The effects of an unsupervised water exercise program on low back pain and sick leave among healthy pregnant women – A randomised controlled trial

<div><p>Background</p><p>Low back pain is highly prevalent among pregnant women, but evidence of an effective treatment are still lacking. Supervised exercise–either land or water based–has shown benefits for low back pain, but no trial has investigated the evidence of an unsupervised water exercise program on low back pain. We aimed to assess the effect of an unsupervised water exercise program on low back pain intensity and days spent on sick leave among healthy pregnant women.</p><p>Methods</p><p>In this randomised, controlled, parallel-group trial, 516 healthy pregnant women were randomly assigned to either unsupervised water exercise twice a week for a period of 12 weeks or standard prenatal care. Healthy pregnant women aged 18 years or older, with a single fetus and between 16–17 gestational weeks were eligible. The primary outcome was low back pain intensity measured by the Low Back Pain Rating scale at 32 weeks. The secondary outcomes were self-reported days spent on sick leave, disability due to low back pain (Roland Morris Disability Questionnaire) and self-rated general health (EQ-5D and EQ-VAS).</p><p>Results</p><p>Low back pain intensity was significantly lower in the water exercise group, with a score of 2.01 (95% CI 1.75–2.26) vs. 2.38 in the control group (95% CI 2.12–2.64) (mean difference = 0.38, 95% CI 0.02–0.74 p = 0.04). No difference was found in the number of days spent on sick leave (median 4 vs. 4, p = 0.83), disability due to low back pain nor self-rated general health. There was a trend towards more women in the water exercise group reporting no low back pain at 32 weeks (21% vs. 14%, p = 0.07).</p><p>Conclusions</p><p>Unsupervised water exercise results in a statistically significant lower intensity of low back pain in healthy pregnant women, but the result was most likely not clinically significant. It did not affect the number of days on sick leave, disability due to low back pain nor self-rated health.</p><p>Trial registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT02354430" target="_blank">NCT02354430</a></p></div

Pregnancy characteristics and outcome in women with gastric bypass prior to their pregnancy compared to all pregnancies registered in the Danish Fetal Medicine Database in 2008.

<p><i>GA = Gestational age, NT = Nuchal Translucency.</i></p>a<p><i>Continuous normally distributed data were compared with Student's t-test, unpaired using two-sided p-values.</i></p>b<p><i>missing values on GA in 46/387.</i></p>c<p><i>missing values on birth weight in 51/387.</i></p

Relation between surgery-to-conception time and fetal birthweight according to expected for gestational age.

<p>Relation between surgery-to-conception time and fetal birthweight according to expected for gestational age.</p

Relation between surgery-to-conception time and fetal growth index.

<p>Relation between surgery-to-conception time and fetal growth index.</p

Baseline characteristics of study participants by randomisation group.

<p>Baseline characteristics of study participants by randomisation group.</p

Mode of delivery, maternal and infant outcomes.

<p>Mode of delivery, maternal and infant outcomes.</p

Secondary outcomes.

<p>Secondary outcomes.</p

Maternal characteristics of women with gastric bypass prior to their pregnancy compared to all pregnancies registered in the Danish Fetal Medicine Database in 2008.

a<p><i>Continuous normally distributed data were compared with Student's t-test and proportions between dichotomous outcomes were compared with χ²-square tests using two-sided p-values.</i></p>b<p><i>Data on Smoking were missing in 4/387 women in the gastric bypass group and 677/57,368 in the general pregnant population.</i></p>c<p><i>Body mass index. Missing values on BMI in 8/387.</i></p>d<p><i>ICSI, IVF and insemination, missing information on 9/387 in the gastric by pass group and 5214/57,368 in the general pregnant population.</i></p>e<p><i>not significant.</i></p

Participant flowchart.

<p>Participant flowchart.</p