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Sequential Introduction of Exercise First Followed by Nutrition Improves Program Adherence During Pregnancy: a Randomized Controlled Trial

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Abstract

Background

Adhering to nutrition and exercise recommendations simultaneously during pregnancy may be challenging. The purpose was to examine adherence to the sequential introduction of nutrition and exercise behaviors during pregnancy in comparison with a simultaneous approach.

Method

A randomized controlled trial including nutrition and exercise was executed. Using a stratified body mass index (BMI) randomization, participants (n = 88) were allocated to one of three groups at 12–18 weeks gestation. Group A received nutrition and exercise simultaneously. Group B received nutrition first and Group C received exercise first, and the second behavior was added at 25 weeks gestation for both groups. The program included weekly weighing, supervised walking sessions, and/or nutrition counseling. Adherence (primary outcome) was measured by scoring women on meeting the intervention goals (3 nutrition and 3 exercise goals) and converted to a percentage. Secondary health outcomes were gestational weight gain (GWG) and excessive GWG on the program, birthweight, macrosomia (birthweight > 4000 g), and low birthweight (birthweight < 2500 g).

Results

Group C (n = 23) had the highest adherence to the program (80.2 ± 14.7%) compared with Groups A (n = 17; 60.9 ± 17.9%) and B (n = 20; 66.8 ± 16.7%; p < 0.05, ηp2 = 0.26). There was a significant effect for gestational weight gain (p < 0.05; ηp2 = 0.10) as Group C gained less weight (7.7 ± 2.2 kg) over Group B (9.8 ± 2.8 kg; p = 0.04), however, not Group A (9.1 ± 3.5, p = 0.35). Non-significant small effects favored Group C for the prevention of EGWG (Cramer’s V = 0.13).

Conclusion

Introducing exercise first followed by nutrition at 25 weeks gestation can improve adherence to multiple behavior change programs and thus have a positive effect on health outcomes.

Trial Registration

ClinicalTrials.gov Identifier: NCT02804061

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Funding

TSN, MM, and KH are funded by an Ontario Graduate Scholarship. RB is funded by Whaley and Harding Fellowship-Children’s Health Research Institute and Western Fellowship Program.

Author information

Authors and Affiliations

  1. R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, University of Western Ontario, 2245, 3-M Centre, London, Ontario, N6A 3K7, Canada

    Taniya S. Nagpal, Roberta Bgeginski, Karishma Hosein, Stephanie Paplinskie, Mollie Manley & Michelle F. Mottola

  2. School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada

    Taniya S. Nagpal, Harry Prapavessis, Roberta Bgeginski, Karishma Hosein, Stephanie Paplinskie, Mollie Manley & Michelle F. Mottola

  3. Exercise and Health Psychology Laboratory, University of Western Ontario, London, Ontario, Canada

    Taniya S. Nagpal & Harry Prapavessis

  4. Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, USA

    Christina G. Campbell

  5. Children’s Health Research Institute, University of Western Ontario, London, Ontario, Canada

    Barbra de Vrijer, Roberta Bgeginski & Michelle F. Mottola

  6. Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, London, Canada

    Barbra de Vrijer

  7. Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada

    Michelle F. Mottola

Authors
  1. Taniya S. Nagpal
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  2. Harry Prapavessis
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  3. Christina G. Campbell
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  9. Michelle F. Mottola
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Corresponding author

Correspondence to Michelle F. Mottola.

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All authors declare that they have no conflicts of interest.

Ethical Approval

The research protocol was reviewed and approved by the Western University Human Research Ethics Board and all participants gave written informed consent.

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Nagpal, T.S., Prapavessis, H., Campbell, C.G. et al. Sequential Introduction of Exercise First Followed by Nutrition Improves Program Adherence During Pregnancy: a Randomized Controlled Trial. Int.J. Behav. Med. 27, 108–118 (2020). https://doi.org/10.1007/s12529-019-09840-0

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