Acute Exercise Effects in Obese Pregnancy
Condition: Pregnancy Complications; Obesity; Pre-Eclampsia; Gestational Diabetes
MeSH terms: Diabetes, Gestational; Eclampsia; Pre-Eclampsia; Pregnancy Complications
Study type: Interventional

Summary: 
      Obesity before and during pregnancy is associated with a higher risk for a number of
      obstetric and metabolic complications in women and their offspring. Of particular importance,
      obese women have a higher risk of developing gestational diabetes and preeclampsia. In
      addition, obese women have larger offspring who have a higher risk for the development of
      obesity and diabetes; both largely attributed to higher maternal glycemia and glucose
      intolerance during pregnancy. Thus, identifying rehabilitative interventions that improve
      maternal and offspring metabolic and cardiovascular health in obese pregnancy are critical
      and have immediate and generational impact. Resistance and aerobic exercise training is a
      clinical staple for improving musculoskeletal, metabolic and cardiovascular health in
      non-gravid adolescents and adults with obesity however little is known regarding the effects
      of exercise during obese pregnancy. This study proposes to collect preliminary data on the
      independent effects of acute aerobic and resistance rehabilitative exercise on glucose
      metabolism and vascular function during pregnancy in n=15 obese women in order to inform a
      large, multisite clinical trial examining the acute and chronic effects of aerobic and
      resistance exercise on glucose metabolism and vascular function in normal weight, overweight
      and obese women during pregnancy.
    

Detailed description: 
      Maternal obesity prevalence is at a historic high with over 1 in 3 women entering pregnancy
      obese and 1 in 10 extremely obese. Obesity before and during pregnancy is associated with a
      higher risk for a number of obstetric and metabolic complications in women and their
      offspring. Of particular importance, obese women have a higher risk of developing gestational
      diabetes and preeclampsia. In addition, obese women have larger offspring who have a higher
      risk for the development of obesity and diabetes; both largely attributed to higher maternal
      glycemia and glucose intolerance during pregnancy. Thus, identifying rehabilitative
      interventions that improve maternal and offspring metabolic and cardiovascular health in
      obese pregnancy are critical and have immediate and generational impact.

      Resistance and aerobic exercise training is a clinical staple for improving musculoskeletal,
      metabolic and cardiovascular health in non-gravid adolescents and adults with obesity.
      Observational studies suggest that exercise in pregnancy is safe and higher levels of
      physical activity before and during pregnancy in normal weight (i.e. lean) women reduces the
      risk of gestational diabetes and gestational hypertensive disorders; however, little is known
      regarding the effects of exercise training during obese pregnancy and several important
      questions still exist. These include: 1) "What are the acute and chronic effects of maternal
      exercise on glucose metabolism and vascular function?", 2) "Are there different effects of
      aerobic and resistance type exercise on glucose metabolism and vascular function?" and 3)
      "What are the physiologic and molecular transducers of maternal aerobic and resistance
      exercise for changes in maternal glucose metabolism and vascular function during pregnancy?"
      This pilot project aims to collect preliminary data on these questions.

      This proposal would be the first study to collect preliminary data on the independent effects
      of acute aerobic and resistance rehabilitative exercise in pregnancy, and further, in obese
      women; a population with a high morbidity during gestation. In addition, this proposal would
      inform a large, multisite clinical trial examining the acute and chronic effects of aerobic
      and resistance exercise on glucose metabolism and vascular function in normal weight,
      overweight and obese women during pregnancy. Moreover, this proposal would provide initial
      evidence of molecular transducers of acute physical activity/rehabilitative exercise
      necessary for a large, comprehensive clinical trial examining the molecular transducers of
      rehabilitative exercise in normal weight, overweight and obese women during different stages
      of pregnancy.

      Specific Aim #1: To characterize the acute effects of aerobic and resistance exercise on
      glucose metabolism (tolerance, insulin sensitivity and β-cell function) in obese women during
      mid-pregnancy.

      Specific Aim #2: To characterize the acute effects of aerobic and resistance exercise on
      vascular function in obese women during mid-pregnancy.

      Specific Aim #3: To explore the molecular transducers of physiologic responses in glucose
      metabolism and vascular function following acute aerobic and resistance exercise in obese
      women during mid-pregnancy.

      The hypothesis is that acute aerobic and resistance rehabilitative exercise will improve
      post-exercise glucose metabolism and vascular function in obese women during mid-pregnancy.
      In a subsequent multi-site clinical trial, this study will examine differences in physiologic
      effects and molecular transducers of aerobic and resistance exercise on glucose metabolism
      and vascular function during different stages of pregnancy in overweight and obese women.
    

Intervention name(s): Resistance exercise; Aerobic Exercise; Rest
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): One acute exercise session of resistance exercise (40 minutes including 3 sets of 8-10 repetitions at the participant's 10 repetition maximum load of upper and lower extremity exercise; One acute session of aerobic exercise (40 minutes of cycle ergometry exercise at 70% of VO2peak); 40 minutes of quiet rest in semi-recumbent position
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Single group crossover design of acute effects of resistance exercise, aerobic exercise or rest (control) on maternal vascular function and glucose metabolism
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: exercise; glucose; vascular