Student Name: Bianca Rochelle

Email: BLRochelle@uams.edu

Description:

This project evaluated existing evidence on structured, low-impact, adapted prenatal exercise programs for high-risk pregnancies (e.g., patients with obesity, hypertension, or limited mobility) and their impact on outcomes such as gestational diabetes, preeclampsia, and preterm birth. It synthesized current research on the safety, efficacy, and accessibility of modified movement interventions across ability levels. The final deliverable is a written review and presentation summarizing key findings, gaps in the literature, and recommendations for implementing inclusive prenatal exercise programs in clinical practice. The final deliverables included infographics and flyers that could be used to implement a program such as “Move, Mama, Move!”

PDF files:

• Move Mama Move Flyer Example
• Move Mama Move Exercises Infographic Example
• Move Mama Move Provider Flyer Example
• Peer Pregnancy Exercise Program Flyer Example

Literature Review:

Introduction:

Research has shown that exercise in pregnancy can decrease several maternal and fetal outcomes. This includes macrosomia, gestational diabetes, preeclampsia, cesarean delivery, low back pain, pelvic girdle pain, and urinary incontinence (Cooper & Yang, 2023). The WHO recommends that healthy pregnant women have 150 minutes of moderate physical activity weekly (Paulsen et. al, 2023). Contrary to these findings, it has been found that pregnant women decrease their level of physical activity, and this can be a multitude of reasons including lack of energy, time, discomfort, and fear of spontaneous abortion. Inactivity in pregnancy can increase risks of preeclampsia, gestational diabetes mellitus (GDM), gestational hypertension, excessive gestational weight gain, delivery complications, early delivery, postpartum depression, and complications in the newborn without increasing the likelihood of a low-birth weight newborn (Paulsen et. al 2023, Joseph et. al, 2025). Similarly, Adesegun et. al (2019) found that prenatal exercise had no association with an increased risk of adverse maternal or neonatal outcomes.

Exercise:

Ferreira et. al found that implementing a controlled and supervised exercise program in pregnancy was associated with significantly lower odds of induced deliveries. When studied, only 19.3% of women exercised during pregnancy with the majority reporting slow walking (Miranda et. al 2022) Their study further showcased that factors associated with moderate or vigorous activity were education, nulliparity, low anxiety, and unemployment. High risk pregnancies were those most likely to exhibit low activity levels.

Pre-eclampsia:

Pre-eclampsia affects approximately 5% of pregnancies worldwide resulting in serious health implications for both mother and fetus (Paulsen et. al, 2023). Their review found that pre-eclampsia risk reduction was associated with mind-body exercise and low-intensity exercise. In contrast, da Silva et. al (2017) found in their randomized controlled trial that there was no significant difference in the incidence of pre-eclampsia between those receiving exercise intervention and those without.

Gestational Diabetes Mellitus:

According to Paulsen et. al GDM is one of the most common complications during pregnancy with 50% of those patients developing type 2 diabetes mellitus (T2DM) within ten years after birth. Neonates born from GDM pregnancies are at a higher risk of developing obesity, metabolic diseases, and cardiovascular diseases later in life (Davenport et. al, 2018).  Problems with GDM include increased incidence of pre-eclampsia, macrosomia, and cesarean delivery. A study done with lifestyle intervention, including lifestyle intervention, diet couns.eling, physical activity, and behavior change found that the relative risk for GDM was 0.59 while compare the intervention group to those with usual antenatal care (Sadiya et. al, 2022). The overall risk reduction was 41% among high-risk pregnant women. Another program intervention focused on nutrition found that women in that cohort were less likely to experience GDM compared with those in the control cohort, only receiving standard antenatal care. In the same study they found that those receiving only an exercise intervention with the lifestyle intervention had the most significant reduction of GDM incidence highlighting it as the most effective way to prevent GDM. In contrast, Davenport et. al (2018) found that exercise only interventions reduced odds of GDM when compared to exercise + co-interventions. Paulsen et. al found that prevention of GDM was substantial with all modalities of exercise e.g. aerobic, resistance, combined, or mind-body exercise. In contrast to the other data sources, a randomized controlled trial from 2017 found no differences in gestational diabetes between groups who had an exercise intervention, and those that did not (da Silva et. al, 2017).

Pre-term Birth:

“Preterm delivery typically increases health risk for neonates and is associated with longer infant hospital stay and financial burden. Prenatal exercise dose (frequency, intensity, type, time, volume) have been shown to influence birth outcomes” (Claiborne et. al, 2025). Cai et. al found that those who participated in physical exercise anywhere from one to five times per week had lower odds of pre-term birth compared to those not involved in any activity. Increasing the physical exercise was associated with lower risk of pre-term birth when exercise was less than 150 minutes per day, the WHO recommended amount for pregnancy (Cai et. al, 2021).  Similarly, it was found that women with higher weekly exercise volume had an increased length in gestation with decreased duration of post-delivery hospitalization (Claiborne et. al, 2025). Findings suggested that prenatal exercise held a dose-dependent associated with improvement of APGAR scores. In contrast, Tinloy et. al (2014) and da Silva et. al (2017) found considerably different results in their analyses, this included regular exercise not being associated with late preterm birth.

It is a commonly known fact that non-Hispanic black women have disproportionate experiences with adverse birth outcomes (Raper et. al, 2021). It was proven that prenatal exercise reduced “borderline significant” racial/ethnic disparities in pre-term birth and gestational age. Similarly, it was found that moderate-intensity exercise was associated with decreased pre-term births in African American women (Moyer et. al, 2016). On that same page, leisure-time activity, outside of work activity, was associated with decreased risk of pre-term birth.

Maternal Outcomes:

Research examining prenatal physical activity suggests that maintaining consistent exercise habits during pregnancy may play an important role in both maternal mental health and birth outcomes (Gildner et. al). In a study by Gildner and colleagues, women who experienced interruptions in their normal exercise routines reported higher prenatal depression scores, highlighting the potential psychological impact of reduced activity during pregnancy. Additional evidence summarized by Adesegun et al. (2019) indicated that prenatal exercise was associated with substantially lower odds of cesarean section among women with type 1 diabetes and chronic hypertension, although the overall quality of evidence ranged from low to very low. Similarly, findings from research conducted by Tinloy (2014) showed that women engaging in at least 150 minutes of physical activity per week tended to have lower odds of cesarean delivery compared with those participating in 60 minutes or less, though the association did not reach statistical significance. Research by Cooper and Yang further identified aerobic exercise as one of the most effective forms of physical activity for reducing adverse pregnancy outcomes. Supporting these findings, Shojaei et al. (2021) demonstrated that walking interventions during pregnancy significantly decreased the duration of the third stage of labor as well as rates of spontaneous labor complications, induced labor, cesarean delivery, and instrumental delivery in the intervention group. However, the study did not identify significant differences between groups in the duration of the first and second stages of labor or in neonatal APGAR scores. Broader social and occupational factors also appear to influence pregnancy outcomes, as women from lower socioeconomic backgrounds demonstrate higher rates of preterm birth, particularly when combined with increased physical demands related to work activity.

Discussion:

Research consistently shows that regular physical activity during pregnancy is a safe and effective way to improve outcomes for both mother and baby, including among higher-risk pregnancies. Moderate exercise has been associated with lower rates of gestational diabetes, high blood pressure during pregnancy, preterm birth, cesarean delivery, prolonged infant hospital stays, and delivery complications, while also supporting healthier birth weights, longer gestational age, and improved newborn health measures. Structured exercise programs combined with nutrition and behavioral support appear to provide the greatest benefits and may also help reduce disparities in pregnancy outcomes across different populations. Physical activity during pregnancy has additionally been linked to improved mental well-being, reduced depressive symptoms, and better overall quality of life. Despite these benefits, many pregnant individuals decrease their activity levels because of fatigue, discomfort, limited time, lack of guidance, or concerns about safety. Current evidence supports that low-to-moderate intensity activities such as walking, stretching, aerobic exercise, resistance training, and mindfulness-based movement can be safely performed throughout pregnancy without increasing risks to maternal or neonatal health, highlighting the importance of accessible education and supportive wellness programs.

Intervention:

To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140min of brisk walking, water aerobics, stationary cycling or resistance training) (Davenport et. al, 2018). Among surveyed pregnant patients, nearly 90% of participants reported feeling sufficiently informed about physical exercise during pregnancy, almost 80% still engaged in either no exercise or lower levels of activity compared to their pre-pregnancy routines (Schmidt et. al 2017). Participants who received counseling from physicians, such as gynecologists or general practitioners, were more likely to report feeling adequately informed, and women who perceived themselves as well counseled generally demonstrated higher levels of physical activity. These findings highlight the importance of standardized prenatal exercise counseling delivered by health professionals, ideally incorporating consistent, evidence-based guidance supported by structured materials such as pamphlets and QR codes linking to APGO, WHO, and other guideline-approved instructional videos to improve patient understanding and adherence to recommended activity levels. My intervention would include a new initiative sent out to providers of obstetrics care to counsel all patients on the standardized guidelines with printed pamphlets for patients and posters for patient waiting areas. An important facet would be also including diet-based interventions and peer accountability groups.  

Email: MEHendrix@uams.edu

Description:

This project examines how structured, realistic physical activity may support mental health and wellbeing among healthcare employees. The goal is to translate current evidence into a practical educational resource that encourages short, flexible movement options during the workday. The final deliverable is an employee-facing brochure that presents movement as a professional, low-barrier adjunctive wellness strategy for stress, mood, sleep, and resilience.

Movement and Mental Health
Small steps for a better workday

Balance movement with the demands of the day.

Movement • Balance • Mental Health
Small breaks | Steady habits | Repeatable routines

A practical wellness brochure for UAMS employees
Mood • Stress • Sleep • Resilience

Why Move?

Movement is a practical support for busy workdays.

• Linked with better mood and less psychological distress.
• In healthcare workers, evidence is strongest for lower stress and better sleep.
• Small amounts can help, especially when starting from none.

Progress, Not Perfection

The goal is to choose one realistic step you can repeat.

• 2: Reset
• 5: Walk
• 10: Break

Choose one small step and repeat it.

Quick Tips: Keep It Simple

• Start with 2 to 5 minutes.
• Walk, stretch, or strengthen.
• Use natural breaks in the day.
• Repeat what works for you.
• Some movement is better than none.

Movement can support wellbeing, but it does not replace mental health care or workplace-level solutions to burnout.

1. Two-minute reset

Reset: stand + breathe

Use between tasks or after a hard encounter.

• 30 sec shoulder rolls
• 30 sec calf raises
• 30 sec upper-back stretch
• 30 sec slow breathing

Best for: a quick mental reset.

2. Five-minute walk

Walk: comfortable pace

Use at lunch, between meetings, or after a shift.

• Walk at a comfortable pace.
• Notice breathing and posture.
• Leave your phone behind if possible.
• Start with two minutes if needed.

Best for: stress relief and clarity.

3. Ten-minute break

Build: walk + stretch + strength

Use when you have a little more time.

• 5 min brisk walking
• 2 min stretching
• 3 min simple strength work
• Try chair squats, wall push-ups, or calf raises.

Bonus: add strength twice weekly.

The best plan is the one you can repeat.

View the brochure with images.

Literature Review 

1. Singh et al. (2023) – Effectiveness of physical activity interventions for improving depression, anxiety, and distress: an overview of systematic reviews 

Singh B, Olds T, Curtis R, Dumuid D, Virgara R, Watson A, Szeto K, O’Connor E, Ferguson T, Eglitis E, Miatke A, Simpson CE, Maher C. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br J Sports Med. 2023;57(18):1203-1209.  

This overview of systematic reviews provides broad support for including physical activity in a mental health project. Across multiple adult populations and intervention types, physical activity was associated with improvements in depression, anxiety, and psychological distress. The main contribution of this source is that it supports a flexible message that benefit is not limited to one specific exercise type, so a brochure can recommend walking, stretching, or light strengthening without overstating that one exact format is necessary. Because the review includes many different populations and interventions, it is best used as general evidence supporting movement as one helpful mental health strategy. 

2. Noetel et al. (2024) – Effect of exercise for depression: systematic review and network meta-analysis of randomized controlled trials 

Noetel M, Sanders T, Gallardo-Gómez D, Taylor P, Del Pozo Cruz B, van den Hoek D, Smith JJ, Mahoney J, Spathis J, Moresi M, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2024;384:e075847.  

Noetel and colleagues strengthen the case for using movement in this project by showing that exercise is relevant to depression treatment itself, not just general wellbeing. Their findings support a range of exercise types, including walking or jogging, yoga, and strength training. This is helpful for a workplace resource because it justifies offering employees multiple movement options rather than a one-size-fits-all prescription. The brochure therefore includes several brief and low-barrier forms of activity. Even so, the source should be interpreted carefully, because exercise should still be framed as an adjunct rather than a replacement for individualized depression care. 

3. Pearce et al. (2022) – Association between physical activity and risk of depression: a systematic review and meta-analysis of prospective cohort studies 

Pearce M, Garcia L, Abbas A, et al. Association between physical activity and risk of depression: a systematic review and meta-analysis of prospective cohort studies. JAMA Psychiatry. 2022;79(6):550-559.  

Pearce et al. are especially useful for the brochure’s tone because they support a ‘start small’ message. This dose-response meta-analysis found that even activity levels below standard guideline targets were associated with lower risk of depression compared with doing none at all, and the greatest relative benefit appeared at the lower end of the activity range. That finding supports encouraging employees to begin with short bouts such as a two-minute reset or a five-minute walk. Since the studies were observational, the findings are best described as an association, but they still provide strong support for the idea that small steps can matter. 

4. Heissel et al. (2023) – Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression 

Heissel A, Heinen D, Brokmeier LL, Skarabis N, Kangas M, Vancampfort D, Stubbs B, Firth J, Ward PB, Rosenbaum S, Hallgren M, Schuch FB. Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. Br J Sports Med. 2023;57(16):1049-1057.  

Heissel et al. reinforce the broader evidence that exercise can reduce depressive symptoms and that movement recommendations are most useful when they are specific enough to act on. This supports the brochure’s use of a brief ‘movement prescription’ format instead of vague encouragement to be healthier. In practical terms, the review helps justify organizing the brochure around short, repeatable actions that employees can try during a workday. As with other exercise literature, study designs varied, so this source is most helpful for reinforcing the overall concept rather than establishing one exact workplace dose. 

5. Martland et al. (2024) – The efficacy of physical activity to improve the mental wellbeing of healthcare workers: a systematic review 

Martland RN, Ma R, Paleri V, Valmaggia L, Riches S, Firth J, Stubbs B. The efficacy of physical activity to improve the mental wellbeing of healthcare workers: a systematic review. Health Promot Int. 2024;39(2):daae022.  

Martland et al. are among the most directly relevant sources because the review focuses specifically on healthcare workers. The strongest and most consistent findings supported reduced psychological stress and improved sleep quality following physical activity interventions. Evidence for burnout, anxiety, depression severity, fatigue, and overall wellbeing was less conclusive. This source is important because it helps the brochure stay appropriately narrow and credible so it can confidently emphasize stress and sleep support while using more cautious language around burnout and broader mental health outcomes. 

6. Mincarone et al. (2024) – Association between physical activity and burnout risk in healthcare workers: a systematic review and meta-analysis 

Mincarone P, Bodini A, Tumolo MR, Sabina S, Colella R, Mannini L, Sabato E, Leo CG. Association between physical activity and burnout risk in healthcare workers: a systematic review and meta-analysis. JMIR Public Health Surveill. 2024;10:e49772.  

Mincarone and colleagues contribute burnout-specific context, which is especially relevant for an employee audience. Their review found that physical activity was often associated with reduced burnout risk, especially in emotional exhaustion and depersonalization. This allows the brochure to mention a possible link between movement and burnout risk, but the source also supports caution because burnout is multifactorial and many included studies differed substantially in measurement and methodology. The resulting brochure language therefore emphasizes that movement may support resilience and may be associated with lower burnout risk, but it does not suggest that movement alone can solve system-level causes of burnout. 

7. CDC Adult Physical Activity Guidance (2023) – Adult Activity: An Overview 

Centers for Disease Control and Prevention. Adult Activity: An Overview. Updated December 20, 2023. Accessed June 29, 2026. https://www.cdc.gov/physical-activity-basics/guidelines/adults.html  

Although the CDC guidance is not a peer-reviewed study, it is valuable for translating evidence into understandable workplace messaging. It recommends at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity per week, plus strength work on at least two days each week. Just as importantly for this project, the guidance emphasizes that activity can be spread throughout the week, broken into smaller chunks, and started gradually. This supports the brochure’s central practical message that some movement is better than none and that brief activity breaks are a realistic way to begin. 

Evidence Synthesis 

Taken together, the literature supports a practical and measured employee-facing message. The strongest general evidence indicates that physical activity can function as an adjunctive strategy for depressive symptoms, anxiety, and psychological distress, while the strongest healthcare-worker-specific evidence suggests benefit for stress reduction and sleep improvement. There is also evidence that physical activity may be associated with lower burnout risk, particularly in emotional exhaustion, but burnout remains heavily shaped by workload, staffing, culture, and other system-level factors. Accordingly, the brochure presents movement as one realistic wellness tool rather than a stand-alone solution. 

Suggested Evaluation Plan 

The brochure could be evaluated with a brief anonymous pre/post survey distributed after brochure review or following a one-week movement challenge. Initial questions could assess whether the brochure improved employee confidence that short movement breaks can support stress, mood, sleep, or general wellbeing and whether the suggested movement options feel realistic for the workday. A short follow-up could ask whether participants tried a movement break and whether they noticed any perceived change in stress, mood, energy, focus, or sleep. Additional open-ended feedback about barriers and helpful workplace supports would provide practical guidance for future wellness programming. 

References 

Singh B, Olds T, Curtis R, et al. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br J Sports Med. 2023;57(18):1203-1209. 

Noetel M, Sanders T, Gallardo-Gómez D, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2024;384:e075847. 

Pearce M, Garcia L, Abbas A, et al. Association between physical activity and risk of depression: a systematic review and meta-analysis of prospective cohort studies. JAMA Psychiatry. 2022;79(6):550-559. 

Heissel A, Heinen D, Brokmeier LL, et al. Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. Br J Sports Med. 2023;57(16):1049-1057. 

Martland RN, Ma R, Paleri V, Valmaggia L, Riches S, Firth J, Stubbs B. The efficacy of physical activity to improve the mental wellbeing of healthcare workers: a systematic review. Health Promot Int. 2024;39(2):daae022. 

Mincarone P, Bodini A, Tumolo MR, Sabina S, Colella R, Mannini L, Sabato E, Leo CG. Association between physical activity and burnout risk in healthcare workers: a systematic review and meta-analysis. JMIR Public Health Surveill. 2024;10:e49772. 

Centers for Disease Control and Prevention. Adult Activity: An Overview. Updated December 20, 2023. Accessed June 29, 2026. https://www.cdc.gov/physical-activity-basics/guidelines/adults.html 

This summer, 3^rd year medical students at UAMS had the opportunity to participate in a new pilot project through the Department of Family and Preventive Medicine (DFPM) Office of Wellness called Medical Students for Movement or “MS4M”. This project allowed students to research and create a project exploring how physical activity positively impacts health and wellbeing, with the goal of disseminating their work to UAMS DFPM employees, students, and ultimately patients. The project was academic in nature and was intended to be used to fulfill or build upon other scholarly requirements of their program including posters for the Student Research Day in 2027. The M3 students that participated in this program received a stipend upon the successful participation and completion of the project.

Students chose a topic based on their interests that explored how movement positively impacts a specific area of health. Projects covered a range of topics and their relationship with movement, from Mental Health to Healthy Aging. Project topics included:

• Movement and Mental Health
• Movement for Musculoskeletal Health: Why Daily Movement Matters for Bones, Joints, Muscles, and Function
• Movement for All Ability Levels to Investigate Adapted Prenatal Exercise Programs for High-Risk Pregnancies
• Movement and Pelvic Floor Function: Promoting Postpartum Recovery and Preventing Incontinence
• Movement and Healthy Aging
• Promoting Accessible Resistance Training Among UAMS Employees
• Movement as Medicine Throughout the Perioperative Period

We are excited to begin sharing the Medical Students for Movement projects here on the Wellness Website! Stay tuned to learn more about each of their projects in more depth and see the great work our medical students did this summer!

Stay Well!

We are excited to announce our upcoming wellness challenge, the Gameday Hustle Challenge! The event will start on 9/21/2026 and run through 10/18/2026.

Join this challenge to focus on your health and wellness with some friendly, football-themed competition! In this challenge, you will learn fun football facts and health tips as well as stay physically active to virtually move the ball as far down the field as you can! As a bonus, every participant that advances the ball during the challenge will have the opportunity to win a prize!

Yardage Raffle

Each yard you travel equals one entry into a raffle, so the odds of winning a prize increases the further you advance down the field (by earning Wellable Points).  Five participants will be chosen as Yardage Raffle winners at the end of the challenge.

5 Yardage Raffle Prizes: $30 gift card of your choosing

Touchdown Raffle

Each participant that travels at least 80 yards (earning at least 16,000 Wellable Points) and makes it into the end zone for the game-winning touchdown will be entered into a Touchdown Raffle.  Three participants will be chosen as Touchdown Raffle winners at the end of the challenge.

3 Touchdown Raffle Prize: $50 gift card of your choosing

• If you have already signed up for Wellable – get ready to start our Gameday Hustle Challenge on 9/21/2026!

• If you have not already signed up for Wellable – what are you waiting for?!

Visit our Sign Up Page and create a Wellable account now! By joining, you will have access to tools that will track your progress and celebrate your success.

Department of Family and Preventive Medicine and the Primary Care and Population Health Service Line has partnered with Wellable to make access to health and wellness initiatives easier for us all! We are excited to officially invite you to sign up for a Wellable Account and participate in our new Wellness Program! 
We will be running service line-wide wellness challenges with Wellable’s award-winning technology platform. In your own Wellable account, you can connect your current apps or devices (Apple Watch, Fitbit, MyFitnessPal, and many more!) to automatically earn Wellable Points to climb a leaderboard and be eligible for rewards!
This initiative is designed to promote:

• Physical Activity
• Healthy Habits
• Team- Building
• Friendly Competition
• Prizes

Ready to get started?! Visit our Sign Up Page and create a Wellable account now! By joining, you will have access to tools that will track your progress and celebrate your success.

Set up your Wellable account today and stay tuned for updates on our challenges with Wellable! If you have questions, please reach out to Caddo Wright or Kathy Emans
We thank you for your commitment to health and look forward to seeing your participation in our Wellness Program!