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Counselling and cognitive behavioural therapy were delivered remotely, and a social prescriber was also involved. This improved her wellbeing and reduced her loneliness. Despite its ubiquity, only one in two adults aged 75 years and older uses the internet.41 Thus, alternative methods of engagement must be sought for this group. Community volunteers can aid with social prescribing, shopping, regular telephone conversations, and home visits while maintaining physical distancing advice. Such schemes are already operational in certain countries, such as the NHS Volunteer Responders in the UK .

The evidence regarding a possible association between fetal–maternal health outcomes and occupational physical activity is mixed and limited. A meta-analysis based on 62 reports assessed the evidence relating preterm delivery, low birth weight, small for gestational age, preeclampsia, and gestational hypertension to five occupational exposures . Although the analysis was limited by the heterogeneity of exposure definitions, especially for lifting and heavy work load, most of the estimates of risk pointed to small or null effects. In contrast, a cohort study of more than 62,000 Danish women reported a dose–response relationship between total daily burden lifted and preterm birth with loads more than 1,000 kg per day . In this study, lifting heavy loads more than 10 times per day was associated with an increased risk of preterm birth.

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Strengthening abdominal and back muscles could minimize this risk. Blood volume, heart rate, stroke volume, and cardiac output normally increase during pregnancy, and systemic vascular resistance decreases . These hemodynamic changes establish the circulatory reserve necessary to sustain the pregnant woman and fetus at rest and during exercise. Physical inactivity is the fourth-leading risk factor for early mortality worldwide . In pregnancy, physical inactivity and excessive weight gain have been recognized as independent risk factors for maternal obesity and related pregnancy complications, including gestational diabetes mellitus (5–7). Activity restriction should not be prescribed routinely as a treatment to reduce preterm birth.

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