The goal of this randomized controlled clinical trial is to investigate the multidimensional recovery process in postpartum women, with particular focus on body image perception, postural alignment, psychological well-being, and functional capacity. The study aims to evaluate how different structured exercise approaches may influence these interconnected domains during the postpartum period, which is characterized by profound physical, physiological, and psychological adaptations.

The study will include women aged 18-45 years, recruited during the third trimester of pregnancy and followed up to 9 months postpartum. Eligible participants will present low levels of physical activity (<150 minutes/week) and no contraindications to exercise. This population is considered particularly vulnerable due to the coexistence of musculoskeletal changes, fatigue, altered body perception, and increased risk of psychological distress during the postpartum period.

The main questions it aims to answer are:

• Can structured exercise interventions influence body image perception and postural alignment in postpartum women, as assessed by validated tools such as the Body Image Dimensional Assessment (BIDA) and instrumental analysis (Moti Physio system and Gyko inertial sensor)?
• Can these interventions impact on psychological well-being and quality of life, including depression, stress, sleep quality, and perceived fatigue, as evaluated through standardized questionnaires (EPDS, PSS, PSQI, SF-36) and functional performance tests? Researchers will compare a sensorimotor training group (SEN), a resistance training group (CR), and a usual care control group (UC) to identify differences in psychological, postural, physiological, and functional outcomes, and to better understand the role of exercise type in postpartum recovery.

Researchers will compare a sensorimotor training group (SEN), a resistance training group (CR), and a usual care control group (UC) to identify differences in psychological, postural, physiological, and functional outcomes, and to better understand the role of exercise type in postpartum recovery. Both training interventions are designed to be safe, adaptable, and suitable for postpartum women.

Outcomes will be assessed at baseline (third trimester), pre-intervention (3 months postpartum), mid-intervention (6 months postpartum), post-intervention (9 months postpartum), and at 6-month follow-up. Particular attention will be given to the interaction between subjective outcomes (e.g., body image perception) and objective measures (e.g., posture and body composition), in order to provide a comprehensive understanding of postpartum recovery trajectories.

Participants will:

• participate in a 24-week supervised exercise intervention (sensorimotor or resistance training, 2 sessions/week), or receive standard care recommendations (control group).
• complete body image questionnaires (BIDA) at each time point to evaluate subjective perception of body changes;
• perform postural assessments using non-invasive technologies (Moti Physio for spinal alignment and Gyko inertial sensors for kinematic and postural analysis);
• undergo body composition assessment using bioelectrical impedance analysis (BIA), providing measures such as fat mass, fat-free mass, and total body water;
• undergo repeated psychological assessments, including physical activity levels (IPAQ), depression (EPDS), perceived stress (PSS), sleep quality (PSQI), and quality of life (SF-36);
• undergo functional testing, including balance (e.g., step test, single-leg stance), muscular strength (e.g., handgrip dynamometry, sit-to-stand test), and flexibility (sit-and-reach, scratch test);

INTRODUCTION The postpartum period is characterized by significant physical, physiological, and psychological changes that may affect body image, postural alignment, functional capacity, and overall well-being. Recovery during this phase is complex and may extend for several months after childbirth, with variability depending on individual conditions and delivery characteristics. Women in the postpartum period may experience musculoskeletal alterations, reduced core stability, fatigue, and changes in body perception, which can negatively influence daily functioning and quality of life. In addition, psychological factors such as stress, sleep disturbances, and depressive symptoms may further impact recovery and adaptation to the maternal role. Despite the recognized importance of physical recovery after childbirth, structured exercise interventions in the postpartum period are often not systematically implemented or tailored to the multidimensional needs of women. In particular, conventional exercise approaches may not fully address aspects such as proprioception, postural control, and body awareness. For this reason, there is increasing interest in integrated exercise models that combine elements of neuromuscular control, breathing, and movement coordination. Sensorimotor approaches, including methods based on controlled and multi-planar movements, may represent a suitable strategy to support both physical and perceptual recovery during the postpartum period. This study is designed to investigate the effects of different structured exercise interventions on multiple domains of postpartum recovery, including body image, posture, psychological well-being, body composition, and functional performance.

RESEARCH OBJECTIVES This randomized controlled trial aims to evaluate the effects of two structured exercise interventions on multiple domains of postpartum recovery, including body image, postural alignment, body composition, psychological well-being, and functional capacity. Participants will be randomly assigned to one of three groups: an integrated sensorimotor training group, a resistance training group, or a usual care group. The study is designed to compare the effects of these interventions on physical, perceptual, and psychological outcomes during the postpartum period. The sensorimotor training group will follow a 24-week program based on a combination of Pilates, GYROKINESIS®, and Yoga, focusing on proprioception, breathing control, and neuromuscular coordination. The resistance training group will perform a structured strength training program targeting major muscle groups through progressive exercises. The usual care group will receive standard postpartum recommendations without participating in a supervised exercise program.

A total of 45 women will be enrolled and equally allocated across the three study groups.

Assessments will be conducted at multiple time points: during the third trimester of pregnancy (baseline), at 3 months postpartum (pre-intervention), at 6 months postpartum (mid-intervention), at 9 months postpartum (post-intervention), and at 6 months after the end of the intervention (follow-up). Outcome domains include body image, postural parameters, body composition, psychological health, physical activity levels, and functional performance. These measures will be used to evaluate changes over time and to compare the effects of the different interventions.

METHODS Participants will be recruited through the Obstetrics and Obstetric Pathology Unit at the Isola Tiberina Gemelli-Isola Hospital. Recruitment will target women in the third trimester of pregnancy who meet the study eligibility criteria. Eligible participants will be enrolled and followed from late pregnancy through the postpartum period according to the study timeline. After baseline and pre-intervention assessments, participants will be randomly assigned to one of the three study groups. All participants will receive detailed information about the study procedures prior to enrollment and will provide written informed consent before participation. Data will be collected and managed using coded identifiers to ensure participant confidentiality. Only data relevant to the study objectives will be collected. The study will be conducted following approval by the appropriate ethics committee.

PARTICIPANTS AND SAMPLE SIZE The study aims to enroll a total of 45 participants, who will be randomly assigned in equal numbers to three study groups. The sample size was determined based on an a priori power analysis, taking into account expected effect size, significance level, and repeated measurements over time, in order to ensure adequate statistical power.

EVALUATION AND TRAINING PROTOCOL All participants will undergo baseline and follow-up assessments according to the study timeline. Assessments will include postural evaluation, body composition, psychological measures, and functional performance tests. Following baseline assessments, participants will be assigned to one of three study groups according to the study design. The two intervention groups will participate in supervised exercise programs conducted twice per week for 24 weeks. Each session will last approximately 60 minutes and will include one in-person session at the University of Rome "Foro Italico" and one remote session delivered online. Exercise sessions will be supervised by qualified professionals in preventive and adapted physical activity. The control group will not participate in supervised exercise sessions and will receive standard postpartum care recommendations.

COMPLIANCE

Adherence to the intervention will be assessed based on attendance at scheduled training sessions. Compliance will be categorized according to the percentage of completed sessions as follows:

• High compliance: 75-100%
• Moderate compliance: 50-74%
• Low compliance: 25-49%
• Very low compliance: 0-24%

STUDY RELEVANCE This study addresses the need to better understand the role of structured exercise interventions in supporting postpartum recovery across physical, psychological, and functional domains. By comparing different types of exercise approaches with usual care, the study aims to provide evidence on their potential impact on body image, postural alignment, and overall well-being in postpartum women. The findings may contribute to the development of more targeted and structured exercise programs to support recovery during the postpartum period.

Inclusion Criteria:

• Women aged 18-45 years
• Third trimester of pregnancy
• Physical activity level <150 minutes per week
• Ability to participate in exercise training
• No contraindications to physical activity

Exclusion Criteria:

• Severe comorbidities or medical conditions limiting exercise
• Participation in structured exercise programs exceeding 150 minutes per week
• Any contraindication to physical activity as determined by medical evaluation

Functional evaluation - Assessment

March 2027 and ending 1 years after the publication of results

Under request to the principal investigator