OBJECTIVE: To evaluate the effectiveness of sequential versus simultaneous introduction of nutrition and exercise behavior intervention strategies at preventing early or late excessive gestational weight gain (EGWG). METHODS: Parallel-group randomized trial at a single center (London, Canada) included 84 healthy pregnant individuals (mean age 32.4 +/- 3.4 yr; prepregnancy body mass index: 26.0 +/- 5.1 kg/m -2) randomly allocated at 12 to 18 wk gestational age (GA; baseline) to either NE (nutrition and exercise delivered simultaneously; n = 25), N plus E (nutrition first and exercise added at 25 wk GA; n = 29) or E plus N (exercise first and nutrition added at 25 wk GA; n = 30). Early weight gain was analyzed weekly from baseline up to 25 wk GA (midpoint) and later from midpoint to 36 wk GA. RESULTS: From baseline to 25 wk, no differences were found for the amount of EGWG (NE: 1.6 +/- 1.4 kg, N plus E: 1.9 +/- 1.7 kg, E plus N: 1.3 +/- 1.3 kg; p = 0.62) or for the number of those who gained excessively (p = 0.38). However, from midpoint to final assessment, N plus E gained more excessive weight (2.9 +/- 2.3 kg; NE 2.5 +/- 1.7 kg; E plus N 1.6 +/- 1.3 kg; p = 0.002, respectively) with more participants (n = 21; p = 0.03) gaining excessively than NE (n = 11) and E plus N (n = 12). CONCLUSIONS: Delivering the components of a nutrition and exercise intervention sequentially or simultaneously equally influences early EGWG. However, after 25 wk GA, introducing nutrition sequentially into an exercise program (E plus N) or the continuation of combined nutrition and exercise (NE), mitigated EGWG compared with introducing exercise sequentially to a nutrition program (N plus E). Sequencing of components may be an important factor to consider for intervention success, specifically by introducing an exercise component first followed by nutrition led to superior overall program adherence, with the least amount of EGWG.

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