Movement is Medicine

If exercise came in pill form, we would only be too eager to take our keep-fit medicine. Movement is medicine, even small doses extend longevity and can prevent and treat disease. Movement truly is a polypill.

Thinkers of ancient times, such as Hippocrates and Plato, suggested that physical activity was good for health. This has been confirmed with recent (and not so recent) studies which tell us that exercise reduces all-cause mortality risk (all causes of death), cardiovascular-related events, as well as warding off chronic lifestyle conditions such as type 2 diabetes, obesity, metabolic syndrome, dementia and cancer.

Every single system in the body relies on us moving. Mental health and cognitive function, muscles and joints, hearts and lungs, hormones and mood, digestive health and gut microbiome, metabolism and blood pressure - you name it, it needs us to move frequently and purposefully to be healthy.

You can review some of this evidence on why exercise is medicine below.

““If there is any deficiency in exercise the body will fall sick.””

— Hippocrates

All-Cause Mortality

Grøntved A, Hu FB. "Television Viewing and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality A Meta-analysis." JAMA, 2011

Myers J, Kaykha A, George S, Abella J, Zaheer N, Lear S, Yamazaki T, Froelicher V. "Fitness versus physical activity patterns in predicting mortality in men." Am J Med, 2004

Alpa V. Patel, Leslie Bernstein, Anusila Deka, Heather Spencer Feigelson, Peter T. Campbell, Susan M. Gapstur, Graham A. Colditz, Michael J. Thun; "Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults." Am J Epidemiol, 2010

Leitzmann MF, Park Y, Blair A, et al. “Physical activity recommendations and decreased risk of mortality”, Arch Intern Med , 2007

Nocon M, Hiemann T, Müller-Riemenschneider F, et al. “Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis”, Eur J Cardiovasc Prev Rehabil , 2008, vol. 15

Paffenbarger RSJr, Hyde RT, Wing AL, et al. “Physical activity, all-cause mortality, and longevity of college alumni”, N Engl J Med , 1986

Blair SN, Morris JN. “Healthy hearts—and the universal benefits of being physically active: physical activity and health”, Ann Epidemiol , 2009

Morris JN, Heady JA, Raffle PA, Roberts CG, Parks JW. "Coronary heart disease and physical activity of work.", Lancet, 1953

Ekelund, U et al. "Activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study", Am J Clin Nutr, 2015

Buckley JP et al. "The sedentary office: an expert statement on the growing case for change towards better health and productivity.", Br J Sports Med, 2015

World Health Organisation "Global Recommendations on Physical Activity for Health. ", 2010

Merom, Dafna et al., "Dancing Participation and Cardiovascular Disease Mortality", American Journal of Preventive Medicine, June 2016, Volume 50

Se-Hong Kim, Minjeong Kim, Yu-Bae Ahn, Hyun-Kook Lim, Sung-Goo Kang, Jung-hyoun Cho, Seo-Jin Park, Sang-Wook Song, "Effect of Dance Exercise on Cognitive Function in Elderly Patients with Metabolic Syndrome: A Pilot Study", J Sports Sci Med, 2011

Blair et al., "Physical fitness and all-cause mortality. A prospective study of healthy men and women", JAMA., 1989

Pedersen BK, Saltin B. "Evidence for prescribing exercise as therapy in chronic disease." Scand J Med Sci Sports 2006;

Ekelund, Ulf et al. “Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women” The Lancet , Volume 388 , Issue 10051 , 1302 - 1310

Wolin KY, Yan Y, Colditz GA, Lee IM. "Physical activity and colon cancer prevention: a meta-analysis.", British Journal of Cancer, 2009

Moore SC, Lee IM, Weiderpass E, et al. "Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults." JAMA Internal Medicine, 2016

Wu Y, Zhang D, Kang S. "Physical activity and risk of breast cancer: a meta-analysis of prospective studies." Breast Cancer Research and Treatment, 2013

Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH. "An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis." Journal of Cancer Survivorship, 2010

Keimling M, Behrens G, Schmid D, Jochem C, Leitzmann MF. "The association between physical activity and bladder cancer: systematic review and meta-analysis." British Journal of Cancer, 2014

Behrens G, Jochem C, Keimling M, et al. "The association between physical activity and gastroesophageal cancer: systematic review and meta-analysis." European Journal of Epidemiology, 2014

Schmid D et al., "Television Viewing and Time Spent Sedentary in Relation to Cancer Risk: A Meta-Analysis", JNCI J Natl Cancer Inst, 2014

Kyu HH, et al. “Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study”, BMJ, 2013

Cardiovascular Disease

Grøntved A, Hu FB. "Television Viewing and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality A Meta-analysis." JAMA. 2011

Alpa V. Patel, Leslie Bernstein, Anusila Deka, Heather Spencer Feigelson, Peter T. Campbell, Susan M. Gapstur, Graham A. Colditz, Michael J. Thun; "Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults." Am J Epidemiol, 2010

Nocon M, Hiemann T, Müller-Riemenschneider F, et al. “Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis”, Eur J Cardiovasc Prev Rehabil , 2008

Blair SN, Morris JN., “Healthy hearts—and the universal benefits of being physically active: physical activity and health”, Ann Epidemiol , 2009

Armstrong ME, Green J, Reeves GK, Beral V, Cairns BJ, "Frequent physical activity may not reduce vascular disease risk as much as moderate activity: large prospective study of women in the United kingdom.," Million Women Study, Circulation, 2015

Monda, KL, et al. “Longitudinal impact of physical activity on lipid profiles in middle-aged adults: the Atherosclerosis Risk in Communities Study.”, Journal of Lipid Research., 2009

Martins RA, et al. “Effects of aerobic and strength-based training on metabolic health indicators in older adults.” Lipids Health Dis., 2010

Kraus WE, et al. “Effects of the amount and intensity of exercise on plasma lipoproteins.” N Engl J Med., 2002

Merom, Dafna et al. "Dancing Participation and Cardiovascular Disease Mortality", American Journal of Preventive Medicine, June 2016, Volume 50 , Issue 6 , 756 - 760

Kyu HH, et al. “Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study”, BMJ, 2013

Dementia/NEURODEGENERATION

Ahlskog, J. Eric et al. “Physical Exercise as a Preventive or Disease-Modifying Treatment of Dementia and Brain Aging.” Mayo Clinic Proceedings 86.9 (2011)

Smith PJ, Blumenthal JA, Hoffman BM, Cooper H, Strauman TA, Welsh-Bohmer K, Browndyke JN, Sherwood A, "Review Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials.", Psychosom Med. 2010

Colcombe SJ, Kramer AF, Erickson KI, Scalf P, McAuley E, Cohen NJ, Webb A, Jerome GJ, Marquez DX, Elavsky S, "Cardiovascular fitness, cortical plasticity, and aging.", Proc Natl Acad Sci U S A. 2004

Hamer M, Chida Y, "Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence.", Psychol Med. 2009 Jan;

Geda YE, Roberts RO, Knopman DS, Christianson TJ, Pankratz VS, Ivnik RJ, Boeve BF, Tangalos EG, Petersen RC, Rocca WA, "Physical exercise, aging, and mild cognitive impairment: a population-based study.", Arch Neurol. 2010 Jan

Se-Hong Kim, Minjeong Kim, Yu-Bae Ahn, Hyun-Kook Lim, Sung-Goo Kang, Jung-hyoun Cho, Seo-Jin Park, Sang-Wook Song, "Effect of Dance Exercise on Cognitive Function in Elderly Patients with Metabolic Syndrome: A Pilot Study", J Sports Sci Med, 2011

Erickson KI et al., "Exercise training increases size of hippocampus and improves memory", Proc Natl Acad Sci U S A, 2011

Cotman CW1, Berchtold NC, Christie LA., “Exercise builds brain health: key roles of growth factor cascades and inflammation.”, Trends Neurosci., 2007

Vidoni ED, Honea RA, Billinger SA, Swerdlow RH, Burns JM. "Cardiorespiratory fitness is associated with atrophy in Alzheimer's and aging over 2 years." Neurobiol Aging 2012;33:16241632.

Colcombe S, Kramer AF. “Fitness effects on the cognitive function of older adults: a meta-analytic study”. Psychol Science 2003;14:125–130

Zhu N, Jacobs DR, Jr, Schreiner PJ, et al. “Cardiorespiratory fitness and cognitive function in middle age: the CARDIA study. “ Neurology 2014;82:1339–1346.

GUT HEALTH

Marlicz W, Loniewski “The effect of exercise and diet on gut microbial diversity.” Gut, 2015

Clarke SF, et al., "Exercise and associated dietary extremes impact on gut microbial diversity.” Gut., 2014

Hullar MA et al, “Diet, the gut microbiome, and epigenetics.” Cancer J, 2014

Estaki M et al, “Cardiorespiratory fitness as a predictor of intestinal microbial diversity and distinct metagenomic functions.”, Microbiome., 2016

Cronin O, “Exercise, fitness, and the gut.”, Curr Opin Gastroenterol., 2016

Johannesson E, Simrén M, Strid H, Bajor A, Sadik R., "Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial.", Am J Gastroenterol. 2011

Inflammation

Petersen, A.M. & Pedersen, B.K., “The anti-inflammatory effect of exercise.” J. Appl. Physiol., 2005

Pedersen BK, Steensberg A, Fischer C, et al. “Searching for the exercise factor – is IL-6 a candidate.” J Muscle Res Cell Motil, 2003

BK Pedersen et al, “Role of myokines in exercise and metabolism." Journal of Applied Physiology, 2007

Pedersen BK et al, "Muscle as an endocrine organ: Focus on muscle-derived interleukin-6.", 2008

Allen DL et al, "Expression and function of myostatin in obesity, diabetes, and exercise adaptation." Med Sci Sports Exerc, 2011.

Ryan AS, et al., “Aerobic exercise and weight loss reduce vascular markers of inflammation and improve insulin sensitivity in obese women.”, J Am Geriatr Soc., 2014

Deminice R, et al., “The Effects of Acute Exercise and Exercise Training on Plasma Homocysteine: A Meta-Analysis.”, PLoS One.", 2016

Mohammadi RH, et al. “The Effect of 12-Week of Aerobic Training on Homocysteine, Lipoprotein A and Lipid Profile Levels in Sedentary Middle-aged Men.” Int J Prev Med., 2014

Martins RA, et al. “Effects of aerobic and strength-based training on metabolic health indicators in older adults.” Lipids Health Dis., 2010

Fischer CP1., ”Interleukin-6 in acute exercise and training: what is the biological relevance?”, Exerc Immunol Rev., 2006

Insulin Resistance

Nightingale CM, Rudnicka AR, Donin AS, et al "Screen time is associated with adiposity and insulin resistance in children", Archives of Disease in Childhood, 2017

Richter EA, et al., “Exercise, GLUT4, and Skeletal Muscle Glucose Uptake.” Physiol Rev, 2013

Thiebaud D, et al., “The effect of graded doses of insulin on total glucose uptake, glucose oxidation, and glucose storage in man.”, Diabetes., 1982

Ryan AS, et al., “Aerobic exercise and weight loss reduce vascular markers of inflammation and improve insulin sensitivity in obese women.”, J Am Geriatr Soc., 2014

Ferrara CM, et al. "Effects of aerobic and resistive exercise training on glucose disposal and skeletal muscle metabolism in older men." J Gerontol A Biol Sci Med Sci., 2006

Pedersen BK, Saltin B. "Evidence for prescribing exercise as therapy in chronic disease." Scand J Med Sci Sports 2006;

Kyu HH, et al. “Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study”, BMJ, 2013

Mental Health

Teychenne, Megan et al., "The association between sedentary behaviour and risk of anxiety: a systematic review", BMC Public Health, 2015

Hopkins ME, et al. “Differential effects of acute and regular physical exercise on cognition and affect.” Neuroscience, 2012

Broman-Fulks J, et al. “Effects of aerobic exercise on anxiety sensitivity.” Behaviour Research and Therapy.", 2008

Guszkowska M, “Effects of exercise on anxiety, depression and mood”, Psychiatr Pol, 2004

Steptoe A et al., “Acute effects of aerobic exercise on mood.”, Health Psychol, 1988

Sylvia LG et al., “Does exercise impact mood? Exercise patterns of patients in a psychiatric partial hospital program.”, J Psychiatr Pract, 2009

Dunn AL, Trivedi MH, O’Neal HA., "Physical activity dose–response effects on outcomes of depression and anxiety.", Med Sci Sports Exerc. 2001

Scully D, Kremer J, Meade MM, et al., "Physical exercise and psychological well being: a critical review.", British Journal of Sports Medicine 1998;32:111-120.

Ströhle, A. "Physical activity, exercise, depression and anxiety disorders", J Neural Transm 116: 777. doi:10.1007/s00702-008-0092-x, 2009

Metabolic Syndrome

Carroll et al., "What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome." Metabolic Syndrome, British Journal of Sports Medicine, 2004

Colberg SR, et al., “The Big Blue Test: Effects of 14 Minutes of Physical Activity on Blood Glucose Levels.” Diabetes Care February, 2013

Harmer RA, et al., “Amount and frequency of exercise affect glycaemic control more than exercise mode or intensity.” Br J Sports Med, 2015

James AP, et al., “Effects of a 1-year randomised controlled trial of resistance training on blood lipid profile and chylomicron concentration in older men.” Eur J Appl Physiol, 2016

Ryan AS, et al., “Aerobic exercise and weight loss reduce vascular markers of inflammation and improve insulin sensitivity in obese women.”, J Am Geriatr Soc., 2014

Ford ES, et al., “Sedentary behavior, physical activity, and the metabolic syndrome among U.S. adults.”, Obes Res., 2005

Richter EA, et al., “Exercise, GLUT4, and Skeletal Muscle Glucose Uptake.” Physiol Rev, 2013

Thiebaud D, et al., “The effect of graded doses of insulin on total glucose uptake, glucose oxidation, and glucose storage in man.”, Diabetes, 1982

Se-Hong Kim, Minjeong Kim, Yu-Bae Ahn, Hyun-Kook Lim, Sung-Goo Kang, Jung-hyoun Cho, Seo-Jin Park, Sang-Wook Song., "Effect of Dance Exercise on Cognitive Function in Elderly Patients with Metabolic Syndrome: A Pilot Study", J Sports Sci Med, 2011

Martins RA, et al., “Effects of aerobic and strength-based training on metabolic health indicators in older adults.” Lipids Health Dis., 2010

Kyu HH, et al. “Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study”, BMJ, 2013

MITOCHONDRIAL FUNCTION

Baar K et al, “Adaptations of skeletal muscle to exercise: rapid increase in the transcriptional coactivator PGC-1.”, Journal of Applied Physiology., 2002

Menshikova, E. V., et al, “Effects of Exercise on Mitochondrial Content and Function in Aging Human Skeletal Muscle.”, The Journals of Gerontology 61(6), 534–540., 2006

Steiner J. L., et al., “Exercise training increases mitochondrial biogenesis in the brain”, Journal of Applied Physiology., 2011

Robinson, Matthew M. et al., “Enhanced Protein Translation Underlies Improved Metabolic and Physical Adaptations to Different Exercise Training Modes in Young and Old Humans”, Cell Metabolism , Volume 25 , Issue 3 , 581 - 592., 2017

MULTIPLE SCLEROSIS

White, L. J. et al., "Resistance training improves strength and functional capacity in persons with multiple sclerosis." Mult. Scler. 10, 668–674, 2004

McCullagh, R., et al., "Long-term benefits of exercising on quality of life and fatigue in multiple sclerosis patients with mild disability: a pilot study.", Clin. Rehabil. 22, 206–214, 2008

Dalgas, U. et al. "Fatigue, mood and quality of life improve in MS patients after progressive resistance training.", Mult. Scler. 16, 480–490, 2010

Dettmers, C., Sulzmann, M., Ruchay-Plossl, A., Gutler, R. & Vieten, M., "Endurance exercise improves walking distance in MS patients with fatigue." Acta Neurol. Scand. 120, 251–257, 2009

Schulz, K.-H. et al. "Impact of aerobic training on immune-endocrine parameters, neurotrophic factors, quality of life and coordinative function in multiple sclerosis." J. Neurol. Sci. 225, 11–18, 2004

Musculoskeletal

Smuck M, Kao MC, Brar N, Martinez-Ith A, Choi J, Tomkins-Lane CC. "Does physical activity influence the relationship between low back pain and obesity?" Spine. 2014

Ragucci KR, Shrader SP. "Osteoporosis treatment: an evidence-based approach." J Geront Nurs., 2011

Hootman JM, Macera CA, Ham SA, Helmick CG, Sniezek JE. "Physical activity levels among the general US adult population and in adults with and without arthritis." Arth Rheum., 2003

Vuori I., "Exercise and physical health: musculoskeletal health and functional capabilities.", Res Q Exerc Sport., 1995

Lima CA et al., "Effectiveness of a physical exercise intervention program in improving functional mobility in older adults after hip fracture in later stage rehabilitation: protocol of a randomized clinical trial (REATIVE Study).", BMC Geriatr., 2016

Sherrington C, Fairhall N, Kirkham C, Clemson L, Howard K, Vogler C, Close JC, Moseley AM, Cameron ID, Mak J, et al., "Exercise and fall prevention self-management to reduce mobility-related disability and falls after fall-related lower limb fracture in older people: protocol for the RESTORE (Recovery Exercises and STepping On afteR fracturE) randomised controlled trial.", BMC Geriatr. 2016

Sherrington C, Lord SR, Vogler CM, Close JC, Howard K, Dean CM, Clemson L, Barraclough E, Ramsay E, O'Rourke SD, et al., "Minimising disability and falls in older people through a post-hospital exercise program: a protocol for a randomised controlled trial and economic evaluation.", BMC Geriatr. 2009

Pedersen BK, Saltin B. "Evidence for prescribing exercise as therapy in chronic disease." Scand J Med Sci Sports 2006;

NAFLD (NON-ALCOHOLIC FATTY LIVER DISEASE)

Katsagoni CN, Georgoulis M, Papatheodordis GV, et al. “Associations between lifestyle characteristics and the presence of nonalcoholic fatty liver disease: a case-control study.” Metab Syndr Relat Disord 2016; 15: 72-79

Obesity

Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. "Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women." JAMA. 2003

Belavy et al., "Preferential deposition of visceral adipose tissue occurs due to physical inactivity." International Journal of Obesity, 2014

Robinson TN. "Reducing children's television viewing to prevent obesity: a randomized controlled trial." JAMA, 1999

Ekelund, U et al. "Activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study", Am J Clin Nutr, 2015

Nightingale CM, Rudnicka AR, Donin AS, et al "Screen time is associated with adiposity and insulin resistance in children", Archives of Disease in Childhood, 2017

Ohkawara K, et al., "A dose-response relation between aerobic exercise and visceral fat reduction: systematic review of clinical trials." Int J Obes (Lond), 2007.

Ismail I, et al, "A systematic review and meta-analysis of the effect of aerobic vs. resistance exercise training on visceral fat." Obes Rev, 2012.

A S Jackson et al., "The effect of sex, age and race on estimating percentage body fat from body mass index: The Heritage Family Study", International Journal of Obesity, 2002

Ferrara CM, et al. "Effects of aerobic and resistive exercise training on glucose disposal and skeletal muscle metabolism in older men." J Gerontol A Biol Sci Med Sci., 2006

Hunter GR, et al. "Resistance training conserves fat-free mass and resting energy expenditure following weight loss." Obesity (Silver Spring)., 2008.

D J Johns et al. "Diet or Exercise Interventions vs Combined Behavioral Weight Management Programs: A Systematic Review and Meta-Analysis of Direct Comparisons", J Acad Nutr Diet., 2014

Verheggen RJ "A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue." Obes Rev., 2016

Allen DL et al, "Expression and function of myostatin in obesity, diabetes, and exercise adaptation." Med Sci Sports Exerc, 2011.

Ryan AS, et al., “Aerobic exercise and weight loss reduce vascular markers of inflammation and improve insulin sensitivity in obese women.”, J Am Geriatr Soc., 2014

Sedentary Behaviour

Thorp A.A., Owen N., Neuhaus M., Dunstan D.W. "Sedentary behaviors and subsequent health outcomes in adults: A systematic review of longitudinal studies", American Journal of Preventive Medicine, 2011

Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. "Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women." JAMA, 2003

Alpa V. Patel, Leslie Bernstein, Anusila Deka, Heather Spencer Feigelson, Peter T. Campbell, Susan M. Gapstur, Graham A. Colditz, Michael J. Thun; "Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults." Am J Epidemiol, 2010

Hu FB, Leitzmann MF, Stampfer MJ, Colditz GA, Willett WC, Rimm EB. "Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men." Arch Intern Med, 2001

Robinson TN. "Reducing children's television viewing to prevent obesity: a randomized controlled trial." JAMA, 1999

Teychenne, Megan et al., "The association between sedentary behaviour and risk of anxiety: a systematic review", BMC Public Health, 2015

Ford ES, et al., “Sedentary behavior, physical activity, and the metabolic syndrome among U.S. adults.”, Obes Res., 2005

Owen, Neville et al. "Too Much Sitting: The Population-Health Science of Sedentary Behavior." Exercise and Sport Sciences Reviews, 2010

Fazzi C, Saunders DH, Linton K, Norman JE, Reynolds RM, "Sedentary behaviours during pregnancy: a systematic review.", Int J Behav Nutr Phys Act., 2017

SEXUAL FUNCTION

Lorenz TA, Meston CM. "Exercise improves sexual function in women taking antidepressants: results from a randomized crossover trial." Depression and anxiety. 2014;

Hoffman BM, Babyak MA, Sherwood A, et al. "Effects of aerobic exercise on sexual functioning in depressed adults." Ment Health Phys Activity., 2009

Meston CM, Gorzalka BB, "Differential effects of sympathetic activation on sexual arousal in sexually dysfunctional and functional women.", J Abnorm Psychol., 1996

Silva AB, Sousa N, Azevedo LF, Martins C, "Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis.", Br J Sports Med., 2016

Loprinzi PD, Edwards M., "Association Between Objectively Measured Physical Activity and Erectile Dysfunction among a Nationally Representative Sample of American Men.", J Sex Med. 2015

Fazzi C, Saunders DH, Linton K, Norman JE, Reynolds RM, "Sedentary behaviours during pregnancy: a systematic review.", Int J Behav Nutr Phys Act., 2017