This group receives core stability training aimed at strengthening deep stabilizing muscles, including the transversus abdominis, to improve lumbar support and control. Participants perform a 50-minute session three times per week over eight weeks, focusing on exercises using unstable surfaces like the Pilates reformer to enhance proprioception and core engagement.

This group participates in aerobic exercise sessions as a comparative intervention. Participants engage in a 50-minute session three times per week over eight weeks. The exercise includes warm-up, a main session (walking at a controlled intensity), and cool-down, with intensity levels adjusted over time to match cardiovascular improvements.

Participants in this group undergo core stability training sessions targeting deep stabilizing muscles. The exercises are designed to enhance spinal support and core control by activating the transversus abdominis and other core muscles. Sessions involve the use of a Pilates reformer and other unstable surfaces, fostering proprioceptive engagement and improved muscle coordination. Training is conducted three times per week for eight weeks, with each session lasting 50 minutes.

The thickness of the core stabilizing muscles, including the rectus abdominis, transversus abdominis, internal oblique, and external oblique, is measured using rehabilitative ultrasound imaging (RUSI). For this assessment, a 10 MHz linear probe or a 3.5 MHz convex probe is positioned 2.5 cm lateral to the umbilicus while the participant lies in a supine position. The measurement captures the distance between the upper and lower fascial layers of each muscle, providing an indication of muscle thickness. Three measurements are taken, and the median value is used in analysis.

This measure assesses the contraction time of deep stabilizing muscles, specifically during a hollowing exercise where the participant engages the transversus abdominis and other abdominal muscles. Using rehabilitative ultrasound imaging (RUSI), the probe is positioned 2.5 cm lateral to the umbilicus to observe muscle activation. Contraction time is recorded as the duration from the onset of muscle activation to full contraction. Measurements are taken three times, with the median value used for analysis.