Page 77 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

Intervention Description
well as opportunities for and barriers to making the changes. Also received two take home leaflets on healthy diet. Weekly record of compliance with the individual objectives was kept.
Diet: consisting of 1000-1500 kcal/d, with fat restricted to 20% of caloric intake. Physical activity: Aerobic exercise program: gradually increasing the frequency and duration of walking, until 2 miles/d on at least 5d/wk was reached. Consistent with guidelines of all adults, American College of Sports Medicine (ACSM)187. Included 3 components: (1) Two group sessions (at beginning and at 2 mo). Discussion of eating and exercise progress and problem solving. (2) Correspondence materials. Consisted of 16 written lessons about nutrition, exercise and behavior change strategies. These lessons were sent weekly for the first 12 wk, biweekly for the next 4 wk and monthly for the last 8 wk. Women were asked to monitor their calorie and fat intake and their exercise on a daily basis throughout the 6-mo program and return their record by mail. Behavioral lessons, which focused on strategies to modify diet and exercise behaviors, were tailored to the special needs of the new mothers. Each lesson included a 1 to 2-page homework assignment, which was to be completed and returned with the self- monitoring diaries. (3) Brief telephone contacts, 5-15 min, weekly or biweekly, depending on the participants’ desires and needs. The discussions focused on eating and exercise progress, goal setting and problem solving.
Diet: 500 kcal fewer than daily energy requirements. Diet prescription: 25% of energy from fat, 20% from protein, 55% from carbohydrate, with no less than 1800 kcal (7531 kJ) total per day. Trained graduate research assistants used the Food Guide Pyramid188 to meet dietary recommendations. Food models were used to demonstrate portion size. Cognitive and behavioral strategies were discussed at individual weekly sessions. Six low-fat, low-calorie frozen dinners were provided each week. Exercise: brisk walking, jogging, or aerobic dancing at 65-80% of maximum
Mean baseline Weight in kg (SD)
I: 78.7 (11.2) C: 82.9 (15.2)
Weight Loss
Weight loss among women in the I group (7.8 kg) differed significantly form weight loss in the C group (4.9 kg) at follow-up (p=0.03). Significantly more women in the I group (33%) returned to their pre- pregnancy weight at follow-up than women in the control group (11.5%) (p<0.05).
3.1 Effect of Postpartum Lifestyle Interventions| 75
I: 75.9 (9.3) C:76.8 (7.8)
Women in the intervention group lost significantly more weight (4.8 [1.7] kg) than women in the control group (0.8 [2.3] kg), (p<0.001)
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