Changes in self-reported and accelerometer-measured physical activity among pregnant TRICARE Beneficiaries

Abstract

Background Physical activity is recommended for all pregnant individuals and can prevent excessive gestational weight gain. However, physical activity has not been assessed among military personnel and other TRICARE beneficiaries, who experience unique military lifestyles. The current study assessed physical activity among pregnant TRICARE beneficiaries, both active duty and non-active duty, as measured by accelerometry and self-report data to examine potential predictors of physical activity engagement in the third trimester, and if self-report data was consistent with accelerometry data. We expected having a lower BMI, being active-duty, and having higher baseline physical activity engagement to be associated with higher physical activity at 32-weeks. We also hypothesized that accelerometry data would show lower physical activity levels than the self-reported measure. Methods Participants were 430 TRICARE adult beneficiaries (204 Active Duty; 226 non-Active Duty) in San Antonio, TX who were part of a randomized controlled parent study that implemented a stepped-care behavioral intervention. Participants were recruited if they were less than 12-weeks gestation and did not have health conditions precluding dietary or physical activity changes (e.g., uncontrolled cardiovascular conditions) or would contribute to weight changes. Participants completed self-report measures and wore an Actical Activity Monitor accelerometer on their wrist to collect physical activity data at baseline and 32-weeks gestation. Results Based on the accelerometer data, 99% of participants were meeting moderate physical activity guidelines recommending 150 min of moderate activity per week at baseline, and 96% were meeting this recommendation at 32-weeks. Based on self-report data, 88% of participants at baseline and 92% at 32-weeks met moderate physical activity recommendations. Linear regression and zero-inflated negative binomial models indicated that baseline physical activity engagement predicted moderate physical activity later in pregnancy above and beyond BMI and military status. Surprisingly, self-reported data, but not accelerometer data, showed that higher baseline activity was associated with decreased vigorous activity at 32-weeks gestation. Additionally, self-report and accelerometry data had small correlations at baseline, but not at 32-weeks. Conclusions Future intervention efforts may benefit from intervening with individuals with lower pre-pregnancy activity levels, as those who are active seem to continue this habit. Trial Registration The trial is registered on clinicaltrials.gov (NCT 03057808).

Gestational Weight Gain During the COVID-19 Pandemic

“…In addition, individuals involved in behavioral intervention research reported the pandemic made it more difficult to engage in recommended health behaviors (Cardel et al, 2020 ). In contrast to this previous literature and our hypotheses, however, we found that participants in this study had slightly lower, albeit non-significant, GWG during the COVID pandemic, which could have been due to the high level of exercise in this population (Pebley et al, 2022 ) and potentially extra time to exercise and cook at home during the pandemic. In addition, we also demonstrated that some research studies, like the current study, may have better retention and remained just as effective during the pandemic.…”

Comparison of the Portuguese Version of the Pregnancy Physical Activity Questionnaire (PPAQ) with Accelerometry for Classifying Physical Activity among Pregnant Women with Obesity

“…International guidelines for PA practice during pregnancy recommend that all pregnant women without medical contraindication should perform at least 150 min of moderateintensity activity per week [12,47,48]; these recommendations were met by 67.7% of the pregnant women. These values are lower than those observed during the French PPAQ validation study for pregnant women with obesity [18] and in the Pebley et al ( 2022) [49] study, where it was reported that 100% and 99% of participants, respectively, complied with the recommendations of PA practice. This may be because the sample in the present study used the accelerometer for an average of 678 min per day (approximately 11 h), while participants in the other studies [18,49] used accelerometers for 24 h, thus promoting higher values of time used.…”

“…These values are lower than those observed during the French PPAQ validation study for pregnant women with obesity [18] and in the Pebley et al ( 2022) [49] study, where it was reported that 100% and 99% of participants, respectively, complied with the recommendations of PA practice. This may be because the sample in the present study used the accelerometer for an average of 678 min per day (approximately 11 h), while participants in the other studies [18,49] used accelerometers for 24 h, thus promoting higher values of time used.…”

“…The correlation between the PPAQ and accelerometry was moderate (r = 0.435) for moderate intensity; however, the values for total activity can be considered weak (r = 0.271), with similar results being found during the validation of the original PPAQ [22]. One potential explanation for the weak values of correlation, aside from the recall bias of the questionnaire arising from the fact that PPAQ data refer to the last three months, may be the fact that the cut-off points for moderate and vigorous activity are based on non-pregnant and non-obese samples, and different cut-offs may be needed to adequately assess activity during pregnancy, given the changes experienced over the course of gestation [22,49].…”

Overweight/obesity, gestational weight gain, postpartum weight retention, and maternal/neonatal complications in the military

“…Although the direct impact of GWG on military fitness test performance is unknown, women tend to have significantly lower fitness test scores after pregnancy [4,19]. PPWR is a major concern for military leaders and health care providers because it likely negatively impacts returning to pregravid fitness levels and also places women at higher risk for negative health outcomes in subsequent pregnancies because of higher body mass index (BMI) [20,21]. Furthermore, PPWR is associated with long-term maternal overweight/ obesity [22,23], a more broad, significant concern for the DOD and the health care system because of the rapid turnover.…”