Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy




Mottola, Michelle F.

2nd Supervisor

Prapavessis, Harry.



Lifestyle interventions (nutrition and exercise) offered during pregnancy may prevent excessive gestational weight gain (EGWG) and improve pregnancy outcomes. The efficacy of previous interventions has been inconsistent as some studies ‘successfully’ achieve their health outcome goals while others have had a null effect. A common limitation reported among ‘unsuccessful’ studies is low adherence. The objective of this dissertation was to execute three independent yet interrelated studies to determine if adherence is a key factor in determining the success of a lifestyle intervention during pregnancy. Study 1 compared adherence to ‘successful’ and ‘unsuccessful’ lifestyle interventions during pregnancy using a systematic review. Results showed that adherence is significantly higher among ‘successful’ health outcome studies than ‘unsuccessful’ ones. Study 2 aimed to determine if adherence remains a key factor in determining program ‘success’ among women with a pre-pregnancy body mass index ≥25.0 kg/m2 who may have experienced weight fluctuations prior to pregnancy. Results revealed that high adherence to nutrition and exercise goals during pregnancy is a significant predictor of appropriate gestational weight gain. Study 3 aimed to determine a strategy to improve program adherence by comparing adherence to the sequential introduction of nutrition and exercise behaviors to the simultaneous approach. Results showed that the sequential introduction of exercise followed by nutrition improves adherence and may also improve health outcomes including promotion of appropriate gestational weight gain. By improving adherence to prenatal nutrition and exercise goals, more women may have a healthy pregnancy and this improves health outcomes for mother and child.

Summary for Lay Audience

Adherence is defined as the degree to which an individual follows the recommendations of a healthcare provider. Among pregnant women, previous authors have reported low adherence as a limitation of nutrition and exercise programs. Low adherence is problematic because it means that the participants are not actually performing the required goals of a program and therefore this can reduce their likelihood of achieving positive health outcomes. Examples of health outcomes include preventing excessive weight gain during pregnancy, macrosomia (large babies, birthweight >4000g) and low birth weight (small babies, birthweight

Included in

Kinesiology Commons