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Postpartum Exercise and Return to Fitness: Optimise Readiness for Military Mums (PERFORM) (PERFORM)

2021年5月26日 更新者：Craig Sale、Nottingham Trent University

The Efficacy of a Post-Partum Physical Development Programme on Occupational Physical Performance and Musculoskeletal Health

The purpose of this research is to investigate the effectiveness of a personalised physical training programme in returning servicewomen to fitness following childbirth. The idea behind the program is to target core and pelvic floor muscles, along with whole body strength and endurance to help servicewomen return to work safely and in a physically fit condition. The study will monitor the response to training using the following measures: urogynaecological measures (e.g., pelvic floor strength, prolapse, urinary incontinence), military specific fitness tests, musculoskeletal health (e.g., muscle and bone mass & function) and mental health and wellbeing.

調査の概要

状態

募集

条件

介入・治療

詳細な説明

In an independent groups study design, the aim was to investigate the efficacy of a postpartum physical development programme on core reconnection (i.e., pelvic floor function, core strength/stability and urogynaecological measures), occupational physical performance, musculoskeletal health, and psychological health/wellbeing in servicewomen. Given that policy guidance is urgently needed regarding the safe return of servicewomen to functional occupational fitness, the aim of our proposed research is to inform the appropriate physical preparation of servicewomen in the postpartum period.

Participants at selected sites around the Royal Military Academy at Sandhurst will receive usual care/no formal intervention (acting as a control group [CON]) and participants at different sites around Army Headquarters will receive usual care and additionally complete an 18-week phased physical development (rehabilitation and training) programme between weeks 6 and 24 postpartum (acting as the intervention group [INT]). If recruitment numbers are low at the main sites (Aldershot and Tidworth) we will seek to recruit participants to INT from Bulford, Middle Wallop, Larkhill and Marlborough Lines for INT and to CON from Sandhurst, Odiham, Pirbright, Keogh, Minley, Deepcut as well as locations outside of the named INT sites. The geographical separation of sites was deemed to be important for maintaining differences between intervention and control group activity.

The investigators have designed a phased 18-week physical development programme to train both rehabilitative and performance enhancement elements of physical preparation. The rehabilitation element of the programme will specifically target pelvic floor function and core strength and stability (known collectively as Core Reconnection training) from weeks 6 to 24 postpartum, and the training element of the programme will contain resistance and high-intensity interval training (HIIT) from weeks 12 to 24 postpartum

The aim of this research is to investigate the effectiveness of a tailored rehabilitation and physical preparation programme for postpartum women on:

  1. Occupational fitness performance;
  2. Female health assessments (i.e., urinary incontinence, pelvic floor strength);
  3. Musculoskeletal health;
  4. Psychological health and wellbeing.

研究の種類

介入

入学 (予想される)

30

段階

  • 適用できない

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究連絡先

研究連絡先のバックアップ

研究場所

  • イギリス
    • Hampshire
      • Aldershot、Hampshire、イギリス、GU12 5RQ
        • 募集
        • Keogh Barracks
        • コンタクト：
        • 副調査官：
          • Emma Bostock, PhD
      • Hook、Hampshire、イギリス、RG29 1QT
        • 募集
        • Station Medical Centre
        • コンタクト：
        • 副調査官：
          • Emma Bostock, PhD
      • Stockbridge,、Hampshire、イギリス、SO20 8DY
        • 募集
        • Middle Wallop Medical Centre,
        • コンタクト：
        • 副調査官：
          • Emma Bostock, PhD
    • Hampshire,
      • Aldershot,、Hampshire,、イギリス、GU11 1AY
        • 募集
        • Aldershot Centre for Health,
        • コンタクト：
        • 副調査官：
          • Emma Bostock, PhD
    • Surrey
      • Blackwater、Surrey、イギリス、Gu17 9LP
        • 募集
        • Minley Medical Centre
        • コンタクト：
        • 副調査官：
          • Emma Bostock, PhD
      • Deepcut、Surrey、イギリス、GU16 6SQ
        • 募集
        • The Princess Royal Barracks
        • コンタクト：
        • 副調査官：
          • Emma Bostock, PhD
      • Pirbright、Surrey、イギリス、GU24 oDT
        • 募集
        • Elizabeth Barracks
        • コンタクト：
        • 副調査官：
          • Emma Bostock, PhD
    • Surrey,
      • Camberley,、Surrey,、イギリス、GU15 4PQ
        • 募集
        • MRS Royal Military Academy
        • コンタクト：
        • 副調査官：
          • Emma Bostock, PhD
    • Wiltshire
      • Salisbury、Wiltshire、イギリス、SP4 9AD
        • 募集
        • Bulford Medical Centre
        • コンタクト：
        • 副調査官：
          • Emma Bostock, PhD
      • Salisbury,、Wiltshire、イギリス、SP4 8QY
        • 募集
        • Larkhill Medical Centre
        • コンタクト：
        • 副調査官：
          • Emma Bostock, PhD
      • Tidworth、Wiltshire、イギリス、SP9 7EA
        • 募集
        • Queen Elizabeth Memorial Health Centre
        • 副調査官：
          • Emma Bostock, PhD
        • コンタクト：

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

18年歳以上 (大人、高齢者)

健康ボランティアの受け入れ

はい

受講資格のある性別

女性

説明

Inclusion Criteria:

  1. Serving, pregnant (third trimester) or 0 to 6 weeks postpartum UK MOD Servicewomen.
  2. ≥ 18 years old.
  3. Free from any condition or injury that may affect the individual's ability to perform exercise (health screen).
  4. Passed fit to exercise by their GP at their routine 6-week postnatal check-up
  5. Passed fit to participate by a specialist women's health physiotherapist using study specific assessment criteria.
  6. Consent to be pregnancy tested before scans at 6 and 24 weeks postpartum.

Exclusion Criteria:

  1. < 18 years old
  2. Diagnosed with post-natal depression or another mental health condition requiring specialist psychiatric secondary care. Additionally, any participant who is found to have, or develops over the course of the trial, severe post-natal depression or suicidal tendencies, will be referred back to their GP.
  3. Injured or suffering from another condition that can affect the individual's ability to perform exercise.
  4. Not passed fit to exercise by their GP at their routine 6-week postnatal check [using standard fitness assessment criteria].
  5. Not passed fit to participate following the women's clinical health assessment [using study specific assessment criteria].
  6. Women who report that they could be pregnant and / or have a positive pregnancy test before measurements at 6 and 24 weeks postpartum will not be scanned using DXA or HR-pQCT. They will cease to take any further part in the trial and will be advised to visit their GP.

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：支持療法
  • 割り当て：非ランダム化
  • 介入モデル：並列代入
  • マスキング：なし（オープンラベル）

武器と介入

参加者グループ / アーム
介入・治療
実験的：Training Intervention
18-week physical development programme to train both rehabilitative and performance enhancement elements of physical preparation.
他の：Training intervention.
The investigators have designed a phased 18-week physical development programme to train both rehabilitative and performance enhancement elements of physical preparation. The rehabilitation element of the programme will specifically target pelvic floor function and core strength and stability (known collectively as Core Reconnection training) from weeks 6 to 24 postpartum, and the training element of the programme will contain resistance and high-intensity interval training (HIIT) from weeks 12 to 24 postpartum.
介入なし：Usual care control
Usual care acting as a control group.

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Physical Performance Change Between 12 and 24 Weeks Postpartum
時間枠：Physical performance will be measured at weeks 12 and 24 postpartum.
Physical performance will be measured at weeks 12 and 24 using elements of the Soldier Strength and Conditioning review , which the servicewomen need to complete as part of their return to service following maternity leave. These tests include a vertical jump, mid-thigh pull, seated medicine ball throw and a 2 km run to best effort.
Physical performance will be measured at weeks 12 and 24 postpartum.

二次結果の測定

結果測定
メジャーの説明
時間枠
Pelvic Organ Prolapse- Quantification System Change in Scores Between 6, 12 and 24 Weeks Postpartum
時間枠：: Pelvic Organ Prolapse- Quantification will be measured at weeks 6, 12 and 24 postpartum.
Pelvic Organ Prolapse will be measured by the research associate women's health physiotherapist at weeks 6, 12 and 24. Vaginal examination will assess for prolapse using the Pelvic Organ Prolapse Quantification system staging pelvic support from 0-4, 0 being no prolapse demonstrated and 4 demonstrating full procidentia.
: Pelvic Organ Prolapse- Quantification will be measured at weeks 6, 12 and 24 postpartum.
Pelvic Floor Strength Change in Scores Between 6,12 and 24 Weeks Postpartum
時間枠：Pelvic floor distress inventory questionnaire will be measured at weeks 6, 12 and 24 postpartum.
Pelvic floor strength will be measured by the research associate women's health physiotherapist at week 6, 12 and 24. Pelvic floor strength will be measured digitally using the modified oxford scale ranging from 0-5, 0 being no discernible contraction and 5 overcoming strong resistance. Over-activity and co-ordination of the pelvic floor muscle will be assessed by a simple yes/no answer following digital vaginal examination.
Pelvic floor distress inventory questionnaire will be measured at weeks 6, 12 and 24 postpartum.
Musculoskeletal Physiotherapy Assessment Change Between 6,12 and 24 Weeks Postpartum
時間枠：: Musculoskeletal physiotherapy assessment will be measured at weeks 6, 12 and 24 postpartum.
Musculoskeletal physiotherapy measures will be assessed by the research associate women's health physiotherapist at weeks 6, 12 and 24. Posture, movement patterns, breathing will be objectively evaluated and commented on. The abdominal muscles (rectus diastasis) will be assessed by measuring the distance between the internal borders of the rectus abdominus muscle by placing the fingers vertically on the linea alba 4 cm above and below the umbilicus, during a curl up movement. Scoring is obtained through an approximation of centimetre width separation and the tone of the linea alba structure. The larger the score in centimetres the greater the separation of the rectus abdominus muscle.
: Musculoskeletal physiotherapy assessment will be measured at weeks 6, 12 and 24 postpartum.
Pelvic Floor Distress Inventory Questionnaire, Change in Scores Between 6, 12 and 24 Weeks Postpartum
時間枠：Pelvic floor distress inventory questionnaire will be measured at weeks 6, 12 and 24 postpartum.
The Pelvic Floor Distress Inventory will be completed at 6, 12 and 24 weeks by all participants. The Pelvic Floor Distress Inventory is scored ranging from 0-300, 0 being the least distress and 300 being the greatest distress.
Pelvic floor distress inventory questionnaire will be measured at weeks 6, 12 and 24 postpartum.
International Consultation on Incontinence Questionnaire - Vaginal Symptoms, Change in Scores Between 6, 12 and 24 Weeks Postpartum
時間枠：International consultation on incontinence questionnaire - vaginal symptoms will be measured at weeks 6, 12 and 24 postpartum.
The International Consultation on Incontinence Questionnaire - Vaginal Symptoms will be completed at 6, 12 and 24 weeks by all participants. The International consultation on Incontinence Questionnaire - Vaginal Symptoms evaluates vaginal symptoms, associated sexual matters and impact on quality of life. Three scores are generated. Subscales range from 0-53 vaginal symptoms, 0-58 sexual matters and 0-10 overall impact on quality of life. 0 represents the least bothersome in each subscale. The subscales are not incorporated in an overall score.
International consultation on incontinence questionnaire - vaginal symptoms will be measured at weeks 6, 12 and 24 postpartum.
World Health Organisation Quality of Life Questionnaire, Change in Scores Between 6, 12 and 24 Weeks Postpartum
時間枠：The World Health Organisation Quality of Life Questionnaire will be measured at weeks 6, 12 and 24 postpartum.
The World Health Organisation Quality of Life Questionnaire (WHOQOL-BREF) will be given to participants in paper. The WHOQOL-BREF provides an overall quality of life/wellbeing score and allows calculation of a score for each of the four sub-scales (physical health, psychological, social relationships and environment). The four domain scores are scaled in a positive direction (higher score equal higher quality of life). The mean score of items within each domain is used to calculate the domain score.
The World Health Organisation Quality of Life Questionnaire will be measured at weeks 6, 12 and 24 postpartum.
Edinburgh Post Natal Depression Scale, Change in Scores Between 6, 12 and 24 Weeks Postpartum
時間枠：The Edinburgh Post Natal Depression Scale will be measured at weeks 6, 12 and 24 postpartum.
The Edinburgh Post Natal Depression Scale (EPDS) asks participants to answer questions by reflecting on the past 7 days. The questionnaire produces a total score of postnatal depression symptoms (range 0-30) with a score of 13 and above indicating likelihood of a depressive illness of varying severity
The Edinburgh Post Natal Depression Scale will be measured at weeks 6, 12 and 24 postpartum.
Body Composition Changes Between 6 and 24 Weeks Postpartum
時間枠：Body composition will be measured at weeks 6 and 24 postpartum.
Body composition (fat mass, fat-free mass and bone mineral density) will be measured at weeks 6 and 24 by a whole-body dual-energy x-ray absorptiometry (DXA) scan.
Body composition will be measured at weeks 6 and 24 postpartum.
Bone Health Changes Between 6 and 24 Weeks Postpartum
時間枠：Bone health will be measured at weeks 6 and 24 postpartum.
Bone microarchitecture will be determined at weeks 6 and 24 by a HRpQCT scan; two scans of the tibia (distal 4% and 30% site) will be performed on the non-dominant leg to assess training-induced changes in bone microarchitecture and density.
Bone health will be measured at weeks 6 and 24 postpartum.
Tendon Properties Changes Between 6, 12 and 24 Weeks Postpartum
時間枠：Tendon properties will be measured at weeks 6, 12 and 24 postpartum.
Tendon stiffness and young's modulus will be measured using ultrasonography with a linear array probe. Patella tendon length and elongation will be calculated as the distance from the apex of the patellar and the shadow created by a fixed marker. Patella tendon stiffness will be calculated by dividing knee extensor torque by the estimated patella tendon moment arm. Knee extensor torque will be calculated as the sum of the measured knee extension torque and the antagonistic torque, estimated through the root mean square of the biceps femoris muscle electromyography signal. Force-elongation data will be fitted with to a second order polynomial curve to determine patella tendon stiffness. Tendon CSA will be assessed along the full resting length of the tendon on the axial plane through ultrasonography. Young's modulus will then be calculated as tendon stiffness multiplied by the ratio of tendon length over tendon cross-sectional area.
Tendon properties will be measured at weeks 6, 12 and 24 postpartum.
Muscle Architecture Changes Between 6, 12 and 24 Weeks Postpartum
時間枠：Muscle architecture will be measured at weeks 6, 12 and 24 postpartum.
Fascicle length of the vastus lateralis will be assessed at weeks 6, 12 and 24 by the acquisition and analysis of images taken using B-mode ultrasonography (MyLab Omega, Esaote, UK), with a linear array probe. Images will be obtained with the participant lying at rest in a supine position. Images will be taken at 50% of the length of the vastus lateralis and at the midsagittal line of the muscle. The transducer will be aligned to the fascicle plane to allow optimal capture of the fascicles.
Muscle architecture will be measured at weeks 6, 12 and 24 postpartum.
Muscle Protein and Collagen Turnover Changes Between 12 and 18 Weeks Postpartum
時間枠：: Muscle protein and collagen turnover will be measured at weeks 12 and 18 postpartum.
Muscle protein/collagen turnover will be measured from blood, saliva and skeletal muscle biopsy samples. Participants will provide a saliva sample before being given a drink of 'heavy' water (D2O); water that is enriched with a metabolic isotope tracer that can be used to evaluate the rate of protein and collagen turnover by determining the rate of tracer incorporation into muscle tissue. The muscle biopsy will be used to measure the incorporation of deuterated alanine into muscle tissue over time and enable the calculation of the fractional rate of muscle protein synthesis by mass spectrometry.
: Muscle protein and collagen turnover will be measured at weeks 12 and 18 postpartum.
Muscle Mass Changes Between 6, 12, 18 and 24 Weeks Postpartum
時間枠：Muscle mass will be measured at weeks 6, 12,18 and 24 postpartum.
We intend to estimate whole-body muscle mass using D3-Creatine (D3-Cr), measured in urine at weeks 6, 12, 18 and 24 postpartum. Using a creatine-tracer measure of muscle mass, Urine D3-creatine and D3-creatinine and unlabelled creatine and creatinine will be measured by liquid chromatography/mass spectrometry, which will allow the calculation of total body creatine pool size and muscle mass.
Muscle mass will be measured at weeks 6, 12,18 and 24 postpartum.
Muscle Breakdown Changes Between 12 and 18 Weeks Postpartum
時間枠：Muscle breakdown will be measured at weeks 12 and 18 postpartum
We intend to estimate muscle breakdown using D3-3-methylhistidine (D3-3MH), measured in urine at weeks 12 and 18 postpartum. Isotopic enrichment of D3-3MH in urine will be measured by gas chromatography/mass spectrometry, which will allow the calculation of muscle protein breakdown.
Muscle breakdown will be measured at weeks 12 and 18 postpartum

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

Nottingham Trent University

協力者

University of Nottingham
Ministry of Defence, United Kingdom
University of Stirling
Robert Gordon University
Clare Pacey Physiotherapy Limited

捜査官

  • 主任研究者：Craig Sale, PhD、Nottingham Trent University
  • 主任研究者：Kirsty Elliott-Sale, PhD、Nottingham Trent University

出版物と役立つリンク

研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。

一般刊行物

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (実際)

2019年7月4日

一次修了 (予想される)

2022年9月20日

研究の完了 (予想される)

2022年9月20日

試験登録日

最初に提出

2020年3月24日

QC基準を満たした最初の提出物

2020年3月31日

最初の投稿 (実際)

2020年4月3日

学習記録の更新

投稿された最後の更新 (実際)

2021年5月28日

QC基準を満たした最後の更新が送信されました

2021年5月26日

最終確認日

2021年5月1日

詳しくは

本研究に関する用語

キーワード

その他の研究ID番号

  • 349408
  • ASC/BA/00665 (その他の助成金/資金番号：ASC Contract Number)

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いいえ

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