After Cesarean Time Interval for Exercise (ACTIVE) Trial

Study Overview
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Brief Summary
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The purpose of this study is to test whether or not activity restrictions after a cesarean section are warranted and if exercise can improve postpartum wellness. This research study is being done because there is no science-based evidence to support postpartum activity restrictions after cesarean sections. Participants will be randomly placed into one of the following study groups: Standard postpartum and post-operative instructions group: activity restrictions, including no strenuous exercise, sexual intercourse, or lifting objects greater than 25 pounds for 6 weeks or until evaluation at the 6 week postpartum visit Study group: Structured 10 week exercise protocol consisting of core strengthening exercises (concentrating on the abdominal, gluteal, and pelvic areas), breathing exercises, and diaphragm exercises.

Official Title
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After Cesarean Time Interval for Exercise (ACTIVE) Trial

Conditions
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Postoperative Complications

Intervention / Treatment
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* Behavioral: Structured exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: pregnant woman at least 18 years of age carrying only one baby at time of delivery delivery planned by scheduled cesarean section baby of gestational age of > 37 weeks no known restrictions to exercise. Exclusion Criteria: woman with pre-existing post operative complications medical history with exercise limitations/disabilities carrying more than one baby at time of delivery delivery (planned by scheduled or emergent) cesarean section with fetal concerns (anomaly, growth restriction, NICU admission, etc)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Standard instructions<br>Standard instructions: activity restrictions, including no strenuous exercise, sexual intercourse, or lifting objects greater than 25 pounds for 6 weeks or until evaluation at the 6 week postpartum visit | |
| Experimental: Study Group<br>Study group: Structured 10 week exercise protocol | Behavioral: Structured exercise<br>* The exercise program will be designed by a physical therapist (Ms. Patricia Ladis) who specializes in postnatal rehabilitation and will be supervised by sports medicine physicians from the Hospital For Special Surgery (HSS). The structured program will include approximately 10 minutes of core muscle group exercises. They will begin this program 2 weeks after their cesarean section. The study group will perform these exercises 5 times per week.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in wellness | As measured by scores in the completion of the PROMIS GSF assessment. The PROMIS GSF assessment uses a method of scoring requiring responses to each item for each participant. Each question usually has five response options ranging in value from one to five. All questions must be answered in order to produce a valid score using the scoring tables. A score of 50 is the average for the United States general population with a standard deviation of 10. A higher PROMIS T-score represents more of the concept being measured. For negatively-worded concepts like Anxiety, a T-score of 60 is one SD worse than average. By comparison, an Anxiety T-score of 40 is one SD better than average. However, for positively-worded concepts like Physical Function-Mobility, a T-score of 60 is one SD better than average while a T-score of 40 is one SD worse than average. | 2, 6, and 10 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in incidence of post operative complications | As measured by number of subjects presenting with any of the following: Wound separation, dehiscence, hernia etc. Re-hospitalization for wound concerns Infection Increased pain, abdominal/core muscle injury Less breastmilk production (adequate-inadequate, Likert scale 1-5) Urinary incontinence Improved fitness | 2, 6, and 10 weeks | 
| Change in incidence of depression, anxiety, and decreased physical functioning | As measured by scores in the completion of the PROMIS GSF assessment. The PROMIS GSF assessment uses a method of scoring requiring responses to each item for each participant. Each question usually has five response options ranging in value from one to five. All questions must be answered in order to produce a valid score using the scoring tables. A score of 50 is the average for the United States general population with a standard deviation of 10. A higher PROMIS T-score represents more of the concept being measured. For negatively-worded concepts like Anxiety, a T-score of 60 is one SD worse than average. By comparison, an Anxiety T-score of 40 is one SD better than average. However, for positively-worded concepts like Physical Function-Mobility, a T-score of 60 is one SD better than average while a T-score of 40 is one SD worse than average. | 2, 6, and 10 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Postpartum wellness, Postoperative activity, Postoperative complication, Postpartum complication