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

项目总结/摘要 久坐不动可能导致孕产妇和儿童死亡率和发病率的过高风险。大多数孕妇， 然而，在妊娠晚期会久坐不动。在我们的随机对照试验中， 对于有先兆子痫病史的久坐超重/肥胖孕妇，我们发现10周或更长时间 伸展运动（SE）降低了先兆子痫的发病率-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）和增强抗氧化剂的上调和生产，比较 孕妇走路时的坚持性很差。我们计划测试这种影响是否可以扩展到更广泛的领域。 孕妇人群。从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SE对BP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干预对肥胖患者心血管健康的影响。 怀孕三个月的妇女。我们包括基于证据的行为策略，以提高依从性。 SE的一个疗程包括30分钟的连续静态拉伸大骨骼肌群20秒， 每个肌肉群3次。虽然对SE的心血管效应知之甚少，但我们的初步发现 在我们的研究中是出乎意料的但又是一致的。如果研究结果持续下去，SE将是一个有效的，可访问的， 肥胖孕妇促进健康和降低心血管疾病风险的成本效益方法 妊娠并发症。因此，SE干预研究是合理的。在本2组RCT中，我们将 确定SE是否上级于增强型常规护理（eUC）的对照条件，包括 中度/剧烈活动，特别是步行，30分钟，每周5天，如美国人建议的那样 妇产科医师学院。治疗组和对照组都将接受支持性治疗。 行为干预以促进依从性。主要结局是血压、交感-迷走神经平衡和动脉 在基线（妊娠27周），然后在5周和10周后，以及在32周和37周时评估僵硬度。 怀孕我们将比较SE与eUC（n = 306;每组153例），并检查选定的心血管功能 这样的话，SE就可以发挥作用。目的1：检验自我效能干预对改善老年人的生活质量的效果 就心血管功能的选定指标（BP， 交感神经-迷走神经平衡和动脉硬度），控制焦虑、年龄、种族/民族、BMI和吸烟; 目的2：测试SE干预对母亲、胎儿和新生儿复合结局的有效性， 在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得不到充分服务的人群中，肥胖负担更重。 伸展运动可能是可行的，以预防心血管疾病，并已被称为有很高的接受度， 更好的依从性，没有已知的不良副作用，以及有希望的有效性初步证据。

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.