title: Is intensive counseling in maternity care feasible and effective in promoting physical activity among women at risk for gestational diabetes? Secondary analysis of a cluster randomized NELLI study in Finland.
abstract: BACKGROUND
  Women who are physically active during early pregnancy have notably lower odds of developing gestational diabetes than do inactive women. The purpose of the intervention was to examine whether intensified physical activity (PA) counseling in Finnish maternity care is feasible and effective in promoting leisure-time PA (LTPA) among pregnant women at risk of gestational diabetes.
  
  
  METHODS
  Fourteen municipalities were randomized to intervention (INT) and usual care group (UC). Nurses in INT integrated five PA counseling sessions into routine maternity visits and offered monthly group meetings on PA instructed by physiotherapists. In UC conventional practices were continued. Feasibility evaluation included safety (incidence of PA-related adverse events; questionnaire), realization (timing and duration of sessions, number of sessions missed, attendance at group meetings; systematic record-keeping of the nurses and physiotherapists) and applicability (nurses' views; telephone interview). Effectiveness outcomes were weekly frequency and duration of total and intensity-specific LTPA and meeting PA recommendation for health self-reported at 8-12 (baseline), 26-28 and 36-37 weeks' gestation. Multilevel analysis with adjustments was used in testing for between-group differences in PA changes.
  
  
  RESULTS
  The decrease in the weekly days of total and moderate-to-vigorous-intensity LTPA was smaller in INT (N = 219) than in UC (N = 180) from baseline to the first follow-up (0.1 vs. -1.2, p = 0.040 and -0.2 vs. -1.3, p = 0.016). A similar trend was seen in meeting the PA recommendation (-11%-points vs. -28%-points, p = 0.06). INT did not experience more adverse events classified as warning signs to terminate exercise than UC, counseling was implemented as planned and viewed positively by the nurses.
  
  
  CONCLUSIONS
  Intensified counseling had no effects on the duration of total or intensity-specific weekly LTPA. However, it was able to reduce the decrease in the weekly frequency of total and moderate-to-vigorous-intensity LTPA from baseline to the end of second trimester and was feasibly embedded into routine practices. TR
authors.affiliation: The UKK Institute for Health Promotion Research, P.O. Box 30 33501, Tampere, Finland. minna.aittasaalo@uta.fi
authors.forename: Minna
authors.initials: M
authors.lastname: Aittasalo
authors.forename: Jani
authors.initials: J
authors.lastname: Raitanen
authors.forename: Tarja I
authors.initials: TI
authors.lastname: Kinnunen
authors.forename: Katriina
authors.initials: K
authors.lastname: Ojala
authors.forename: Päivi
authors.initials: P
authors.lastname: Kolu
authors.forename: Riitta
authors.initials: R
authors.lastname: Luoto
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D003376:Counseling / Q000379:methods*; D016640:Diabetes, Gestational / Q000517:prevention & control*; D015444:Exercise / Q000502:physiology; D005240:Feasibility Studies; D005260:Female; D005387:Finland; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008425:Maternal Behavior; D008427:Maternal Health Services / Q000592:standards; D009043:Motor Activity / Q000502:physiology*; D010353:Patient Education as Topic; D061214:Patient Safety; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D011795:Surveys and Questionnaires