A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial.
A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial.
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DOI：
10.2196/33929
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发表时间：
2022-06-22
影响因子：
2.2
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孕妇超重或肥胖是围产期并发症的高危人群。妊娠期体重增加过多（GWG）进一步加剧了这种风险。利用技术促进自我监测并提供及时反馈的移动健康（mHealth）生活方式干预措施可能会激发行为改变，从而减少过量的GWG，降低干预成本，并通过改善获取途径提高可扩展性。本研究旨在测试试点移动健康生活方式干预超重或肥胖孕妇的可接受性和可行性，以促进中等强度的身体活动（PA），鼓励符合指南的GWG，并为设计更大的实用群随机对照试验提供信息。我们对孕前BMI为25 ~ 40 kg/m2的孕妇进行了混合方法可接受性和可行性随机对照试验。通过电子邮件从Kaiser Permanente北加州的两个诊所招募年龄≥21岁且有Wi-Fi接入的8至15周的单胎患者，随机接受常规产前护理或移动健康生活方式干预。干预组的参与者得到了无线秤，可以访问干预网站，可以自动接收体重增加和活动目标反馈的活动追踪器，以及生活方式教练每月打来的电话。调查和焦点小组的干预参与者评估干预满意度和方法，以改善干预。使用妊娠身体活动问卷对PA结果进行自我评估，使用电子健康记录数据对两组的GWG进行评估。总体而言，33名患者被随机分配到干预组，35名患者被随机分配到常规护理组。干预组的所有参与者每周至少称重一次，而常规护理组的参与者只有20%（7/35）。干预组的参与者每周佩戴活动追踪器6.4天，每周称5.3次体重，88%（29/33）的人认为这个项目“好到优秀”。焦点小组发现，参与者希望获得更多与营养相关的支持，以帮助他们管理GWG，他们更喜欢使用应用程序而不是网站。在未调整的模型中，干预组的参与者每周总PA的代谢当量变化增加了23.46个任务小时，每周中等强度PA的变化增加了247.2分钟，但这些影响在调整后的模型中减弱了（总PA的变化：每周代谢当量15.55个任务小时；中等强度PA的变化：每周199.6分钟）。我们发现与常规治疗相比，总GWG没有差异（平均差1.14 kg）。试点移动健康生活方式干预是可行的，高度可接受的，并促进了自我监测。需要完善的干预措施来有效影响超重或肥胖孕妇的PA和GWG。ClinicalTrials.gov NCT03936283;https://clinicaltrials.gov/ct2/show/NCT03936283
Pregnant patients with overweight or obesity are at high risk for perinatal complications. Excess gestational weight gain (GWG) further exacerbates this risk. Mobile health (mHealth) lifestyle interventions that leverage technology to facilitate self-monitoring and provide just-in-time feedback may motivate behavior change to reduce excess GWG, reduce intervention costs, and increase scalability by improving access. This study aimed to test the acceptability and feasibility of a pilot mHealth lifestyle intervention for pregnant patients with overweight or obesity to promote moderate intensity physical activity (PA), encourage guideline-concordant GWG, and inform the design of a larger pragmatic cluster randomized controlled trial. We conducted a mixed methods acceptability and feasibility randomized controlled trial among pregnant patients with a prepregnancy BMI of 25 to 40 kg/m2. Patients with singletons at 8 to 15 weeks of gestation who were aged ≥21 years and had Wi-Fi access were recruited via email from 2 clinics within Kaiser Permanente Northern California and randomized to receive usual prenatal care or an mHealth lifestyle intervention. Participants in the intervention arm received wireless scales, access to an intervention website, activity trackers to receive automated feedback on weight gain and activity goals, and monthly calls from a lifestyle coach. Surveys and focus groups with intervention participants assessed intervention satisfaction and ways to improve the intervention. PA outcomes were self-assessed using the Pregnancy Physical Activity Questionnaire, and GWG was assessed using electronic health record data for both arms. Overall, 33 patients were randomly assigned to the intervention arm, and 35 patients were randomly assigned to the usual care arm. All participants in the intervention arm weighed themselves at least once a week, compared with 20% (7/35) of the participants in the usual care arm. Participants in the intervention arm wore the activity tracker 6.4 days per week and weighed themselves 5.3 times per week, and 88% (29/33) of them rated the program “good to excellent.” Focus groups found that participants desired more nutrition-related support to help them manage GWG and would have preferred an app instead of a website. Participants in the intervention arm had a 23.46 metabolic equivalent of task hours greater change in total PA per week and a 247.2-minute greater change in moderate intensity PA per week in unadjusted models, but these effects were attenuated in adjusted models (change in total PA: 15.55 metabolic equivalent of task hours per week; change in moderate intensity PA: 199.6 minutes per week). We found no difference in total GWG (mean difference 1.14 kg) compared with usual care. The pilot mHealth lifestyle intervention was feasible, highly acceptable, and promoted self-monitoring. Refined interventions are needed to effectively affect PA and GWG among pregnant patients with overweight or obesity. ClinicalTrials.gov NCT03936283; https://clinicaltrials.gov/ct2/show/NCT03936283