Biofeedback system in remotely monitored exercise program in pregnant women with obesity: a pre-experimental research
DOI:
https://doi.org/10.47197/retos.v61.103985Keywords:
remote, e-health, physical activity, exercise, pregnancy, obesityAbstract
Objectives: E-health programs may be an excellent strategy to overcome some barriers related to the non-practice of exercise among pregnant women with obesity. This study aims to present a monitored exercise program for pregnant women with obesity using the Sword Phoenix® biofeedback system; and to evaluate pregnant women's perception of the biofeedback system and the exercise program protocol. Methods: A pre-experimental research was done through a One-shot case study design. Twelve pregnant women with Body Mass Index ≥ 30 kg/m2, were invited to perform for two weeks a home-based structured exercise program protocol with a digital biofeedback system, during exercise the women used an accelerometer to measure the intensity of the exercises. At the end of the two-week exercise period, the pregnant women filled in a questionnaire to assess their perception of usability, satisfaction, safety and motivation regarding exercise program and biofeedback system. Results: The accelerometry results indicate that, during the exercise program protocol, the pregnant women spent 79.3% of the time in moderate activities. The adherence to the program had an average performance of 40%. The results of the questionnaire demonstrated that 100% (n=12) of the participants enjoyed the system and recognized it as a safe instrument with the potential to increase physical activity during pregnancy.
Discussion: The biofeedback system can be a useful tool for implementing an exercise program for pregnant women with obesity. The proposed exercise program complies with international recommendations for physical exercise during pregnancy, ensuring safety. Additionally, it reduces the team intervention, increases participant motivation, and has the potential to reduce sedentary behavior in pregnant women with obesity.
References
ACOG. (2015a). Committee Opinion number 650: Physical Activity an Exercise During Pregnancy and the Postpartum Period. Obstetrics and Gynecology, 126(6), 135–142. https://doi.org/10.1097/AOG.0000000000001214
ACOG. (2015b). PRACTICE BULLETIN- Obesity in Pregnancy. Obstetrics and Gynecology, 126(5), 1118–1119. https://doi.org/10.1097/AOG.0000000000001211
ACOG. (2020). Committee Opinion number 804: Physical activity and exercise during pregnancy and Postpartum Period. OBSTETRICS & GYNECOLOGY, 135(4), 178–188. https://doi.org/10.3109/21679169.2013.861509
ActiGraph Software Department. (2012). ActiLife 6 User ’s Manual.
Ainscough, K. M., O’Brien, E. C., Lindsay, K. L., Kennelly, M. A., O’Sullivan, E. J., O’Brien, O. A., McCarthy, M., De Vito, G., & McAuliffe, F. M. (2020). Nutrition, Behavior Change and Physical Activity Outcomes From the PEARS RCT—An mHealth-Supported, Lifestyle Intervention Among Pregnant Women With Overweight and Obesity. Frontiers in Endocrinology, 10(February). https://doi.org/10.3389/fendo.2019.00938
Banbury, A., Nancarrow, S., Dart, J., Gray, L., & Parkinson, L. (2018). Telehealth interventions delivering home-based support group videoconferencing: Systematic review. Journal of Medical Internet Research, 20(2). https://doi.org/10.2196/jmir.8090
Bernardo, D., Bobadilla-agouborde, C., Festas, C., Carvalho, C., Abdalla, P. P., Amezcua-prieto, C., Naia-entonado, Z., Mesquita, C. C., & Mota, J. (2024). Feasibility , Clinical Efficacy , and Maternal Outcomes of a Remote Exercise Program in Pregnant Women with Obesity : The GROB Randomized Control Pilot Study. Clinical and Experimental Obstetrics & Gynecology, 51(3), 70. https://doi.org/doi.org/10.31083/j.ceog5103070 Original
Bernardo, D., Carvalho, C., Conde, M., Mota, J., & Santos, P. C. (2023). The effectiveness of structured exercise intervention in gestational weight gain in pregnant women with overweight and obesity: A Systematic Review with Meta-Analysis. International Journal of Gynecology and Obstetrics, 0(0), 1–12. https://doi.org/10.1002/ijgo.14741
Bernardo, D., Carvalho, C., Ferreira, M., Mota, J., & Santos, P. C. (2023). The Influence of Pregestational Body Mass Index and Physical Activity Patterns on Maternal , Delivery , and Newborn Outcomes in a Sample of Portuguese Pregnant Women : A Retrospective Cohort Study. Portuguese Journal of Public Health, 0(0), 1–11. https://doi.org/10.1159/000531587
Bernardo, D., Carvalho, C., Leirós-Rodríguez, R., Mota, J., & Santos, P. C. (2023). Comparison of the Portuguese Version of the Pregnancy Physical Activity Questionnaire ( PPAQ ) with Accelerometry for Classifying Physical Activity among Pregnant Women with Obesity. International Journal of Environmental Research and Public Health, 20(929), 1–11.
Bernardo, D., Sousa, D. R., Agouborde, I. H. F. C. B., Soto-Rodriguez, F., & Santos, P. C. (2024). Effects of Physical Activity on Quality of Life of Pregnant Women with Overweight or Obesity: A Systematic Review. Women, 4, 130–143. https://doi.org/10.3390/women4020010
Billingham, S. A., Whitehead, A. L., & Julious, S. A. (2013). An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom Clinical Research Network database. BMC Medical Research Methodology, 13(1), 1. https://doi.org/10.1186/1471-2288-13-104
Bisson, M., Alméras, N., Dufresne, S. S., Robitaille, J., Rhéaume, C., Bujold, E., Frenette, J., Tremblay, A., & Marc, I. (2015). A 12-week exercise program for pregnant women with obesity to improve physical activity levels: An open randomised preliminary study. PLoS ONE, 10(9), 1–17. https://doi.org/10.1371/journal.pone.0137742
Block, V. A. J., Pitsch, E., Tahir, P., Cree, B. A. C., Allen, D. D., & Gelfand, J. M. (2016). Remote physical activity monitoring in neurological disease: A systematic review. PLoS ONE, 11(4), 1–41. https://doi.org/10.1371/journal.pone.0154335
Bogaerts, A., Devlieger, R., Van den Bergh, B. R. H., & Witters, I. (2014). Obesity and pregnancy, an epidemiological and intervention study from a psychosocial perspective. Facts, Views & Vision in ObGyn, 6(2), 81–95. http://www.ncbi.nlm.nih.gov/pubmed/25009731%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4086020
Borg, G. (1970). Perceived exertion as an indicator of somatic stress. Scandinavian Journal of Rehabilitation Medicine, 2(2), 92–98.
Brouwers, R. W. M., van Exel, H. J., van Hal, J. M. C., Jorstad, H. T., de Kluiver, E. P., Kraaijenhagen, R. A., Kuijpers, P. M. J. C., van der Linde, M. R., Spee, R. F., Sunamura, M., Uszko-Lencer, N. H. M. K., Vromen, T., Wittekoek, M. E., & Kemps, H. M. C. (2020). Cardiac telerehabilitation as an alternative to centre-based cardiac rehabilitation. Netherlands Heart Journal, 28(9), 443–451. https://doi.org/10.1007/s12471-020-01432-y
Conway, M. R., Marshall, M. R., Schlaff, R. A., Pfeiffer, K. A., & Pivarnik, J. M. (2018). Physical Activity Device Reliability and Validity during Pregnancy and Postpartum. Medicine and Science in Sports and Exercise, 50(3), 617–623. https://doi.org/10.1249/MSS.0000000000001469
Correia, F. D., Molinos, M., Luís, S., Carvalho, D., Carvalho, C., Costa, P., Seabra, R., Francisco, G., Bento, V., & Lains, J. (2021). Digitally assisted versus conventional home-based rehabilitation after Arthroscopic Rotator Cuff Repair. In American Journal of Physical Medicine & Rehabilitation: Vol. Publish Ah (Issue September). https://doi.org/10.1097/phm.0000000000001780
Correia, F. D., Nogueira, A., Magalhães, I., Guimarães, J., Moreira, M., Barradas, I., Molinos, M., Teixeira, L., Tulha, J., Seabra, R., Lains, J., & Bento, V. (2019). Medium-term outcomes of digital versus conventional home-based rehabilitation after total knee arthroplasty: Prospective, parallel-group feasibility study. Journal of Medical Internet Research, 21(2), 22. https://doi.org/10.2196/13111
Correia, F. D., Nogueira, A., Magalhães, I., Guimarães, J., Moreira, M., Barradas, I., Teixeira, L., Tulha, J., Seabra, R., Lains, J., & Bento, V. (2018). Home-based Rehabilitation With A Novel Digital Biofeedback System versus Conventional In-person Rehabilitation after Total Knee Replacement: a feasibility study. Scientific Reports, 8(1), 1–12. https://doi.org/10.1038/s41598-018-29668-0
Crouter, S. E., DellaValle, D. M., Haas, J. D., Frongillo, E. A., & Bassett, D. R. (2013). Validity of ActiGraph 2-regression model, Matthews cut-points, and NHANES cut-points for assessing free-living physical activity. Journal of Physical Activity & Health, 10(4), 504–514. https://doi.org/10.1123/jpah.10.4.504
da Fonseca, M. H., Kovaleski, F., Picinin, C. T., Pedroso, B., & Rubbo, P. (2021). E-health practices and technologies: A systematic review from 2014 to 2019. Healthcare (Switzerland), 9(9), 1–32. https://doi.org/10.3390/healthcare9091192
Driscoll, A. K., & Gregory, E. C. W. (2020). Increases in Prepregnancy Obesity: United States, 2016-2019. In U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention, National Center for Health Statistics (Issue 392).
Freedson, P. S., Melanson, E., & Sirard, J. (1998). Calibration of the Computer Science and Applications, Inc. accelerometer. Medicine and Science in Sports and Exercise, 30(5), 777–781. https://doi.org/10.1097/00005768-199805000-00021
Fuchs, S. C., Harzheim, E., Iochpe, C., de David, C. N., Gonçalves, M. R., Sesin, G. P., Costa, C. M., Moreira, L. B., & Fuchs, F. D. (2018). Technologies for innovative monitoring to reduce blood pressure and change lifestyle using mobile phones in adult and elderly populations (TIM Study): Protocol for a randomized controlled trial. JMIR Research Protocols, 7(8). https://doi.org/10.2196/resprot.9619
Gallo-Galán, L. M., Gallo-Vallejo, M. Á., & Gallo-Vallejo, J. L. (2023). Practical recommendations on physical exercise during pregnancy based on the main clinical practice guidelines. Atencion Primaria, 55(3). https://doi.org/10.1016/j.aprim.2022.102553
Gandolfi, M., Geroin, C., Dimitrova, E., Boldrini, P., Waldner, A., Bonadiman, S., Picelli, A., Regazzo, S., Stirbu, E., Primon, D., Bosello, C., Gravina, A. R., Peron, L., Trevisan, M., Garcia, A. C., Menel, A., Bloccari, L., Valè, N., Saltuari, L., … Smania, N. (2017). Virtual Reality Telerehabilitation for Postural Instability in Parkinson’s Disease: A Multicenter, Single-Blind, Randomized, Controlled Trial. BioMed Research International, 2017, 11. https://doi.org/10.1155/2017/7962826
Garnæs, K. K., Helvik, A. S., Stafne, S. N., Mørkved, S., Salvesen, K., Salvesen, Ø., & Moholdt, T. (2019). Effects of supervised exercise training during pregnancy on psychological well-being among overweight and obese women: secondary analyses of the ETIP-trial, a randomised controlled trial. BMJ Open, 9(11), e028252. https://doi.org/10.1136/bmjopen-2018-028252
Garnæs, K. K., Mørkved, S., Salvesen, Ø., & Moholdt, T. (2016). Exercise Training and Weight Gain in Obese Pregnant Women: A Randomized Controlled Trial (ETIP Trial). PLoS Medicine, 13(7), 1–18. https://doi.org/10.1371/journal.pmed.1002079
Gascoigne, E. L., Webster, C. M., Honart, A. W., Wang, P., Smith-Ryan, A., & Manuck, T. A. (2023). Physical activity and pregnancy outcomes: an expert review. American Journal of Obstetrics and Gynecology MFM, 5(1), 1–18. https://doi.org/10.1016/j.ajogmf.2022.100758
Gonzalez-Plaza, E., Bellart, J., Arranz, Á., Luján-Barroso, L., Mirasol, E. C., & Seguranyes, G. (2022). Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial. JMIR MHealth and UHealth, 10(2), 1–29. https://doi.org/10.2196/28886
Harrison, C. L., Thompson, R. G., Teede, H. J., & Lombard, C. B. (2011). Measuring physical activity during pregnancy. Western Journal of Nursing Research, 8(19), 722–734. https://doi.org/10.1177/0193945905276523
Hayes, L., Mcparlin, C., Kinnunen, T. I., Poston, L., Robson, S. C., & Bell, R. (2015). Change in level of physical activity during pregnancy in obese women: Findings from the UPBEAT pilot trial. BMC Pregnancy and Childbirth, 15(1), 2–9. https://doi.org/10.1186/s12884-015-0479-2
Hosseiniravandi, M., Kahlaee, A. H., Karim, H., Ghamkhar, L., & Safdari, R. (2020). Home-based telerehabilitation software systems for remote supervising: A systematic review. International Journal of Technology Assessment in Health Care, 36(2), 113–125. https://doi.org/10.1017/S0266462320000021
Hui, A. L., Back, L., Ludwig, S., Gardiner, P., Sevenhuysen, G., Dean, H. J., Sellers, E., McGavock, J., Morris, M., Jiang, D., & Shen, G. X. (2014). Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy Body Mass Index in a randomized control trial. BMC Pregnancy and Childbirth, 14(1), 1–9. https://doi.org/10.1186/1471-2393-14-331
Joseph, R. P., Durant, N. H., Benitez, T. J., & Pekmezi, D. W. (2014). Internet-Based Physical Activity Interventions. American Journal of Lifestyle Medicine, 8(1), 42–67. https://doi.org/10.1177/1559827613498059
Kianfard, L., Niknami, S., Shokravi, F. A., & Rakhshanderou, S. (2022). Facilitators, Barriers, and Structural Determinants of Physical Activity in Nulliparous Pregnant Women: A Qualitative Study. Journal of Pregnancy, 2022. https://doi.org/10.1155/2022/5543684
Kinnunen, T. I., Tennant, P., McParlin, C., Poston, L., Robson, S. C., & Bell, R. (2011). Agreement between pedometer and accelerometer in measuring physical activity in overweight and obese pregnant women. BMC Public Health, 11, 501. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed11&NEWS=N&AN=21703033
Marchi, J., Berg, M., Dencker, A., Olander, E. K., & Begley, C. (2015). Risks associated with obesity in pregnancy, for the mother and baby: A systematic review of reviews. Obesity Reviews, 16(8), 621–638. https://doi.org/10.1111/obr.12288
Matheve, T., Brumagne, S., & Timmermans, A. A. A. (2017). The Effectiveness of Technology-Supported Exercise Therapy for Low Back Pain. American Journal of Physical Medicine and Rehabilitation, 96(5), 347–356. https://doi.org/10.1097/PHM.0000000000000615
Migueles, J. H., Cadenas-Sanchez, C., Ekelund, U., Delisle Nyström, C., Mora-Gonzalez, J., Löf, M., Labayen, I., Ruiz, J. R., & Ortega, F. B. (2017). Accelerometer Data Collection and Processing Criteria to Assess Physical Activity and Other Outcomes: A Systematic Review and Practical Considerations. Sports Medicine, 47(9), 1821–1845. https://doi.org/10.1007/s40279-017-0716-0
Morales-Suárez-Varela, M., Puig, B. M., Peraita-Costa, I., Llopis-Morales, J., Hernandez-Segura, N., & Llopis-González, A. (2023). Sedentary lifestyle in pregnancy: Effects on the mother and the newborn. Semergen, 49(7), 102025–102025.
Polley, B. A., Wing, R. R., & Sims, C. J. (2002). Randomized controlled trial to prevent excessive weight gain in pregnant women. International Journal of Obesity, 26(11), 1494–1502. https://doi.org/10.1038/sj.ijo.0802130
RANZCOG. (2020). Exercise during pregnancy. C-Obs 62. https://doi.org/10.12968/bjom.2020.28.7.450
Santos-Lozano, A., Santín-Medeiros, F., Cardon, G., Torres-Luque, G., Bailón, R., Bergmeir, C., Ruiz, J. R., Lucia, A., & Garatachea, N. (2013). Actigraph GT3X: Validation and determination of physical activity intensity cut points. International Journal of Sports Medicine, 34(11), 975–982. https://doi.org/10.1055/s-0033-1337945
Santos, P. C., Abreu, S., Moreira, C., Santos, R., Ferreira, M., Alves, O., Moreira, P., & Mota, J. (2016). Physical Activity Patterns During Pregnancy in a Sample of Portuguese Women: A Longitudinal Prospective Study. Iranian Red Crescent Medical Journal, 18(3), 0–7. https://doi.org/10.5812/ircmj.22455
Santos, P. C., Bernardo, D., Abdalla, P. P., Leirós-Rodrígues, R., Silva, L. S. L. da, Mesquita, C., Mota, J., & Machado, D. R. L. (2024). Influence of physical activity on self-esteem and anxiety during pregnancy: a longitudinal prospective study. Women, 4, 340–350. https://doi.org/10.3390/women4040026
Sarsak, H. I. (2020). Telerehabilitation services : A successful paradigm for occupational therapy clinical services ? International Physical Medicine & Rehabilitation Journal, 5(Figure 3), 93–98. https://doi.org/10.15406/ipmrj.2020.05.00237
Seneviratne, S. N., Jiang, Y., Derraik, J. G. B., McCowan, L. M. E., Parry, G. K., Biggs, J. B., Craigie, S., Gusso, S., Peres, G., Rodrigues, R. O., Ekeroma, A., Cutfield, W. S., & Hofman, P. L. (2016). Effects of antenatal exercise in overweight and obese pregnant women on maternal and perinatal outcomes: A randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology, 123(4), 588–597. https://doi.org/10.1111/1471-0528.13738
Van Den Heuvel, J. F. M., Groenhof, T. K., Veerbeek, J. H. W., Van Solinge, W. W., Lely, A. T., Franx, A., & Bekker, M. N. (2018). eHealth as the next-generation perinatal care: An overview of the literature. Journal of Medical Internet Research, 20(6). https://doi.org/10.2196/jmir.9262
Vieira, Á. S. da S., Cristina Damas Argel de Melo, M., Andreia Raquel Santos Noites, S. P., Machado, J. P., & Joaquim Gabriel, M. M. (2017). The effect of virtual reality on a home-based cardiac rehabilitation program on body composition, lipid profile and eating patterns: A randomized controlled trial. European Journal of Integrative Medicine, 9, 69–78. https://doi.org/10.1016/j.eujim.2016.11.008
Wang, C., Wei, Y., Zhang, X., Zhang, Y., Xu, Q., Sun, Y., Su, S., Zhang, L., Liu, C., Feng, Y., Shou, C., Guelfi, K. J., Newnham, J. P., & Yang, H. (2017). A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women. American Journal of Obstetrics and Gynecology, 216(4), 340–351. https://doi.org/10.1016/j.ajog.2017.01.037
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Retos
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.
