EQOL Journal (2019) 11(2):
ORIGINAL ARTICLE
Preliminary study on
Viktória Prémusz 1,2✉ • Alexandra Makai 3 • Boróka Gács 4 • Ágnes Nagy 2 • Beatrix Perjés 2 • Pongrác Ács 2 • Kinga Lampek 2 • Ákos Várnagy 1,2
Received: 16th May, 2019 |
DOI: 10.31382/eqol.191201 |
Accepted: 5th July, 2019 |
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© The Author(s) 2019. This article is published with open access. |
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Abstract
The increasing incidence of infertility and contrary the remaining levels of success rate of assisted reproductive therapies (ART) justify expanding the biomedical approach and underline the importance of psychosocial and lifestyle factors. The aim of the study was to examine the effects of
infertility diagnosis. Standardized QoL questionnaires and
✉premusz.viktoria@pte.hu
1University of Pécs,
Hungary
2University of Pécs, Faculty of Health Sciences,
Doctoral School of Health Sciences, Pécs,
Hungary
3University of Pécs, Faculty of Health Sciences, Institute of Sport Sciences and Physiotherapy,
Pécs, Hungary
4University of Pécs, Medical School, Department of
Behavioural Sciences, Pécs, Hungary
and most with Psychological Domain (72.2±12.1) of
Keywords physical activity • assisted reproduction •
Introduction
Burden of infertility as a critical component of reproductive health has often been neglected in the global efforts for success in improving maternal and child health. 10 to 15% of couples of fertile age struggle with
34.5% of pregnancies per aspiration can be reported
5
EQOL Journal (2019) 11(2):
valence of secondary infertility (as the percent of women who seek a child aged
The increasing incidence of assisted reproductive investigations and unchanged success rates highlighting the need for inspection of social, psychological and lifestyle covariates. To describe the impact of interventions or health conditions in a broader way allowed us the generic quality of life (QoL) concept of the WHO, defined as “people's perception of their position in life in the context of the culture and value systems in which they live in relation to their objectives, expectations, standards and concerns” (WHO, 1995). This comprehensive framework involves physical and psychological health aspects as well as social relationships, environment and spiritual aspects and widely used on subjects with different conditions, inter alia in infertility (Chachamovich, Chachamovich, Zachia, Knauth, & Passos, 2007). The failure to become pregnant may specifically affect various life dimensions such as depression, anxiety, social
isolation, sexual dysfunction, social and psychological distress, poorer marital adjustment (Rashidi et al., 2008). For this reason, it is necessary to explore the fertility quality of life (FertiQoL) as well.
Benefits from regular physical activity in maintain physical, mental and social health do not call into question (WHO, 2018). Although depending on intensity or duration, certain studies controversially evaluating health effects of exercise or even PA in relation to assisted reproductive treatments (ART) (Morris et al., 2006; Palomba et al., 2014; Rao, Zeng,
&Tang, 2018;
6
Therefore, the aim of the current research was to describe PA and QoL patterns and their relationships in ART patients.
Method
A
Data collection was carried out during the routine examination on the 3rd day of the unstimulated cycles. 50 women agreed and tended to participate in the study until April 2019, which means approximately 80% response rate.
Assessment Scales
To describe PA and exercise habits participants
EQOL Journal (2019) 11(2):
respondents in the introduction section of the questionnaires:
Results could be expressed in time (minutes) or in energy expenditure (MET: Metabolic Equivalent of Task). Translation and cultural adaptation of the questionnaire on general population was carried out by our research group and the tool’s Hungarian version proved reliable and valid. Validation and related findings are currently in press.
Quality of life was measured in general, and as
Ethical approval
This study was approved in advance by the University of Pécs, Clinical Center, Regional and Local Research Ethics Committee (Nr. 6533). Each participant voluntarily provided written informed consent before participating. The investigation conforms to the principles outlined in the Declaration of Helsinki.
Data analysis
Statistical analyses were performed using SPSS 24.0 software (SPSS Inc., Chicago, IL, USA). Normality of data distribution was tested by Kolmogorov- Smirnov test.
Results
General characteristics
The major
75.5% of the participants rated their physical health particularly good or very good. In general, they
7
EQOL Journal (2019) 11(2):
Healthy Diet
Table 1. General characteristics of women undergoing ART |
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Pay particular attention |
1 |
(2.0%) |
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Pay some attention |
21 |
(42.9%) |
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Not really |
23 |
(46.9%) |
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Age (years) |
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Not |
4 |
(8.2%) |
Mean (SD) |
34.0 (±5.3) |
|
Tobacco Use (N=48) |
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Education |
|
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Regular |
1 |
(2.1%) |
Low |
4 |
(8.2%) |
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Occasional |
3 |
(6.3%) |
Intermediate |
15 |
(30.6%) |
|
44 |
(91.7%) |
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High |
30 |
(61.2%) |
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Exercise |
|
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Marital status (N=44) |
|
|
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Regularly |
24 |
(49.0%) |
Married |
38 |
(77.6%) |
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Not |
25 |
(51.0%) |
Partner |
11 |
(22.4%) |
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Regular exercise (N=24) |
|
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Place of residence |
|
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|
18 |
(75.0%) |
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County seat |
15 |
(30.6%) |
|
6 (25.0%) |
||
City |
22 |
(44.9%) |
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Infertility |
|
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Village |
12 |
(24.5%) |
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Case of infertility (N=48) |
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Income |
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Female |
21 |
(43.8%) |
Low |
1 |
(2.0%) |
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Male |
4 |
(8.3%) |
Medium |
28 |
(57.1%) |
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Dual |
9 (18.8%) |
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High |
20 |
(40.8%) |
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Undefined (by medical professionals) |
11 |
(22.9%) |
Health Status and Lifestyle |
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Final diagnosis in progress |
3 |
(6.3%) |
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BMI (kg/m2. N=47) |
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Type of ART Treatment – at baseline |
|
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Mean (SD) |
23.5 (±4.6) |
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(N=31) |
|
|
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Underweight (<18.5) |
6 (12.8%) |
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IVF/ICSI |
39 |
(81.3%) |
|
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IUI |
1 |
(2.1%) |
|||
Normal weight |
30 |
(63.8%) |
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OI |
2 |
(4.2%) |
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Overweight |
4 |
(8.5%) |
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HSG |
2 |
(4.2%) |
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Obesity (>30) |
7 (14.9%) |
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Examination in progress |
14 |
(31.1%) |
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Poor |
|
0 |
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Mean (SD) |
44.2 (±27.0) |
|||
Fair |
1 |
(2.0%) |
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Relationship (years) |
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Neither good nor bad |
11 |
(22.4%) |
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Mean (SD) |
7.7 (±3.8) |
||||
Good |
31 |
(63.3%) |
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Parity |
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Excellent |
6 (12.2%) |
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Nulliparous |
43 (87.8) |
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Multiparous |
6 (12.2) |
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Quality of Life
Based on the
8
For the purpose of measuring the level of infertility- related QoL, a more specific tool, the FertiQoL was applied. We found similar values with this specific scale like with
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EQOL Journal (2019) 11(2): |
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receiving ART treatment rated their QoL referring the |
Environment Scale (67.46±17.99) and Tolerability |
|||||
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interventions equally in both Treatment subscales: |
Scale (63.30±25.12) (Table 2). |
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Table 2. |
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Very poor |
Poor |
Neither poor |
Good |
Very good |
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nor good |
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SRH (%) |
0.0 |
4.1 |
16.3 |
22.4 |
57.1 |
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Very |
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Neither |
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Very |
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Dissatisfied |
dissatisfied |
Satisfied |
|||
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dissatisfied |
satisfied |
||||
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nor satisfied |
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QoL (%) |
2.0 |
0.0 |
12.2 |
12.2 |
73.5 |
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Domains |
Mean |
SD |
Median |
IQR lower |
IQR upper |
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Physical Health Domain |
57.7 |
7.5 |
56.0 |
56.0 |
63.0 |
|
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Psychological Domain |
72.2 |
12.1 |
75.0 |
66.0 |
81.0 |
|
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Social Relationships Domain |
71.5 |
15.1 |
75.0 |
63.0 |
81.0 |
|
|
Environment Domain |
62.3 |
12.8 |
63.0 |
56.0 |
69.0 |
|
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FertiQol |
|
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|
|
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Emotional Scale |
56.46 |
18.12 |
58.33 |
41.67 |
72.92 |
|
|
56.84 |
19.67 |
58.33 |
43.75 |
70.83 |
|
|
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Relational Scale |
76.48 |
19.62 |
79.17 |
62.50 |
93.75 |
|
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Social Scale |
62.76 |
17.40 |
62.50 |
50.00 |
72.92 |
|
|
Environment Scale |
67.46 |
17.99 |
68.75 |
62.50 |
79.17 |
|
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Tolerability Scale |
63.30 |
25.12 |
68.75 |
43.75 |
81.25 |
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Physical activity
in these relations also, only 120 min transportation and 90 min moderate work PA are characteristic. They spend sedentary
If we analyse data by intensity, we found that
respondents spent 716.3±892.0 minutes (3705.2±5188.4 MET) with moderate to vigorous activities (MVPA). When taken together all type and intensity activities lasting more than 10 minutes, women performed around 16 hours (970.6±1199.3 min/week) or 4722.5±6199.6 MET PA. In case we categorise they performance, 31 individual (68,89%)
reach the WHO’s 150min/week MVPA recommendation and 12 (18.2%) person spend more than 4 hours with exercise type PA.
9
EQOL Journal (2019) 11(2):
Table 3.
Measure |
Mean |
SD |
Median |
IQR lower |
IQR upper |
|
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PA by domains |
|
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Work – vigorous PA |
|
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|
min/week |
169.3 |
515.8 |
0.0 |
0.0 |
0.0 |
MET |
1354.7 |
4126.6 |
0.0 |
0.0 |
0.0 |
|
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|
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|
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Work – moderate PA |
|
|
|
|
|
|
|
|
|
|
min/week |
376.7 |
585.1 |
90.0 |
0.0 |
615.0 |
MET |
1506.7 |
2340.6 |
360.0 |
0.0 |
2460.0 |
|
|
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Transport |
|
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min/week |
254.3 |
489.8 |
120.0 |
60.0 |
210.0 |
MET |
1017.3 |
1959.4 |
480.0 |
240.0 |
840.0 |
|
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|
|
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|
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Recreation - vigorous PA |
|
|
|
|
|
|
|
|
|
|
min/week |
40.7 |
91.4 |
0.0 |
0.0 |
30.0 |
MET |
325.3 |
731.1 |
0.0 |
0.0 |
240.0 |
|
|
|
|
|
|
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Recreation - moderate PA |
|
|
|
|
|
|
|
|
|
|
min/week |
139.6 |
379.9 |
45.0 |
0.0 |
135.0 |
MET |
558.5 |
1519.5 |
180.0 |
0.0 |
540.0 |
|
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Sitting |
|
|
|
|
|
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|
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min/day |
2782.5 |
1824.7 |
2940.0 |
1260.0 |
4200.0 |
|
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PA by intensity |
|
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|
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|
|
|
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|
MVPA min/week |
716.3 |
892.0 |
300.0 |
104.0 |
967.5 |
MVPA MET |
3705.2 |
5188.4 |
1680.0 |
480.0 |
4680.0 |
Total PA min/week |
970.6 |
1199.3 |
470.0 |
210.0 |
1202.5 |
Total MET |
4722.5 |
6199.6 |
2040.0 |
840.0 |
5200.0 |
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Relationship between quality of life aspects and physical activity
Based on physical activity patterns, women were divided into two groups and means of QoL generic questions and domains were compared regarding PA as the grouping variable. In this
case WHO’s 150min/week MVPA
recommendation to categorize women in active or inactive group. Results showed significant difference between the groups only for Psychological domain of
10
EQOL Journal (2019) 11(2):
Table 4. Relationship between
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Physical |
Psychological |
Social |
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Environmental |
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Relationships |
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Health Domain |
Domain |
|
Domain |
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Domain |
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Z |
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p |
0.359 |
0.025* |
0.700 |
|
0.097 |
|
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FertiQoL |
|
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Emotional |
Relational Scale |
Social |
Environment |
Tolerability Scale |
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Scale |
Scale |
Scale |
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Z |
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p |
0.099 |
0.263 |
0.648 |
|
0.815 |
0.386 |
0.541 |
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Regarding generic QoL scores, weak correlations were found between Psychological Domain of
Similar correlations could be detected between the specific FertiQoL Core Scale
activity
11
EQOL Journal (2019) 11(2):
Table 5. Relationship between
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Physical Health |
Psychological |
Social |
Environmental |
|
GPAQ |
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Relationships |
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Domain |
Domain |
Domain |
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Domain |
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Work |
R |
0.070 |
0.132 |
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VPA (m/w) |
p |
0.374 |
0.646 |
0.387 |
0.801 |
|
Work |
R |
0.070 |
0.132 |
|||
VPA (MET) |
p |
0.374 |
0.646 |
0.387 |
0.801 |
|
Work |
R |
0.171 |
0.314* |
0.182 |
0.166 |
|
MPA (m/w) |
p |
0.261 |
0.036 |
0.233 |
0.276 |
|
Work |
R |
0.171 |
0.314* |
0.182 |
0.166 |
|
MPA (MET) |
p |
0.261 |
0.036 |
0.233 |
0.276 |
|
Work |
R |
0.123 |
0.323* |
0.247 |
0.121 |
|
TPA (m/w) |
p |
0.422 |
0.030 |
0.102 |
0.429 |
|
Transport |
R |
0.166 |
0.032 |
0.226 |
||
TPA (m/w) |
p |
0.276 |
0.793 |
0.834 |
0.136 |
|
Transport |
R |
0.166 |
0.032 |
0.226 |
||
TPA (MET) |
p |
0.276 |
0.793 |
0.834 |
0.136 |
|
Recreation |
R |
0.317* |
0.154 |
0.266 |
||
VPA (m/w) |
p |
0.877 |
0.034 |
0.311 |
0.078 |
|
Recreation |
R |
0.317* |
0.154 |
0.266 |
||
VPA (MET) |
p |
0.877 |
0.034 |
0.311 |
0.078 |
|
Recreation |
R |
0.057 |
0.011 |
|||
MPA (m/w) |
p |
0.703 |
0.711 |
0.293 |
0.943 |
|
Recreation |
R |
0.057 |
0.011 |
|||
MPA (MET) |
p |
0.703 |
0.711 |
0.293 |
0.943 |
|
Recreation |
R |
0.177 |
0.176 |
|||
TPA (m/w) |
p |
0.852 |
0.246 |
0.857 |
0.248 |
|
Sitting |
R |
|||||
(m/w) |
p |
0.707 |
0.550 |
0.285 |
0.617 |
|
MVPA |
R |
0.051 |
0.277 |
0.098 |
0.104 |
|
(m/w) |
p |
0.738 |
0.065 |
0.523 |
0.497 |
|
MVPA MET |
R |
0.071 |
0.292 |
0.129 |
0.149 |
|
p |
0.642 |
0.052 |
0.398 |
0.329 |
||
|
||||||
Total PA |
R |
0.092 |
0.239 |
0.108 |
0.143 |
|
(m/w) |
p |
0.546 |
0.114 |
0.482 |
0.348 |
|
Total MET |
R |
0.094 |
0.245 |
0.118 |
0.160 |
|
p |
0.541 |
0.105 |
0.441 |
0.294 |
||
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12
EQOL Journal (2019) 11(2):
Table 6. Relationship between
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FertiQoL |
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GPAQ |
|
Emotional |
Mind Body |
Relational |
Social |
Environment |
Tolerability |
|
|
Scale |
Scale |
Scale |
Scale |
Scale |
Scale |
||
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|||||||
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Work |
R |
0.174 |
0.151 |
0.162 |
0.159 |
|||
|
|
|
|
|
|
|
||
VPA (m/w) |
p |
0.252 |
0.323 |
0.940 |
0.834 |
0.304 |
0.308 |
|
|
||||||||
Work |
R |
0.174 |
0.151 |
0.162 |
0.159 |
|||
|
|
|
|
|
|
|
||
VPA (MET) |
p |
0.252 |
0.323 |
0.940 |
0.834 |
0.304 |
0.308 |
|
|
||||||||
Work |
R |
0.342* |
0.369* |
0.118 |
0.290 |
0.227 |
0.228 |
|
|
|
|
|
|
|
|
||
MPA (m/w) |
p |
0.022 |
0.013 |
0.442 |
0.053 |
0.148 |
0.141 |
|
|
||||||||
Work |
R |
0.342* |
0.369* |
0.118 |
0.290 |
0.227 |
0.228 |
|
|
|
|
|
|
|
|
||
MPA (MET) |
p |
0.022 |
0.013 |
0.442 |
0.053 |
0.148 |
0.141 |
|
|
||||||||
Work |
R |
0.335* |
0.403** |
0.150 |
0.319* |
0.268 |
0.321* |
|
|
|
|
|
|
|
|
||
TPA (m/w) |
p |
0.025 |
0.006 |
0.325 |
0.033 |
0.087 |
0.036 |
|
|
||||||||
Transport |
R |
0.208 |
0.190 |
0.114 |
0.089 |
0.190 |
||
|
|
|
|
|
|
|
||
TPA (m/w) |
p |
0.171 |
0.211 |
0.462 |
0.454 |
0.575 |
0.221 |
|
|
||||||||
Transport |
R |
0.208 |
0.190 |
0.114 |
0.089 |
0.190 |
||
|
|
|
|
|
|
|
||
TPA (MET) |
p |
0.171 |
0.211 |
0.462 |
0.454 |
0.575 |
0.221 |
|
|
||||||||
Recreation VPA |
R |
0.311* |
0.176 |
0.010 |
0.082 |
0.008 |
||
|
|
|
|
|
|
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||
(m/w) |
p |
0.037 |
0.248 |
0.871 |
0.949 |
0.607 |
0.957 |
|
|
||||||||
Recreation VPA |
R |
0.311* |
0.176 |
0.010 |
0.082 |
0.008 |
||
|
|
|
|
|
|
|
||
(MET) |
p |
0.037 |
0.248 |
0.871 |
0.949 |
0.607 |
0.957 |
|
|
||||||||
Recreation |
R |
|||||||
|
|
|
|
|
|
|
||
MPA (m/w) |
p |
0.688 |
0.414 |
0.389 |
0.039 |
0.635 |
0.053 |
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Recreation |
R |
|||||||
|
|
|
|
|
|
|
||
MPA (MET) |
p |
0.688 |
0.414 |
0.389 |
0.039 |
0.635 |
0.053 |
|
|
||||||||
Recreation |
R |
0.101 |
||||||
|
|
|
|
|
|
|
||
TPA (m/w) |
p |
0.509 |
0.703 |
0.302 |
0.230 |
0.465 |
0.067 |
|
|
||||||||
Sitting |
R |
0.024 |
||||||
|
|
|
|
|
|
|
||
(m/w) |
p |
0.639 |
0.357 |
0.871 |
0.220 |
0.886 |
0.910 |
|
|
||||||||
MVPA |
R |
0.316* |
0.274 |
0.162 |
0.089 |
0.109 |
||
|
|
|
|
|
|
|
||
(m/w) |
p |
0.035 |
0.069 |
0.894 |
0.289 |
0.575 |
0.489 |
|
|
||||||||
MVPA MET |
R |
0.365* |
0.314* |
0.174 |
0.126 |
0.158 |
||
p |
0.014 |
0.036 |
0.898 |
0.252 |
0.425 |
0.312 |
||
|
||||||||
|
|
|
|
|
|
|
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|
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|
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13 |
EQOL Journal (2019) 11(2):
Table 6 (continued). Relationship between
|
|
|
|
FertiQoL |
|
|
|
|
|
|
|
|
|
|
|
|
|
GPAQ |
|
Emotional |
Mind Body |
Relational |
Social |
Environment |
Tolerability |
|
|
Scale |
Scale |
Scale |
Scale |
Scale |
Scale |
||
|
|
|||||||
|
|
|
|
|
|
|
|
|
Total PA |
R |
0.338* |
0.301* |
0.216 |
0.096 |
0.162 |
||
|
|
|
|
|
|
|
||
(m/w) |
p |
0.023 |
0.045 |
0.909 |
0.155 |
0.544 |
0.298 |
|
|
||||||||
Total MET |
R |
0.385** |
0.336* |
0.225 |
0.120 |
0.187 |
||
p |
0.009 |
0.024 |
0.911 |
0.137 |
0.449 |
0.230 |
||
|
||||||||
|
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|
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Discussion
It was assumed that abundance of
43% of the women in the sample reported regular exercise, which could be discussed as a relatively active subpopulation in Hungary. However, Ács et al reported 10% improvement in PA habits based on representative Eurobarometer data from 2018: Hungarians regular sport participation and physical activity is 33%, which is behind the EU average (40%). Authors noted that 42% of Hungarian citizens spent more than 2.5 and less than 5.5 hours sedentary. With 3.5 hours daily sitting time (2782.5±1824.7 min/day), our results are in line with the above findings (Ács et al., 2018).
Regarding GPAQ, our respondents performed moderate intensity PA during work and preferred that during recreation. However, mean values showed some vigorous activity in work (169.3±515.8 min/week) and recreation (40.7±91.4 min/week). Medians demonstrated that most of these women completely avoided heavy forms of movement. Regarding female reproduction, there is a wide consensus on beneficial effects of PA on gestation. Most studies take attention to risk of frequent vigorous PA on fertility (Green, Daling, Weiss, Liff,
&Koepsell, 1986; Wise et al., 2012) and on success of ART (Domar, Conboy,
14
Rooney, 2012; Morris et al., 2006). To describe PA levels, both instrumental and
Regarding the benefits of
EQOL Journal (2019) 11(2):
engaged only in light activity (ME 3.0 hour/day) and sedentary behaviours (ME 9.0 hour/day).
In the Hungarian validation study of the
Comparison of
Domar et. al underline the role of improving mental health with psychological interventions in improved pregnancy rates among infertile women (Domar, Gross, Rooney, & Boivin, 2015). Other studies shift focus to lifestyle behaviours: Domar et al made surprising observations regrading interfering health behaviors as exhausting exercise, smoking, regular consumption of alcohol and caffeinated beverages and taking herbal supplements during IVF cycles (Domar et al., 2012). In our sample more
reported higher scores for the FertiQol Relational domain and lower for the Social domain (p=0.005, p=0.010), greater utilization of psychosocial support (p<0.001), and higher rates of PA (p=0.004) and consulting with dietitians (p=0.050)
We intend to expand the current research to gain accelerometer data on
Acknowledgements
We want to thank women who underwent ART at the Assisted Reproduction Unit, Department of Obstetrics and Gynecology, University of Pécs, for participating in our study. This research was supported by the
Conflict of interest
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
15
EQOL Journal (2019) 11(2):
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How to cite this article:
Prémusz, V., Makai , A., Gács, B., Nagy, Á., Perjés, B., Ács, P., . . . Várnagy,
APA:Á. (2019). Preliminary study on
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Prémusz, Viktória, et al. "Preliminary study on |
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and quality of life in infertility." Exercise and Quality of Life 11.2 |
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(2019): |
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Prémusz, Viktória, et al. "Preliminary study on |
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and quality of life in infertility." Exercise and Quality of Life 11, no. 2 |
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(2019): |
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