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Trial Review
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Trial registered on ANZCTR
Registration number
ACTRN12624001182583
Ethics application status
Approved
Date submitted
2/09/2024
Date registered
27/09/2024
Date last updated
27/09/2024
Date data sharing statement initially provided
27/09/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
POSTFIT: Postpartum Optimised Strength Training and Fitness - A testing battery and exercise intervention for postpartum women
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Scientific title
POSTFIT: Postpartum Optimised Strength Training and Fitness - A testing battery and exercise intervention for postpartum women
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Secondary ID [1]
312866
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
POSTFIT
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Postpartum
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Condition category
Condition code
Physical Medicine / Rehabilitation
331519
331519
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0
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Other physical medicine / rehabilitation
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Musculoskeletal
331520
331520
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0
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Other muscular and skeletal disorders
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Reproductive Health and Childbirth
331605
331605
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0
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Childbirth and postnatal care
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Study Procedure
This study consists of four phases addressing separate research questions and aims. Participants will be recruited at baseline and will progress sequentially through each phase of the larger study as detailed below.
Phase 1
Pre-intervention assessments and baseline testing (completed by Groups 1 & 2)
Phase 2
Week one to 12 of a 12 week supervised exercise intervention (Group 1 only)
Phase 3
Post-intervention assessments (Groups 1 & 2)
Phase 4
One year followup consisting of several questionnaires which will be electronically sent to participants (Groups 1 & 2)
Assessment and baseline testing:
Once enrolled, the participant will complete various physical assessments and questionnaires.
The assessments will be conducted prior to the exercise intervention to screen for common postpartum musculoskeletal injuries and to assess baseline strength and function, and we envisage that they will take approximately 60 – 90 minutes per participant. The proposed outcome measures are routinely used in clinical practice by Exercise Physiologists, and they are considered safe and straightforward to conduct (by the Exercise Physiologist) and complete (by the participant). Additionally, the Exercise and Sports Science Australia (ESSA) scope of practice and professional standards outlines that Exercise physiologists can screen, assess, and measure capacity and function to inform interventions and improve health outcomes https://www.essa.org.au/Public/Public/Professional_Standards/ESSA_Scope_of_Practice_documents.aspx.
Test order
Tests will be conducted in a specified order so that participants are provided enough rest between tests and to ensure that results from the previous test do not affect subsequent tests. For example, provocation tests will be alternated with strength tests and participants fatigue and RPE will be monitored throughout.
Group one Supervised Exercise Intervention
All participants in the supervised exercise group will then complete a 12-week individualized exercise program which will be undertaken in one of the exercise clinics listed below (depending on which are the participant was recruited from) under the supervision of an Accredited Exercise Physiologist (AEP). The participants will undergo further testing mid intervention (week six), post intervention (week 12) and at a one-year follow-up (questionnaires only) to identify any changes.
1. ACU Strathfield Exercise Lifestyle Clinic
2. ACU North Sydney ACU Active
3. ACU Blacktown BEST
Simple randomisation with stratification will be implemented after phase 1 (initial baseline testing). This will account for potential confounders such as length of time after delivery (6-16 weeks postpartum), mode of delivery and perineal trauma. Research has shown that the above mentioned variables have significant effects on pelvic floor strength and function.
The exercise intervention will consist of progressive individualized programs for each participant, based off the data collected in their initial assessment. The goals of the exercise program are to.
1. Increase pelvic floor and core strength with Pilates style exercises (e.g. Tzone activation, supine kegels, leg slides, mini crunch, kneeling planks, bird dog, glute bridge)
2. Increase lumbopelvic stability with body weight strength exercises (e.g. reformer feet in straps, crunch in table top, standing kegels, oblique crunch, side plank, scooter on reformer, single leg glute bridge)
3. Progressively increase whole body functional strength with the use of body weight, resistance bands, free weights, and weight machines. (single leg V up, oblique curl on reformer, dead bug, dynamic plank, elevated bird dog, hip thrust, barbell squat and deadlift)
(Please note the above mentioned examples are based off an exercise library developed for this research project and as the exercise prescription is individualised we can not specify exact exercises)
Note: Exercises will only be progressed once the participant is able to perform the required sets and repetitions with the correct form, and report a low RPE (borg 6 - 20 scale). High intensity exercises will not be prescribed until >12 weeks postpartum and you have completed high impact screening exercises.
Evidence based exercises are prescribed by an accredited exercise physiologist that has extensive experience working with the postpartum population. The participants will complete three sessions per week (consisting of 60 minutes each), two will be one to one and face to face in the clinic, and one will consist of a home exercise program delivered via Physitrack. Adherence will be monitored face to face and via physitrack. Participants will also fill out a weekly physical activity questionnaire.
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Intervention code [1]
329406
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Treatment: Other
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Comparator / control treatment
Group two – Usual care home exercise
Participants in the control group will not receive the structured 12-week postpartum exercise intervention. Instead, they will receive what is considered "usual care." Usual care involves standard postpartum healthcare practices and advice provided by medical healthcare professionals during routine postnatal care e.g regular health check-ups, education and assessments as provided by your main medical health care provider.
Participants will also be asked to complete a digital physical activity questionnaire every week for 12 weeks via REDcap.
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Control group
Active
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Outcomes
Primary outcome [1]
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Symptoms of pelvic floor dysfunction
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Assessment method [1]
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Pelvic floor distress Inventory (PFDI-20) - Questionnaire
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Timepoint [1]
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1. Measured pre-intervention (week 1)
2. Measured post - intervention (week 13)
3. Measured at 12 month followup (questionnaire only)
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Primary outcome [2]
339265
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Change in core stabilisation
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Assessment method [2]
339265
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Sahrmann core test
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Timepoint [2]
339265
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1. Measured pre-intervention (week 1)
2. Measured post- intervention (week 13)
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Primary outcome [3]
339266
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Core strength
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Assessment method [3]
339266
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Transabdominal ultrasound - measurement of abdominal separation
McGills core strength test
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Timepoint [3]
339266
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
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Secondary outcome [1]
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Postpartum depression and anxiety
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Assessment method [1]
439300
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Edinburgh postnatal depression scale (EPDS)
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Timepoint [1]
439300
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
3. Measured at 12 month followup
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Secondary outcome [2]
439301
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Lower back pain
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Assessment method [2]
439301
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Oswestry disability index (ODI)
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Timepoint [2]
439301
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
3. Measured at 12 month followup
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Secondary outcome [3]
439302
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Pelvic girdle pain
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Assessment method [3]
439302
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Pelvic girdle pain questionnaire (PGQ)
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Timepoint [3]
439302
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
3. Measured at 12 month followup
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Secondary outcome [4]
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Diastasis recti abdominis muscle (DRAM)
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Assessment method [4]
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Transabdominal ultrasound of DRAM
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Timepoint [4]
439776
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
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Secondary outcome [5]
439777
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Pelvic floor muscle activity
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Assessment method [5]
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Transabdominal ultrasound of bladder base displacement
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Timepoint [5]
439777
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
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Secondary outcome [6]
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Lower body strength
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Assessment method [6]
439848
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Single leg sit to stand (SLS STS)
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Timepoint [6]
439848
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
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Secondary outcome [7]
439849
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Lower body strength
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Assessment method [7]
439849
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Unilateral hip bridge endurance test (UHBE)
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Timepoint [7]
439849
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
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Secondary outcome [8]
439850
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Hip isometric muscle strength
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Assessment method [8]
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Hip dynamometry isometric hip strength
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Timepoint [8]
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
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Secondary outcome [9]
439851
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Hip pain
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Assessment method [9]
439851
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Active single leg raise (ASLR)
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Timepoint [9]
439851
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
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Secondary outcome [10]
439852
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Hip Pain
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Assessment method [10]
439852
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FABER test
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Timepoint [10]
439852
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
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Secondary outcome [11]
439853
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Hip Pain
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Assessment method [11]
439853
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Gaenslens test
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Timepoint [11]
439853
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
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Secondary outcome [12]
440163
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Cardiovascular fitness
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Assessment method [12]
440163
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Submaximal graded exercise test
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Timepoint [12]
440163
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1. Measured pre-intervention (week 1)
2. Measured post-intervention (week 13)
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Eligibility
Key inclusion criteria
Aged over 18 years
Understand written and verbal commands provided in English.
Childbirth in the last 6 to 16 weeks
Attended their 6 week GP or obstetrician maternal health check
Meet the Covid 19 vaccination requirements of ACU and be willing to adhere to all public health orders regarding testing (if still required at the time of the intervention)
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Minimum age
18
Years
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Maximum age
45
Years
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
- currently pregnant
- Uncontrolled pulmonary, metabolic, and/or orthopedic conditions that prohibit exercise training
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Central randomisation by an online random number generator.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation with stratification will be implemented.
This will account for potential confounders such as length of time after delivery (6-16 weeks postpartum), mode of delivery and perineal trauma.
Research has shown that the above-mentioned variables have significant effects on pelvic floor strength and function
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
Demographic data will be tested for normality and presented as mean and standard deviations, medians and interquartile range and percentages where appropriate.
Repeated Measures ANOVA with an effect of time and pairwise comparisons will be used to establish the effect of exercise training on the primary and secondary outcome measures.
One Way Repeated Measures ANOVAs will be used for functional assessment data.
Significance will be taken at p less than 0.05.
Repeated measures analysis of covariance examined Group x Time changes in outcome measures listed above at six weeks, 12 weeks and one year follow up.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/11/2024
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Actual
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Date of last participant enrolment
Anticipated
31/10/2025
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Actual
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Date of last data collection
Anticipated
30/10/2026
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Actual
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Sample size
Target
42
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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Australian Catholic University
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Address [1]
317311
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Country [1]
317311
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Australia
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Primary sponsor type
University
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Name
Australian Catholic University
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Address
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Country
Australia
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Secondary sponsor category [1]
319662
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None
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Name [1]
319662
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Address [1]
319662
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Country [1]
319662
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
316042
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ACU Human Research Ethics Committee
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Ethics committee address [1]
316042
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https://staff.acu.edu.au/our_university/research/research-services/research-ethics
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Ethics committee country [1]
316042
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Australia
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Date submitted for ethics approval [1]
316042
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26/10/2023
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Approval date [1]
316042
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04/12/2023
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Ethics approval number [1]
316042
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2023-3329HC
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Summary
Brief summary
POSTFIT is an exercise intervention that aims to help women who have recently given birth and want to return to exercise to regain their strength and optimise their long-term health and wellbeing. Specifically, we would like to develop a battery of exercise tests to screen for common postpartum musculoskeletal health issues and examine the effectiveness of a 12-week postpartum specific supervised exercise program that aims to improve pelvic floor function, increase core function and strength, and reduce musculoskeletal pain. Women from the general population are not routinely guided on how to return to exercise safely following birth which puts them at risk of sustaining lifelong irreversible injuries, such as pelvic organ prolapse and incontinence. A multidisciplinary approach to postpartum care with the inclusion of an Accredited Exercise Physiologist could ensure a woman’s return to exercise is safe and effective in treating and preventing these common postpartum related musculoskeletal issues. The results from this study can contribute to evidence based postpartum exercise guidelines to improve the care that postpartum women receive when returning to exercise.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Mrs Samantha Jane Walsh
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Address
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The Australian Catholic University, Level 1, 163-167 Albert Rd, Strathfield, NSW 2135
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Country
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Australia
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Phone
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+61 0403128696
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
136595
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Samantha Jane Walsh
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Address
136595
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The Australian Catholic University. Level 1, 163-167 Albert Rd, Strathfield, NSW 2135
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Country
136595
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Australia
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Phone
136595
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+61 0403128696
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Fax
136595
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Email
136595
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[email protected]
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Contact person for scientific queries
Name
136596
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Samantha Jane Walsh
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Address
136596
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The Australian Catholic University. Level 1, 163-167 Albert Rd, Strathfield, NSW 2135
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Country
136596
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Australia
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Phone
136596
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+61 0403128696
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Fax
136596
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Email
136596
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
This is a small sample size and we don't want the data to be potentially re-identifiable.
The aggregate data may be made available upon request to the Principle Investigator.
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF