Lene Annette Hagen Haakstad

• Haakstad, Lene Annette Hagen; Bø, Kari; Kalhovde, John Magne; Tangen, Elene Mauseth; Clemm, Hege Synnøve Havstad & Gjestvang, Christina (2026). Varying In-Person Coaching: Effects on Weight and Urinary Incontinence in Women with Obesity in a 20-Week Randomized Controlled Trial. International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-026-06862-7. Full text in Research Archive
• Haakstad, Lene Annette Hagen; Kissel, Iselin Haugland & Dalhaug, Emilie Frederikke Mass (2026). What is the Influence of Prenatal Physical Activity on Body Weight, BMI, and Health Behavior in Seven-Year-Old Children? Translational Sports Medicine (TSM). 2026. doi: 10.1155/tsm2/3876111. Full text in Research Archive Show summary

  Objectives: To investigate the efects of a prenatal exercise intervention on ofspring body weight, body mass index (BMI), andlifestyle variables at 7 years of age. Methods: Out of 105 physically inactive participants initially randomized to either a physical activity intervention or controlgroup, 80 women and their children (76.2%) participated in this follow-up study. The intervention consisted of intensive physicalactivity counseling and supervised, group-based moderate-intensity exercise sessions during the second and third trimesters ofpregnancy, while the control group received standard prenatal care only. Data were collected via a standardized telephone in-terview with the mother and included the ofspring’s body weight and height, physical activity level, sports participation, andadherence to general health recommendations regarding screen time and diet. Diferences between groups were examined usingtwo-sided independent sample t-tests or chi-squared tests as appropriate. Results: Mean BMI was similar in both groups (intervention group: n = 40; control group: n = 40), but the intervention group had fewer children with overweight/obesity (1 vs. 4) and underweight (3 vs. 6) than the control group. There was a nonsignificant trend toward increased physical activity among the offspring of the intervention group compared with the control group. This was reflected in a higher number following guidelines (≥ 60 min of daily moderate-to-vigorous physical activity [MVPA] according to WHO recommendations) (97.5% vs. 87.5%), number of bouts of MVPA per week (6.4 ± 3.8 vs. 5.8 ± 2.3), and daily hours of MVPA in both summer and winter seasons (2.4 ± 1.3 vs. 2.2 ± 1.3 and 1.6 ± 1.0 vs. 1.4 ± 1.0). The intervention group also reported higher rates of active school transportation than the control group (72.5% vs. 57.5%). No differences were observed in sedentary screen time and diet between the groups. Conclusions: Our results suggest that the intervention may have positively infuenced the BMI status and physical activity levelsof the ofspring.

• Hansson, Siri Elicabeth; Abrahamsen, Frank Eirik; Haakstad, Geir; Gjestvang, Christina; Jørgensen, Rannei Johanne Grimsmo & Brown, Wendy J. [Show all 7 contributors for this article] (2026). Mind in motion: patients’ experiences with group-based physical activity in psychiatric treatment- a mixed-methods study. BMC Psychiatry. 26(1). doi: 10.1186/s12888-026-08117-7. Full text in Research Archive Show summary

  Background: Individuals with severe mental illness face significant health challenges, such as cardiovascular diseases and social isolation. Physical activity is increasingly recognized as an integral part of psychiatric treatment, with evidence showing it can prevent and manage somatic diseases, enhance mental health, reduce premature mortality, and support social inclusion. In Oslo, Norway, group-based physical activity is offered as part of routine care at Diakonhjemmet Hospital. Participants attended one to four sessions per week, including endurance- and strengthbased activities such as hiking, swimming, and strength training. In this study, we aimed to explore how adults with severe mental illness experienced this group-based physical activity program during psychiatric treatment. Methods: Participants were receiving psychiatric treatment for severe mental illness, including schizophrenia spectrum disorders and bipolar disorder. This qualitative-driven mixed-methods study combined eight in-depth, semi-structured interviews with questionnaire data from 33 adults, including the interview participants. Three main areas were explored: (1) holistic health benefits (2), addressing barriers, and (3) transition and continuity. Data analyses were organised around the three predefined study areas, using reflexive thematic analysis of the interview data and descriptive statistics from the questionnaire. Quantitative results were integrated at the thematic level to enrich interpretation and understanding. Results: Within each study area, two-three themes were constructed. Combined findings from both methods showed that participants experienced broad health improvements, including fostering well-being, social connectedness, and structured daily routines. Perceived barriers were related to medication side effects, fatigue, and fluctuating motivation. Support from knowledgeable and enthusiastic activity leaders was essential in helping participants overcome barriers and stay active. While most participants intended to remain active after treatment, limited follow-up support and access to similar community programs hindered the prospect of continued engagement. Conclusions: Participants perceived that tailored and well-led physical activity during treatment contributed to improvements in health and social connectedness. However, long-term maintenance was perceived to be hindered by limited access to follow-up programs, highlighting the need for better post-treatment support. These findings underscore the importance of expanding access to physical activity programs within real-world psychiatric care, to ensure that individuals with severe mental illness have genuine opportunities to establish physical activity as a routine part of daily life.

• Allotey, John; Coomar, Dyuti; Ensor, Joie; Ruiz-Calvo, Gabriel; Boath, Anna & Ogwulu, Chidubem Okeke [Show all 103 contributors for this article] (2026). Effects of lifestyle interventions in pregnancy on gestational diabetes: individual participant data and network meta-analysis. The BMJ. 392. doi: 10.1136/bmj-2025-084159. Full text in Research Archive
• Dalhaug, Emilie Frederikke Mass; Sanda, Birgitte; Bø, Kari; Brown, Wendy & Haakstad, Lene Annette Hagen (2025). Pushing limits: the acute effects of a heavy-load resistance protocol and supine exercise on fetal well-being. BMJ Open sport & exercise medicine. 11(3), p. 1–8. doi: 10.1136/bmjsem-2025-002639. Full text in Research Archive Show summary

  Objectives To explore the acute effects of a heavy-load resistance protocol and exercise in the supine position on fetal heart rate (FHR) and uteroplacental blood flow. Method In this experimental laboratory study, 48 healthy pregnant athletes (elite: n=7; recreational: n=41) completed 3×8 repetitions with one repetition in reserve in sumo deadlift, bench press and incline bench press. FHR and umbilical and uterine artery pulsatility index (PI) were assessed before and after exercise. Symptoms of vena cava syndrome were recorded following the supine exercise. Results Pre- and post-exercise FHR remained within the normal range (110–160 bpm), but there were statistically significant increases after sumo deadlifts (p=0.002) and incline bench press (p=0.008), with no significant change after bench press (p=0.122). Umbilical artery PI did not change, while uterine artery PI significantly decreased after the sumo deadlift (p=0.005), bench press (p<0.001) and incline bench press (p<0.001). No fetal bradycardia was observed after the sumo deadlift or incline bench press, but one case occurred after bench press, resolving shortly after 3 min. Fetal tachycardia (>160 bpm) occurred in four cases after sumo deadlift, five after bench press and three after incline bench press, though none exceeded pathological levels (>180 bpm). One recreational athlete experienced symptoms of vena cava syndrome after the supine exercise, coinciding with a slight decrease in umbilical artery PI, but with stable FHR. Conclusion The results indicate that highly active women, especially those with resistance training experience, can safely engage in a heavy-load resistance protocol, including supine exercise, without jeopardising fetal well-being.

• Gjestvang, Christina; Kalhovde, John Magne; Tangen, Elene Mauseth; Clemm, Hege Synnøve Havstad & Haakstad, Lene Annette Hagen (2025). Impact of In-Person and Mobile Exercise Coaching on Psychosocial Factors Affecting Exercise Adherence in Inactive Women With Obesity: 20-Week Randomized Controlled Trial. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 27. doi: 10.2196/68462. Full text in Research Archive Show summary

  Background: Regular exercise may counteract obesity-related health risks, but adherence is low among individuals with obesity. Personal trainers may positively influence exercise behavior by providing motivational support. Individuals who receive regular exercise coaching are more likely to adhere to their exercise routine, compared with those who exercise individually. However, investing in personalized exercise guidance, such as a personal trainer, can be expensive for the individual. Thus, integrating web-based coaching could be a more economically sustainable option, offering both flexibility and reduced costs compared with in-person coaching only. Yet, research is needed to assess the effect of hybrid models in improving psychosocial factors among women with obesity. Objective: This 20-week, pragmatic randomized controlled trial aimed to investigate the effect of weekly in-person coaching compared with 2 combinations of in-person and web-based coaching on 5 psychosocial factors in women with obesity (BMI ≥30 kg/m2). Methods: Participants were invited through Facebook and Instagram advertisements posted by various fitness clubs across rural and urban locations in Norway (7 different counties and 12 different municipalities). Women with low activity (n=188; <150 minutes of moderate-intensity physical activity/week; 42.7, SD 10.5 years; mean BMI of 35.1, SD 6.9 kg/m2) were allocated into 3 groups of in-person coaching—weekly (n=47), twice weekly (n=47), and once monthly (n=47)—and as controls (n=47). Those with twice weekly and once monthly in-person coaching received web-based coaching of 15 minutes during weeks without in-person coaching. Data included background variables, motivation (Behavioral Regulation in Exercise Questionnaire-2), barriers, self-efficacy (The Self-Efficacy Survey), social support (Social Support Questionnaire), and health-related quality of life (36-Item Short Form Health Survey [SF-36]). Results: A total of 120 (64%) out of 188 participants completed baseline and postintervention assessments. A minor difference was observed in one item of the SF-36, where all intervention groups reported a greater “change in health last year” than the control group (mean difference: 14.2-17.1, 95% CI 2.04-29.5; g=0.79-1.14; P≤.01). No other effects were found on the selected psychosocial factors. It should be noted that controls reported higher intrinsic motivational regulation at baseline than intervention groups (mean difference: 0.43-0.93; P≤.05). All intervention arms exercised more frequently than controls (mean difference: 1.1-1.5; P≤.001), with no differences in weekly exercise frequency between the 3 intervention arms (P=.30). Conclusions: We found no effects on motivation, barriers, self-efficacy, perceived social support, or other health domains compared with controls. All intervention groups reported a slight improvement in self-perceived health in 1 of the 8 subscales of the SF-36. Combined in-person and web-based coaching may give a minor improvement in self-perceived health in women with obesity. However, the lack of impact on motivation, barriers, and self-efficacy warrants further research. Trial Registration: ClinicalTrials.gov NCT05792657; https://clinicaltrials.gov/study/NCT05792657 J Med Internet Res 2025;27:e68462

• Dalhaug, Emilie Frederikke Mass; Sanda, Birgitte; Bø, Kari; Brown, Wendy J.; Sundgot-Borgen, Jorunn & Haakstad, Lene Annette Hagen (2025). Exceeding the guidelines: A descriptive study of exercise, pregnancy, maternal and neonatal health outcomes in elite and recreational athletes. BMC Pregnancy and Childbirth. 25(1). doi: 10.1186/s12884-025-07572-6. Full text in Research Archive Show summary

  Background Exercise during pregnancy is associated with numerous health benefits. However, guidelines for elite and recreational athletes, who often exceed general recommendations regarding intensity, duration, and frequency are lacking, and potential risks remain unclear. The aim of the study was to describe exercise levels, pregnancy, and maternal and neonatal health outcomes in elite and recreational athletes. Method This study was part of the Strong Mama research project, which was carried out in Oslo, Norway, between October 2022 and February 2024. Sixty athletes (10 elite and 50 recreational) participated in the study. They completed an online survey during late pregnancy and participated in a structured telephone interview six weeks postpartum. The survey and interview collected data on exercise habits, pregnancy experiences, and maternal and neonatal health outcomes. Results The athletes maintained high exercise levels during pregnancy, with elite athletes exercising an average of 11.6 h per week (SD 3.2) and recreational athletes exercising 7.0 h per week (SD 2.4). Most athletes resumed exercising within six weeks postpartum. Almost all pregnancies were planned, including six which involved fertility treatment. Most women (76.7%) had spontaneous onset of labor and vaginal deliveries to term (between 36 and 42 weeks). The mean birthweight was 3487 (SD 519.4, range 2600–4775) grams. Two of the elite athletes were diagnosed with gestational diabetes mellitus and two with hypertension during pregnancy. None of the 50 recreational athletes reported any pregnancy complications. Conclusion High levels of exercise during pregnancy did not seem to negatively impact maternal or neonatal health in this descriptive sample of Norwegian elite and recreational athletes. However, more research is needed to confirm these findings

• Dalhaug, Emilie Frederikke Mass; Sanda, Birgitte; Bø, Kari; Brown, Wendy J.; Øvstedal, Kaia & Brevik-Persson, Anna Sofia [Show all 7 contributors for this article] (2025). Is fetal well-being jeopardised during high-intensity interval training? BMJ Open sport & exercise medicine. 11(2). doi: 10.1136/bmjsem-2025-002496. Full text in Research Archive Show summary

  Objectives: To explore the acute effects of highintensity interval training on fetal heart rate (FHR) and uteroplacental blood flow. Method: Elite (n=10) and recreational athletes (n=50) participated in an experimental laboratory study involving 5×5min intervals of high-intensity exercise on both a treadmill and cycle ergometer, with a 4min pause between intervals for measurement of FHR and uteroplacental blood flow. Target intensity was 17 on Borg’s rating of perceived exertion (RPE) scale and 90% of estimated maximal maternal heart rate (MHRmax). Results: Mean exercise intensity was 16.4 (SD 1.0) RPE and 89.4 (SD 3.8) % of MHRmax during running and 16.0 (SD 1.0) RPE and 84.6 (SD 5.0) % of MHRmax during cycling. Mean FHR was 140.9 (SD 27.4) beats per minute (bpm) during pauses between running bouts and 148.9 (SD 16.0) bpm during pauses between cycling bouts. Six cases of prolonged fetal bradycardia (3min) occurred during running, leading to the termination of exercise. The mothers exercised at 17–18 on Borg’s RPE scale and 86.4%–92.6% of MHRmax in these cases. All cases were normalised within 8min of ending the protocol. There were no cases of prolonged fetal bradycardia during cycling. Exercise was terminated for three women during running and two women during cycling due to fetal tachycardia (≥180 bpm for >4min during rest). Conclusion: Despite cases of fetal bradycardia and tachycardia, our results indicate that highly active women can engage in multiple intervals of high-intensity interval training without apparent harm to fetal well-being.

• Marken, Marlene Zahl; Dalhaug, Emilie Frederikke Mass; Thing, Lone Friis; Abrahamsen, Frank Eirik; Bø, Kari & Haakstad, Lene Annette Hagen (2025). Experiences and perspectives on pregnancy and motherhood in elite athletes–a qualitative study. Sexual and Reproductive Health Matters (SRHM). 33(1), p. 1–16. doi: 10.1080/26410397.2025.2501832. Full text in Research Archive Show summary

  Elite athletes routinely undertake strenuous training routines, which often involve high-intensity sessions. However, there are knowledge gaps in how they experience training during pregnancy and subsequent return to sport. Combined with inadequate financial and contractual safety, female athletes may jeopardise their careers when starting families. This study aimed to describe female athletes’ experiences and perspectives related to pregnancy and motherhood within the context of elite sports in Norway. We interviewed five world-class athletes between October 2022 and April 2023, using a descriptive qualitative approach. Full interview transcripts were analysed based on a reflexive thematic analysis model. Five overarching themes were identified: (1) uncertainty, (2) lack of supportive networks, (3) physical capacity, (4) the impact of postpartum return to sports on maternal health, and (5) combining motherhood and elite sports. Our findings emphasise the challenges that Norwegian pregnant and postpartum athletes face in balancing motherhood with successful careers, highlighting the importance of providing adequate support systems to ensure their health and the well-being of their child.

• Gjestvang, Christina & Haakstad, Lene Annette Hagen (2024). Navigating Pregnancy: Information Sources and Lifestyle Behavior Choices-A Narrative Review. Journal of Pregnancy. ISSN 2090-2727. 2024. doi: 10.1155/2024/4040825. Full text in Research Archive Show summary

  Background: Accessible health information during pregnancy is important to positively affect maternal and fetal health. However, the quality and accuracy of health information can greatly vary across numerous sources. This narrative review is aimed at summarizing the literature on pregnant individuals’ information sources and how these sources influence their habits toward GWG, PA, and nutrition. Such data will highlight preferences and needs, reveal challenges, and identify opportunities for improvement. Methods: We searched PubMed for studies published in the last decade. Out of 299 studies initially identified, 20 (16 quantitative and four qualitative) met the eligibility criteria (investigating information sources and their influence on health habits toward GWG, PA, nutrition, pregnant participants, adequate data reporting, and being available in full text). Results: Primary sources of health information varied. The Internet (26%–97%) and healthcare providers (HCPs) (14%–74%) predominated, followed by family/friends (12%71%), books/magazines (49%–65%), and guidelines/brochures (25%–53%). Despite the widespread use of the Internet, HCPs were considered the most reliable source. The use of the Internet to retrieve health information was reported to be 2–4 h a week, and ＜ 50% discussed the online information with their HCP. The Internet was also used as a supplementary resource on topics raised by HCPs. Regarding the influence on health habits, the Internet, HCPs, media, and family positively influenced GWG and promoted adherence to recommended guidelines (OR = 0.55–15.5). Only one study showed a positive association between Internet use and PA level. The Internet, media, HCPs, and information brochures were associated with better adherence to nutritional recommendations. Conclusions: Pregnant individuals relied on the Internet and HCP, with a preference for the Internet despite trust in midwives. Several sources of health information were positively associated with adherence to GWG and nutrition recommendations. Improving the quality of online information should be a priority for policymakers and health authorities.

• Brevik-Persson, Sofia; Gjestvang, Christina; Dalhaug, Emilie Frederikke Mass; Sanda, Birgitte; Melau, Jørgen & Haakstad, Lene Annette Hagen (2024). Cool mama: Temperature regulation during high-intensity interval running in pregnant elite and recreational athletes. Journal of Exercise Science and Fitness. ISSN 1728-869X. 22(4), p. 429–437. doi: 10.1016/j.jesf.2024.09.003. Full text in Research Archive Show summary

  Background/Objective: Regular exercise during pregnancy is beneficial, but athletes often exceed the recommended 150 min of moderate-intensity activity, incorporate high-intensity exercises. The upper limit for exercise intensity and duration on fetal and maternal safety remains uncertain. A concern is a maternal core body temperature of >39.0 °C, potentially increase the risk of heat-related fetal malformations and complications during pregnancy. Blood flow redirection for thermoregulation could compromise fetal cardiovascular function, increasing the risk of miscarriage and preterm labor. This study evaluated whether pregnant women (gestational weeks 25–35) were at risk of exceeding a core body temperature of 39.0 °C during high-intensity running. We also investigated effects on skin temperature, fluid loss, and thermal sensation, comparing pregnant athletes to non-pregnant controls. Methods: In this comparative cross-sectional study, 30 elite and recreational athletes (pregnant n = 15) completed up to five high-intensity treadmill-intervals. Core and skin temperature were continuously measured. Body weight was utilized to calculate the amount of fluid loss. Results: Highest core body temperature were 38.76 °C and 39.56 °C in one pregnant and non-pregnant participant, respectively. Pregnant participants had lower core body temperatures (mean difference −0.47 °C, p ≤ 0.001) initially and a smaller increase (0.10 °C, p ≤ 0.003) during later intervals compared with the non-pregnant controls. Pregnant participants also showed a greater increase in skin temperature (4.08 ± 0.72 °C vs. 3.25 ± 0.86 °C, p = 0.008) and fluid loss (0.81 ± 0.19 L vs. 0.50 ± 0.12 L, p˂0.001). Conclusion: Physiological changes in pregnancy may enhance thermoregulation, indicating that high-intensity interval runs are unlikely to pose a risk of exceeding a core body temperature of 39 °C for pregnant athletes.

• Gjestvang, Christina; Mathisen, Therese Fostervold; Bratland-Sanda, Solfrid & Haakstad, Lene Annette Hagen (2024). The Risk of Disordered Eating in Fitness Club Members—A Cross-Sectional Study. Sports. 12(12). doi: 10.3390/sports12120343. Full text in Research Archive Show summary

  Fitness clubs may be environments where abnormal eating behaviors and excessive exercise are socially accepted, potentially putting individuals at risk for disordered eating (DE). This study examined the DE risk prevalence among gym members, comparing body appreciation, exercise motivation, frequency, BMI, and age across DE risk levels, and assessed the associated factors. A sample of 232 gym members (age: 39.6 ± 13.7) completed an online survey measuring DE risk (Eating Disorder Screen for Primary Care (ESP)), body appreciation (Body Appreciation Scale version 2), and exercise motivation (Behavioral Regulation in Exercise Questionnaire-2). One out of five (19.4%) were at risk of DE, while 15.5% and 11.6% reported having secretive eating behaviors and a history of eating disorders, respectively. Body weight impacted self-perception for 62.5% of the respondents. Those at DE risk had a higher mean BMI (26.23 ± 4.36 vs. 24.68 ± 3.61, p = 0.032) with a higher proportion of those with a BMI of 25–29.9 (46.67% vs. 29.41%, p = 0.027) compared to non-at-risk individuals. DE risk was associated with lower body appreciation (3.00 ± 3.60 versus 4.00 ± 3.70, p = ≤0.001), with body appreciation being the only factor associated with DE risk (OR = 0.24, 95% CI = 0.15, 0.39, p = ≤0.001).

• Gjestvang, Christina; Olsen, Malin Landro; Dalhaug, Emilie Frederikke Mass & Haakstad, Lene Annette Hagen (2024). Rating of perceived exertion as a tool for managing exercise intensity during pregnancy: a scoping review. BMJ Open. 14(10). doi: 10.1136/bmjopen-2024-086682. Full text in Research Archive Show summary

  Objective: During pregnancy, international guidelines recommend ≥150 min of moderate-intensity aerobic physical activity per week, with an intensity perceived as fairly light to somewhat hard on the Borg Rating of Perceived Exertion (RPE) scale (ranging from 6 ‘no exertion’ to 20 ‘maximal exertion’, corresponding to 60% to 80% of maximum heart rate). However, the determination and monitoring of exercise intensity seem to be a particular source of confusion, and the most effective method to monitor exercise intensity remains uncertain. This study aimed to examine existing research on the correlation between the Borg RPE scale and maternal heart rate (MHR) for monitoring exercise intensity during pregnancy. Design: Scoping review using the mixed methods appraisal tool (MMAT) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Data sources: PubMed, Web of Science and SPORTDiscus were searched from 16–17 April 2023, with a subsequent search on 1 November 2023. Eligibility criteria: We included studies investigating the correlation between perceived intensity on the Borg RPE scale (6–20) and MHR during exercise in pregnant individuals and written in English/Scandinavian language. There were no restrictions on publication year or study design. Data extraction and synthesis: Two independent reviewers screened the articles based on title and abstract. Selected articles were read in full text and reference lists of screened articles were also checked. Out of 120 studies screened, six articles met the inclusion criteria after removing one duplicate. The results were qualitatively summarised to provide an overview of common themes and variations between studies. MMAT and GRADE assessed the risk of bias and the certainty of the evidence. Results: The six studies involved a total of 260 healthy pregnant individuals (gestational week: from 16 to 38), with various exercise protocols (cycling, walking, running and resistance exercise) and intensities (from light to moderate). Three studies supported the Borg RPE scale to estimate exercise intensity during pregnancy, while three found no correlation between this scale and MHR. The certainty of the evidence was graded as low to moderate, with a potential risk of bias due to small sample sizes, incomplete outcome data and inconsistencies across studies. Conclusion: The mixed results highlight the complexity of monitoring exercise intensity during pregnancy. Using both the Borg RPE scale and MHR might be better than using them separately for monitoring exercise intensity during pregnancy. Due to limited and inconsistent research, more extensive studies are needed.

• Kyte, Karoline Holsen; Haakstad, Lene Annette Hagen; Hisdal, Jonny; Sunde, Andrine & Stensrud, Trine (2023). Bone health in Norwegian female elite runners: A cross-sectional, controlled study. BMJ Open sport & exercise medicine. 9(1). doi: 10.1136/bmjsem-2022-001472. Full text in Research Archive Show summary

  Objective: The primary objective was to compare bone mineral density (BMD) in Norwegian female elite long-distance runners with a control group of inactive females. Secondary objectives were to identify cases of low BMD, to compare the concentration of bone turnover markers, vitamin D and symptoms of low energy availability (LEA) between the groups, and to identify possible associations between BMD and selected variables. Methods: Fifteen runners and fifteen controls were included. Assessments included dual-energy X-ray absorptiometry measurement of BMD in the total body, lumbar spine and dual proximal femur. Blood samples included endocrine analyses and circulating bone turnover markers. The risk of LEA was assessed through a questionnaire. Results: Runners had higher Z-scores in the dual proximal femur (1.30 (0.20 to 1.80) vs 0.20 (−0.20 to 0.80), p<0.021) and total body (1.70 (1.20 to 2.30) vs 0.90 (0.80 to 1.00), p<0.001). The lumbar spine Z-score was similar between groups (0.10 (−0.70 to 0.60) vs −0.10(−0.50 to 0.50), p=0.983). Three runners had low BMD (Z-score <−1) in the lumbar spine. Vitamin D and bone turnover markers showed no differences between the groups. Forty-seven per cent of the runners were at risk of LEA. Dual proximal femur BMD showed a positive correlation to estradiol and a negative correlation to LEA symptoms in runners. Conclusion: Norwegian female elite runners had higher BMD Z-score in the dual proximal femur and total body compared with controls, while no difference was observed in the lumbar spine. The advantages of long-distance running on bone health seem to be site specific, and there is still a need for the prevention of LEA and menstrual disorders in this group.

• Gjestvang, Christina; Tangen, Elene Mauseth; Arntzen, Miriam Basma & Haakstad, Lene Annette Hagen (2023). How Do Fitness Club Members Differentiate in Background Characteristics, Exercise Motivation, and Social Support? A Cross-Sectional Study. Journal of Sports Science and Medicine (JSSM). ISSN 1303-2968. 22(2), p. 235–244. doi: 10.52082/jssm.2023.235. Full text in Research Archive Show summary

  Fitness clubs are one of the largest exercise arenas worldwide. Still, membership withdrawal and exercise dropout rates are 40-65% in the first six months. One important approach to retaining members may be to create an environment that feels inclusive, and clusters members with mutual needs and interests. Increased knowledge in this field can provide valuable information that leads to more effective exercise promotion strategies and better retention rates, important to the long-term success of the gym and public health. Thus, we aimed to compare background factors, motivation, and social support between members of multipurpose (wide range of exercise concepts/facilities, middle to high membership fee), fitness-only (low membership fee), and boutique (one or two specialized exercise concepts, high membership fee) fitness clubs. A total of 232 members from multipurpose (n = 107), fitness-only (n = 52), and boutique gyms (n = 73) were recruited for this cross-sectional study. Data included background variables (age, gender, body weight and height, smoking, total household income, occupation, education, and general health), exercise behaviour, exercise motivation, and social support. A one-way between-group ANOVA with Bonferroni correction or a chi-square test was used as appropriate. Multipurpose and fitness-only members were older (mean diff: 9.1 years, p = <0.001) and exercised less (mean diff: 1-1.2 sessions/week, p = <0.001) than members from boutique clubs. Compared with multipurpose and fitness-only members, members from boutique clubs reported the highest autonomous motivation (intrinsic regulation: mean diff: 0.3, p = 0.030), and perceived greater social support from family/friends (mean diff: 6.4 to 6.6, p = <0.001). Boutique members were younger, exercised more, and reported higher autonomous motivation and social support than multipurpose and fitness-only members. Our results suggest that exercise enjoyment and a social community, the “philosophy” of boutique gyms, may be important for regular exercise.

• Hayman, Melanie; Keppel, Marian; Stanton, Robert; Thwaite, Tanya L.; Alfrey, Kristie-Lee & Alley, Stephanie [Show all 13 contributors for this article] (2023). A mixed-methods exploration of attitudes towards pregnant Facebook fitness influencers. BMC Public Health. 23. doi: 10.1186/s12889-023-15457-6. Full text in Research Archive Show summary

  Background: Exercise during pregnancy is associated with various health benefits for both mother and child. Despite these benefits, most pregnant women do not meet physical activity recommendations. A known barrier to engaging in exercise during pregnancy is a lack of knowledge about appropriate and safe exercise. In our current era of social media, many pregnant women are turning to online information sources for guidance, including social media influencers. Little is known about attitudes towards pregnancy exercise information provided by influencers on social media platforms. This study aimed to explore attitudes towards exercise during pregnancy depicted by social media influencers on Facebook, and user engagement with posted content. Methods: A mixed-methods approach was used to analyse data from 10 Facebook video posts of social media influencers exercising during pregnancy. Quantitative descriptive analyses were used to report the number of views, shares, comments and emotive reactions. Qualitative analysis of user comments was achieved using an inductive thematic approach. Results: The 10 video posts analysed were viewed a total of 12,117,200 times, shared on 11,181 occasions, included 13,455 user comments and 128,804 emotive icon reactions, with the most frequently used icon being ‘like’ (81.48%). The thematic analysis identified three themes associated with attitudes including [1] exercise during pregnancy [2] influencers and [3] type of exercise. A fourth theme of community was also identified. Most user comments were associated with positive attitudes towards exercise during pregnancy and the influencer. However, attitudes towards the types of exercise the influencer performed were mixed (aerobic and body weight exercises were positive; resistance-based exercise with weights were negative). Finally, the online community perceived by users was mostly positive and recognised for offering social support and guidance. Conclusions: User comments imply resistance-based exercise with weights as unsafe and unnecessary when pregnant, a perception that does not align with current best practice guidelines. Collectively, the findings from this study highlight the need for continued education regarding exercise during pregnancy and the potential for social media influencers to disseminate evidence-based material to pregnant women who are highly receptive to, and in need of reliable health information.

• Haakstad, Lene Annette Hagen; Benvenuti, Maria Beatrice; Dalhaug, Emilie Frederikke Mass & Bø, Kari (2023). Lumbopelvic pain and sick leave during pregnancy: A comparison of Italy and Norway. Women's Health. ISSN 1745-5057. 19. doi: 10.1177/17455057231218197. Full text in Research Archive Show summary

  Background: Pregnancy-related lumbopelvic pain is a frequently reported musculoskeletal disorder, but few studies have compared data between countries. Objectives: Examine prevalence, severity, and sick leave and explore potential risk factors associated with pregnancy-related lumbopelvic pain in Italian women and compare the results to a similar study in Norway, utilizing the same questionnaire. Design: Cross-sectional Methods: Italian (n = 481) and Norwegian women (n = 435) were allocated from two public hospitals in Rome (Fatebenefratelli San Giovanni Calibita-Isola Tiberina) and Oslo (Oslo University Hospital), as well as four antenatal clinics in Modena (Italy). The questionnaire was completed between gestation weeks 32 and 36, addressing women’s experiences of pregnancy-related lumbopelvic pain and sick leave in current week, and retrospectively for prepregnancy, first and second trimesters. Results: In Italy and Norway, 39% and 57% of pregnant women reported pregnancy-related lumbopelvic pain, respectively, with 11% and 25% experiencing severe pregnancy-related lumbopelvic pain. Pregnancy-related lumbopelvic pain was associated with sick leave in Norway (p < 0.01), but not in Italy (p = 0.66) at late gestation. In both countries, women with pregnancy-related lumbopelvic pain versus those with no pregnancy-related lumbopelvic pain were more likely to be multiparous (Italy: 40% versus 31%, p = 0.06 and Norway: 53% versus 38%, p < 0.01), and have gestational weight gain above guidelines (Italy: 21% versus 13%, p = 0.02% and Norway: 27% versus 14%, p < 0.01) and previous experience of pregnancy-related lumbopelvic pain (Italy: 15% versus 2%, p < 0.01 and Norway: 31% versus 4%, p < 0.01). Maternal exercise (⩾2 times weekly) was associated with less pregnancy-related lumbopelvic pain (Italy: odds ratio = 0.33, 95% confidence interval = 0.11–1.0, p = 0.05 and Norway: odds ratio = 0.55, 95% confidence interval = 0.29–1.0, p = 0.06). Conclusion: We observed high rates of pregnancy-related lumbopelvic pain in Italy and Norway, with Norwegian women reporting the highest prevalence and severity level. While both countries had similar rates of sick leave in late gestation, an association between pregnancy-related lumbopelvic pain and sick leave was observed among Norwegian women only. Health care providers should be proactive in addressing pregnancy-related lumbopelvic pain through open communication and seeking input from pregnant individuals. However, it is essential to acknowledge that the current evidence on effective treatments remains limited and inconclusive, highlighting the need for further research in this field.

• Moore, Isabel S.; Crossley, Kay M.; Bø, Kari; Mountjoy, Margo; Ackerman, Kathryn E. & Antero, Juliana da Silva [Show all 25 contributors for this article] (2023). Female athlete health domains: A supplement to the International Olympic Committee consensus statement on methods for recording and reporting epidemiological data on injury and illness in sport. British Journal of Sports Medicine. ISSN 0306-3674. 57(18), p. 1164–1174. doi: 10.1136/bjsports-2022-106620. Full text in Research Archive Show summary

  The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan; (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) to female athlete health data. In May 2021, five researchers and clinicians with expertise in sports medicine, epidemiology and female athlete health convened to form a consensus working group, which identified key themes. Twenty additional experts were invited and an iterative process involving all authors was then used to extend the IOC consensus statement, to include issues which affect female athletes. Ten domains of female health for categorising health problems according to biological, life stage or environmental factors that affect females in sport were identified: menstrual and gynaecological health; preconception and assisted reproduction; pregnancy; postpartum; menopause; breast health; pelvic floor health; breast feeding, parenting and caregiving; mental health and sport environments. This paper extends the IOC consensus statement to include 10 domains of female health, which may affect female athletes across the lifespan, from adolescence through young adulthood, to mid-age and older age. Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies.

• Skjold, Ingvild; Benvenuti, Maria Beatrice & Haakstad, Lene Annette Hagen (2022). Why do so many pregnant women give up exercise? An Italian cross-sectional study. Women's Health. ISSN 1745-5057. 18. doi: 10.1177/17455057221117967. Full text in Research Archive Show summary

  Objective: Current exercise guidelines recommend women to exercise throughout pregnancy, and the benefits are well documented. Still, there is an increasing decline of exercise levels during pregnancy and a high percentage of them are sedentary. It is well established that individual attitudes and perception of barriers may influence the ability to engage in sufficient amount of exercise. This has, however, not been examined in an Italian pregnant population. Hence, the aims of the present study were to increase knowledge of facilitators and barriers to regular exercise in Italian pregnant women and to report their social support in regard to maternal exercise. Methods: Healthy, pregnant women (n = 513) were allocated from Fatebenefratelli San Giovanni Calibita, a public hospital in Rome, and four antenatal clinics in Rome and Modena. The participants completed a validated self-administrated questionnaire, the Physical Activity Pregnancy Questionnaire, in gestational week 36. In line with current American College of Obstetricians and Gynecologists guidelines (2020), participants were categorized as “regular exercisers” (⩾150 min/week) and “not regular exercisers” (< 150 min/week). Results: Only 4.6% of the women engaged in regular physical activity/exercise in the third trimester. “Insufficient time” (54%) were the only barrier negatively associated with exercise. The facilitators “relaxation/recreation” (18%), “prevention of health complaints” (15%), “enjoyment” (10%), and “prevention of gestational weight gain” (4%) were associated with achieving the recommendations of exercise. This study found no association between achieving the recommendations and childhood exercise/having social modeling, or exercising network/milieu (p = 0.294 and p = 0.123). Nevertheless, exercising together with others was a significant predictor for regular maternal exercise (p < 0.001). Most women did not receive any advice on exercise during pregnancy from their doctor or midwife (60.0 %). Yet, those who received such advice were significantly more likely to exercise regularly compared to those who did not (75.0% vs 38.2%; p < 0.001). Conclusion: Italian pregnant women mainly reported internal facilitators for their willingness to participate in regular maternal exercise, while barriers were primarily related to inconveniences (such as insufficient time and difficulty combining with work/studies). The study addresses the positive association between achieving the recommended amount of exercise and social support in terms of exercising with others and getting advice from health professions. Because women respect their doctor and have regular prenatal checkups, this health care setting can play a pivotal role in the initiation and maintenance of exercise behavior during pregnancy.

• Tangen, Elene Mauseth; Gjestvang, Christina; Stensrud, Trine & Haakstad, Lene Annette Hagen (2022). Is there an association between total physical activity level and VO<inf>2max</inf> among fitness club members? A cross-sectional study. BMC sports science, medicine and rehabilitation. 14(1). doi: 10.1186/s13102-022-00503-4. Full text in Research Archive Show summary

  Background: Since cardiorespiratory fitness is an important predictor for all-cause mortality, it is of interest to know if meeting the physical activity (PA) recommendations is associated with higher levels of maximal oxygen uptake (VO2max). We aimed to investigate the association between total PA level given as counts per minute (cpm) and minutes in moderate-to-vigorous PA (MVPA), and VO2max in new fitness club members. Methods: A total of 62 men and 63 women (≥ 18 years), defined as healthy (no disease considered to hinder PA) participated in this study. VO2max (mL kg−1 min−1) was measured with a cardiopulmonary exercise (modified Balke protocol), and total PA level was measured with ActiGraph GT1M for seven consecutive days. All participants accumulating ≥ 10 h of activity recordings ≥ 4 days were included in the data analysis. To examine associations between PA level and VO2max, a Pearson correlation and a multiple linear regression analysis adjusted for covariates were used. Results: VO2max (mL kg−1 min−1) was 40.5 ± 7.2 in men and 35.1 ± 6.0 in women. Total PA level (cpm) and MVPA (min) were 352.4 ± 123.4 and 260.0 ± 132.6 in men and 361.4 ± 103.8 and 273.2 ± 137.0 in women. Total PA level (men: r = 0.346, p < 0.01, women: r = 0.267 p < 0.01) and MVPA (men: r = 0.359, p =  < 0.01, women: r = 0.236, p = 0.03) was associated with VO2max. When adjusting for age and body fat percentage, total PA level and MVPA were no longer associated with VO2max (men: p = 0.11 and p = 0.79, women: p = 0.40 and p = 0.61). In men, age (β = − 0.469 p < 0.01) and body fat percentage (β = − 0.483, p < 0.01) were the strongest predictor for VO2max. For women, body fat percentage was the strongest predictor for VO2max (β = − 0.483, p < 0.01). Conclusions: Total PA level and MVPA were associated with VO2max, but the association was low and diminished when adjusted for age and body fat percentage. Body fat percentage (men and women) and age (men) were more strongly associated with VO2max than total PA level and MVPA.

• Gjestvang, Christina; Tangen, Elene Mauseth & Haakstad, Lene Annette Hagen (2022). The Coronavirus pandemic and closed fitness clubs negatively affected members exercise habits. Frontiers in Sports and Active Living. 4. doi: 10.3389/fspor.2022.985782. Full text in Research Archive Show summary

  Introduction: Due to the Coronavirus pandemic, politicians enacted directions to reduce social interactions, including lockdown of fitness clubs. We aimed to investigate how this changed exercise habits of Norwegian gym members. Method: Based on survey data, men and women (≥18 years, n = 233, data collection from Aug. 2020 to Jan. 2021) were recruited to this study by an email-invitation from their fitness club chain or by Facebook advertisement. The participants reported on background variables (e.g., age, gender, total household income, occupation, and education), and exercise habits pre- and during social lockdown. Data were analyzed using independent or student t-test, chi-squared test, or McNemar's test, as appropriate. Results: Home-based exercise (18.0 vs. 72.5%, p = <0.001), walking (49.8 vs. 65.2%, p = <0.001), and cycling (16.7 vs. 24.5%, p = 0.004) was more common during than pre-lockdown. Also, men (4.33 to 3.68 days/week, p =0.013) and women (4.20 to 3.79 days/week, p = 0.001) reported a lower exercise frequency, and a shorter duration. Exercise frequency was lower in those with a BMI ≥25 than in those with BMI <25 (3.95 vs. 4.48 days/week, p = <0.007) pre-lockdown. High exercise attendees (≥3 sessions/week, 66.5%) reported a smaller decrease in exercise frequency (mean change: 0.06 vs. 1.24 days/week, p = <0.001) and duration (>60 min. per session: 33.0 vs. 3.8%, p = <0.001) than low exercise attendees during lockdown. Discussion: Home-based exercise, walking, and cycling were most frequently reported during lockdown. Participants reported a small decrease in exercise duration and frequency compared with pre-lockdown. Closure of fitness clubs impacted low attendees more than high attendees.

• Dalhaug, Emilie Frederikke Mass & Haakstad, Lene Annette Hagen (2022). Does Appearance Matter during Pregnancy? A Cross-Sectional Study of Body Satisfaction from Pre-Pregnancy to Late Gestation. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(23). doi: 10.3390/ijerph192316375. Full text in Research Archive Show summary

  Few studies have explored the associations between body satisfaction and physical activity and weight gain during pregnancy, and none have been conducted in Scandinavia. Hence, the aim of the present study was to evaluate changes in body satisfaction from pre-pregnancy to late pregnancy and investigate whether this differed according to parity. We also wanted to explore the association between body satisfaction and physical activity and weight gain among pregnant women in Norway. This cross-sectional survey used an electronic questionnaire to assess physical activity level, weight gain and women’s satisfaction with body weight and size. In total, 150 pregnant women answered the questionnaire. Related-samples Wilcoxon signed rank tests, Mann–Whitney U tests and chi-square tests were used to answer our research questions. The proportion of women who were dissatisfied with their body weight and shape increased from pre-pregnancy to late gestation (body weight p = 0.030 and body shape p = 0.040). Body dissatisfaction before and during pregnancy was linked to weight gain above recommendations. Characterising oneself as physically active prior to pregnancy was associated with satisfaction with body shape pre-pregnancy. Given that mothers strongly influence how a child will judge their body later in life, the results of this study underline the importance of addressing these issues during pregnancy.

• Haakstad, Lene Annette Hagen; Stensrud, Trine; Rugseth, Gro & Gjestvang, Christina (2022). Weight Cycling and Dieting Behavior in Fitness Club Members. Frontiers in Endocrinology. 13. doi: 10.3389/fendo.2022.851887. Full text in Research Archive Show summary

  Background: Along with the rising prevalence of high body-mass index (BMI), there is also increased emphasis on leanness and fitness. Both these trends suggest that many individuals are concerned about weight management and may try to lose weight. Using data from the research project “Fitness clubs - a venue for public health?”, we aimed to describe weight cycling and energy-restricted dieting in men and women at start-up of fitness club membership, and to investigate influencing factors [age, BMI, educational level, self-classified overweight/obesity, compliance with nutritional guidelines, unhealthy weight control strategies and self-perceived health (SPH)]. Methods: In a cross-sectional online survey, 250 men and women from 25 fitness clubs in Oslo, reported anthropometrics, self-classified weight group, weight cycling, weight loss/gain, eating habits/dieting, and background/health information. Enrollment was limited to adult (≥18 years) novice exercisers (exercising <60 min/week at a moderate or vigorous intensity or brisk walking <150 min/week, the past six months) with less than four weeks of membership. Factors associated with weight cycling were examined using simple and multiple logistic regression, separated for men and women. Results: In both sexes (mean age: 36.4 ± 11.3, range 18-71 years), a high number reported substantial weight fluctuation (+/-5 kg) the past 12 months (men: 50% and women: 62%, mean difference 12%, 95% CI -0.3 to 23.8, p=0.056) and unhealthy weight control strategies (men: 24.8% and women: 47.2%, mean difference 22.4%, 95% CI 10.5 to 33.4, p<0.001). Weight cyclers had a higher mean BMI compared with non-cyclers (mean difference -1.5, 95% CI -2.6 to - 0.4, p= 0.003). Further, the difference in body weight was 6.7 kg (95% CI 2.2 to 10.8, p=0.004) and 10.8 kg (95% CI 5.8 to 15.8, <0.001) in men and women, respectively. Besides BMI status, self-classified overweight/obesity was the strongest predictor of reporting weight cycling (men: OR 5.54, 95% CI 2.03 to 15.12, p<0.01 and women: OR 7.17, 95% CI 2.48 to 20.68, p<0.001). Conclusion: In novice exercisers, a large proportion reported weight cycling and unhealthy weight control strategies, and both were more prevalent in women than in men. Self-classified overweight was found to be the most important factor influencing weight cycling.

• Brown, Wendy J.; Hayman, Melanie; Haakstad, Lene Annette Hagen; Lamerton, Tayla; Mena, Gabriela P & Green, Anita [Show all 10 contributors for this article] (2022). Australian guidelines for physical activity in pregnancy and postpartum. Journal of Science and Medicine in Sport. ISSN 1440-2440. doi: 10.1016/j.jsams.2022.03.008. Full text in Research Archive Show summary

  Objectives: To develop Australian guidelines on physical activity/exercise during pregnancy and the postpartum period. Design: Critical ‘umbrella’ reviews of the scientific evidence, combined with adaptation of recently published guidelines. Methods: A five stage approach included: identification of key source documents (including national physical activity/exercise guidelines and position statements from professional organisations, published since 2010); narrative review of evidence relating to 27 health outcomes; summarising the evidence; development of draft guidelines and supporting information; and review and consultation to finalise the guidelines. Results: Our evidence review found that physical activity/exercise during pregnancy and the postpartum period is safe, has health benefits for the woman and her unborn child, and may reduce the risks of some pregnancy related complications. Four specific guidelines were developed. These encourage all women without pregnancy complications to: (1) meet the Australian Physical Activity and Sedentary Behaviour Guidelines for Adults before, during and after pregnancy; (2) modify activities to accommodate the physical changes that occur as pregnancy progresses; (3) do pelvic floor exercises during and after pregnancy; and (4) take an active role in shared decision-making about their physical activity/exercise during and after pregnancy. The review also identified warning signs and contraindications for physical activity/exercise during pregnancy. Conclusions: All women who are pregnant or planning a pregnancy should be aware of the benefits of physical activity/exercise, and health professionals should encourage safe levels of activity and be familiar with the contraindications, signs and symptoms which suggest that physical activity/exercise should be modified or avoided.

• Bø, Kari; Haakstad, Lene Annette Hagen; Paulsen, Gøran & Rustaden, Anne Mette (2021). Does regular strength training cause urinary incontinence in overweight inactive women? : A randomized controlled trial. International Urogynecology Journal. ISSN 0937-3462. 32. doi: 10.1007/s00192-021-04739-5. Full text in Research Archive Show summary

  Introduction and hypothesis: Urinary incontinence (UI) is common in women who exercise. We aimed to investigate new onset UI in formerly inactive, overweight or obese women (BMI > 25) participating in three different strength training modalities compared with a non-exercising control group. Methods: This was a secondary analysis of an assessor blinded randomized controlled trial investigating the effect of 12 weeks of three strength training concepts for women on muscle strength and body composition. None of the programs included pelvic floor muscle training. International Consensus on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was used to investigate primary outcome; new onset UI, and secondary outcome; ICIQ-UI-SF sum score. Suissa and Shuster’s exact unconditional test was used to analyze difference in new onset UI. Difference in ICIQ-UI-SF sum score is presented as mean with 95% CI. Results: At baseline 40 out of 128 (31.2%) participants reported UI. Three out of 27, 2 out of 17, 2 out of 23, and 0 out of 21 women in the three training and control groups respectively had new onset UI. There were no statistically significant differences in new onset UI across the groups or when collapsing new onset UI in the intervention groups compared with the controls (7 out of 67 vs 0 out of 21), p = 0.124. After the intervention the control group reported worse ICIQ-UI-SF sum score than any of the training groups; mean difference − 6.6 (95% CI: −11.9, −1.27), p = 0.012, but there was no difference in change from baseline to 12 weeks between the groups p = 0.145). Conclusions: There was no statistically significant change in UI after strength training.

• Haakstad, Lene Annette Hagen; Jakobsen, Charlotte; Solberg, Runar Barstad; Sundgot-Borgen, Christine & Gjestvang, Christina (2021). Mirror, mirror - Does the fitness club industry have a body image problem? Psychology of Sport And Exercise. ISSN 1469-0292. 53. doi: 10.1016/j.psychsport.2020.101880. Full text in Research Archive Show summary

  The primary aim of the present study was to report longitudinal data on body image across the first year of gym engagement. Second, we aimed to compare body image among those who reported regular use of the fitness club (≥2 sessions/week) with those who did not (≤1exercise session/week or no exercise/dropout), as well as between genders and Body Mass Index groups (BMI<25 and BMI≥25) at membership start-up. Novice exercisers (n = 250) from 25 fitness clubs in Oslo (Norway) responded to an online questionnaire at start-up, three, six and 12-months follow-up, with a high response rate (100%, 89.6%, 85.2% and 74.8%). The questionnaire covered background/health information and exercise involvement. A modified Multidimensional Body Self Relations Questionnaire Appearance Scales (MBSRQ-AS), comprising five subscales (appearance satisfaction, appearance investment, weight-related attitude, self-classified weight and Body Areas Satisfaction Scale (BASS), was used to gather repeated measures of body image. Data were analysed separately for each subscale and as a body image total score, using a linear mixed model adjusted for baseline, gender and BMI. We found differences in body image total score reported at six months when compared with onset (0.04, 95% CI 0.005–0.078, p = 0.024), whereas the subscale appearance satisfaction was different at three (0.08, 95% CI 0.015–0.164, p = 0.018), six (0.11, 95% CI 0.039–0.197, p = 0.003) and twelve (0.10, 95% CI 0.021–0.179, p = 0.013) months when compared with onset. Also the subscale BASS was different at three (0.17, 95% CI 0.009–0.255, p < 0.001), six (0.21, 95% CI 0.127–0.301, p < 0.001) and twelve (0.26, 95% CI 0.143–0.388, p < 0.001). Participants adhering to regular exercise (≥2 times weekly) had better outcomes on total body image than those who exercised less frequently or irregularly (three: 2.94 vs. 2.83, p = 0.027 and 12-months: 2.97 vs. 2.85, p = 0.028). At membership start-up, being male (p < 0.001) and having a BMI<25 (p = 0.003), were the strongest factors associated with reporting a higher score on total body image. In conclusion, we found improved body area and appearance satisfaction in novice exercisers across the first year of fitness club membership.

• Gjestvang, Christina; Stensrud, Trine; Paulsen, Gøran & Haakstad, Lene Annette Hagen (2021). Stay true to your workout: Does repeated physical testing boost exercise attendance? A one-year follow-up study. Journal of Sports Science and Medicine (JSSM). ISSN 1303-2968. 20(1), p. 35–44. doi: 10.52082/jssm.2021.35. Full text in Research Archive Show summary

  No prospective studies have investigated if repeated testing of physical performance and body composition are associated with exercise attendance or patterns in fitness club members. This study aimed to investigate if repeated physical testing was associated with exercise attendance and patterns in gym members and to report prospective data on use of the fitness club’s facilities and products. Untrained new members were recruited and divided into a test group (n = 125) and as controls (n = 125). All participants answered a survey including exercise involvement, at onset, and after 3, 6, and 12 months follow-up. The test group also measured body composition, maximal oxygen uptake, and maximal muscle strength (onset, and after 3 and 12 months). In total 73.6% answered all surveys, and in the test group, 44.8% completed all physical tests. Regular exercise attendance was defined as ≥2 sessions/week. Repeated testing showed no association with long-term regular exercise attendance (test group: 19.6%, controls: 19.8%; p = 0.638). At 3 months, a lower proportion in the test group reported engagement in resistance exercise (35.3% and 60.2%; p = 0.003) and had lower exercise frequency (2.0 and 2.6 days/week; p = 0.008) than controls. The test group had higher participation in group exercise classes (28.0% and 13.6%; p = 0.040). Exercise frequency decreased from onset to 12 months (from 2.6 to 2.2 days/week; p = 0.025) At 3, 6, and 12 months, 51.8%, 37.6%, and 37.4% reported regular exercise attendance, and 16.9% at all follow-ups. At all time-points, most common workout mode was individual resistance exercise (43.8% to 46.3%). Few attended group exercise classes (7.5% to 13.8%) or used a personal trainer (22.5% to 27.5%). Repeated physical testing did not improve exercise attendance, and we found no changes in members` use of the fitness club’s facilities and products. Only 16.9% reported regular exercise attendance throughout the first year of membership.

• Haakstad, Lene Annette Hagen; Kissel, Iselin Haugland & Bø, Kari (2021). Long-term effects of participation in a prenatal exercise intervention on body weight, body mass index, and physical activity level: a 6-year follow-up study of a randomized controlled trial. Journal of Maternal-Fetal & Neonatal Medicine. ISSN 1476-7058. 34(9), p. 1347–1355. doi: 10.1080/14767058.2019.1636028. Full text in Research Archive Show summary

  Background: Growing evidence supports that physical activity and exercise during pregnancy is favorable for the mother, with persisting benefits in the postpartum period. However, there is scant knowledge of the effect of a prenatal exercise program on long-term health and lifestyle habits. Objectives: This 6-year follow-up study of a randomized controlled trial had two aims: (1) compare body weight, weight retention and body mass index (BMI) in the intervention group and control group, and (2) evaluate effects on physical activity level and recreational exercise. Materials and methods: Out of 105 participants initially randomized to either an intervention group, n = 52 (twice weekly group-exercises and physical activity counselling) or control group, n = 53 (standard prenatal care), 80 women (76.2%) participated in the present long-term follow-up study, performed in a general community in Oslo, Norway. Data were collected through a standardized telephone interview based on the baseline protocol and a modified Physical Activity and Pregnancy Questionnaire (PAPQ). Body weight at 6 years follow-up was self-reported (kg), and calculation of current BMI (kg/m2) was based on self-reported weight and measured height at study inclusion. Investigators were unaware of the original randomization at the time of the interviews. Analyses of covariance were used to examine the difference in change in body weight and BMI between the groups. Even though the MET-values were not normally distributed, differences were examined using a two-sided independent sample t-test due to large sample size (n ≥ 30). Results: At 6 years follow-up there were no differences in mean BMI (kg/m2) (24.0 ± 3.8 versus 24.8 ± 4.0, p = .37), physical activity level (4167 ± 2638 versus 3925 ± 3075 MET-min/week, p = .67) or recreational exercise (630 ± 1290 versus 720 ± 1005 MET-min/week, p = .88) between the intervention and control group, respectively. Subgroup analysis of participants with high adherence during the intervention 6 years ago (≥24 prenatal exercise classes), showed a positive intervention effect at long-term follow up in body weight (kg) (62.8 ± 7.9 versus 70.8 ± 11.8, p = .03) and BMI (kg/m2) (22.5 ± 3.1 versus 24.8 ± 4.0, p = .05), and none (versus 11 in the control group) had gained ≥5 kg compared to prepregnancy weight (p = .02). Conclusions: Women who adhered to the original prenatal exercise intervention demonstrated significantly lower body weight and BMI at 6-year follow-up. Otherwise, no long-term intervention effect was observed.

• Haakstad, Lene Annette Hagen; Stensrud, Trine & Gjestvang, Christina (2021). Does Self-Perception Equal the Truth When Judging Own Body Weight and Height? International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(16). doi: 10.3390/ijerph18168502. Full text in Research Archive Show summary

  Background: Data from the research project “Fitness clubs—a venue for public health?” provided an opportunity to evaluate the accuracy of self-reported body weight and height, and subsequent Body Mass Index (BMI), as well as the “trueness” of novice exercisers perception of weight status category, which has not been examined in this population. The aims were to examine self-reported body weight, height, and calculated BMI data from an online survey compared with measured data at fitness club start-up, investigate how accurately novice exercisers place themselves within self-classified weight group (underweight, normal weight, overweight, and obese), and compare this with fitness club attendance at three months follow-up. Methods: Prior to anthropometric measurements, 62 men and 63 women responded to an online questionnaire, including body weight (kilogram, kg) and height (centimeters, cm), and self-classified weight group (“I think I am … underweight, normal weight, overweight, obese”). We used the following statistical analysis: Paired sample t-tests, a Bland–Altman plot kappa statistics, chi-squared tests, and a logistic regression. Results: Mean difference of BMI calculated from self-reported and measured data was 0.06 (95% CI −0.29 to 0.17, p = 0.593) in men, and 0.16 (95% CI −0.40 to 0.09, p = 0.224) in women, with four participants being outliers of the 95% limits of agreement (Bland-Altman plot). Allowing a difference of 0.5 kg between self-reported and measured weight, we found that 16% reported their weight correctly, 31.2% underreported (−1.89 ± 1.59 kg), and 52.8% overreported (1.85 ± 1.23 kg), with no sex differences (p = 0.870). Further, our results suggest that both sexes may have difficulty recognizing overweight/obesity in themselves, and particularly men are likely to underreport their perceived weight group compared with women. More than half (53.3%) of the overweight men perceived themselves to be normal weight (women: 14%), and only 33.3% of obese men and women correctly classified themselves as being obese. We did not find any difference between participants correctly or incorrectly classifying weight group and fitness club attendance (≥2 times a week) at three months follow-up. Conclusion: Both sexes reported body weight and height reasonably accurately, and BMI based on self-report appears to be valid measure. Still, a large proportion of novice exercisers do not recognise their own overweight or obesity status, which may in part explain why public health campaigns do not reach risk populations.

• Benvenuti, Maria Beatrice; Bø, Kari; Draghi, Simonetta; Tandoi, Elisabetta & Haakstad, Lene Annette Hagen (2021). The weight of motherhood: Identifying obesity, gestational weight gain and physical activity level of Italian pregnant women. Women's Health. ISSN 1745-5057. 17. doi: 10.1177/17455065211016136. Full text in Research Archive Show summary

  Objective: Pre-pregnancy obesity and suboptimal gestational weight gain are on the rise globally and are independently associated with several maternal and neonatal complications. A healthy lifestyle, including regular physical activity, may improve health and reduce these complications, but many women are less active and willing to engage in physical activity with advancing gestation. Therefore, the inclusion of a wider range of physical activity such as domestic chore, occupational activity and active commuting may help pregnant women to meet the physical activity recommendations of 150 min/week. Very little is known about these issues in Italy, a country with strong traditional roles regarding pregnancy and motherhood, including “la famiglia” (the family). Primary objective describes health and lifestyle behavior of pregnant Italian women. Secondary objective reports total physical activity level, recreational exercise and context of these activities from pre-pregnancy and throughout gestation in regard to gestational weight gain management. Study design: Cross-sectional study performed in one public hospital and four antenatal clinics in Italy. Participants (n = 513) completed a validated self-administered questionnaire, the Physical Activity Pregnancy Questionnaire, in gestation week 36.01 (standard deviation 2.0). Pre-pregnancy body weight (kg) was self-reported, whereas maternal weight (kg) was measured at gestation week 36. In line with current American College of Obstetricians and Gynecologists guidelines (2020), participants were categorized into regular physical activity (⩾150 min/week) or non-regular physical activity (<150 min/week). Results: Mean pre-pregnancy body-mass index was 22.8 kg/m2 (standard deviation 3.9), with 14.4% of women entering motherhood overweight and 5.3% obese. Mean gestational weight gain was 11.9 kg (standard deviation 4.1). Among those with a body-mass index ⩾25, 46.5% gained above the Institute of Medicine recommendations. With respect to recreational exercise/sport, 4.7% were active according to guidelines, whereas 82.7% accumulated ⩾150 min/week when combining exercise/sport with daily-life physical activity (commuting and occupational). Exercising ⩾150 min/week and working 100% in third trimester were associated with gestational weight gain within Institute of Medicine recommendations (p = 0.06 and p = 0.03). Conclusion: Italian pregnant women have a low exercise level, still over 80% achieved a total physical activity level ⩾150 min/week when adding occupational and commuting activities. Nearly 50% of overweight and obese women exceeded the recommended gestational weight gain during pregnancy.

• Bø, Kari; Haakstad, Lene Annette Hagen; Paulsen, Gøran & Rustaden, Anne Mette (2021). DOES REGULAR STRENGTH TRAINING CAUSE URINARY INCONTINENCE IN OVERWEIGHT INACTIVE WOMEN? A randomized controlled trial. International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-021-04739-5. Full text in Research Archive
• Gjestvang, Christina; Abrahamsen, Frank Eirik; Stensrud, Trine & Haakstad, Lene Annette Hagen (2021). What Makes Individuals Stick to Their Exercise Regime? A One-Year Follow-Up Study Among Novice Exercisers in a Fitness Club Setting. Frontiers in Psychology. 12. doi: 10.3389/fpsyg.2021.638928. Full text in Research Archive Show summary

  Objectives: A fitness club may be an important arena to promote regular exercise. However, authors have reported low attendance rates (10 to 37%) the first months after individuals sign up for membership. It is therefore important to understand the reasons for poor exercise adherence. In this project, we aimed to investigate different psychosocial factors that might increase the likelihood of reporting regular exercise the first year of a fitness club membership, including self-efficacy, motives, social support, life satisfaction, and customer satisfaction. Methods: New members (≤4 weeks membership, n = 250) classified as novice exercisers (exercise < 60 min/week the last 6 months) from 25 multipurpose gyms were followed for 1 year. Data were collected by an electronic survey including background and health factors, self-efficacy, social support, life satisfaction, motives, customer satisfaction, and exercise attendance, and was answered at start-up and after three (n = 224), six (n = 213), and 12 (n = 187) months. It is well established in the literature that ≥2 exercise sessions/week improve physical fitness in novice exercisers (if adhered to). Hence, we divided the participants into regular exercise attendance (≥2 sessions/week) and non-regular exercise attendance (≤1 session/week, exercise dropout, or membership dropout) in the analysis. Results: A mixed-effects logistic regression model revealed that the strongest predictor for reporting regular exercise attendance was higher levels of the motive “enjoyment” (OR = 1.84, p ≤ 0.001, 95% CI for OR = 1.35, 2.50), followed by self-efficacy “sticking to it” (OR = 1.73, p = 0.002, 95% CI for OR = 1.22, 2.46) and social support from friends and family (OR = 1.16, p ≤ 0.001, 95% CI for OR = 1.09, 1.23). Conclusion: In novice exercisers, regular exercise at three, six, and 12 months was associated with higher scores of the motive “enjoyment,” self-efficacy (“sticking to it”), and social support compared with non-regular exercise. Our results show that the majority of new fitness club members do not achieve regular exercise behavior.

• Haakstad, Lene Annette Hagen; Gjestvang, Christina; Lamerton, Tayla & Bø, Kari (2020). Urinary incontinence in a fitness club setting?is it a workout problem? International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-020-04253-0. Full text in Research Archive Show summary

  Introduction: The aims of the present study were to report longitudinal data on the prevalence of urinary incontinence (UI) in a fitness club setting and to investigate whether gym members are educated about and exercise their pelvic floor muscles. Methods: New members (125 women) from 25 fitness clubs in Oslo, Norway, filled in a 25-min online questionnaire (SurveyXact) at four time points (onset, 3, 6 and 12 months of fitness club membership). The questionnaire covered background/health information, membership dropout and exercise habits, including pelvic floor muscle training (PFMT). A modified Subjective Health Complaints Inventory (SHC Inventory) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were used to gather repeated measures of UI. Results: At onset, 3, 6 and 12 months of fitness club membership, 16.8%, 13.8%, 19.6% and 18.7% reported UI, respectively (p = 0.11). Of these, 57.1% to 76.2% reported leakage during exercise and perceived the UI to be slight. Less than 8% had received information about PFMT by the fitness club staff. Adherence to regular exercise and PFMT throughout the follow-up period (minimum two sessions/week) did not show any association with absent or present UI at 12 months (p = 0.48 and p = 0.63) and was reported by 30% and 22.2% of the participants, respectively. Conclusions: About 17% reported UI at onset of fitness club membership, with no changes in proportions throughout the first year. Adherence to regular exercise and PFMT did not show any association with absent or present UI at 12 months. Few had been taught PFMT.

• Rustaden, Anne Mette; Gjestvang, Christina; Bø, Kari; Haakstad, Lene Annette Hagen & Paulsen, Gøran (2020). Similar Energy Expenditure During BodyPump and Heavy Load Resistance Exercise in Overweight Women. Frontiers in Physiology. 11. doi: 10.3389/fphys.2020.00570. Full text in Research Archive Show summary

  Purpose: High-repetition, low-load resistance exercise in group class settings has gained popularity in recent years, with BodyPump as a prime example. For individuals using exercise for body-weight management, the energy expenditure during exercise is of interest. Therefore, we herein aimed to estimate the energy expenditure during a session of BodyPump and a time-matched session of heavy load resistance training in overweight women (BMI ≥ 25.0). Methods: Eighteen women participated in the study (mean age 35.4 years ± 10.2, BMI 30.4 kg/m2 ± 4.8), 10 exercising BodyPump (50–100 repetitions each muscle group) and eight performed a heavy load session (eight repetition maximum × three sets). The energy expenditure was assessed with indirect calorimetry during the sessions and for two intervals at rest during the recovery phase: 0–20 and 120–140 min after the sessions. Results: The BodyPump group lifted significantly more loads than the heavy load group (19,485 kg ± 2258 vs 15,616 kg ± 2976, p = 0.006), while energy expenditure was similar with 302 kcal ± 67 and 289 kcal ± 69 in BodyPump and heavy load group, respectively (p = 0.69). With no group differences, the resting metabolic rate (RMR) was elevated with 15–22% 2 h after exercise. Conclusion: Overweight women achieved an energy expenditure of approximately 300 kcal (4.7 kcal per min) during a single session of BodyPump, which was similar with the women performing a single session of heavy load resistance exercise.

• Gjestvang, Christina; Abrahamsen, Frank Eirik; Stensrud, Trine & Haakstad, Lene Annette Hagen (2020). Motives and barriers to initiation and sustained exercise adherence in a fitness club setting—A one-year follow-up study. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 30(9), p. 1796–1805. doi: 10.1111/sms.13736. Full text in Research Archive Show summary

  No prospective studies have investigated motives and barriers to exercise in new untrained fitness club members. The aims of the present prospective longitudinal study were to 1) examine proportions reporting regular exercise, non‐regular exercise and exercise dropout, 2) identify motives and barriers to exercise, and 3) compare motives between regular and non‐regular exercisers the first year of fitness club membership. New members (n = 250) were followed for one year. A questionnaire including demographics, exercise frequency, motives (EMI‐2) and barriers (18 common reported barriers) was used, and 184 answered at four time‐points (onset, and after three, six and 12 months). Participants were categorized into: regular exercise: ≥two sessions/week or non‐regular exercise: ≤one session/week, exercise relapse or dropout. At three, six and 12 months, 63.4%, 59.6% and 57.2% exercised regularly, whereas 20.1%, 21.1% and 28.3%, dropped out, respectively. Throughout the follow‐up, 37% reported regular exercise. At all time‐points, motives regarding positive health and strength/endurance were rated highest on a six‐point scale. Exercise dropouts rated priority as the greatest barrier. Regular exercisers rated the motives enjoyment (such as “I enjoy the feeling of exerting myself” ) and challenge (such as “To give me goals to work towards” ) higher than non‐regular exercisers (p = ≤0.05). In conclusion, less than half exercised regularly, and most members were motivated by factors such as positive health and physical fitness the first year of fitness club membership. Higher levels of the motives enjoyment and challenge were associated with regular exercise.

• Haakstad, Lene Annette Hagen & Bø, Kari (2020). The marathon of labour—Does regular exercise training influence course of labour and mode of delivery?: Secondary analysis from a randomized controlled trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology. ISSN 0301-2115. 251, p. 8–13. doi: 10.1016/j.ejogrb.2020.05.014. Full text in Research Archive Show summary

  Objectives: Today all pregnant women are recommended to participate in moderate intensity aerobic and resistance-based physical activity/exercise ≥150 min/week. However, there are still controversies and scant knowledge on the role of regular exercise on delivery outcomes, including mode of delivery and length of active labour. In addition, nutritional counselling have often been examined together with exercise, which may independently effect the outcomes. Hence, the aims of the present study were to investigate the sole effect of supervised group exercise, including pelvic floor muscle training on course of labour and mode of delivery. Study design: A single blind, randomized controlled trial, performed in the municipality of Oslo, Norway. Out of 105 healthy, inactive nulliparous women, initially enrolled (gestation week 17.7 ± 4.2) to study the effect regular aerobic exercise (60 min 2/week) on health benefits for both mother and her baby, 90 (85.7%) completed postpartum follow-up (7.7 ± 1.7) on labour outcomes (exercise: 43 and control: 47). Data were collected via standardized interviews and birth partographs from hospital records, reported on the postpartum visit (weeks after labour 7.6 ± 1.6). The primary investigator was unaware of the original randomization at the time of the interviews. The principal analysis was done on an intention to treat basis (ITT). For the planned subgroup analyses (per protocol), acceptable intervention adherence was defined as attending ≥ 80% of the recommended exercise program (≥ 19 exercise sessions). Results: There were no differences between the exercise and control groups in induction of labour, use of analgesia, duration of active labour or prolonged labour, according to ITT. Per protocol analyses, showed a shorter duration of total active labour in the exercise group (6.8 ± 5.5 h) than the control group (9.8 ± 5.4 h), with a mean between group difference of 3.1 h (95% CI 0.31–5.9, p = 0.029). Rate of normal vaginal delivery was 85.7% among adherent participants and 62.3% in the control group (p = 0.051). Conclusions: Regular exercise during pregnancy decreased duration of total active labour and showed a trend towards more normal vaginal deliveries among participants who adhered to the prescribed program.

• Heiestad, Hege; Gjestvang, Christina & Haakstad, Lene Annette Hagen (2020). Investigating self-perceived health and quality of life: a longitudinal prospective study among beginner recreational exercisers in a fitness club setting. BMJ Open. 10(6). doi: 10.1136/bmjopen-2019-036250. Full text in Research Archive Show summary

  Objectives: This study investigated self-perception of overall health (SPH) and quality of life (QoL) at onset and after 3, 6 and 12 months of fitness club membership. Also, we compared SPH and QoL between those who reported regular use of the fitness club (≥2 exercise sessions/week the last month) with those who did not (one exercise session/week or no exercise the last month). Design: Longitudinal prospective study. Setting: 25 fitness clubs in Oslo, Norway. Participants: In total, 250 newly registered fitness club members (equal numbers of men and women, mean age=36.4±11.3 years, mean body mass index=25.7±4.4) were recruited. At onset (n=250), after 3 (n=224), 6 (n=213) and 12 months (n=187), the participants answered an electronic questionnaire, covering background variables, exercise involvement, perceived SPH and QoL. Outcome measures: SPH was measured by a single-item question, rating health status from poor to excellent on a 5-point scale. High SPH was dichotomised as excellent or good, and low SPH as moderate, fair or poor. QoL was measured on a 7-item scale, rating five statements and dichotomised according to a total max sum score of 35, with low QoL ≤25 and high QoL >25. Results: Repeated measurements did not show any changes in SPH. In QoL, we observed an improvement in QoL sum score and a significant increase in mean scores for two out of five statements at 12 months follow-up: ‘In most ways, my life is close to my ideal’ (p=0.036) and ‘If I could live my life over, I would change almost nothing’ (p<0.001). Regular use of the fitness club was associated with high SPH (OR 3.532 (95% CI 1.60–7.82), p=0.002) and high QoL (OR 1.914 (95% CI 0.95–3.86), p=0.069). The results were unchanged after adjusting for confounders. Conclusion: Regular attendance at a fitness club was associated with high SPH and high QoL at 12 months follow-up.

• Haakstad, Lene Annette Hagen; Mjønerud, Julie & Mass, Emilie (2020). MAMMA MIA! Norwegian midwives’ practices and views about gestational weight gain, physical activity and nutrition. Frontiers in Psychology. 11. doi: 10.3389/fpsyg.2020.01463. Full text in Research Archive Show summary

  Objectives: Most studies regarding prevalence of prenatal lifestyle counselling are based on patient-report of provider advice. The aim of the present study was to describe midwives’ practice and views in promoting three distinct, but importantly related lifestyle factors: gestational weight gain (GWG), regular physical activity (PA) and nutrition. Design: A cross-sectional study. Setting: Healthcare clinics in Oslo and Akershus County, Norway. Participants: Clinics that expressed interest to participate provided an email list of the midwives. Out of 107 midwives invited to participate, 65 completed the 15-minute electronic survey (SurveyXact), giving a response rate of 60.7%. Outcome measures: We developed a new questionnaire based on questions and results from similar studies, as no validated questionnaires existed when we initiated this project in 2014. The final electronic questionnaire included a mix of close-ended questions, semi close-ended questions and 11-point Likert scales, and covered demographics, personal health behaviors, counselling practice, views and self-perceived role in lifestyle counselling. Results: Mean workload in prenatal care was 78% and mean years practicing was 8.9 (± 7.5). Across all three health-topics, most (74%-95%) reported to give advice on the first meeting, with a mean frequency of 2.2 (± 1.4), 2.7 (± 1.8) and 2.7 (± 2.0) for GWG, PA and nutrition counselling, respectively. About 40% did not report advice on GWG or gave advice discordant with the IOM recommendations (2009) for at least one pre-pregnancy BMI category. GWG was rated as more unpleasant to talk about than PA (3.0±2.8 versus 1.1±2.5, p<0.001) and nutrition (3.0±2.8 versus 1.2±2.5, p = 0.002). Also, regarding the importance of giving lifestyle advice, PA (9.6±0.9 versus 8.3±2.2, p<0.001) and nutrition (9.9±0.4 versus 8.3±2.2, p<0.001) were rated as more important than advice about GWG. Postpartum, nearly 40% gave advice about PA, whereas only two (3.1%) reported to discuss weight/weight retention (p<0.001). Conclusions: While most midwives gave advice on GWG, PA and nutrition at the first meeting, and rated lifestyle counselling as an important topic, the advice on GWG were often discordant with IOM recommendations, and the topic was viewed as more unpleasant to talk about than PA and nutrition.

• Gjestvang, Christina; Stensrud, Trine; Hansen, Bjørge Hermann; Kolle, Elin & Haakstad, Lene Annette Hagen (2019). Are fitness club members likely to meet the current physical activity recommendations? Translational Sports Medicine (TSM). 3(2), p. 75–83. doi: 10.1002/tsm2.120. Full text in Research Archive
• Dalhaug, Emilie Mass & Haakstad, Lene Annette Hagen (2019). What the health? information sources and maternal lifestyle behaviors. Interactive Journal of Medical Research. 8(3). doi: 10.2196/10355. Full text in Research Archive Show summary

  Background: Regular physical activity (PA), adequate gestational weight gain (GWG), and healthy eating are important for the long-term health of both mother and baby. Hence, it is important that women receive current and updated advice on these topics and are encouraged to adopt a healthy lifestyle during pregnancy. Objective: The aim of this study was to investigate the main information sources among pregnant women regarding PA, GWG, and nutrition as well as to evaluate how these information sources may affect their health behaviors. Methods: A cross-sectional study design, comprising an electronic questionnaire, was distributed to 2 antenatal clinics, as well as pregnancy-related online chat forums and social media. The inclusion criteria were ≥18 years, ≥20 weeks gestation, and able to read and write Norwegian. In total, 150 pregnant women answered the questionnaire, which was a mix of 11-point Likert scales, close-ended questions, and semi–close-ended questions with the option to elaborate. The relationship between information sources and selected variables, including health behaviors and descriptive variables, were assessed by logistic regression, linear regression, or chi-square as appropriate (P<.05). Results: Mean age (years), gestation week, and prepregnancy body mass index (kg/m2) were 31.1 (SD 4.3), 30.6 (SD 5.9), and 24.2 (SD 4.2), respectively. More than eight out of 10 had received or retrieved information about nutrition (88.7%, 133/150) and PA (80.7%, 121/150), whereas 54.0% (81/150) reported information on GWG. When combining all 3 lifestyle factors, 38.5% had retrieved information from blogs and online forums and 26.6%, from their midwife or family physician. Women who reported the internet and media as their primary source of information on weight gain had increased odds of gaining weight below the Institute of Medicine (IOM) guidelines compared with gaining within the guidelines (odds ratio [OR] 15.5, 95% CI 1.4-167.4; P=.02). Higher compliance with nutritional guidelines was seen among those who cited the internet and media as their main source of information on nutrition (beta=.7, 95% CI 0.07-1.3; P=.03). On the other side, receiving advice from friends and family on weight gain was significantly associated with gaining weight above the IOM guidelines compared with gaining within the guidelines (OR 12.0, 95% CI 1.3-111.7; P=.03). No other associations were found between information sources and health behaviors. Conclusions: The small number of health professionals giving information and the extensive use of internet- and media-based sources emphasize the need to address the quality of internet advice and guide women toward trustworthy sources of information during pregnancy. The association between information sources and PA, GWG, and nutrition requires further research.

• Rustaden, Anne Mette; Haakstad, Lene Annette Hagen; Paulsen, Gøran & Bø, Kari (2019). Does low and heavy load resistance training affect musculoskeletal pain in overweight and obese women? Secondary analysis of a randomized controlled trial. Brazilian Journal of Physical Therapy (BJPT). ISSN 1413-3555. doi: 10.1016/j.bjpt.2019.01.005. Full text in Research Archive Show summary

  Background: Overweight and obesity are associated with musculoskeletal pain, particularly in the female population. However, regular resistance training may positively affect these complaints. Objective: The present study aimed to investigate between group differences in musculoskeletal pain in previously inactive women, allocated to three different resistance-training modalities available in health- and fitness clubs. Methods: This is secondary analysis from a single-blinded randomized controlled trial, including healthy women (aged 18–65) with a BMI (kg/m2) ≥25. The participants were allocated to 12 weeks (3 times/weekly) of either BodyPump (high-repetition low-load group session) (n = 24), heavy load resistance training with a personal trainer (n = 28), non-supervised heavy load resistance training (n = 19) or non-exercising controls (n = 21). Primary outcome was self-reported musculoskeletal pain in ten different body parts, measured with the Standardized Nordic Pain Questionnaire, at baseline and post-test. In addition, the study included sub-analyses of the participants when they were divided into high (≥28 of 36 sessions, n = 38) and low (≤27 of 36 sessions, n = 22) exercise adherence. Results: The analysis revealed no between group differences in musculoskeletal pain in any of the ten body parts. The results did not change when the participants were divided into high versus low adherence. Conclusions: Twelve weeks of BodyPump, heavy load resistance training with a personal trainer and non-supervised heavy load resistance training did not show any effect on self-reported musculoskeletal pain in overweight women.

• Haakstad, Lene Annette Hagen; Voldner, Nanna & Bø, Kari (2019). Pregnancy and advanced maternal age — The associations between regular exercise and maternal and newborn health variables. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. doi: 10.1111/aogs.13738. Full text in Research Archive Show summary

  Introduction: Despite the associations between delayed childbearing and poorer maternal and perinatal outcomes, little is known about these issues in regular exercisers and in women with healthy lifestyles. The aims of the present study were to : (a) compare lifestyle variables and exercise, pregnancy and birth outcomes in women ≥35 years and women <35 years of age, and (b) investigate the associations between regular exercise and maternal health and newborn variables in women of advanced maternal age. Material and methods: Healthy pregnant women (≥35 years, n = 104 and <35 years, n = 362) were allocated to the study from Rikshospitalet, Oslo University Hospital, Norway. The participants completed a validated self‐administered questionnaire, the Physical Activity Pregnancy Questionnaire (PAPQ) in gestational weeks 32‐36. Prepregnancy body weight (kg) was self‐reported, whereas maternal weight (kg) was measured at gestational weeks 14‐16, 22‐24, 30‐32, and 36‐38. Details of the delivery (gestational week at delivery, mode of delivery, Apgar score) and birthweight (g) were obtained from the hospital’s medical records. Results: More women <35 than ≥35 years of age reported to have exercised prepregnancy (83.7% vs 74.0%, P = 0.04) and in the 1st trimester (71.2% vs 61.5%, P = 0.05). At gestational week 36, fewer than 50% were exercising regularly, with no group differences (P = 0.74). Current alcohol use (10.5% vs 3.3%, P = 0.02) and tobacco use (5.8% vs 1.7%, P = 0.02) were higher among women ≥35 than women <35 years, whereas for healthy diet the result was reversed (<35 years 67.1% and ≥35 years 80.8%, P = 0.02). There were higher rates of post‐term birth (13.5% vs 6.4%, P = 0.02) and induction of labor (40.5% vs 27.9%, P = 0.02) in the ≥35 years group, otherwise no other differences were observed in perinatal outcomes. In women with advanced maternal age, exercising ≥2 times weekly was associated with less pelvic girdle pain (40.0% vs 61.1%, P = 0.02), lower gestational weight gain (12.7 ± 4.0 kg vs 15.5 ± 5.5 kg, P < 0.01), fewer had gestational weight gain ≥16 kg (22.0% vs 51.9%, P < 0.01) and a newborn with macrosomia (10.0% vs 37.0%, P < 0.01). The results were unchanged after adjusting for recognized confounders.

• O'Brien, Eileen C.; Segurado, Ricardo; Geraghty, Aisling A.; Alberdi, Goiuri; Rogozinska, Ewelina & Astrup, Arne [Show all 50 contributors for this article] (2019). Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis. BMJ Open. 9:e025620(8), p. 1–12. doi: 10.1136/bmjopen-2018-025620. Full text in Research Archive Show summary

  Objectives: To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment. Design: Individual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed. Data sources: Major electronic databases, from inception to February 2017. Eligibility criteria: Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary). Risk of bias: Cochrane risk of bias tool was used. Data synthesis: Principle measures of effect were OR and regression coefficient. Results: Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B −0.055; 95% CI −0.098 to −0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B −0.053; 95% CI −0.069 to −0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education. Conclusions: Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.

• Rogozińska, Ewelina; Zamora, Javier; Marlin, Nadine; Betran, Ana Pilar; Astrup, Arne & Bogaerts, Annick [Show all 27 contributors for this article] (2019). Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. BMC Pregnancy and Childbirth. 19. doi: 10.1186/s12884-019-2472-7. Full text in Research Archive Show summary

  Background:High Body Mass Index (BMI) and gestational weight gain (GWG) affect an increasing number ofpregnancies. The Institute of Medicine (IOM) has issued recommendations on the optimal GWG for womenaccording to their pre-pregnancy BMI (healthy, overweight or obese). It has been shown that pregnantwomen rarely met the recommendations; however, it is unclear by how much. Previous studies also adjustedthe analyses for various women’s characteristics making their comparison challenging.Methods:We analysed individual participant data (IPD) of healthy women with a singleton pregnancy and aBMI of 18.5 kg/m2or more from the control arms of 36 randomised trials (16 countries). Adjusted odds ratios(aOR) and 95% confidence intervals (CI) were used to describe the association between GWG outside (aboveor below) the IOM recommendations (2009) and risks of caesarean section, preterm birth, and large or smallfor gestational age (LGA or SGA) infants. The association was examined overall, within the BMI categories andby quartile of GWG departure from the IOM recommendations. We obtained aOR using mixed-effects logisticregression, accounting for the within-study clustering and a priori identified characteristics. Results:Out of 4429 women (from 33 trials) meeting the inclusion criteria, two thirds gained weight outsidethe IOM recommendations (1646 above; 1291 below). The median GWG outside the IOM recommendationswas 3.1 kg above and 2.7 kg below. In comparison to GWG within the IOM recommendations, GWG abovewas associated with increased odds of caesarean section (aOR 1.50; 95%CI 1.25, 1.80), LGA (2.00; 1.58, 2.54),and reduced odds of SGA (0.66; 0.50, 0.87); no significant effect on preterm birth was detected. Therelationship between GWG below the IOM recommendation and caesarean section or LGA was inconclusive;however, the odds of preterm birth (1.94; 1.31, 2.28) and SGA (1.52; 1.18, 1.96) were increased.Conclusions:Consistently with previous findings, adherence tothe IOM recommendations seem to help achieve betterpregnancy outcomes. Nevertheless, even in the context of clinical trials, women find it difficult to adhere to them. Furtherresearch should focus on identifying ways of achieving a healthier GWG as defined by the IOM recommendations.

• Gjestvang, Christina; Stensrud, Trine & Haakstad, Lene Annette Hagen (2019). Are changes in physical fitness, body composition and weight associated with exercise attendance and dropout among fitness club members? Longitudinal prospective study. BMJ Open. 9(4). doi: 10.1136/bmjopen-2018-027987. Full text in Research Archive Show summary

  Objectives The primary aim of the present study was to investigate if changes in physical fitness, body composition and weight are associated with exercise attendance and dropout among fitness club members. Secondary, we wanted to identify motives for fitness club membership and exercise. Setting New members at 25 fitness clubs in Oslo, Norway. Participants In total, 125 new fitness club members were recruited. Eligible criteria were <4 weeks of membership, untrained (exercising <60min once a week) and ≥18 years. At inclusion, and after 3 (n=87) and 12 months (n=64), participants answered a questionnaire (including motives for membership and exercise, and attendance) and performed measurements of maximum oxygen uptake (VO2max), one repetition maximum (bench press and leg press), body composition and weight. In total, 56 participants underwent measurements at all time points. Based on self-reported attendance, participants were divided into three groups: regular attendance (≥2 sessions per week), low attendance (<2 sessions per week) and exercise dropout (no sessions the last month). Results At 3months, regular attendees had significantly higher VO2max than dropout (6.54mL/min/kg, 95%CI 2.00 to 11.07, p=0.003). At 12 months, a difference in VO2max of 5.32mL/min/kg (95%CI −0.08 to 10.72, p=0.054) was found between regular attendees and dropout, and between regular and low exercise attendance (6.17mL/ min/kg, 95%CI 0.19 to 12.15, p=0.042). VO2max was the only factor showing an association with attendance. No differences or associations were observed in maximal muscle strength or body composition between the three groups. Primary motive for fitness club membership and exercise was increase in physical fitness (92.8%). Conclusions VO2max was the only factor associated with exercise attendance at two time points. Increased physical fitness was primary motive for fitness club membership and exercise.

• Bø, Kari; Artal, Raul; Barakat, Ruben; Brown, Wendy J.; Davies, Gregory A.L. & Dooley, Michael [Show all 16 contributors for this article] (2018). Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2018-099351. Full text in Research Archive
• Haakstad, Lene Annette Hagen; Dalhaug, Emilie Mass & Torstveit, Monica Klungland (2018). Fysisk aktivitet i og etter svangerskap. In Torstveit, Monica Klungland; Lohne-Seiler, Hilde; Berntsen, Sveinung & Anderssen, Sigmund Alfred (Ed.), Fysisk aktivitet og helse: Fra begrepsforståelse til implementering av kunnskap. Cappelen Damm Akademisk. ISSN 9788202568313. p. 269–294. Full text in Research Archive
• Haakstad, Lene Annette Hagen; Vistad, Ingvild; Sagedal, Linda Reme; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2018). How does a lifestyle intervention during pregnancy influence perceived barriers to leisure-time physical activity? The Norwegian fit for delivery study, a randomized controlled trial. BMC Pregnancy and Childbirth. 18(127). doi: 10.1186/s12884-018-1771-8. Full text in Research Archive Show summary

  Background: To develop effective health promotional and preventive prenatal programs, it is important to understand perceived barriers to leisure-time physical activity during pregnancy, including exercise and sport participation. The aims of the present study was 1) to assess the effect of prenatal lifestyle intervention on the perceived barrier to leisure-time physical activity during pregnancy and the first year after delivery and 2) identify the most important perceived barriers to leisure-time physical activity at multiple time points during and after pregnancy. Methods: This secondary analysis was part of the Norwegian Fit for Delivery study, a combined lifestyle intervention evaluated in a blinded, randomized controlled trial. Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥ 18 years and body mass index ≥19 kg/m2 were recruited via healthcare clinics in southern Norway, including urban and rural settings. Participants were randomized to either twice-weekly supervised exercise sessions and nutritional counselling (n = 303) or standard prenatal care (n = 303). The principal analysis was based on the participants who completed the standardized questionnaire assessing their perceived barriers to leisure-time physical activity at inclusion (gestational week 16, n = 589) and following intervention (gestational week 36, n = 509), as well as six months (n = 470) and 12 months (n = 424) postpartum. Results: Following intervention (gestation week 35.4 ± 1.0), a significant between-group difference in perceived barriers to leisure-time physical activity was found with respect to time constraints: “... I do not have the time” (intervention: 22 vs. control: 38, p = 0.030), mother-child safety concerns: “... afraid to harm the baby” (intervention: 8 vs. control: 25, p = 0.002) and self-efficacy: “... I do not believe/think that I can do it” (intervention: 3 vs. control: 10, p = 0.050). No positive effect was seen at postpartum follow-up. Intrapersonal factors (lack of time, energy and interest) were the most frequently perceived barriers, and consistent over time among all participants. Conclusion: The intervention had effect on intrapersonal perceived barriers in pregnancy, but not in the postpartum period. Perceived barriers to leisure-time physical activity were similar from early pregnancy to 12 months postpartum.

• Sanda, Birgitte; Vistad, Ingvild; Sagedal, Linda Reme; Haakstad, Lene Annette Hagen; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2018). What is the effect of physical activity on duration and mode of delivery? Secondary analysis from the Norwegian Fit for Delivery trial. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 97(7), p. 861–871. doi: 10.1111/aogs.13351. Full text in Research Archive Show summary

  Introduction: The beneficial effects of physical activity during pregnancy for the mother and offspring have been reported by several studies but there are conflicting results concerning the possible effect of physical activity on the course of labor and risk of cesarean delivery. This study presents secondary analyses from the Norwegian Fit for Delivery randomized controlled trial, aiming at studying the effect of a lifestyle intervention including group exercise classes, as well as the possible influence of physical activity level in late pregnancy, on labor outcomes. Material and methods: Healthy nulliparous women with singleton pregnancy were randomized to an intervention group, n = 303 (dietary counseling and twice‐weekly exercise classes) or a control group, n = 303 (standard care). The participants were analyzed both by randomization and as a cohort comparing women with lowest (quartile 1, 0 metabolic equivalent of task‐hours moderate‐to‐vigorous physical activity/week) (n = 140) vs. highest (quartile 4, ≥16 metabolic equivalent of task‐hours moderate‐to‐vigorous physical activity/week) (n = 131) physical activity level in late pregnancy, assessed with the International Physical Activity Questionnaire. Result: The intervention group had a longer first stage of labor compared with the control group (293 ± 202 min vs. 257 ± 181 min, p = 0.030). No differences between the randomization groups were seen for time spent in second stage of labor, prolonged labor or mode of delivery. In the total sample, women with the highest physical activity level had lower odds ratio (OR) of acute cesarean delivery (OR 0.33, 95% CI 0.11–0.97, p = 0.044) than did those with the lowest physical activity‐level. Conclusion: A significantly longer first stage of labor was observed in the intervention group than in the control group. A high physical activity level in late pregnancy was associated with lower odds of acute cesarean delivery compared with a low physical activity level.

• Sanda, Birgitte; Vistad, Ingvild; Haakstad, Lene Annette Hagen; Berntsen, Sveinung; Sagedal, Linda Reme & Lohne-Seiler, Hilde [Show all 7 contributors for this article] (2017). Reliability and concurrent validity of the International Physical Activity Questionnaire short form among pregnant women. BMC sports science, medicine and rehabilitation. 9:7(7), p. 1–10. doi: 10.1186/s13102-017-0070-4. Full text in Research Archive Show summary

  Background: The International Physical Activity Questionnaire short-form (IPAQ-SF) is frequently used to assess physical activity (PA) level in the general adult population including pregnant women. However, the reliability and validity of the questionnaire in pregnancy is unknown. Therefore, the aims of the present study were to investigate test-retest reliability and concurrent validity of IPAQ-SF among pregnant women, and whether PA is reported differently among those who fulfill (active) vs. do not fulfill (inactive) recommendations of ≥150 min of weekly moderate intensity PA in pregnancy. Method: Test-retest reliability was examined by answering IPAQ-SF twice, two weeks apart (n = 88). To assess validity, IPAQ-SF was compared to the physical activity monitor SenseWear Armband® (SWA) (n = 64). The participants wore SWA for 8 consecutive days before answering IPAQ-SF. PA level was reported as time spent in moderate-, vigorous- and moderate-to-vigorous intensity PA (MPA, VPA and MVPA) corresponding to the cut-off points 3–6, >6 and >3 Metabolic Equivalents (METs), respectively. Results: Test-retest intraclass-correlation of MPA, VPA and MVPA ranged from 0.81-0.84 (95% Confidence Intervals: 0.69,0.90). Comparing time spent performing PA at various intensities; the mean differences and limits of agreement (±1.96 Standard Deviation) from Bland-Altman plots were−84 ± 402 min/week for MPA,−85 ± 452 min/week for MVPA and 26 ± 78 min/week for VPA, illustrating that the total group under-reported MPA by 72% and MVPA by 52%, while VPA was over-reported by 1400%. For the inactive group corresponding numbers were 44 ± 327 min/week for MPA, 52 ± 355 min/week for MVPA and 16 ± 33 min/week for VPA, illustrating that the inactive group over-reported MPA by 13% and MVPA by 49%, while VPA was not detected by SWA, but participants reported 16 min of VPA/week. In contrast, corresponding numbers for the active group were−197 ± 326 min/week for MPA,−205 ± 396 min/week for MVPA and 35 ± 85 min/week for VPA, illustrating that the active group under-reported MPA by 81% and MVPA by 60%, while they over-reported VPA by 975%. Conclusion: IPAQ-SF had good test-retest reliability, but low to fair concurrent validity for MPA, VPA and MVPA compared to an objective criterion measure among pregnant women. Further, women fulfilling PA guidelines in pregnancy under-reported, while inactive women over-reported PA level.

• Rustaden, Anne Mette; Gjestvang, Christina; Bø, Kari; Haakstad, Lene Annette Hagen & Paulsen, Gøran (2017). BodyPump versus traditional heavy load resistance training on changes in resting metabolic rate in overweight untrained women. Journal of Sports Medicine and Physical Fitness. ISSN 0022-4707. 58(9), p. 1304–1311. doi: 10.23736/S0022-4707.17.07613-7. Full text in Research Archive Show summary

  BACKGROUND: Moderate to heavy load resistance training (RT) is advocated for overweight and obese individuals. One of the beneficial effects of RT is increased resting metabolic rate (RMR), which typically makes up the majority of the total daily energy expenditure. It is, however, unclear if low to moderate load RT affects RMR. Hence, the present study aimed to examine the effects of twelve weeks of BodyPump, on RMR in previous untrained women with BMI ≥25.0, and to compare the results with individual heavy load RT. METHODS: Eighteen overweight women participated in the study (mean age 35.4 years ±10.2, BMI 30.4 kg/m2 ±4.8), ten allocated to BodyPump (high-repetition, low to moderate load RT) and eight to heavy load RT (linear periodization with 3-6, 8-10 and 13-15 repetitions, 2-4 series) Both groups exercised 3 times/week for 12 weeks. RMR was assessed with indirect calorimetry at baseline, midway (after six weeks) and at post-test. RESULTS: Adherence to exercise were 62% and 93% in the BodyPump and heavy load RT group, respectively (p=0.003). RMR in the BodyPump increased with 8.5% (±10.8) from baseline to post-test (p=0.041). The heavy load RT group increased 10.5% (±10.4) from baseline to post-test (p=0.025). There was no significant group difference in RMR from baseline to post-test (p=0.593). CONCLUSIONS: BodyPump and heavy load RT resulted in a similar increase in RMR after 12 weeks of training. Assuming that elevation of RMR is important for combating overweight and obesity, BodyPump appears to have the same potential as heavy load RT.

• Sanda, Birgitte; Vistad, Ingvild; Sagedal, Linda Reme; Haakstad, Lene Annette Hagen; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2017). Effect of a prenatal lifestyle intervention on physical activity level in late pregnancy and the first year postpartum. PLOS ONE. 12(11). doi: 10.1371/journal.pone.0188102. Full text in Research Archive Show summary

  Background: Despite documented health benefits for mother and baby, physical activity (PA)-level tends to decline in pregnancy. Overweight/obese and physically inactive women are two selected groups at increased risk of pregnancy complications. Thus, efficient strategies to maintain or increase PA-level in pregnancy and the postpartum period, especially among these women, are warranted. This secondary analysis examined the effect of a prenatal lifestyle-intervention on PA-level in late pregnancy and the first year postpartum, with subanalysis on initially physically active versus inactive and normal-weight versus overweight/obese women. Method: The Norwegian Fit for Delivery (NFFD) randomized controlled trial included healthy primiparous women with singleton pregnancies and body mass index (BMI) ≥19 kg/m2 assigned to an intervention group, n = 303 (twice weekly group-exercises and dietary counseling) or a control group, n = 303 (standard prenatal care). The International Physical Activity Questionnaire short-form was used to assess PA-levels at inclusion (mean gestational week (GW) 16), GW 36, and six and 12 months postpartum. Results: At GW 36, a positive intervention-effect with a significant between-group difference in total PA-level compared to time of inclusion was found for the total group (530 MET-min/week, p = 0.001) and the subgroups of normal-weight (533 MET-min/week, p = 0.003) and initially active women (717 MET-min/week, p<0.001). Intervention-effect was dependent on exercise-adherence among overweight/obese and inactive women. Compared to time of inclusion, the intervention groups maintained total PA-level at GW 36, while total PA-level decreased in the control groups. The PA-levels increased postpartum, but with no significant differences between the randomization groups. Conclusion: The NFFD prenatal combined lifestyle intervention had a significant effect on TPA-level in late pregnancy among women entering pregnancy normal-weight or physically active, thereby preventing the downward trend typically seen during pregnancy. Intervention-effect among overweight/obese and physically inactive women was, however, dependent on exercise-adherence. Long-term intervention-effect was not observed in the postpartum period.

• Haakstad, Lene Annette Hagen; Sanda, Birgitte; Vistad, Ingvild; Sagedal, Linda Reme; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2017). Evaluation of implementing a community-based exercise intervention during pregnancy. Midwifery. ISSN 0266-6138. 46, p. 45–51. doi: 10.1016/j.midw.2017.01.010. Full text in Research Archive Show summary

  Objective: To evaluate the implementation of a community-based exercise intervention (the Norwegian Fit for Delivery study) during pregnancy. Design: Descriptive, explorative. Setting: Healthcare clinics in southern Norway, including urban and rural settings. Participants: Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥18 years and body mass index ≥19 kg/m2. Methods: Women were randomized to either twice-weekly supervised exercise sessions combined with nutritional counselling (n=303) or standard prenatal care (n=303). The exercise program was based on ACOG guidelines, with the same low-impact workout for all participants, including 60 minutes of moderate-intensity cardiovascular and strength training, performed in a group of maximum 25 women. The aim of the present secondary analysis was to report on the intervention group's experience with participating in an exercise program in the 2nd and 3rd trimester, including satisfaction, adherence, adverse effects, as well as motives and barriers for attending the classes. Results: Of 303 women randomized to exercise, 274 (92.6%) attended at least one class and 187 (68.2%) completed a questionnaire after completion of the trial assessing their experience with the group sessions. For 71.7%, self-reported exercise dosage was ≥75% of the twice-weekly exercise program and more than seven out of 10 reported to be satisfied or very satisfied with the exercise sessions. A total of 95.1% answered that they would recommend this type of exercise for pregnant friends. Reported motives and health benefits included better aerobic capacity, increased energy levels and exercise enjoyment. No harmful effects of the exercise intervention were noted in the mother or the fetus. Key conclusions and implications for practice: Results demonstrated that regular group exercise was feasible, safe, and well tolerated in pregnancy, which may encourage incorporating this program into a routine health care setting.

• Bø, Kari; Artal, Raul; Barakat, Ruben; Brown, Wendy J.; Davies, Gregory A.L. & Dooley, Michael [Show all 16 contributors for this article] (2017). Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC expert group meeting, Lausanne. Part 4—Recommendations for future research. British Journal of Sports Medicine. ISSN 0306-3674. 51(24), p. 1724–1726. doi: 10.1136/bjsports-2017-098387. Full text in Research Archive Show summary

  This is Part 4 in the series of reviews from the International Olympic Committee (IOC) expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related complaints experienced by athletes;1 Part 2 addressed maternal and foetal perinatal outcomes;2 Part 3 reviewed the implications of pregnancy and childbirth on return to exercise and on common illnesses and complaints in the postpartum period.3 Parts 1–3 are all open access papers. In Part 4, we recommend future research based on Parts 1–3. The systematic reviews, on which the previous Parts were based, revealed many gaps in knowledge relating to strenuous exercise during pregnancy and in the postpartum period, in both regular recreational exercisers and elite athletes. Important research questions are listed below, in relation to the foci of Parts 1–3, under the following headings: exercise during pregnancy, exercise related to birth outcomes and exercise in the postpartum period. References to existing research in the respective areas are listed in the previously Parts 1–3 and are not repeated here.

• Rustaden, Anne Mette; Haakstad, Lene Annette Hagen; Paulsen, Gøran & Bø, Kari (2017). Effects of BodyPump and resistance training with and without a personal trainer on muscle strength and body composition in overweight and obese women-A randomised controlled trial. Obesity Research and Clinical Practice. ISSN 1871-403X. 11(6), p. 728–739. doi: 10.1016/j.orcp.2017.03.003. Full text in Research Archive Show summary

  Objectives: Overweight and obese individuals are recommended to perform regular resistance training, and the health- and fitness industry offer several exercise programs with purpose to improve muscle strength and body composition. This randomised controlled trial aimed to compare 12 weeks (45–60 min, 3 sessions/weeks) of popular exercise programs, available at health- and fitness centers worldwide. Methods: Previous untrained women with BMI ≥ 25 were allocated to either BodyPump (a high-repetition group session) (n = 25), individual resistance training with a personal trainer (n = 25), non-supervised individual resistance training (n = 21) and non-exercising control group (n = 21). Primary outcome was one repetition maximum (1RM) in squat and bench press, and secondary outcome was body composition (Inbody720). Results: The BodyPump group did not improve muscle strength, compared to any of the other groups. In 1RM squat, the personal trainer group increased 17% (95% CI 5.1–23.0), 20% (95% CI 7.5–24.8) and 30% (95% CI 15.8–33.0 kg) more than the non-supervised group, BodyPump and controls, respectively. In bench press the personal trainer group increased 10% (95% CI 1.5–7.2) and 16% (95% CI 3.5–9.3 kg) more compared to BodyPump and controls. No difference was found compared to the non-supervised group in bench press. There were no between-group differences in body composition. Conclusion: Twelve weeks of BodyPump did not improve muscle strength in overweight women, but a personal trainer amplified the effects of individual resistance training on maximal strength in squat. None of the intervention groups showed effect in body composition.

• Rogozińska, Ewelina; Marlin, Nadine; Jackson, Louise; Rayanagoudar, Girish; Ruifrok, Anneloes E. & Dodds, Julie [Show all 57 contributors for this article] (2017). Effects of antenatal diet and physical activity on maternal and fetal outcomes: Individual patient data meta-analysis and health economic evaluation. Health Technology Assessment. ISSN 1366-5278. 21:41, p. 1–194. doi: 10.3310/hta21410. Full text in Research Archive Show summary

  Abstract Background Diet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes. Objectives To assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions. Data sources MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search). Review methods Researchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions. Results Diet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI –0.92 to –0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate –0.10 kg, 95% CI –0.14 to –0.06 kg) and multiparity (summary estimate –0.73 kg, 95% CI –1.24 to –0.23 kg). Limitations The findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies. Conclusion Diet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes. Future work The differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation. Study registration This study is registered as PROSPERO CRD42013003804. Funding The National Institute for Health Research Health Technology Assessment programme.

• Bø, Kari; Artal, Raul; Barakat, Ruben; Brown, Wendy J.; Davies, Gregory A.L. & Dooley, Michael [Show all 16 contributors for this article] (2017). Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3 - exercise in the postpartum period. British Journal of Sports Medicine. ISSN 0306-3674. 51(21), p. 1516–1525. doi: 10.1136/bjsports-2017-097964. Full text in Research Archive
• Gjestvang, Christina; Stensrud, Trine & Haakstad, Lene Annette Hagen (2017). How is rating of perceived capacity related to VO2max and what is VO2max at onset of training? BMJ Open sport & exercise medicine. 3(1). doi: 10.1136/bmjsem-2017-000232. Full text in Research Archive Show summary

  Objective: To evaluate how rating of perceived capacity (RPC) is related to maximal oxygen uptake (VO2max) and examine VO2max at onset of training in healthy adults. Methods: In total, 125 newly registered fitness centre members, equally men and women, answered the RPC scale and performed a treadmill test for measurement of VO2max. Eligible criteria were <4 weeks of fitness centre membership, physically inactive, ≥18 years and not pregnant. The RPC is a one-page scale (1–20) based on metabolic equivalent tasks, where the individual chooses the most strenuous activity that can be sustained for at least 30 min. Results: The Bland-Altman plot demonstrated a tendency of overestimation, meaning that the participants ranked their own aerobic capacity 17.5% higher than objectively measured values of VO2max. The mean difference between the two methods were +4.92±1.96 and +6.35±1.96 mL/min/kg VO2 in men and women, respectively. The Pearson correlation coefficient was moderate, with r=0.426 (p<0.01). A linear regression analysis showed that both age and VO2max were significant predictors of RPC (p<0.01). Measured VO2max at onset of fitness centre membership was in men aged 38.7±11.7 and women aged 34.7±9.9, 40.5±7.2 and 35.0±6.0 mL/min/kg, respectively. Estimated VO2max from the RPC scale was 45.7±9.8 and 41.4±10.1 mL/min/kg in men and women, respectively. Conclusions: The RPC seems less accurate at the individual level and may overestimate VO2max. Still, it may be considered useful in large-scale studies.

• Bø, Kari; Artal, Raul; Barakat, Ruben; Brown, Wendy J.; Davies, Gregory A.L. & Dooley, Michael [Show all 16 contributors for this article] (2016). Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1—exercise in women planning pregnancy and those who are pregnant. British Journal of Sports Medicine. ISSN 0306-3674. 50(10), p. 571–589. doi: 10.1136/bjsports-2016-096218. Full text in Research Archive
• Haakstad, Lene Annette Hagen; Edvardsen, Elisabeth & Bø, Kari (2016). Effect of regular exercise on blood pressure in normotensive pregnant women. A randomized controlled trial. Hypertension in Pregnancy. ISSN 1064-1955. 35(2), p. 170–180. doi: 10.3109/10641955.2015.1122036. Full text in Research Archive Show summary

  Objective: To evaluate the effect of regular exercise on maternal arterial blood pressure (BP) at rest and during uphill walking, in healthy former inactive pregnant women. Methods: A single-blind, single-center, randomized controlled trial including 61 out of 105 healthy, inactive nulliparous pregnant women, initially enrolled in a controlled trial studying the effect of 12 weeks of aerobic exercise (60 min 2/week) on maternal weight gain. Primary outcome was the mean adjusted difference in change in resting systolic and diastolic BP from baseline to after intervention. Secondary outcome was the mean adjusted difference in change in systolic BP during uphill treadmill walking at critical power. Measurements were performed prior to the intervention (gestation week 17.6 ± 4.2) and after the intervention (gestation week 36.5 ± 0.9). Results: At baseline, resting systolic and diastolic BP was 115/66 ± 12/7 and 115/67 ± 10/9 mmHg in the exercise (n = 35) and control group (n = 26), respectively. After the intervention, resting systolic BP was 112 ± 8 mmHg in the exercise group and 119 ± 14 mmHg in the control group, giving a between-group difference of 7.5 mmHg (95% CI 1.5 to 12.6, p = 0.013). Diastolic BP was 71 ± 9 and 76 ± 8 mmHg, with a between-group difference of 3.9 mmHg (95% CI −0.07 to 7.8, p = 0.054). During uphill treadmill walking at critical power, the between-group difference in systolic and diastolic BP was 5.9 mmHg (95% CI −4.4 to 16.1, p = 0.254) and 5.5 mmHg (95% CI –0.2 to 11.1, p = 0.059), respectively. Conclusions: Aerobic exercise reduced resting systolic BP in healthy former inactive pregnant women.

• Rogozińska, Ewelina; D'Amico, Maria I.; Khan, Khalid Saeed; Cecatti, Jose Guilherme; Teede, Helena & Yeo, SeonAe [Show all 30 contributors for this article] (2016). Development of composite outcomes for individual patient data (IPD) meta-analysis on the effects of diet and lifestyle in pregnancy: A Delphi survey. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 123(2), p. 190–198. doi: 10.1111/1471-0528.13764. Full text in Research Archive
• Flynn, Angela C.; Dalrymple, Kathryn; Barr, Suzanne; Poston, Lucilla; Goff, Louise M. & Rogozińska, Ewelina [Show all 35 contributors for this article] (2016). Dietary interventions in overweight and obese pregnant women: A systematic review of the content, delivery, and outcomes of randomized controlled trials. Nutrition reviews. ISSN 0029-6643. 74(5), p. 312–328. doi: 10.1093/nutrit/nuw005. Full text in Research Archive
• Haakstad, Lene Annette Hagen; Torset, Beate S. & Bø, Kari (2016). What is the effect of regular group exercise on maternal psychological outcomes and common pregnancy complaints? An assessor blinded RCT. Midwifery. ISSN 0266-6138. 32, p. 81–86. doi: 10.1016/j.midw.2015.10.008. Full text in Research Archive Show summary

  Objective: to examine the effects of supervised group exercise on maternal psychological outcomes and commonly reported pregnancy complaints. Design: an observer-blinded randomized controlled trial. Setting: Norwegian School of Sport Sciences, Oslo, Norway. Participants: 105 sedentary, nulliparous pregnant women, mean age 30.7(±4.0) years, pre-pregnancy BMI 23.8 (±4.3), were assigned to either exercise (n=52) or control group (n= 53) at mean gestation week 17.7 (±4.2). Intervention: the exercise intervention followed ACOG guidelines and included a 60 minutes general fitness class, with 40 minutes of endurance training/aerobic and 20 minutes of strength training and stretching/relaxation, performed at least twice per week for a minimum of 12 weeks. Measurements: outcome measures were assessed through standardized interviews pre- and post-intervention (gestation week 36.6, ±0.9), and included psychological variables related to quality of life, well-being, body image and pregnancy depression, as well as assessment of 13 commonly reported pregnancy complaints. Findings: post-intervention, using intention to treat (ITT) analysis, women randomized to exercise rated their health significantly better compared to women in the control group (p=0.02) and reported less fatigue related to everyday activities (p=0.04). Women with complete exercise adherence (≥24 sessions) had significantly better scores on measurements of feelings related to sadness, hopelessness and anxiety (p<0.01), compared to the control group. Contradictory, the control group reported higher life enjoyment (p<0.01). There were no significant group differences in body-image or pregnancy depression. With respect to analysing pregnancy complaints according to ITT, no differences between the groups were found. A comparison of the women who attended ≥19 (80%, n=21) or ≥24 (100%, n=14) exercise sessions with the control-participants, showed that fewer women in the exercise group reported nausea/vomiting and numbness/poor circulation in legs. Key conclusion and implication for practise: participation in regular group exercise during pregnancy contributed to improvements in some variables related to maternal well-being and quality of life. Women with high exercise adherence had significantly better results on several health variables reaping the highest benefits. A qualitative study exploring the barriers of women in achieving recommended amount of activity may be necessary to understand this population and developing better clinical practice educational tools.

• Heiestad, Hege; Rustaden, Anne Mette; Bø, Kari & Haakstad, Lene Annette Hagen (2016). Effect of Regular Resistance Training on Motivation, Self-Perceived Health, and Quality of Life in Previously Inactive Overweight Women: A Randomized, Controlled Trial. BioMed Research International. ISSN 2314-6133. 2016. doi: 10.1155/2016/3815976. Full text in Research Archive Show summary

  Objectives. The aim was to investigate the effects of three different types of resistance training implementation. Design. Randomized controlled trial. Methods. Inactive, overweight women (), mean BMI  kg/m2, mean age years, were randomized to one of the following groups: A (BodyPump group training), B (individual follow-up by a personal trainer), C (nonsupervised exercise), or D (controls). The intervention included 12 weeks of 45–60 minutes’ full-body resistance training three sessions per week. The outcomes in this paper are all secondary outcome measures: exercise motivation, self-perceived health, and quality of life. Results. Adherence averaged of 36 prescribed sessions. After the intervention period, all three training groups (A–C) had better scores on exercise motivation (, , ) compared to the control group (D) () (). Groups B and C scored better on self-perceived health (, ), compared to group D () (). For quality of life measurement, there was no statistically significant difference between either intervention groups or the control. Conclusions. Resistance training contributed to higher scores in important variables related to exercise motivation and self-perceived health. Low adherence showed that it was difficult to motivate previously inactive, overweight women to participate in regular strength training.

• Bø, Kari; Artal, Raul; Barakat, Ruben; Brown, Wendy J.; Dooley, Michael & Evenson, Kelly R. [Show all 15 contributors for this article] (2016). Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2 - The effect of exercise on the fetus, labour and birth. British Journal of Sports Medicine. ISSN 0306-3674. 50(21), p. 1297–1305. doi: 10.1136/bjsports-2016-096810. Full text in Research Archive Show summary

  This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes.

• Haakstad, Lene Annette Hagen & Bø, Kari (2015). Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: A randomized controlled trial. Journal of Rehabilitation Medicine. ISSN 1650-1977. 47(3), p. 229–234. doi: 10.2340/16501977-1906. Full text in Research Archive Show summary

  Objective: To determine whether participation in a group fitness class for pregnant women can prevent and treat pelvic girdle pain and low back pain. Design: An observer-blinded randomized controlled trial. Participants: A total of 105 sedentary, nulliparous pregnant women, mean age 30.7 years (standard deviation (SD) 4.0), mean pre-pregnancy body mass index 23.8 (SD 4.3), were assigned to either control or exercise groups at mean gestation week 17.7 (SD 4.2). Methods: The exercise intervention followed the guidelines of American College of Obstetricians and Gynecologists and included a 60 min general fitness class, with 40 min of endurance training and 20 min of strength training including stretching, performed at least twice per week for a minimum of 12 weeks. Outcome measures were number of women reporting pelvic girdle pain and low back pain after the intervention (mean pregnancy week 36.6 (SD 0.9)) and postpartum (mean 7.7 (SD 1.7)). Results: There were no statistically significant differences between the exercisers and controls in numbers reporting the 2 conditions after the intervention (pelvic girdle pain: odds ratio (OR) = 1.34, CI = 0.56–3.20 or low back pain: OR = 1.10, CI = 0.47–2.60) or postpartum (pelvic girdle pain: OR = 0.38, CI = 0.13–1.10 or low back pain: OR = 1.45, CI = 0.54–3.94). A comparison of the women who had attended at least 80% of the weekly exercise classes with the control participants did not change the results. Conclusion: Participation in regular group fitness classes during pregnancy did not alter the proportion of women reporting pelvic girdle pain or low back pain during pregnancy or after childbirth.

• Haakstad, Lene Annette Hagen; Voldner, Nanna & Bø, Kari (2015). Attitudes and awareness towards weight gain among normal weight and overweight pregnant women. Journal of Maternal-Fetal & Neonatal Medicine. ISSN 1476-7058. 28(13), p. 1569–1574. doi: 10.3109/14767058.2014.961005. Full text in Research Archive Show summary

  Objectives: 1) evaluate the proportion who correctly classify- or misclassify maternal weight gain; 2) investigate weight gain attitudes, and 3) compare weight gain attitudes with weight gain recommendations by the Institute of Medicine (IOM), as well as background and lifestyle factors. Methods: This is secondary analysis of cohort data collected as part of a prospective study of determinants of macrosomic infants in Norway (the STORKproject). The participants (n=467) answered a self-administered questionnaire, including report on maternal weight gain and attitudes towards weight gain, in mean gestation week 36.4 (SD=1.7). The women were also weighted (kg) at the hospital using a digital beam scale. Results: A significant discrepancy was found between self-reported and measured maternal weight gain. About 76% reported to be satisfied with maternal weight gain while 24% were dissatisfied. Women reporting to be dissatisfied were significantly more likely to be sedentary, sick-listed, reporting poor eating habits and to be multiparous. Conclusions: Most women reported to be satisfied with their maternal weight gain, but had gained excessively according to recommended weight gain ranges issued by IOM. Pregnant women may need targeted advice on their specific weight gain and impact of increased weight gain on health variables for mother and child.

• Ruifrok, Anneloes E.; Rogozinska, Ewelina; Poppel, Mireille N.M. Van; Rayanagoudar, Girish; Kerry, Sally & Groot, Christianne J.M. De [Show all 21 contributors for this article] (2014). Study protocol: Differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes-individual patient data (IPD) meta-analysis and health economic evaluation. Systematic Reviews. 3(1). doi: 10.1186/2046-4053-3-131. Full text in Research Archive
• Halvorsen, Silje; Haakstad, Lene Annette Hagen; Edvardsen, Elisabeth & Bø, Kari (2013). Effect of aerobic dance on cardiorespiratory fitness in pregnant women: A randomised controlled trial. Physiotherapy. ISSN 0031-9406. 99(1), p. 42–48. doi: 10.1016/j.physio.2011.11.002. Full text in Research Archive Show summary

  Objective: To evaluate the effectiveness of aerobic dance on cardiorespiratory fitness in pregnant women. Design: Randomised controlled trial. Participants: Sixty-two primiparous women with a mean age of 30.6 [standard deviation (SD) 3.7] years randomised to exercise (n = 34) and (n = 28) control groups. Intervention: Two aerobic dance classes per week and 30 minutes of daily self-imposed physical activity for 12 weeks. Main outcome measure: Cardiorespiratory fitness, assessed using a submaximal treadmill test to establish oxygen uptake (VO2) (ml/kg/minute) at three different levels of blood lactate. Levels 1, 2 and 3 were calculated and defined as 0.5, 1.0 and 1.5 mmol/l above resting blood lactate level, respectively. Results: The women in the exercise group attended a mean of 20 (SD 12) out of 24 aerobic dance classes. Both groups had a small significant decrease in VO2 between baseline and post-intervention: the exercise group decreased from 25.8 (SD 3.3) to 24.5 (SD 3.8) ml/kg/minute and the control group decreased from 25.8 (SD 3.1) to 24.5 (SD 2.5) ml/kg/minute at Level 3 (anaerobic threshold) (mean difference in change at Level 3 = 0.1, 95% confidence interval −1.4 to 1.7; P = 0.89). There were no differences in change between the groups at any level. Conclusion: A 12-week aerobic dance programme had no effect on cardiorespiratory fitness in pregnant women.

• Haakstad, Lene Annette Hagen; Voldner, Nanna & Bø, Kari (2013). Stages of Change Model for Participation in Physical Activity during Pregnancy. Journal of Pregnancy. ISSN 2090-2727. doi: 10.1155/2013/193170. Full text in Research Archive Show summary

  Background: The transtheoretical model (TTM) has been successful in promoting health behavioral change in the general population. However, there is a scant knowledge about physical activity in relation to the TTM during pregnancy. Hence, the aims of the present study were (1) to assess readiness to become or stay physically active according to the TTM and (2) to compare background and health variables across the TTM. Methods: Healthy pregnant women (n=467) were allocated to the study from Oslo University Hospital, Norway. The participants filled in a validated self-administered questionnaire, physical activity pregnancy questionnaire (PAPQ) in gestation, weeks 32–36. The questionnaire contained 53 questions with one particular question addressing the TTM and the five stages: (1) precontemplation stage, (2) contemplation stage, (3) preparation stage, (4) action stage, and (5) maintenance stage. Results: More than half of the participants (53%) were involved in regular exercise (stages 4-5); however, only six specified that they had recently started an exercise program (stage 4). About 33% reported engaging in some physical activity, but not regularly (stage 3). The results showed that receiving advice from health professionals to exercise during pregnancy increased the likeliness of being in stages 4-5, while higher age, multiparity, pregravid overweight, unhealthy eating habits, pelvic girdle pain, and urinary incontinence were more prevalent with low readiness to change exercise habits (stages 1–3). Conclusion: According to the TTM, more than half of the participants reported to be physically active. Moreover, most of the participants classified as inactive showed a high motivational readiness or intention to increase their physical activity level. Hence, pregnancy may be a window of opportunity for the establishment of long-term physical activity habits.

• Bø, Kari & Haakstad, Lene Annette Hagen (2011). Is pelvic floor muscle training effective when taught in a general fitness class in pregnancy? : a randomised controlled trial. Physiotherapy. ISSN 0031-9406. 97(3), p. 190–195. doi: 10.1016/j.physio.2010.08.014. Full text in Research Archive Show summary

  Objectives Pelvic floor muscle training (PFMT) following vaginal assessment of correct contraction can prevent and treat urinary incontinence in the peripartum period. The aim of this study was to evaluate the effectiveness of PFMT instructed in a general fitness class for pregnant women. Design Single-blind randomised controlled trial. Setting University-conducted primary care study. Participants One hundred and five sedentary primiparous women randomised to a general fitness class including PFMT (n = 52) or a control group (n = 53). Ten and 11 women were lost to follow-up in the exercise and control groups, respectively. Intervention Twelve weeks of training comprising twice-weekly 1-hour fitness classes including three sets of eight to 12 maximal pelvic floor muscle contractions. The control group received usual care. Outcome measure Number of women reporting urinary, flatus or anal incontinence. Results No significant differences were found in the number of women reporting urinary, flatus or anal incontinence between the exercise group and the control group during pregnancy or at 6 weeks post partum. Conclusions No effect of PFMT was found when the exercises were taught in a general fitness class for pregnant women without individual instruction of correct PFM contraction. Low adherence and the small sample size may have contributed to the negative results. Further studies are warranted to assess the effect of population-based PFMT in the prevention of urinary and fecal incontinence.

• Haakstad, Lene Annette Hagen & Bø, Kari (2011). Effect of regular exercise on prevention of excessive weight gain in pregnancy : a randomised controlled trial. European journal of contraception & reproductive health care. ISSN 1362-5187. 16(2), p. 116–125. doi: 10.3109/13625187.2011.560307. Full text in Research Archive Show summary

  Objectives: To assess whether a 12-week supervised exercise-programme with anadditional 30 min of moderate self-imposed physical activity on the non-supervised weekdays prevents excessive weight gain in pregnancy, as well as postpartum weight retention. Methods: One hundred and five sedentary, nulliparous pregnant women with a mean age of 30.7+4.0 years and a pre-pregnancy body mass index of 23.8+4.3 kg/m2 were randomised to either an exercise group (EG, n¼52) or a control group (CG, n¼53). The exercise programme consisted of 60 min supervised aerobic dance and strength training for 60 min, at least twice per week for a minimum of 12 weeks. Results: Drop-out rates were 19% and 21% in the EG and CG, respectively. Fewer women in the EG than in the CG exceeded the Institute of Medicine recommendations; however, only EG participants who attended 24 exercise sessions (n¼14) differed significantly from controls (p¼0.006) with regard to weight gain during pregnancy (11.0+2.3 vs. 13.8+3.8 kg, p50.01) and postpartum weight retention (0.8+1.7 vs. 3.3+4.1 kg, p50.01). Conclusions: Regular participation in aerobic dance exercise can contribute to significantly reduce weight gain during pregnancy.

• Haakstad, Lene Annette Hagen & Bø, Kari (2011). Exercise in pregnant women and birth weight: a randomized controlled trial. BMC Pregnancy and Childbirth. 11. doi: 10.1186/1471-2393-11-66. Full text in Research Archive Show summary

  Background: Birth weight plays an important role in infant mortality and morbidity, childhood development, and adult health. To date there are contradictory results regarding the role of physical activity on birth weight. In addition, it is questioned whether exercise during second and third trimesters of pregnancy might affect gestational age and increase the risk of preterm delivery. Hence, the purpose of this study was to examine the effect of a supervised exercise-program on birth weight, gestational age at delivery and Apgar-score. Methods: Sedentary, nulliparous pregnant women (N = 105), mean age 30.7 ± 4.0 years, pre-pregnancy BMI 23.8 ± 4.3 were randomized to either an exercise group (EG, n = 52) or a control group (CG, n = 53). The exercise program consisted of supervised aerobic dance and strength training for 60 minutes, twice per week for a minimum of 12 weeks, with an additional 30 minutes of self-imposed physical activity on the non-supervised week-days. Results: There was no statistically significant difference between groups in mean birth weight, low birth weight (< 2500 g) or macrosomia (≥ 4000 g). Per protocol analyses showed higher Apgar score (1 min) in the EG compared with the CG (p = 0.02). No difference was seen in length of gestation. Conclusion: Aerobic-dance exercise was not associated with reduction in birth weight, preterm birth rate or neonatal well-being.

• Haakstad, Lene Annette Hagen; Gundersen, Ingvild & Bø, Kari (2010). Self-reporting compared to motion monitor in the measurement of physical activity during pregnancy. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 89(6), p. 749–756. doi: 10.3109/00016349.2010.484482. Full text in Research Archive Show summary

  Most pregnancy-studies have relied on retrospective, cross-sectional surveys to measure physical activity level. Questionnaires are cost-effective, but validity of the data may be questionable. Objective. The aim of the present study was to validate a physical activity and pregnancy questionnaire (PAPQ) with a portable activity monitor (ActiReg®). Design. Prospective comparison study. Setting. Healthy pregnant women recruited in a capital area. Population. Seventy-seven pregnant women wore the ActiReg® sensors during waking hours for seven consecutive days and answered the PAPQ. Main outcome measures. Agreement between the two methods was analyzed by Bland?Altman plots and Spearman correlation coefficients. Results. The results indicated only small differences between the PAPQ and the ActiReg® in cross-tabulation of total physical activity level and proportion of participants meeting the current exercise guidelines. The correlation between the methods was good (r = 0.59) for time spent in activities with high intensity (METS > 6), moderate for time spent standing/moving (r = 0.36) and fair for sitting/lying (r = 0.29). The Bland?Altman plot of the activity patterns, showed a mean difference near zero with no apparent trends and wide scatter of individual observations. Conclusions. The PAPQ may be considered an acceptable method for assessing habitual physical activity and exercise among pregnant women at group level. However, as questionnaires and portable activity monitors have their strengths in measuring different aspects of physical activity, there may be advantages in combining these two types of instruments for registrations of physical activity level during pregnancy.

• Voldner, N; Frøslie, KF; Haakstad, Lene Annette Hagen; Bø, Kari & Henriksen, Tore (2009). Birth complications, overweight, and physical inactivity. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 88(5), p. 550–555. Full text in Research Archive Show summary

  Objective. Maternal lifestyle factors are potential predictors of pregnancy complications. We examined relations between modifiable factors and delivery complications. Design. Prospective cohort. Setting. University hospital antenatal clinic, Oslo, Norway. Sample. A cohort of 553 women followed through pregnancy and delivery. Main outcome measures. Pre-specified birth complications: cesarean section (CS), operative vaginal deliveries (VDs), third and fourth degree of perineal lacerations and hemorrhage (1,000 ml). Methods. Univariate and multiple logistic regression analyses were performed. Besides high birthweight (4,200 g), modifiable predictors (high body mass index (BMI), fasting glucose and physical inactivity) and non-modifiable predictors (parity, maternal age, gestational age, and gender) were considered. Results. Significant predictors for induction of labor were parity (odds ratio (OR): 2.1; 95% CI 1.3-3.5), maternal age (OR: 2.0; 1.2-3.4), gestational age (OR: 1.9; 1.1-3.1), and BMI 30 (OR: 4.2; 2.2-7.8, p0.01). High birthweight and high BMI were overrepresented among CSs. Emergency CS was associated with birthweight (OR: 3.7; 1.7-8.1), parity (OR: 3.5; 1.7-7.2), maternal age (OR: 2.6; 1.3-5.3), and induction of labor (OR: 4.8; 2.6-9.1). After excluding CS, operative VD was associated with parity (OR: 8.7; 3.8-20) and gender (OR: 2.2; 1.2-14.1). Perineal laceration was associated with pre-gestational physical inactivity (OR: 6.1; 1.6-22.9) and operative VD (OR: 5.1; 1.5-17.6). Hemorrhage was associated with high birthweight (OR: 4.2; 1.2-4.7) and BMI 30 (OR: 4.6; 1.2-17.7). Conclusions. Pre-gestational physical inactivity increased the risk of perineal lacerations and male infants were associated with higher risk of vaginal operative delivery.

• Haakstad, Lene Annette Hagen; Voldner, N; Henriksen, Tore & Bø, Kari (2009). Why do pregnant women stop exercising in the third trimester? Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 88(11), p. 1267–1275. Full text in Research Archive Show summary

  Current exercise guidelines recommend pregnant women to exercise throughout pregnancy. However, a high percentage of pregnant women are sedentary, and there is an increasing decline of physical activity and exercise, especially in the third trimester. Objective: The aim of the present study was to compare demographic and health-related factors in pregnant women exercising and not exercising in the third trimester. Design: Cross-sectional design comparing exercisers and non-exercisers. Setting. Rikshospitalet University Hospital and Norwegian School of Sport Sciences, Oslo, Norway. Population: Healthy pregnant women (n = 467) were successively allocated from the application form for birth at Rikshospitalet University Hospital. Methods: A questionnaire, including questions about demographic variables, physical activity level, common pregnancy complaints, social modeling, attitudes and barriers towards exercise participation was answered between gestation-week 32 and 36. Main outcome measures: Demographic variables, pregnancy related health factors and social modeling, including exercise counseling by health care providers, were tested using binary logistic regression analysis. Results: Less than 11% were defined as regular exercisers in the third trimester. Having high gestational weight gain and no social role models with respect to exercise behavior during childhood were inversely associated with third trimester exercise. Pre-pregnancy exercise was the strongest predictor of regular exercise at late gestation. Not receiving advice about exercise from health professionals was borderline significant. Pelvic girdle pain and sick-leave were not statistically significant factors. Conclusions: Pre-pregnancy exercise was strongly related to exercise at late gestation. This study indicates a need for more information and motivation for moderate exercise before and throughout pregnancy.

• Voldner, N; Frøslie, KF; Bø, Kari; Haakstad, Lene Annette Hagen; Hoff, C & Godang, K [Show all 8 contributors for this article] (2008). Modifiable determinants of fetal macrosomia: role of lifestyle-related factors. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 87(4), p. 423–429. Full text in Research Archive Show summary

  Background. Newborn macrosomia is associated with both short- and long-term health risks for the infant, and increases the prevalence of birth complications. Parity, maternal age and gender of the child are known variables that influence fetal growth. The purpose of the present investigation was to evaluate prospectively the contributions of modifiable maternal predictors of fetal macrosomia (>= 4,200 g), which included lifestyle-related factors, such as nutritional intake, physical activity, and plasma glucose values, in addition to overweight and pregnancy weight gain. Methods. Some 553 women were followed through pregnancy. Predictive variables were subjected to univariate and multiple logistic regression analysis. Among these were: body mass index (BMI), weight gain, maternal subcutaneous fat (mm), fasting and 2-h plasma glucose, self-reported physical activity before and during pregnancy, and nutritional intake of macronutrients. Gestational age, parity and gender were also included in the model. All continuous variables were dichotomized using the upper quartile as the cut-off point in most cases. Results. If physical activity was left out of the analyses, BMI, weight gain, plasma glucose and gestational age were independent determinants of macrosomia. After including low level pre-gestational physical activity in the model, we found that this was now a significant determinant of delivering a macrosomic infant with an OR=2.9 (95% CI: 1.9, 7.3). Conclusion. The present study indicates that a low level of pre-gestational physical activity adds to the modifiable determinants of newborn macrosomia.

• Haakstad, Lene Annette Hagen; Voldner, N; Henriksen, Tore & Bø, Kari (2007). Physical activity level and weight gain in a cohort of pregnant Norwegian women. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 86(5), p. 559–564. Full text in Research Archive Show summary

  Background. It is generally recommended that healthy, pregnant women should engage in moderate exercise on most days of the week. However, there is scant knowledge about the overall physical activity and exercise levels among pregnant women. Purpose. To assess the total physical activity level of pregnant women, and to investigate the association between weight gain, physical activity and exercise during pregnancy. Methods. Pregnant women (n = 467) answered a questionnaire on total physical activity level in gestation week 36. Results. Some 55% of the participants reported working in a sitting position. Most women drove (52.9%) or used public transport (31.7%) to work. A total of 39% reported sedentary activities of A h (watching television and reading) daily; 19% were defined as non-exercisers before pregnancy, 30% in the first trimester, 36% in the second trimester and 53% in the third trimester. Fifty women (10.6%) continued to exercise >= 4 times/week in the third trimester. Mean weight gain was 13.8 kg (SD: 5.2). Of the normal pregestational weight women (pre-BMI: >= 26) and overweight women (pre-BMI: >= 26), 32 and 51% had exceeded weight gain above accepted recommendations, respectively. Women who exercised regularly had significantly lower weight gain than inactive women in the third trimester only. Conclusion. Pregnant women have a low total physical activity level, and a high percentage of women exceed the recommended weight gain during pregnancy.

• Bø, Kari; Haakstad, Lene Annette Hagen & Voldner, N (2007). Do pregnant women exercise their pelvic floor muscles? International Urogynecology Journal. ISSN 0937-3462. 18(7), p. 733–736. Full text in Research Archive Show summary

  The aims of the present study were to assess the number of women performing pelvic floor muscle training (PFMT) during pregnancy and to compare the background variables in those exercising and in those who did not. Four hundred and sixty-seven pregnant women (response rate 84%), mean age 31.5 years (range 20-49), answered a questionnaire on general physical activity level during pregnancy including PFMT. The questionnaire was sent out in week 32 of gestation and answered within week 36. Twenty-four percent reported problems with urinary incontinence and 9% flatus/fecal incontinence. The percentages of pregnant women performing PFMT at least once a week before pregnancy and during trimesters 1, 2, and 3 were 7, 12.9, 17.6, and 17.4%, respectively. More women with lower prepregnancy BMI and with present and past pelvic girdle pain were performing regular PFMT. No significant differences were found in any other background variables. It is concluded that relatively few women perform regular PFMT during pregnancy. In conclusion, only 17% of pregnant Norwegian women reported performing PFMT during pregnancy.

• Haakstad, Lene Annette Hagen & Bø, Kari (2007). Fitness and physical activity in Norwegian adults. Advances in Physiotherapy. ISSN 1403-8196. 9(2), p. 89–96. Full text in Research Archive Show summary

  To date there is scant knowledge about cardio-respiratory fitness in the general adult population. The aims of the present study were to assess physical activity and fitness level in adults, and to obtain practical experience with field testing in the adult population. Employees in a rural municipality (n=925) were invited to answer a questionnaire about physical activity and participate in the UKK 2-km Walk Test. Sixty per cent (n=554) answered the questionnaire and 42% (n=388) performed the test. Sixty per cent of the men and 32% of the women had a body mass index 25. Twenty-three per cent of the participants were physically active 30 min/day. Estimated VO2 max (±SD) was 39.1±8.9 for men and 32.0±5.9 for women. The Walk Test was well received by participants and easy to arrange. The Norwegian adult population was not as fit as expected. The feasibility of the test was good. However, it is important to develop strategies to increase participation rates in future fitness tests and surveillances.

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• Gjestvang, Christina; Erikstein-Midtbø, Gjermund; Hansson, Siri Elicabeth; Haakstad, Lene Annette Hagen & Henningsen, Preben Sævartveit (2026). Mind in Motion i NIH-podden. doi: https:/www.podbean.com/ew/pb-xcnuj-1b53934. Full text in Research Archive Show summary

  Invitert til å snakke om "Mind in Motion" prosjektet i en episode av NIH-podden

• Gjestvang, Christina; Haakstad, Lene Annette Hagen & Sundgot-Borgen, Christine (2023). Kunnskapen kan være avgjørende. Full text in Research Archive
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• Haakstad, Lene Annette Hagen; Voldner, N; Henriksen, T.-H. & Bø, Kari (2007). Physical activity level and weight gain in a cohort of pregnant Norwegian women. Full text in Research Archive
• Haakstad, Lene Annette Hagen; Voldner, N; Henriksen, Tore & Bø, Kari (2007). Hvorfor blir gravide kvinner fysisk inaktive? Norsk idrettsmedisin. ISSN 0806-9328. p. 22–22. Full text in Research Archive
• Haakstad, Lene Annette Hagen; Voldner, N; Henriksen, T.-H. & Bø, Kari (2007). Physical activity level and weight gain in a cohort of pregnant Norwegian women. Medicine & Science in Sports & Exercise. ISSN 0195-9131. Full text in Research Archive
• Haakstad, Lene Annette Hagen (2007). Physical activity level and weight gain in a cohort of pregnant norwegian women. Full text in Research Archive
• Bø, Kari; Haakstad, Lene Annette Hagen & Voldner, N (2006). Do pregnant women exercise the pelvic floor muscles? Full text in Research Archive
• Haakstad, Lene Annette Hagen; Voldner, N; Henriksen, T & Bø, Kari (2006). Fysisk aktivitetsnivå og vektøkning i en kohort av norske gravide kvinner. Norsk idrettsmedisin. ISSN 0806-9328. p. 22–22. Full text in Research Archive
• Voldner, N; Frøslie, KF; Bø, Kari; Haakstad, Lene Annette Hagen; Godang, K & Bollerslev, Jens [Show all 7 contributors for this article] (2006). Determinants of newborn macrosomia. Full text in Research Archive
• Haakstad, Lene Annette Hagen; Voldner, N; Henriksen, T & Bø, Kari (2006). Fysisk aktivitetsnivå og vektøkning i en kohort av norske gravide kvinner. Full text in Research Archive
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  Paper II: Tatt ut av filen i Brage p.g.a. copyright-restriksjoner. / Not in the file in Brage because of copyright issues.

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