Exercise Research Articles

Holistic approaches to mitigating psychological distress in gynecological cancer patients

This article delves into the psychological impact of gynecological malignancies and suggests pathways to improve the quality of life (QoL) for affected patients. Building on Shang et al 's comprehensive analysis, this piece integrates insights from various studies to highlight the profound influence of psychological and physical symptoms on patients undergoing treatment for gynecological cancers. The study underscores that anxiety and depression significantly exacerbate the disease's toll. Factors such as physical exercise and digital and interactive health interventions show promise in mitigating these adverse effects. The article emphasizes the necessity for a holistic care approach that addresses both physical and emotional needs. Recommendations include enhanced training for healthcare providers, public awareness campaigns, streamlined diagnostic pathways, and improved access to specialist care. These integrated strategies aim to ensure that women facing gynecological cancers can maintain an optimal QoL through comprehensive and multidisciplinary care models.

Research progress on the mechanism of exercise against depression

The substantial global health burden of depression encourages the development of innovative and broadly effective interventions. This paper aimed to examine recent advancements by which exercise works as an antidepressant and recommends optimal types and quantity of exercise as supplemental therapies in treating depression. Sedentary behavior and low physical activity significantly influence the onset of depression. Being an effective treatment option, exercise can significantly reduce depression risk. Exercise exerts antidepressant effects as it modulates neurotransmitters, neuroplasticity, the immune system, and hormone levels. Effective exercise forms include yoga, strength training, and walking/jogging. Tailored exercise regimens that consider individual preferences and tolerability can improve outcomes. Regular exercise enhances general well-being and reduces depressive symptoms. Additional research is needed to understand the complex basis of exercise's effects on depression. Exercise is a cost-effective and accessible intervention for depression management that needs additional exploration. Thus, customized exercise programs, as per each patient’s needs, are essential for their successful implementation clinically.

Development and Impact of a Cognitive Reserve Enhancement Program for Climacteric Korean Women

ABSTRACT Background In light of the rising incidence of mild cognitive impairment in women, an appropriate cognitive reserve enhancement program is urgently needed for women experiencing climacteric symptoms. Purpose The purpose of this study was to develop a cognitive reserve enhancement program for climacteric women based on cognitive reserve theory (CRT) and to verify its effectiveness. Methods A nonequivalence control group, pre- and post-quasi-experimental design was used. The 58 climacteric women with subjective memory deterioration enrolled as participants were divided into the experimental group (28 women), which received a 24-session CRT-based cognitive reserve enhance program, and the control group (30 women), the members of which received the cognitive training via a mobile application after completion of the study. Valid data from 24 experimental and 26 control participants were available for analysis. Objective cognitive functions, including overall cognitive, memory, attention, and language, were measured pretest and posttest using the following tools: Everyday Cognition Scale (subjective cognitive function), Center for Epidemiologic Studies Depression Scale (depression), and World Health Organization Quality of Life-Brief Version (quality of life). Results The experimental group showed a statistically significant increase in overall cognitive function (t = 3.82, p = .001), memory (t = 2.63, p = .012), attention: number of correct answers (t = 2.12, p = .040), language high-frequency response speed (Z = −2.49, p = .013), and language low-frequency response speed (Z = −2.77, p = .006) in objective cognitive function after 8 weeks in comparison to the control group. Conclusions/Implications for Practice The intervention program tested in this study to enhance cognitive reserve in climacteric women includes cognitive training, emotional and social support, and group physical activity components was found to be effective in enhancing cognitive function.

Understanding Adult’s Experiences and Perceptions of How to Maintain Physical Activity: A Systematic Review and Qualitative Synthesis

Abstract Background Many adults do not meet physical activity recommendations for optimal health, and this is often because people find it difficult to maintain physical activity in the long term. This study focuses on identifying and synthesising factors that may influence the maintenance of physical activity in adults with and without known health conditions. Method A systematic review and qualitative synthesis using thematic analysis was conducted. Four databases (MEDLINE, SPORT Discus, APA, and Web of Science) were systematically searched for studies published from inception to February 2023 that included qualitative data about people’s experiences of maintaining physical activity. Results A total of 9337 abstracts were screened and 68 studies from 14 countries were included. Six main themes were identified: (1) influence of others (e.g. four forms of social support, accountability); (2) contextual and environmental influences (e.g. cost and access of physical activity, weather); (3) health-related influences (e.g. reflexivity about how physical activity improves health conditions, weight control); (4) making it work (e.g. flexibility, prioritising exercise); (5) habits; and (6) psychological processes (e.g. enjoyment, identifying as a physically active person). Conclusion People who maintained their participation in physical activity found it enjoyable, prioritised it, and integrated it into their daily routine. Participants were motivated to continue being physically active when they realised the benefits for their health. Social support, in particular companion support, was a key component facilitating continued engagement. Findings specific to maintenance of physical activity included reflexivity of how physical activity benefited health, flexibility, and identifying as a physically active person.

Exploring the impact of physical exercise on mental health among female college students: the chain mediating role of coping styles and psychological resilience

BackgroundFemale college students are a high-risk group for psychological conflicts, and they are more likely to adopt negative coping styles under stress, which can lead to anxiety, depression, and other psychological problems, as well as pose hidden threats to the healthy development of school education and social work. Although physical exercise is an important means of effectively alleviating the psychological health of female college students, and there may be a close relationship between coping styles and psychological resilience with physical exercise and psychological health, specific ways to promote the psychological health of female college students by influencing their coping styles and enhancing their psychological resilience have yet to be explored.MethodsThe present study employed a cross-sectional design to investigate a sample of Chinese undergraduate female college students. A total of 659 participants were recruited during the second half of the 2023–2024 academic year, and they all completed assessments including the Physical Activity Rating Scale, College Mental Health Scale, Brief Coping Styles Questionnaire, and Psychological Resilience Scale. Subsequently, descriptive statistics were utilized to analyze the obtained reliable data.Results and conclusionThe study revealed two significant correlations among female college students, namely the associations between physical exercise, coping styles, psychological flexibility, and mental health. Specifically, physical exercise exhibited a positive relationship with positive coping styles and psychological resilience while displaying a negative association with negative coping styles and mental health. Moreover, psychological resilience demonstrated a positive correlation with positive coping styles but displayed negative relationships with both negative coping styles and mental health. Additionally, there was a negative relationship observed between positive coping styles and mental health. Furthermore, it was found that physical exercise significantly impacted the mental health of female college students in a detrimental manner; meanwhile, coping styles and psychological resilience played crucial mediating roles in linking physical exercise to mental health outcomes. Ultimately, our mediation model sheds the underlying mechanisms through which physical exercise predicts mental health levels among female college students; these findings underscore the importance of promoting physical exercise as an effective means to enhance overall well-being.

Reassessing the Association of Sedentary Behavior and Physical Activity with Ischemic Stroke: A Mendelian Randomization Study

ABSTRACT Purpose Findings from previous Mendelian randomization (MR) studies disagreed with the current scientific consensus regarding the role of physical activity (PA) and sedentary behavior in ischemic stroke (IS). We reassessed these associations with a focus on etiological subtypes of IS and the potential mediating roles of cardiometabolic traits and brain imaging-derived phenotypes (IDPs). Methods We performed MR analyses using summary statistics from genome-wide association studies of sedentary behavior and PA (n = 88,411~608,595), cardiometabolic traits (n = 393,193~694,649), brain IDPs (n = 33,224) and the latest IS data (62,100 cases and 1,234,808 controls). Inverse-variance weighted regression was used as the primary method, complemented by several sensitivity analyses. A two-step MR approach was employed to assess the mediating effects of cardiometabolic traits and brain IDPs. Results Genetic liability to leisure-time moderate-to-vigorous PA (LTMVPA) and higher overall PA (OPA) were associated with reduced risks of IS and small vessel stroke (Benjamini–Hochberg adjusted P < 0.05). Suggestive associations were observed between longer leisure-screen time and higher IS risk and between higher OPA and lower cardioembolic stroke risk (P < 0.05). The isotropic volume fraction in the anterior limb of the left internal capsule (ALIC), as well as some cardiometabolic metrics, partially mediated these associations. There was no evidence for causal effects of overall MVPA, overall light-intensity PA or overall sedentary duration on IS. Conclusions Longer LST, less OPA and not engaging in moderate-to-vigorous PA during leisure time were associated with higher risk of ischemic stroke. The associations between PA and ischemic stroke depended on different subtypes and were mediated by changes in ALIC and cardiometabolic biomarkers.

Physical Activity and Exercise Interventions in Abdominal Wall Hernia Patients: Impact on Quality of Life and Health Outcomes - A Systematic Review and Meta-Analysis

ABSTRACT Objective Abdominal wall hernias are a common pathology in the surgical field, often leading to symptoms such as pain and tightness that can significantly reduce quality of life. Some studies have suggested that exercise and physical activity may improve both quality of life and health outcomes. This study aimed to evaluate the impact of exercise on quality of life and health outcomes in abdominal wall hernia patients through a qualitative systematic review and a quantitative meta-analysis. Design The systematic review identified six studies (n = 2409) that met the inclusion criteria, all demonstrating that exercise and physical activity positively affected health outcomes in abdominal wall hernia patients. Due to the limited number of studies available, the meta-analysis focused specifically on the effects of exercise and physical activity on quality of life and pain. Results The meta-analysis results indicated significant improvements in quality of life between pre- and postsurgery after a physical exercise intervention. However, no significant differences were found in pain levels between pre- and postsurgery following the exercise program. Conclusion This systematic review and meta-analysis offer promising insights into the potential benefits of physical activity and exercise interventions on health outcomes for AWH patients.

Assessing the impact of 24-hour activity behaviors on cardiorespiratory fitness in the older adult: a component analysis approach

BackgroundCardiorespiratory fitness (CRF) serves as a critical measure of the cardiovascular system’s efficiency in delivering oxygenated blood to tissues and organs. Understanding the relationship between various activity behaviors and CRF is essential for devising effective health interventions for the older adult population.ObjectiveThis study aimed to investigate the association between 24-h activity behaviors and CRF in older adult individuals, utilizing compositional data analysis.MethodsWe utilized baseline data from the “Fifth National Physical Fitness Monitoring Cohort Study in Tianjin, China,” which included 540 older adult participants. Physical activity and sedentary behavior were objectively measured using a three-dimensional accelerometer, and CRF was assessed via a gas metabolism analyzer. Compositional data analysis was employed to examine the relationships between 24-h activity behaviors—specifically, moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behavior (SB), and sleep (SLP)—and CRF.ResultsThe analysis demonstrated that MVPA was significantly positively associated with CRF (βMVPA = 5.36, p < 0.01), whereas SB was significantly negatively associated (βSB = −3.97, p < 0.01). No significant associations were observed for LPA and SLP with CRF. The isochronous substitution model revealed that reallocating 15 min of MVPA to SB, LPA, or SLP significantly decreased CRF by 0.31, 0.27, and 0.23 mL/kg/min, respectively. Conversely, substituting 15 min of SB, LPA, or SLP with MVPA resulted in increases in CRF by 0.29, 0.22, and 0.17 mL/kg/min, respectively. Additionally, replacing SB with LPA or SLP led to improvements in CRF, though these changes were not significant, underscoring the potential benefits of reducing sedentary time and enhancing physical activity levels.ConclusionThese findings underscore the critical role of increasing MVPA and reducing SB in improving CRF among the older adult. This study provides a robust scientific foundation for health promotion and intervention strategies targeting older adults. Comprehensive modifications to daily activity patterns are imperative for optimizing cardiovascular health in this population.

Impact of a Physical Exercise and Health Education Program on Metabolic Syndrome and Quality of Life in Postmenopausal Breast Cancer Women Undergoing Adjuvant Treatment with Aromatase Inhibitors

Background and Objectives: Adjuvant treatment with aromatase inhibitors (AIs) in breast cancer (BC) survivors can cause adverse effects such as metabolic syndrome (MS) (insulin resistance, central obesity, atherogenic dyslipidemia, and hypertension) associated with morbidity and premature mortality. We evaluate the effect of a multimodal program based on physical exercise and health education on MS and health-related quality of life (QoL) in postmenopausal women with BC under AIs. Methods: A total of 56 postmenopausal women, diagnosed with BC, aged 60 years or older (mean age 67.2 years) and on hormonal treatment with AIs, were included in the multimodal physical exercise and health education program, and evaluated before and after their participation. The assessment of the five criteria of the MS included the following: waist circumference, high blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol. Two main instruments were used to evaluate the impact of the intervention on QoL: the EORTC QLQ C30 (questionnaire for cancers in general) and the EORTC QLQ BR23 (specifically for breast cancer patients). The EuroQol 5D (EQ-5D) was also used to compare these results. Results: The percentage of women meeting the MS criteria was 37.7% at baseline and fell to 15.1% at 3 months after the intervention (p = 0.02). The intervention significantly reduced hypertension (p < 0.001), central obesity (p < 0.001), and the concentration of triglycerides (p = 0.016). No significant changes were observed in fasting glucose and HDL concentration. A statistically significant improvement was found in QoL (on both the QLQ30 and BR23 scales). A multivariate regression model analysis identified marital status (being married) (95% CI: 1.728–131.615, p = 0.014), and percentage of attendance at health education sessions (95% CI: 1.010–1.211, p = 0.029) as positive predictive variables of improvement in MS. Conclusions: The implementation of multimodal, community-based programs of physical exercise and health education improve the prevalence of MS and specific criteria of MS and QoL in postmenopausal women with breast cancer receiving AI treatment.

Absolute and relative intensities of solo, free-form dancing in adults: A pilot study

Objectives Engaging in dance of various styles confers health benefits among adults; however, additional studies on free-form dancing are needed to quantify its intensity and advance research on dance and health. This study characterized the absolute and relative physical activity (PA) intensities of solo, free-form dancing at self-determined moderate and vigorous intensities in adults. Method Participants (N = 48) ages 18 to 83 years old, with 0 to 56 years of dance training experience, engaged in 5-minute free-form dance bouts at respectively self-determined moderate and vigorous intensities, both with and without music. Absolute intensity was measured during bouts using indirect calorimetry (metabolic equivalents; METs = V˙O2 ml·kg-1·min-1/3.5). Relative intensity was measured by ratings of perceived exertion (Borg scale) and heart rate. Linear mixed effects models were used to assess the relationship between absolute and relative intensity metrics and model covariates. Results On average, the relative intensity of self-determined moderate-to-vigorous intensity dancing, with and without music, was 76% of the age-predicted maximal heart rate; 74% of the heart rate reserve (HRR); and 13 on the Borg scale. By measure of %HRR, all adults reached at least a moderate PA intensity across all dance bouts. The mean absolute intensity of self-determined moderate intensity free-form dancing without music was 5.6 METs, and the presence of music (β = 0.6) and the intention to dance at a vigorous intensity (β = 1.1) were both significantly positively associated with METs, as participants engaged in free-form dance; METs were significantly inversely associated with age (β = -0.05) and BMI (β = -0.10). Conclusions When characterized using HRR, engaging in free-form dance at self-determined moderate-to-vigorous PA intensities provided a sufficient stimulus for all adults to reach a moderate PA intensity, which provides evidence that dancing however one wishes at such perceived intensities may support adults in accumulating the recommended weekly dose of 3150 minutes of moderate intensity PA.

A Scoping Review of Existing Policy Instruments to Tackle Overweight and Obesity in India: Recommendations for a Social and Behaviour Change Communication Strategy

Background The Indian government is committed to addressing various manifestations of malnutrition, including overweight and obesity, inorder to improve individual health and well-being. The scoping review aims to map existing national policy instruments (programmes, schemes, regulations and guidelines) addressing overweight and obesity in India and analysing them for Social and Behaviour Change Communication (SBCC) strategies. Methods Systematic identification and selection of policy instruments using ‘Arksey and O’Malley’ framework was conducted from central government ministry websites, between March and June 2023. These instruments focused on nutrition and/or physical activity, targeting specific demographic groups like pregnant women, lactating mothers, children (0-5 years and 5-9 years), or adolescents (10-19 years); excluding those focusing on specific diseases like micronutrient deficiencies, wasting, and stunting. Based on search strategy six policy instruments were included and analysed for SBCC strategies. Results While many policy instruments incorporated SBCC plans; the ‘National Programme for Prevention of Non-Communicable Diseases (NP-NCD)’ stands out as a significant policy initiative specifically targeting the prevention of overweight and obesity within the broader context of Non-Communicable Diseases. It adopts a comprehensive approach addressing key drivers contributing to overweight/obesity across multiple levels of behavioural influence i.e., individual, interpersonal, community and organisation for health promotion. However, there’s need to strengthen SBCC strategies related to prevention and management of obesity, especially screening and counselling, to cover all age groups with a particular focus on adolescents and youth. SBCC strategies can also be incorporated into India’s Integrated Nutrition Support Programme (POSHAN 2.0) and/or Reproductive, Maternal, New-born, Child, Adolescent Health and Nutrition (RMNCAH+N) under the National Health Mission. Conclusion This paper underscores the necessity for comprehensive strategies to address multifaceted origins of overweight and obesity. The NP-NCD stands out as a noteworthy initiative, and there is considerable potential for other programmes to emulate SBCC strategies to bolster their overall effectiveness. Note : *Policy instruments throughout the paper have been used to cover programmes, schemes, regulations and guidelines.

The mediation effect of liver and anthropometric indices on the relationship between incidence of diabetes and physical activity: results of 5-year follow up azar cohort study

The mediation effect of liver and anthropometric indices on the relationship between incidence of diabetes and physical activity: results of 5-year follow up azar cohort study

Children’s and Adolescents’ Use of Nature During the COVID-19 Pandemic in a Very Green Country

Play, physical activity, and social interaction with other children in nature are important for healthy and social development in childhood and adolescence. The extent to which lockdown policies during the COVID-19 pandemic impacted the way children engaged in outdoor activities remains unclear, especially in a country with free access to abundant nature during the pandemic. We performed a national survey of parents (n = 1002) in Norway in January 2021 to uncover changes in outdoor play for children (6–12 years, n = 396) and adolescents (13–19 years, n = 606) compared with the situation before the lockdown on 12 March 2020. Ten months after the start of the COVID-19 lockdown, 38% of the parents reported that their children played and spent time outside ‘less than usual’ in their neighborhood, compared with 15% who reported ‘more than usual’ time spent outside. Parents indicated that the children’s play activities were highly organized and institutionalized, and when the activities ceased, their children had less motivation to spend time outdoors and tended to engage more in screen-based activities indoors. We conclude that while children and adolescents had many opportunities to be outdoors in natural settings during the COVID-19 pandemic restrictions, they did so much less than before the lockdown.

Associations of physical activity and sedentary time with health-related quality of life in patients with localized renal cell cancer: a cross-sectional analysis within the ReLife study

Abstract Purpose This study examined the associations of device-measured moderate-to-vigorous physical activity (MVPA) and sedentary time as well as self-reported MVPA with health-related quality of life (HRQoL) in patients with localized renal cell cancer (RCC) in the recovery phase after surgery. Methods At 3 months post-surgery, 341 patients with stage I-III RCC participating in the ReLife study wore an ActivPAL3 device to determine MVPA and sedentary time. The SQUASH questionnaire was used for assessing self-reported MVPA, and the EORTC QLQ-C30 for assessing HRQoL (range 0–100). Multivariable linear regression models were used to examine the cross-sectional associations of MVPA and sedentary time with HRQoL. Results The highest (≥ 6.7 h/week) versus lowest (≤ 2.7 h/week) quartile of MVPA was associated with a better global health status (β, 10.2; 95% CI, 5.1, 15.3), summary score (β, 4.6; 95% CI, 1.1, 8.1), physical (β, 7.7; 95% CI, 3.8, 11.6), role (β, 12.4; 95% CI, 4.7, 20.2), and social functioning (β, 7.3; 95% CI, 0.2, 14.4), and lower fatigue (β, − 11.2; 95% CI, − 18.1, − 4.2). Results for self-reported MVPA were in the same direction but weaker. The lowest (≤ 8.8 h/day) versus highest (≥ 11.5 h/day) quartile of sedentary time was associated with better physical functioning (β, 4.6; 95% CI, 0.8, 8.5). Conclusions In patients with localized RCC, higher MVPA 3 months post-surgery was associated with better HRQoL outcomes including less fatigue whereas lower sedentary time was only associated with better physical functioning. This information can contribute to the development of physical activity guidelines and interventions to improve HRQoL.

Relationship between different levels of internet use and depressive tendencies in Chinese college students: the chain mediating effect based on physical activity and social adaptability

Relationship between different levels of internet use and depressive tendencies in Chinese college students: the chain mediating effect based on physical activity and social adaptability

Cognitive impact and brain structural changes in long COVID patients: a cross-sectional MRI study two years post infection in a cohort from Argentina

Abstract Objective Long COVID is a condition characterised by persistent symptoms after a SARS-CoV-2 infection, with neurological manifestations being particularly frequent. Existing research suggests that long COVID patients not only report cognitive symptoms but also exhibit measurable cognitive impairment. Neuroimaging studies have identified structural alterations in brain regions linked to cognitive functions. However, most of these studies have focused on patients within months of their initial infection. This study aims to explore the longer-term cognitive effects and brain structural changes in long COVID patients, approximately two years post-infection, in a cohort from San Martín, Buenos Aires, Argentina. Methods We conducted a cross-sectional study involving 137 participants: 109 with long COVID symptoms and 28 healthy controls. The participants underwent an initial clinical assessment, completed a structured questionnaire and standardised scales, underwent a cognitive assessment, and had a brain MRI scan. Structural MRI images were processed via FreeSurfer and FSL to obtain volumetric measures for subcortical and cortical regions, along with regional cortical thickness. Differences between groups for these variables were analysed using ANCOVA, with permutation tests applied to correct for multiple comparisons. Results Long COVID patients reported persistent cognitive symptoms such as memory problems and brain fog, with higher levels of fatigue and reduced quality of life compared to controls. Despite subjective cognitive complaints, cognitive tests did not reveal significant differences between groups, except for the TMT-A (p = 0.05). MRI analysis revealed decreased volume in the cerebellum (p = 0.03), lingual gyrus (p = 0.04), and inferior parietal regions (p = 0.03), and reduced cortical thickness in several areas, including the left and right postcentral gyri (p = 0.02, p = 0.03) and precuneus (p = 0.01, p = 0.02). Conclusions This study highlights the enduring impact of long COVID on quality of life and physical activity, with specific brain structural changes identified two years post-infection. Although cognitive tests did not show clear impairment, the observed brain atrophy and significant reduction in quality of life emphasize the need for comprehensive interventions and further longitudinal studies to understand the long-term effects of long COVID on cognition and brain health.

Cancer Mortality Among Women in the European Union: A Comprehensive Analysis of Economic, Social, and Health Factors

This study provides a comprehensive analysis of factors associated with cancer mortality among women in twenty-seven European Union (EU) countries from 2013 to 2021. Using Pooled Ordinary Least Squares and Quantile Regression models, we examine the impact of socioeconomic, health, and lifestyle factors on gender disparities in cancer mortality. Key findings reveal that higher average years of schooling among women is associated with an increase in cancer mortality, while higher Gross National Income per capita is linked to reduced mortality rates. Lifestyle variables, such as regular physical activity and dietary habits, are associated with lower cancer mortality, whereas unmet healthcare needs and certain socio-political factors correlate with increased mortality. The results underscore the importance of addressing healthcare access and gender equity to inform policy interventions aligned with UN Sustainable Development Goals (SDGs) aimed at reducing cancer mortality among women in the EU.

Muscle fibroblasts and stem cells stimulate motor neurons in an age and exercise‐dependent manner

AbstractExercise preserves neuromuscular function in aging through unknown mechanisms. Skeletal muscle fibroblasts (FIB) and stem cells (MuSC) are abundant in skeletal muscle and reside close to neuromuscular junctions, but their relative roles in motor neuron maintenance remain undescribed. Using direct cocultures of embryonic rat motor neurons with either human MuSC or FIB, RNA sequencing revealed profound differential regulation of the motor neuron transcriptome, with FIB generally favoring neuron growth and cell migration and MuSC favoring production of ribosomes and translational machinery. Conditioned medium from FIB was superior to MuSC in preserving motor neurons and increasing their maturity. Lastly, we established the importance of donor age and exercise status and found an age‐related distortion of motor neuron and muscle cell interaction that was fully mitigated by lifelong physical activity. In conclusion, we show that human muscle FIB and MuSC synergistically stimulate the growth and viability of motor neurons, which is further amplified by regular exercise.

Construction of physical activity promoting indicators system for older adults with subjective cognitive decline using Delphi method

Construction of physical activity promoting indicators system for older adults with subjective cognitive decline using Delphi method

Adherence to Healthy Prepregnancy Lifestyle and Risk of Adverse Pregnancy Outcomes: A Prospective Cohort Study

ABSTRACTObjectiveTo quantify the association between a combination of modifiable prepregnancy lifestyle factors and the risk of adverse pregnancy outcomes (APOs).DesignProspective cohort study.SettingThe Japan Environment and Children's Study.PopulationA total of 79 703 pregnant Japanese women without chronic disease.MethodsMaternal lifestyle before pregnancy was assessed using a self‐administered questionnaire. A healthy lifestyle score (HLS, 0–5 points) was calculated based on adherence to five prepregnancy healthy lifestyle factors: healthy weight, high‐quality diet, regular physical activity, not smoking, and not drinking alcohol. Relative risks (RRs) and 95% credible intervals (CrIs) were estimated using a Bayesian log‐binomial regression model.Main Outcome MeasuresComposite APOs, defined as the development of any APO, including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, low birth weight, and small‐for‐gestational‐age, transcribed from medical records.ResultsA total of 13 894 women (17.4%) experienced one or more APOs. HLS was inversely associated with the risk of APOs in a dose–response manner. Women with an HLS of 5 points had a 33% (RR 0.67; 95% CrI, 0.61–0.74) lower risk of APOs than those with the lowest HLS (0–1 points). The population attributable fraction of five healthy lifestyle factors was 10.3%. A 1‐point increase of HLS could have reduced APO cases by 6.6%.ConclusionsA higher HLS was associated with a lower risk of APOs, suggesting that adopting a healthy lifestyle before pregnancy may reduce the risk of APOs, which can increase the risk of future chronic diseases in both mother and child.