Exercise and Lumbopelvic Mobility in Pregnancy

Effectiveness of a Six-Week Progressive Resistance Exercise Program on Lumbopelvic Range of Motion in Second-Trimester Pregnancy: A Randomized Controlled Trial

Introduction. Pregnancy-induced biomechanical alterations frequently precipitate lumbopelvic mobility restrictions, contributing to musculoskeletal dysfunction and compromised maternal quality of life. This investigation evaluated whether a structured therapeutic exercise rehabilitation protocol could counteract gestational mobility decline and enhance lumbopelvic range of motion in second-trimester pregnant women through targeted neuromuscular conditioning.

Methods. A randomized controlled trial enrolled 50 pregnant women (gestational age mean±standard deviation (range): 22±5 (14 -31) weeks) allocated to experimental (n=25) or control (n=25) groups. The experimental group completed a six-week progressive resistance exercise rehabilitation program (36 supervised sessions) targeting lumbopelvic stabilizers, paraspinal musculature, and hip girdle complexes. Primary outcomes comprised eight goniometrically assessed range of motion parameters across sagittal (ie.; lumbar flexion and extension), frontal (ie.; lumbar right and left lateral flexion), and transverse (ie.; right and left axial rotation) anatomical planes, anterior and posterior pelvic tilt. Secondary outcomes comprised back and pelvic pain. All outcomes were measured at baseline, midintervention (week 3), and postintervention (week 6). Percentage changes between postintervention and baseline were calculated.

Study Overview

• Status: Completed
• Conditions: Lumbopelvic Range of Motion in Second-Trimester Pregnancy
• Intervention / Treatment: Behavioral: Effectiveness of a Six-Week Progressive Resistance Exercise Program on Lumbopelvic Range of Motion in Second-Trimester Pregnancy; Behavioral: Standard prenatal care

Detailed Description

Low back pain and pelvic girdle pain constitute the most prevalent musculoskeletal complaints during pregnancy, collectively affecting 50% to 70% of pregnant women, with prevalence escalating substantially during second and third trimesters. These conditions exhibit multifactorial etiology involving altered biomechanics, compromised neuromuscular control, weakened core musculature, and progressive joint stiffness. The syndrome extends beyond subjective pain to encompass objective functional impairments including restricted lumbopelvic range of motion, compromised postural stability, reduced occupational capacity, increased sick leave utilization, and elevated fall risk, collectively imposing substantial individual and societal burdens. Biomechanical alterations include increased spinal loading (estimated at 56% elevation above non-pregnant baseline), hormonal mediation of ligamentous integrity affecting sacroiliac and pubic symphysis articulations, and neuromuscular control deficits impairing load transfer mechanisms across the lumbopelvic complex.

Therapeutic exercise has emerged as a cornerstone non-pharmacological intervention in prenatal care. Structured protocols targeting core stability, spinal mobility, and pelvic floor function demonstrate beneficial effects on pain reduction, postural optimization, and functional capacity preservation. A 2019 systematic reviews established that prenatal exercise reduces pain severity and improves functional capacity, though effects on symptom prevalence remain equivocal. Exercise enhances lumbopelvic stability through strengthening deep abdominal and paraspinal musculature, improving neuromuscular coordination and proprioceptive acuity, optimizing load distribution across compromised joints, and potentially modulating inflammatory cascades contributing to pain sensitization. Randomized controlled trials (RCT) indicated that combined stabilization and pelvic floor training surpasses isolated exercise approaches for improving lumbopelvic function and reducing disability.

The present investigation addressed these methodological limitations through a RCT design incorporating validated goniometric assessment of eight discrete lumbopelvic range of motion parameters across three temporal measurement points. The study compared outcomes between pregnant women participating in a structured six-week progressive resistance exercise program targeting lumbopelvic stabilizers and controls engaging only in routine daily activities. This design enables characterization of both intervention effects (comparing exercising (experimental group) vs. non-exercising group (control group) and natural gestational trajectories (examining temporal changes within the control group), thereby providing comprehensive evidence regarding therapeutic exercise efficacy and the biomechanical consequences of pregnancy progression in the absence of structured physical conditioning. The primary aim was to evaluate whether a structured therapeutic exercise rehabilitation protocol could counteract gestational mobility decline and enhance lumbopelvic range of motion in second-trimester pregnant women through targeted neuromuscular conditioning. The investigators hypothesized that the progressive resistance exercise intervention would generate substantial improvements in all measured lumbopelvic mobility parameters, while control participants would exhibit progressive restrictions as pregnancy advanced, resulting in large between-group differences favoring the intervention group at postintervention assessment. The secondary aim was to compare back and pelvic pain between the two groups.

• Study Type: Interventional
• Enrollment (Actual): 50
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Tunisia
  • Ariana Governorate
    • Aryanah, Ariana Governorate, Tunisia, 2073
      • Institut Supérieur du Sport et de l'Education Physique de Ksar-Saïd

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• specified singleton intrauterine pregnancies confirmed ultrasonographically
• gestational age between 14 and 28 weeks calculated from last menstrual period and corroborated by first-trimester ultrasound biometry
• absence of diagnosed musculoskeletal pathology requiring medical intervention
• medical clearance for moderate-intensity aerobic and resistance exercise from attending obstetricians
• capacity to commit to supervised exercise sessions six days weekly for six consecutive weeks

Exclusion Criteria:

• encompassed high-risk pregnancy classifications including placenta previa
• pregnancy-induced arterial hypertension or preeclampsia (systolic blood pressure ≥140 mmHg or diastolic ≥90 mmHg with proteinuria
• gestational diabetes mellitus requiring insulin therapy
• multiple gestation
• incompetent cervix or cerclage placement
• persistent second-trimester vaginal bleeding
• premature rupture of membranes
• history of preterm labor
• intrauterine growth restriction below tenth percentile
• contraindications to exercise per American College of Obstetricians and Gynecologists guidelines
• concurrent participation in structured exercise programs exceeding 60 minutes weekly
• acute lumbopelvic pain intensity exceeding six on numerical rating scale (0 to 10) necessitating pharmacological management

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Resistance training; participated in a six-week progressive resistance exercise program	Behavioral: Effectiveness of a Six-Week Progressive Resistance Exercise Program on Lumbopelvic Range of Motion in Second-Trimester Pregnancy; We hypothesized that the progressive resistance exercise intervention would generate substantial improvements in all measured lumbopelvic mobility parameters, while control participants would exhibit progressive restrictions as pregnancy advanced, resulting in large between-group differences favoring the intervention group at postintervention assessment. The secondary aim was to compare back and pelvic pain between the two groups.
Placebo Comparator: Control group; received standard prenatal care without structured exercise prescription, engaging only in routine daily activities	Behavioral: Standard prenatal care; The control group received standard prenatal care without structured exercise prescription, engaging only in routine daily activities. Control group received counseling to maintain habitual activity patterns without intentional modification, avoiding initiation of new exercise programs during the study period

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lumbopelvic range of motion	Lumbopelvic range of motion constituted eight discrete movement parameters across three anatomical planes consistent with standardized normative values; Lumbar spine sagittal plane flexion (0 to 80 degrees normative range); Lumbar spine sagittal plane extension (0 to 30 degrees),; Lumbar spine frontal plane lateral flexion to right and left (0 to 40 degrees bilaterally),; Lumbar spine transverse plane axial rotation to right and left (0 to 45 degrees bilaterally); Anterior pelvic tilt in sagittal plane (13±4.9 degrees population mean), and; Posterior pelvic tilt in sagittal plane (8.9±4.5 degrees population mean)	All outcomes were measured at baseline, midintervention (week 3), and postintervention (week 6)
Back and pelvic pain changes	The endpoint criterion required attainment of end-range position where participants reported substantial stretch sensation without pain (numerical rating scale intensity 4 to 5 of 10) (Hatano et al., 2022)maintained for two seconds	Back and pelvic pain were measured at baseline, midintervention (week 3), and postintervention (week 6)

Collaborators and Investigators

• Sponsor: Habil Hamdouni
• Collaborators: Faculty of Medicine, Sousse

Study record dates

Study Major Dates

• Study Start (Actual): September 15, 2024
• Primary Completion (Actual): October 31, 2024
• Study Completion (Actual): January 20, 2025

Study Registration Dates

• First Submitted: February 21, 2026
• First Submitted That Met QC Criteria: February 26, 2026
• First Posted (Actual): March 3, 2026

Study Record Updates

• Last Update Posted (Actual): March 3, 2026
• Last Update Submitted That Met QC Criteria: February 26, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Biomechanics; exercise therapy; physical therapy modalities; postural balance; joint instability; goniometry; prenatal care; musculoskeletal; manipulations
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases; Joint Instability; Reproductive Physiological Phenomena; Reproductive and Urinary Physiological Phenomena; Pregnancy Trimesters; Pregnancy Trimester, Second
• Other Study ID Numbers: ERC-2024-076

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No