Targeted exercise for quality of life and physical condition in people who have undergone stoma formation living without a parastomal hernia: a feasibility study

Arm 1 only - All participants will receive the intervention. - All participants were allocated to receive the exercise intervention comprising 4-6 face to face sessions delivered fortnightly by a physiotherapist. - Exercise intervention aimed at improving abdominal muscle function and physical activity levels The first Physiotherapy session (45-90 minutes) incorporated an assessment of the ostomate’s knowledge and skills regarding abdominal muscle exercise. Next, motivational interviewing using the Brief Action Planning (BAP) approach was used to establish a SMART goal around exercise and guide ostomates to plan exercise details such type and frequency of exercises to be conducted in the home exercise program. Consenting participants received verbal, written and video feedback (recorded on their own personal device and used only for their person) on the exercises so that they can continue these at home, to provide them with visual feedback and remind them of what is required. Participants were asked to complete paper-based exercise diary to record the exercises completed and report any concerns to the led investigator. At each subsequent session (30-60 minutes), the physiotherapist reviewed the participants diary and progressed the exercises. Examples of exercises undertaken included: engaging the core/pelvic floor engagement "like doing up the zipper on your pants", diaphragm breathing, crook lying down, knees side to side lying down, bridging, knee lifts in crook position, heel glides, sitting with arm raises, sitting with knee lifts, sit to stand, quadruped with arm raises and leg raises, diagonal sit ups, legs from side to side laying down (taken from previous research by Anderson and colleagues), walking, running, dead lifts. These were individually prescribed and it was expected that not all participants were able to achieve/prescribed all the exercises. Physiotherapist / Research Assistant training Prior to commencement of the study, the Physiotherapist administering the exercise program attended a two-hour training session by the study investigators summarising the evidence for core abdominal exercises for parastomal hernia prevention, behaviour change techniques, as well as a discussion of broader ostomate healthcare issues including surgical procedure, type of stoma (ileostomy, colostomy or urinary stoma), peristomal skin condition and any appliance issues including the use of hernia support garment. The physiotherapist-researcher completed an online module on an overview on motivational interviewing using the Brief Action Planning (BAP) approach to establish a SMART goals.