Impact of a Telehealth Clinical Reformer- versus Mat-based Pilates on metabolic syndrome severity among women with a history of gestational diabetes mellitus: a pilot mixed-methods study

Intervention protocol Eligible participants will receive a Pilates reformer equipment via Australia Post after completing a series of baseline assessments. The reformer equipment will be purchased from Kogan Marketplace (Fortis Foldable Pilates Reformer Machine) which must comply with Australian and New Zealand laws and regulations, as well as Kogan's restrictions, including compliance with the ACCC Mandatory Standards. Information regarding equipment set-up, capacity, and hazard is provided in the study's Participant Information sheet (PIS). A link to an instructional video to safely assemble the reformer equipment is also provided within the PIS. The 16-week intervention will consist of two phases. Phase 1 refers to the initial 8-weeks of the 16-week program. This will involve one supervised group exercise session, and two unsupervised exercise sessions per week. The unsupervised sessions will be based on the exercise prescribed during the supervised session for the week. The supervised sessions will serve to introduce participants to different exercise techniques (i.e. breathing and form), monitoring (i.e. intensity) and variations that can allow them to safely self-manage their prescribed unsupervised exercise sessions. Training logs will be provided to all participants to monitor adherence and exercise type, frequency, duration, and intensity during both supervised and unsupervised sessions. All participants will be required to attend an initial one-on-one online consultation (1.5 h) with a YMCA Accredited Exercise Physiologist (AEP) before beginning Phase 1, to ensure the program design is tailored to the participants’ needs and preferences relative to the current exercise guidelines, and goal of the research study (to reduce metabolic syndrome severity). During this initial consult, participants will also be provided a tutorial on how to use the reformer equipment to complete their prescribed exercises, as well as education and advice on scheduling an exercise session around breastfeeding during the postpartum period. The supervised group exercise sessions (Reformer-based Pilates) will be delivered through YMCA’s Allied Health Telehealth program. These group exercise sessions will be guided and supervised by a team of AEPs and Accredited Exercise Scientists (AES) who are required to adhere to the ESSA Digital Practice Standards (https://www.essa.org.au/Web/Web/Accreditation/Becoming-accredited/professional-standards.aspx). There will be a maximum of five participants in a group session supervised by one AEP/AES. All telehealth sessions will incorporate video feedback, allowing participants to share their exercise forms for real-time correction. Emergency protocols and procedure are also in place to address emergencies and adverse events. Participants will be educated on these emergency protocols and procedures during initial consultation. The researchers at Flinders University will provide protocol specific training to all AEPs and AES involved. A set of exercises will be planned and recommended for each intervention group session, including aerobic activities (e.g. fast footwork, mountain climbers), resistance/strength training (e.g. single leg extension, reformer calf raises, kneeling arm raises), and pelvic floor specific exercises (e.g. kegel, bridge, clamshells), according to the current exercise guidelines and the participants’ needs and preferences. Exercise sessions will be scheduled according to the convenience of each participant and delivered in three training stages ensuring progressive overload until the end of the 8-week program. Stage 1 (weeks 1-3) will include 5 min of aerobic exercise and 45 min of strength, pelvic floor, and flexibility exercises (3 sets of 12 repetitions); stage 2 (weeks 4-6), 10 min of aerobics and 40 min of strength, pelvic floor, and flexibility exercises (3 sets of 10 repetitions); and stage 3 (week 7-8), 15 min of aerobics and 35 min of strength, pelvic floor, and flexibility exercises (3 sets of 8 repetitions). Following the initial 8-week intervention, participants will enter Phase 2 of the 16-week exercise program. Phase 2 requires participants to continue with ‘stage 3’ of the initial 8-week program in an unsupervised environment, two times per week. Participants will also participate in a parkrun (https://www.parkrun.com.au/) once per week. The parkrun is a free weekly community event where participants can choose to walk, jog, or run at their own pace to complete a distance of five kilometers. Logbooks will also be provided to all participants to monitor adherence and intensity via rate of perceived exertion using the Borg scale and heart rate if they have a monitor available. During this phase, participants will also be provided with the following educational material on different methods to reduce their overall sedentary behaviour: https://www.sbm.org/healthy-living/move-more-and-sit-less-how-to-reduce-sedentary-time.