One at a time

It’s been said that numbers don’t tell the story. But in the case of the publication of the 2019 Canadian Guideline for Physical Activity throughout Pregnancy, established jointly by the Society of Obstetricians and Gynaecologists of Canada and the Canadian Society for Exercise Physiology, they do.

Not only do they help to create context, they serve as evidence of the thoroughness undertaken in creating the methodology and the evidence-based Guideline and the demonstrated impact on health.

The 2019 Guideline is the end result of one of the most rigorous processes ever undertaken in this realm and now stands as a model for researchers and health care providers around the world.

And here’s why the numbers are so important.

Michelle Mottola, 2019 Canadian Guideline for Physical Activity throughout Pregnancy

With an estimated 250 babies born in the world every minute, including an estimated 385,777 babies born in Canada between July 1, 2017 and June 30, 2018, the future impact to human health is staggering.

The Guideline was developed by a consensus panel of experts in the field with representation of 19 individuals who spent three-and-a-half years reviewing more than 25,000 international research papers, developed thanks to the millions of women over the past 20 years who have had babies and helped to guide the research. Twelve systematic reviews of the entire body of research informed the draft Guideline.

Six different recommendations related to physical activity for pregnant women are outlined in the Guideline including recommending pregnant women accumulate 150 minutes of moderate-intensity physical activity each week and that physical activity should be accumulated within a minimum of three days per week.

The Guideline shows that regular exercise can cut the risk of illnesses such as depression by 25 per cent and the risk of gestational diabetes, high blood pressure and pre-eclampsia by 40 per cent.

Professor Michelle Mottola, PhD, one of the co-leads of the Guideline calls this one of her foremost achievements in an already gratifying 20-year career. It’s her hope that in addition to strengthening the health of pregnant women, the Guideline will help to decrease the future disease risk to developing babies.

“These findings which formed the Guideline mark a shift in our thinking regarding physical activity during pregnancy,” said Mottola. “We have moved from looking at it as a recommended behaviour to it being a critical component of achieving a healthy pregnancy.”

Professor Mottola, who is jointly appointed to the Schulich School of Medicine & Dentistry and the Faculty of Health Sciences, says that the extensive process was made easier thanks to the commitment of the team and the support of the methodologists who ensured adherence to established methods.

“The team was amazing working through any barriers and the nitty gritty of the actual writing of the guidelines,” she said.

In just three months, the Guideline, which was jointly published by the British Journal of Medicine and the Journal of Obstetrics and Gynecology Canada, were downloaded 80,000 times.

But for Mottola, this is just the beginning; the next step is knowledge translation.

“We now need to provide the evidence to those health care practitioners so they can begin to use it,” she said. “We also need to empower women to embrace the idea of being physically active during their pregnancy, and know they can have the tools they need to manage their health and that of their baby.”

Working with her team, which includes one master’s and three PhD trainees, as well as a postdoctoral fellow, Mottola’s research interest continues to focus on preventing excessive gestational weight gain in pregnant women.

The Nutrition and Exercise Lifestyle Intervention Program is a major study that Mottola’s team is undertaking. It is focused on adherence and behaviour change of pregnant women to physical activity and nutrition. Participants are divided into three groups with one group following both nutrition and physical activity plans, another group following a nutrition plan first and then adding on a physical activity plan at 25 weeks, and the third group begins with the physical activity plan and then adding the nutrition plan.

“The whole idea is to see what strategy works better with adherence and which one helps to prevent excessive weight gain,” said Mottola.

Partnering with a colleague at McMaster University, she is also looking at emotion regulation and determining if the emotion regulation of the baby is affected by any of the strategies.

Mottola is also working on a muscle conditioning project for postpartum women. Women who have had babies within the past year are engaging in the fitness program along with their babies. The mother’s fitness level and interaction with their baby are being monitored.

Being able to see the new babies being born healthy and happy keeps Mottola inspired to continue with her research.

“Meeting the babies is the exciting part. Our pregnant women are with us for such a long time, and we get to know them really well; it’s great to see the finished product,” she said with a smile.

“We just keep working on this one baby and one mom at a time.”

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Schulich School of Medicine & Dentistry, Western University
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London, Ontario, Canada, N6A 5C1