The Effect of Progressive Muscle Relaxation Exercise Training Given to Pregnant Women With Restless Leg Syndrome
Condition: Restless Legs Syndrome
MeSH terms: Psychomotor Agitation; Restless Legs Syndrome; Syndrome
Study type: Interventional

Summary: 
      Restless Leg Syndrome (RLS) is a sensory-motor problem characterized by an uncomfortable and
      unpleasant feeling that causes a strong and overwhelming desire to move the legs, usually
      during periods of inactivity during sleep.It is reported that pregnancy is an important risk
      factor in the onset and worsening of RLS.Individuals with RLS avoid social activities, often
      experience psychiatric problems such as depression, anxiety disorders, and chronic sleep
      disorders. Therefore, restless leg syndrome significantly affects daily life and coping with
      these problems. Individuals with RLS initially undertake a variety of non-pharmacological
      practices to relieve symptoms.Progressive muscle relaxation exercises, reducing the level of
      epinephrine and norepinephrine in the blood and heart rate, reducing oxygen consumption,
      regulating metabolic rate, lowering blood pressure, reducing muscle tension, preventing
      fatigue and restlessness, decreasing pain by increasing endorphin levels, increasing coping
      with pain and stress, It has many benefits such as improving sleep and quality of life.This
      study will be conducted to evaluate the effect of progressive muscle relaxation exercise
      training and follow-up given to pregnant women with restless leg syndrome on the severity of
      restless leg syndrome, quality of life associated with restless legs syndrome, and sleep
      quality.
    

Detailed description: 
      Restless Leg Syndrome (RLS) is a sensory-motor problem characterized by an uncomfortable and
      unpleasant feeling that causes a strong and irresistible desire to move in the legs, usually
      during periods of inactivity during sleep. Depending on cultural, environmental and genetic
      differences, the prevalence of RLS is reported to be the highest in North America and Europe,
      ranging from 5.5% to 11.6%, and this prevalence is reported to be between 1.0 and 7.5% in
      Asia. Turkey made society based on two studies in RLS prevalence of respectively 3.19% and 7%
      were found.

      HBS 's with age, e increases from and in women has been reported from two times higher than
      that seen in man. The reason for its higher incidence in women has not been clearly
      explained, but it has been thought to be related to hormonal changes during pregnancy,
      menstruation and menopause. In a systematic review and meta-analysis study, it was reported
      that the prevalence of RLS in pregnant women worldwide is 21% and the symptoms are more
      common in the third trimester. In our country, g is reported to vary between midwives in HBS
      19-26% incidence. In the study conducted by Neyal et al. (2015) in our country, it was found
      that 15.6% in the first trimester of pregnancy; 32.8 % in the second trimester ; It is
      reported that RLS symptoms are observed with a rate of 38.8% in the third trimester and the
      symptoms continue at a rate of 34.8% after birth. In the study conducted by Akbaş and Yaman
      Sözbir (2019), approximately half of the pregnant women (46.4%) had RLS symptoms and the RLS
      severity mean score of pregnant women with RLS was found to be 20.82 ± 6.61 . In the same
      study, the HBS of 49.1% of women with severe and very Siddiqui has been determined that there
      is live meat that fell to the severity of RLS increases quality of life reported and un.

      Pregnancy is reported to be an important risk factor in the onset and worsening of RLS. It
      has been proven that the dopaminergic system plays an important role in the pathogenesis of
      RLS . Iron acts as a cofactor in the synthesis and formation of dopamine and normal dopamine
      production is impaired in iron deficiency. It is reported that increased iron need and anemia
      during pregnancy triggers RLS and the problem gets worse in the third trimester of pregnancy.
      In addition, vitamin D and folate increase dopamine synthesis and are reported to be
      protective of dopaminargic neurons and the brain against metabolite toxins. Studies have
      shown that iron , folate, and vitamin D deficiency cause restless leg syndrome. In addition,
      increasing estrogen, progesterone and prolactin levels during pregnancy accelerate the
      appearance of symptoms, especially in the third trimester. It has been reported that estrogen
      inhibits the synthesis and release of dopamine during pregnancy and progesterone increases
      neuronal excitability, leading to frequent hyper- reflexes and periodic leg movements and RLS
      during pregnancy. After birth, with the rapid increase of prolactin hormone, symptoms begin
      to improve.

      Individuals with RLS avoid social activities, often experience psychiatric problems such as
      depression, anxiety disorders, and chronic sleep disorders. Therefore, restless leg syndrome
      significantly affects daily life and coping with these problems . HBS to relieve symptoms of
      various individuals who initially non-pharmacological located in the application s . However,
      it may be necessary to benefit from pharmacological treatment in cases with severe RLS.
      However, the use of drugs in pregnant women may be inconvenient. A standard drug therapy has
      not been determined for the treatment of RLS in pregnant women and the number of drugs that
      can be used is limited. Because most drugs have been used according to the evidence of
      non-pregnant patients and controlled studies in the treatment of RLS during pregnancy are
      insufficient. Therefore, GeBa steel during treatment of RLS in terms of drug therapy with the
      benefits of fetal compromise between the advantages/disadvantages of evaluation and decision
      making in this regard is necessary . However, during the treatment of RLS in pregnancy, the
      effect of drugs on the fetus , especially putting njenital me lformasyo considering the
      possibility should be taken.

      The purpose of progressive relaxation exercises; It is to learn to feel the difference
      between tension and looseness in our body and to relax by ourselves in our daily life. For
      this purpose, the most widely used muscle groups, hands, arms, neck, shoulders, face, chest,
      abdomen, hips, feet and fingers were run . This method, which is applied in the form of
      stretching and relaxing the muscles , enables people to learn where their muscles are, what
      they have become during tension, and the difference when this tension disappears.

      Progressive muscle relaxation exercises, reducing the level of epinephrine and norepinephrine
      in the blood and heart rate, reducing oxygen consumption, regulating metabolic rate, lowering
      blood pressure, reducing muscle tension, preventing fatigue and restlessness, reducing pain
      by increasing endorphin levels, increasing coping with pain and stress, It has many benefits
      such as increasing the quality of sleep and life.

      RLS, which increases in frequency during pregnancy, disrupts sleep quality and affects the
      quality of life as it increases fatigue in pregnant women. During the follow-up, care and
      counseling process performed by nurses during pregnancy, pregnant women should be evaluated
      for sleep disturbance, fatigue, anxiety and stress that may be caused by RLS and attempts
      should be made to increase the quality of life by solving problems in cases . At this point,
      it is especially important to teach how to deal with RLS or how to relieve symptoms . In this
      context, progressive muscle relaxation exercises, which have many benefits and can be applied
      by nurses, should be taught to pregnant women during the routine follow-up and care process,
      and the use of relaxation exercises should be provided both at home and in clinics.
    

Intervention name(s): progressive muscle relaxation exercise training
Intervention type(s): Behavioral
Intervention description(s): Progressive muscle relaxation exercises (PKGE); 16 large muscles (right hand and forearm, right upper arm, left hand and forearm of left arm, left upper arm, forehead, upper cheek and nose, chin, neck, abdomen, upper right arm, which people can do on their own after learning) leg, right calf, right foot, left upper leg, left thigh and left foot), followed by the contraction and then relaxation and accompanied by deep breathing, is a preferred method for reducing pain, anxiety and depression in individuals.The relaxation will be required to take 10-20 before stretching the next muscle group. In this way, the muscle groups in the hands, arms, neck, shoulder, chest, abdomen, hips, feet and fingers, face and the whole body will be voluntarily stretched and relaxed, and pregnant women will be relieved.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Research, single -centered , stratified randomization (hafif-moderate, severe-very severe ) with a pre-test and post-test control group parallel randomized control with experimental was designed as an operation.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: restless legs sendrome; progressive muscle relaxation exercise; quality of life; sleep hygiene