Programa de Exercícios Remotamente Monitorizados em Grávidas com Obesidade: Estudo GROB

Abstract

Background: Obesity has increased exponentially around the world, including among pregnant women. Studies indicate that physical exercise during pregnancy has a positive impact on maternal and fetal outcomes, namely weight control during pregnancy. Objectives: The "grávidas obesas" (GROB) study arose with the aim of 1) Determining the associations between physical activity (PA) levels and body mass index BMI on maternal and neonatal outcomes, in Portuguese pregnant women; 2) Presenting a remotely monitored exercise program for pregnant women with obesity; 3) testing the feasibility, acceptability and clinical efficacy of a remotely monitored exerc ise program using a biofeedback system, for pregnant women with a pre gestational BMI ≥ 30kg/m 2 . Secondary objectives include analysis of the clinical effectiveness of remote physical exercise in promoting PA during pregnancy; adequate gestational weight g ain; and prevention of musculoskeletal disorders such as low back pain. Methods: Three studies were carried out with different samples. In the longitudinal study, healthy pregnant women were recruited and the Pregnancy Physical Activity Questionnaire (PPAQ ) and accelerometry were used to determine their PA levels. A pre experimental, single arm study with a sample size of 12 pregnant women with obesity was carried out. The women were invited to perform a structured exercise protocol at home for two weeks wi th a digital biofeedback system, a satisfaction questionnaire was administered and accelerometry was used to determine the intensity of the proposed exercises. In the third study, a randomized clinical feasibility trial was carried out. Twenty four pregnan t women with a pre pregnancy BMI categorized as obese were randomly assigned to the 8 week remote physical exercise program, using a biofeedback system available 24 hours a day, 7 days a week, or to the control group. PA levels, gestational weight gain and functional disability due to low back pain were assessed. Results: The longitudinal study showed that pregnant women spend 42.9% of their time on domestic activities, and pregnant women with obesity spend 91.5% of their time on sedentary activities. A lar ge percentage of pregnant women with overweight and obesity did not comply with the recommendations for gestational weight gain and the incidence of gestational diabetes was higher in the obesity group (p=0.03 between the groups). The accelerometry results of the pre experimental study indicate that during the proposed exercise program, pregnant women spent 79.3% of their time in moderate activities, which is in line with international recommendations forPA practice. The results of the questionnaire showed that 100% (n=12) of the participants liked the system and recognized it as a safe tool with the potential to increase PA during pregnancy. Regarding the results of the feasibility study, of the 63 eligible participants, 24 (38.1%) were successfully random ized and completed the initial assessment. The control group had 8.3% loss to follow up and the experimental group had no loss to follow up. Pregnant women in the experimental group had higher levels of PA for sports activities, lower levels of inactivity and lower rates of disability caused by low back pain. Conclusion: The biofeedback system can be a useful tool to implement an exercise program for pregnant women with obesity, has the potential to increase PA levels during pregnancy and improve maternal o utcomes. Keywords: Pregnancy, Maternal, Obesity, Exercise, Physical Activity, E Health, Remote