Dissertation
A remote postpartum physical activity intervention for individuals with a hypertensive disorder of pregnancy
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2024
DOI: 10.25820/etd.007506
Abstract
Background: The United States is facing a maternal health crisis, with increased incidence of maternal morbidity and mortality. Concurrently, rates of cardiovascular disease (CVD) mortality among US females appear to be on the rise. Hypertensive Disorders of Pregnancy (HDP) negatively impact acute and long-term cardiovascular health, with approximately 16% of all pregnancies affected. With CVD 2-4 times more likely after HDP compared to normotensive pregnancies, effective interventions to promote cardiovascular health are imperative. Given that physical activity (PA) is associated with decreased CVD risk, promotion of this behavior may be a promising approach in a postpartum population affected by HDP.
Objectives: 1) To effectively describe the barriers and facilitators to postpartum PAPA and determine interest in a postpartum PA intervention after HDP. 2) Develop and test the feasibility, acceptability, and preliminary efficacy of a remote intervention designed to promote postpartum PA after HDP. 3) Determine the effects of a remote postpartum PA intervention on blood pressure after HDP.
Methods: Two studies, funded by an American Heart Association pre-doctoral fellowship grant (#23PRE1018306), were conducted to address the study aims. In the first study, 72 postpartum individuals after a pregnancy complicated by HDP in Iowa completed an online survey assessing current PA behaviors, PA behavioral determinants, and desired intervention components. In the second study, a remote postpartum PA intervention was developed leveraging results from the first study. The study created was a 14-week virtual health coaching intervention designed to promote an increase in steps during the postpartum period. The intervention’s feasibility, acceptability, and preliminary efficacy to increase PA was tested via a single arm pilot study involving 17 participants. PA efficacy was measured by change in step counts which were assessed with an aActivPAL4 micro. The final study also assessed changes in postpartum blood pressure throughout the intervention.
Results: In the first study, behavioral determinants that were associated with postpartum PA after HDP included lack of access to resources, low social support, and limited cues to action. Despite this, all participants indicated that they would be interested in a postpartum intervention that featured information about how to be active when busy or with their child, involved their partner, used a Fitbit, and was remotely delivered. The intervention developed from this formative work, the HyPE Intervention (The Hypertensive disorder of pregnancy Postpartum Exercise Intervention), was overall highly feasible and acceptable. A total of 140 of 152 possible sessions were attended by those who started the intervention (n = 19; 92.1%). All participants who completed the intervention indicated that they were satisfied with the program and would recommend it to others. In the overall sample, there were no changes in activPAL estimated steps from pre- to post-testing (+138.40±1294.00 steps/day; P = 0.75). However, individuals achieving <7500 steps a day at baseline significantly increased their stepping time (66.74±13.85 to 75.22±18.91 minutes/day, P = 0.04). In addition, significant increases were found in the ability to plan for PA, monitor PA, and participants describing themselves as an active person. A significant reduction in the number of individuals with hypertensive readings from baseline to follow-up (64.6% to 41.2%, P = 0.03) was observed. No significant changes in systolic or diastolic blood pressure were detected.
Conclusion: The present study was able to successfully identify the PA behavioral determinants of postpartum individuals after HDP, their desired intervention attributes, and subsequently design and test this intervention in the target population. The PA intervention was highly feasible and acceptable in this population. No significant differences were observed in activPAL measured steps. A significant decrease in the prevalence of hypertension was observed. Future studies should target less active populations and leverage a randomized controlled study design to more rigorously test the effects of an intervention on postpartum PA and blood pressure after HDP.
Details
- Title: Subtitle
- A remote postpartum physical activity intervention for individuals with a hypertensive disorder of pregnancy
- Creators
- Jaclyn Dziewior Borrowman
- Contributors
- Kara M. Whitaker (Advisor)Lucas J. Carr (Committee Member)Gary L. Pierce (Committee Member)William T. Story (Committee Member)Bethany Barone Gibbs (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Health and Human Physiology
- Date degree season
- Spring 2024
- DOI
- 10.25820/etd.007506
- Publisher
- University of Iowa
- Number of pages
- xiv, 132 pages
- Copyright
- Copyright 2024 Jaclyn Dziewior Borrowman
- Grant note
- Two studies, funded by an American Heart Association pre-doctoral fellowship grant (#23PRE1018306), were conducted to address the study aims (v).
- Language
- English
- Date submitted
- 04/02/2024
- Description illustrations
- Illustrations, tables, graphs, charts
- Description bibliographic
- Includes bibliographical references (pages 113-132).
- Public Abstract (ETD)
Individuals with pregnancies complicated by a hypertensive disorder of pregnancy (HDP) are at significantly greater risk of developing cardiovascular disease (CVD) later in life. Discovering effective strategies to mitigate future risk of CVD in this high-risk population is critical. Although the benefits of increasing physical activity (PA) for cardiovascular health are well known, less is known about the unique factors influencing postpartum PA after HDP and whether this population would be interested in an intervention promoting optimal activity patterns. The following dissertation project was focused on answering these main questions: 1) what are the major influences on postpartum PA after HDP, 2) would those who experienced a HDP be interested in a postpartum PA intervention, and if so, what would they like this program to look like, 3) would a program informed by those who experienced a HDP be feasible, acceptable, and able to increase PA in the postpartum period, and 4) would this program decrease postpartum blood pressure? Results from this study indicate that major barriers to activity in this population included difficulty being active with current resources and remembering to be active daily. Despite this, there was high interest in a postpartum PA intervention that included information on how to be active with children, involved partners, and used remote communication channels. This informed the development of the HyPE intervention, which was highly feasible, acceptable, and demonstrated preliminary efficacy to increase PA and decrease blood pressure in this population.
- Academic Unit
- Health and Human Physiology
- Record Identifier
- 9984647356702771
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