POSTFIT: Postpartum Optimised Strength Training and Fitness - A testing battery and exercise intervention for postpartum women

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.