculoskeletal pain in overweight women., Clinical Trial Registration Number: NCT01993953. (https://clinicaltrials.gov/ct2/show/NCT01993953)., (Copyright © 2019 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Competing Interests: Competing interests: None declared.

Introduction: The beneficial effects of physical activity during pregnancy for the mother and offspring have been reported by several studies but there are conflicting results concerning the possible effect of physical activity on the course of labor and risk of cesarean delivery. This study presents secondary analyses from the Norwegian Fit for Delivery randomized controlled trial, aiming at studying the effect of a lifestyle intervention including group exercise classes, as well as the possible influence of physical activity level in late pregnancy, on labor outcomes., Material and Methods: Healthy nulliparous women with singleton pregnancy were randomized to an intervention group, n = 303 (dietary counseling and twice-weekly exercise classes) or a control group, n = 303 (standard care). The participants were analyzed both by randomization and as a cohort comparing women with lowest (quartile 1, 0 metabolic equivalent of task-hours moderate-to-vigorous physical activity/week) (n = 140) vs. highest (quartile 4, ≥16 metabolic equivalent of task-hours moderate-to-vigorous physical activity/week) (n = 131) physical activity level in late pregnancy, assessed with the International Physical Activity Questionnaire., Result: The intervention group had a longer first stage of labor compared with the control group (293 ± 202 min vs. 257 ± 181 min, p = 0.030). No differences between the randomization groups were seen for time spent in second stage of labor, prolonged labor or mode of delivery. In the total sample, women with the highest physical activity level had lower odds ratio (OR) of acute cesarean delivery (OR 0.33, 95% CI 0.11-0.97, p = 0.044) than did those with the lowest physical activity-level., Conclusion: A significantly longer first stage of labor was observed in the intervention group than in the control group. A high physical activity level in late pregnancy was associated with lower odds of acute cesarean delivery compared with a low physical activity level., (© 2018 Nordic Federation of Societies of Obstetrics and Gynecology.)

Background: To develop effective health promotional and preventive prenatal programs, it is important to understand perceived barriers to leisure-time physical activity during pregnancy, including exercise and sport participation. The aims of the present study was 1) to assess the effect of prenatal lifestyle intervention on the perceived barrier to leisure-time physical activity during pregnancy and the first year after delivery and 2) identify the most important perceived barriers to leisure-time physical activity at multiple time points during and after pregnancy., Methods: This secondary analysis was part of the Norwegian Fit for Delivery study, a combined lifestyle intervention evaluated in a blinded, randomized controlled trial. Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥ 18 years and body mass index ≥19 kg/m 2 were recruited via healthcare clinics in southern Norway, including urban and rural settings. Participants were randomized to either twice-weekly supervised exercise sessions and nutritional counselling (n = 303) or standard prenatal care (n = 303). The principal analysis was based on the participants who completed the standardized questionnaire assessing their perceived barriers to leisure-time physical activity at inclusion (gestational week 16, n = 589) and following intervention (gestational week 36, n = 509), as well as six months (n = 470) and 12 months (n = 424) postpartum., Results: Following intervention (gestation week 35.4 ± 1.0), a significant between-group difference in perceived barriers to leisure-time physical activity was found with respect to time constraints: "... I do not have the time" (intervention: 22 vs. control: 38, p = 0.030), mother-child safety concerns: "... afraid to harm the baby" (intervention: 8 vs. control: 25, p = 0.002) and self-efficacy: "... I do not believe/think that I can do it" (intervention: 3 vs. control: 10, p = 0.050). No positive effect was seen at postpartum follow-up. Intrapersonal factors (lack of time, energy and interest) were the most frequently perceived barriers, and consistent over time among all participants., Conclusion: The intervention had effect on intrapersonal perceived barriers in pregnancy, but not in the postpartum period. Perceived barriers to leisure-time physical activity were similar from early pregnancy to 12 months postpartum., Trial Registration: ClinicalTrials.gov: NCT01001689 , registered July 2, 2009.

Competing Interests: Competing interests: None declared.

Background: Despite documented health benefits for mother and baby, physical activity (PA)-level tends to decline in pregnancy. Overweight/obese and physically inactive women are two selected groups at increased risk of pregnancy complications. Thus, efficient strategies to maintain or increase PA-level in pregnancy and the postpartum period, especially among these women, are warranted. This secondary analysis examined the effect of a prenatal lifestyle-intervention on PA-level in late pregnancy and the first year postpartum, with subanalysis on initially physically active versus inactive and normal-weight versus overweight/obese women., Method: The Norwegian Fit for Delivery (NFFD) randomized controlled trial included healthy primiparous women with singleton pregnancies and body mass index (BMI) ≥19 kg/m2 assigned to an intervention group, n = 303 (twice weekly group-exercises and dietary counseling) or a control group, n = 303 (standard prenatal care). The International Physical Activity Questionnaire short-form was used to assess PA-levels at inclusion (mean gestational week (GW) 16), GW 36, and six and 12 months postpartum., Results: At GW 36, a positive intervention-effect with a significant between-group difference in total PA-level compared to time of inclusion was found for the total group (530 MET-min/week, p = 0.001) and the subgroups of normal-weight (533 MET-min/week, p = 0.003) and initially active women (717 MET-min/week, p<0.001). Intervention-effect was dependent on exercise-adherence among overweight/obese and inactive women. Compared to time of inclusion, the intervention groups maintained total PA-level at GW 36, while total PA-level decreased in the control groups. The PA-levels increased postpartum, but with no significant differences between the randomization groups., Conclusion: The NFFD prenatal combined lifestyle intervention had a significant effect on TPA-level in late pregnancy among women entering pregnancy normal-weight or physically active, thereby preventing the downward trend typically seen during pregnancy. Intervention-effect among overweight/obese and physically inactive women was, however, dependent on exercise-adherence. Long-term intervention-effect was not observed in the postpartum period.

Objectives: Overweight and obese individuals are recommended to perform regular resistance training, and the health- and fitness industry offer several exercise programs with purpose to improve muscle strength and body composition. This randomised controlled trial aimed to compare 12 weeks (45-60min, 3 sessions/weeks) of popular exercise programs, available at health- and fitness centers worldwide., Methods: Previous untrained women with BMI≥25 were allocated to either BodyPump (a high-repetition group session) (n=25), individual resistance training with a personal trainer (n=25), non-supervised individual resistance training (n=21) and non-exercising control group (n=21). Primary outcome was one repetition maximum (1RM) in squat and bench press, and secondary outcome was body composition (Inbody720)., Results: The BodyPump group did not improve muscle strength, compared to any of the other groups. In 1RM squat, the personal trainer group increased 17% (95% CI 5.1-23.0), 20% (95% CI 7.5-24.8) and 30% (95% CI 15.8-33.0kg) more than the non-supervised group, BodyPump and controls, respectively. In bench press the personal trainer group increased 10% (95% CI 1.5-7.2) and 16% (95% CI 3.5-9.3kg) more compared to BodyPump and controls. No difference was found compared to the non-supervised group in bench press. There were no between-group differences in body composition., Conclusion: Twelve weeks of BodyPump did not improve muscle strength in overweight women, but a personal trainer amplified the effects of individual resistance training on maximal strength in squat. None of the intervention groups showed effect in body composition., (Copyright © 2017 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

Competing Interests: Competing interests: None declared.

Objective: To evaluate how rating of perceived capacity (RPC) is related to maximal oxygen uptake (VO 2max ) and examine VO 2max at onset of training in healthy adults., Methods: In total, 125 newly registered fitness centre members, equally men and women, answered the RPC scale and performed a treadmill test for measurement of VO 2max . Eligible criteria were <4 weeks of fitness centre membership, physically inactive, ≥18 years and not pregnant. The RPC is a one-page scale (1-20) based on metabolic equivalent tasks, where the individual chooses the most strenuous activity that can be sustained for at least 30 min., Results: The Bland-Altman plot demonstrated a tendency of overestimation, meaning that the participants ranked their own aerobic capacity 17.5% higher than objectively measured values of VO 2max . The mean difference between the two methods were +4.92±1.96 and +6.35±1.96 mL/min/kg VO 2 in men and women, respectively. The Pearson correlation coefficient was moderate, with r=0.426 (p<0.01). A linear regression analysis showed that both age and VO 2max were significant predictors of RPC (p<0.01). Measured VO 2max at onset of fitness centre membership was in men aged 38.7±11.7 and women aged 34.7±9.9, 40.5±7.2 and 35.0±6.0 mL/min/kg, respectively. Estimated VO 2max from the RPC scale was 45.7±9.8 and 41.4±10.1 mL/min/kg in men and women, respectively., Conclusions: The RPC seems less accurate at the individual level and may overestimate VO 2max . Still, it may be considered useful in large-scale studies., Competing Interests: Competing interests: None declared.

Abstract: Sanda B, Vistad I, Haakstad LAH, Berntsen S, Sagedal LR, Lohne-Seiler H, Torstveit MK. Reliability and concurrent validity of the International Physical Activity Questionnaire short form among pregnant women., Background: The International Physical Activity Questionnaire short-form (IPAQ-SF) is frequently used to assess physical activity (PA) level in the general adult population including pregnant women. However, the reliability and validity of the questionnaire in pregnancy is unknown. Therefore, the aims of the present study were to investigate test-retest reliability and concurrent validity of IPAQ-SF among pregnant women, and whether PA is reported differently among those who fulfill (active) vs. do not fulfill (inactive) recommendations of ≥150 min of weekly moderate intensity PA in pregnancy., Method: Test-retest reliability was examined by answering IPAQ-SF twice, two weeks apart ( n  = 88). To assess validity, IPAQ-SF was compared to the physical activity monitor SenseWear Armband® (SWA) ( n  = 64). The participants wore SWA for 8 consecutive days before answering IPAQ-SF. PA level was reported as time spent in moderate-, vigorous- and moderate-to-vigorous intensity PA (MPA, VPA and MVPA) corresponding to the cut-off points 3-6, >6 and >3 Metabolic Equivalents (METs), respectively., Results: Test-retest intraclass-correlation of MPA, VPA and MVPA ranged from 0.81-0.84 (95% Confidence Intervals: 0.69,0.90). Comparing time spent performing PA at various intensities; the mean differences and limits of agreement (±1.96 Standard Deviation) from Bland-Altman plots were-84 ± 402 min/week for MPA,-85 ± 452 min/week for MVPA and 26 ± 78 min/week for VPA, illustrating that the total group under-reported MPA by 72% and MVPA by 52%, while VPA was over-reported by 1400%. For the inactive group corresponding numbers were 44 ± 327 min/week for MPA, 52 ± 355 min/week for MVPA and 16 ± 33 min/week for VPA, illustrating that the inactive group over-reported MPA by 13% and MVPA by 49%, while VPA was not detected by SWA, but participants reported 16 min of VPA/week. In contrast, corresponding numbers for the active group were-197 ± 326 min/week for MPA,-205 ± 396 min/week for MVPA and 35 ± 85 min/week for VPA, illustrating that the active group under-reported MPA by 81% and MVPA by 60%, while they over-reported VPA by 975%., Conclusion: IPAQ-SF had good test-retest reliability, but low to fair concurrent validity for MPA, VPA and MVPA compared to an objective criterion measure among pregnant women. Further, women fulfilling PA guidelines in pregnancy under-reported, while inactive women over-reported PA level.

This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)