Facilitating and encouraging clinicians and researchers to connect across the globe will help to support the growth of the physiotherapy profession. With this idea in mind, we are happy to provide a platform for researchers to share their current research projects and findings with the Physiopedia community.
We would like to introduce you to Dr. Margie Davenport. Dr. Davenport an Associate Professor in the Faculty of Kinesiology, Sport, and Recreation at the University of Alberta. Dr. Davenport is the director of the Program for Pregnancy and Postpartum Health (PPPH), a research program with a mission to conduct research which improves the life-long health of pregnant and postpartum women and their children.
Dr. Davenport, thank you for taking the time to provide the Physiopedia community with a look at the work of a clinician-scientist.
Q. What inspired you to pursue a career in research?
A. When I was an undergrad I wanted to know more about obesity and diabetes but this wasn’t covered in my classes. I sought out an undergraduate honours project on diabetes during pregnancy. This involved learning about how to conduct research and how it can have direct impacts on individuals and groups. I found it very exciting to be on the front edge of new knowledge. After this experience, I knew I wanted to continue with research of some kind way.
After my honours project I enrolled in a MSc focused on exercise and pregnancy and fell in love with the physiology. The adaptations women go through during pregnancy are incredible and I found it immediately relevant to myself as a woman.
As a researcher I love the flexibility my job, and the ability to pursue exciting new questions that are relevant to women and children’s health. The overriding goal of my research is to promote healthy pregnancies to improve the lifelong health of women and their children. This involves studies in my lab, but also getting new knowledge to pregnant women and their health care providers. Working with care givers and policy makers at a local, national and international level means that the work we’re doing can and will make a difference. This is the most important and fulfilling thing that I do.
Q. Can you describe to the Physiopedia community how you and your team created the recently published 2019 Canadian guideline for physical activity throughout pregnancy?
A. The Society of Obstetricians and Gynecologists of Canada (SOGC), and Canadian Society for Exercise Physiology (CSEP) 2019 Canadian Guideline for Physical Activity throughout Pregnancy represents the culmination of a three year process by a pan-Canadian panel to develop evidence-based recommendations for exercise during pregnancy. I was the Chair of the Guideline Consensus Panel which consisted of experts in the field including my co-leads Stephanie Ruchat and Michelle Mottola, as well as representatives from the SOGC and CSEP, the College of Family Physicians of Canada, the Canadian Association of Midwives, the Canadian Academy of Sport and Exercise Medicine, Exercise is Medicine Canada, and a public health unit. Importantly, pregnant women provided input throughout the process. Our amazing methodologists guided us through the Guideline development process including a librarian, statistician and experts in the gold standard methods for guideline development which is Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Appraisal of Guidelines for Research & Evaluation II (AGREE II) methodology.
In order to inform our recommendations, we scoured the entirety of the current literature on the topic – over 27,000 abstracts! After wading through all of this information, we developed twelve systematic reviews which examine 37 outcomes including pregnancy, labour and delivery complications, maternal mental health, as well as fetal growth and development. Using the results of the systematic review and input from pregnant women, exercise professionals and obstetric health care providers, we developed six key recommendations for prenatal exercise which have important impacts on the health of both the mother and fetus. The Guideline document is jointly published in the British Journal of Sports Medicine (BJSM) and the Journal of Obstetricians and Gynecologists Canada. The 12 systematic reviews were published in two editions of BJSM.
Q. Why is physical activity such an important component of pregnancy?
A. Our systematic reviews based on evidence from randomized controlled trials found that women who exercise during pregnancy have a 40 percent reduction in the risk of developing gestational diabetes, gestational hypertension and preeclampsia, have a substantial reduction in the severity of depressive symptoms, as well as a decreased risk of having a large baby. Importantly, our evidence suggested no increased risk of having a miscarriage, small baby or preterm birth. We now have strong evidence regarding the safety and benefits of being physically active throughout pregnancy for both mother and baby. These findings are critically important as it represents a foundational shift in our understanding of exercise from a recommended behaviour to a critical component of a healthy pregnancy to achieve significant and potentially lifelong health benefits for both mother and child.
Q. What new information was added to the guidelines?
A. Our previous guideline was from 2003; however, it was primarily based on expert opinion as there was minimal evidence available at that time regarding the safety and potential benefits of exercise for pregnant women. The new 2019 Guideline is evidence-based and clearly demonstrates the importance of physical activity throughout pregnancy – from conception to delivery.
The recommendations were developed based on the frequency, intensity and volume of exercise associated with a 25% reduction in the odds of developing pregnancy complications. We found that increasing the frequency, intensity, or volume of exercise was associated with a greater reduction in the risk of developing complications including gestational diabetes, preeclampsia, gestational hypertension, having excessive gestational weight gain and severity of depressive symptoms. But to have at least a 25% reduction in each of these conditions, women need to accumulate at least 150 minutes of moderate intensity exercise over three or more days per week. However, it is important to note that we were not able to identify an upper threshold of safety because there was very minimal information regarding exercise intensities beyond the equivalent of a jog.
Q. What do you think is the biggest barrier to implementing evidence from research into clinical practice?
A. There are many barriers to translating evidence into practice. However, one of the most important steps is conducting research which is actually relevant to the individuals who would utilize it. Over the past decade, there has been a shift in health research to include stakeholders (patients and clinicians) in all stages of research to ensure that research is conducted with, rather than for them. We engage pregnant women in the research process and get feedback from them. This dialog is important, and so many women tell us how happy and excited they are that they can help inform evidence that is relevant to them and will help pregnant women in the future.