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

项目摘要/摘要 久坐会导致产妇和儿童死亡和发病的风险过高。大多数怀孕的女性， 然而，在怀孕的第三个三个月要久坐不动。在我们的随机对照试验中，高危人群 久坐不动的超重/肥胖孕妇有先兆子痫病史，我们发现10周或更长时间 伸展运动(SE)减少先兆子痫的发生率--这是心血管疾病的一个重要危险因素 疾病-通过降低血压(BP)和增强抗氧化剂上调和产生，比较 到走路，孕妇对此的坚持程度很低。我们计划测试这种效应是否可以扩大到更广泛的范围。 怀孕妇女的数量。来自我们对健康孕妇的初步研究，其中84%是 超重/肥胖，我们报告了SES对血压和交感迷走神经的短期影响的有希望的结果 平衡。因此，我们建议测试一种新的SE干预措施对肥胖患者心血管健康的影响 妊娠晚期妇女。我们包括以证据为基础的行为策略，以提高遵从性。 SE的一次训练包括30分钟的大型骨骼肌群的连续静态伸展20秒， 每肌肉组3次。尽管对SE对心血管的影响知之甚少，但我们的初步发现 是出乎意料的，但在我们的研究中是一致的。如果这些发现持续下去，SE将是一个有效的、可访问的、 为肥胖孕妇提供促进健康和降低心血管风险的经济高效方法 妊娠并发症。因此，对SE干预措施的研究是合理的。在这个双臂RCT中，我们将 确定SE是否优于加强日常护理(EUC)的控制条件，其包括 中等/剧烈运动，特别是步行，按照美国人的建议，每周5天，每次30分钟 产科医生和妇科医生学院。治疗组和对照组都将接受支持性治疗 行为干预，以促进坚持。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)、5周和10周后、32周和37周时评估僵硬 怀孕了。我们将比较SE和EUC(n=306；每臂153)，并检查选定的心血管功能 SE可以通过它来发挥作用。研究的目的是：目标1：检验自尊干预的效果 心血管健康与EUC在选定的心血管功能指标方面的比较(BP， 交感-迷走神经平衡和动脉僵硬)，控制焦虑、年龄、种族/民族、BMI和吸烟； 目的2：比较SE干预对母体、胎儿和新生儿综合结局的影响 致EUC。目的3：探讨依从性和心血管措施与妊娠的关系 并发症。我们的目标符合NINR促进健康和预防疾病的战略目标 在条件、环境、寿命以及少数群体和服务不足的人群中，他们承担着更高的肥胖负担。 伸展运动可能对预防心血管疾病是可行的，而且众所周知，人们对拉伸运动的接受度很高， 更好的依从性，没有已知的不良副作用，以及有希望的有效的初步证据。

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.