The goal of this clinical trial is to determine whether a prenatal exercise program integrating Liuzijue qigong with traditional levator ani training, guided by the MoVo (Motivation-Volition) theory and delivered via a supervised mobile application, can effectively prevent postpartum urinary incontinence and pelvic organ prolapse in pregnant women, compared with app-supervised conventional Kegel exercises and routine prenatal care.
The main questions it aims to answer are:
Does the integrated Liuzijue-and-levator-ani program reduce the incidence of postpartum urinary incontinence and prolapse more effectively than app-supervised Kegel exercises or routine care?
Can the MoVo-based behavioural framework (motivation enhancement, action planning, and self-monitoring) improve long-term adherence to pelvic floor training during pregnancy and the postpartum period?
What are the effects of the three interventions on pelvic floor muscle function, exercise self-efficacy, anxiety levels, and delivery outcomes?
Researchers will compare three parallel groups: (1) the integrated Liuzijue-and-levator-ani exercise group, (2) the app-supervised conventional Kegel exercise group, and (3) the routine care control group receiving only verbal instruction on pelvic floor exercises during standard prenatal visits. All three groups will be followed from enrolment through 6 weeks postpartum to determine whether the culturally adapted mind-body intervention offers superior pelvic floor protection beyond app-delivered Kegel training and routine care.
Participants will:
Be enrolled in the third trimester and randomly assigned to one of the three groups.
In the integrated exercise group, perform daily combined Liuzijue-and-levator-ani exercises via a supervised mobile app and attend periodic check-ins until 6 weeks postpartum.
In the app-supervised Kegel group, perform daily conventional Kegel exercises via the same mobile app platform with the same supervision schedule.
In the routine care group, receive only standard verbal instructions on Kegel exercises during regular antenatal check-ups, without app supervision.
Undergo outcome evaluations at enrolment, before delivery, and at the postpartum follow-up visit, including assessments of urinary incontinence, pelvic organ prolapse, exercise adherence, self-efficacy, anxiety, and any adverse events.
Age ≥ 19 years
Singleton pregnancy with cephalic presentation；
No absolute contraindications to vaginal delivery；
No history of urinary incontinence, pelvic organ prolapse, or pelvic floor surgery before pregnancy；
History of second- or third-trimester miscarriage, recurrent miscarriage, or spontaneous preterm birth；
Presence of pregnancy complications, such as severe preeclampsia, fetal distress, placenta previa, placental abruption, or symptoms of threatened preterm labour；
Contraindications to exercise, including cervical shortening, cervical insufficiency, or unexplained vaginal bleeding or fluid leakage；
Comorbid conditions, such as asthma, cardiovascular disease, hypertension, uncontrolled diabetes mellitus, or thyroid disease；
Parallel
Routine Verbal Instruction Group
BehavioralRoutine prenatal care with only verbal instructions on Kegel exercises (no app, no supervision)
App-Supervised Kegel Exercise Group
BehavioralApp-supervised daily conventional Kegel exercises (same platform, no Liuzijue/MoVo).
Liuzijue & Levator Ani Training Group
BehavioralApp-supervised daily Liuzijue combined with levator ani training, guided by MoVo theory.
Proportion of participants with urinary incontinence at 42 days postpartum, assessed by the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF)
The ICIQ-UI SF is a validated, self-administered questionnaire that evaluates the frequency, volume, and impact of urinary incontinence (UI) over the previous 4 weeks. Total scores range from 0 to 21, with higher scores indicating more severe symptoms. This outcome is defined as the proportion of participants reporting any urine leakage (score ≥1) on the ICIQ-UI SF at the 42-day postpartum follow-up. The chi-square test will be used to compare the incidence of urinary incontinence between the intervention and control groups.
Adherence to the antenatal exercise intervention, assessed by exercise diary completion rate
Adherence is evaluated by two combined measures: (1) exercise diary completion rate = (actual number of training sets completed / planned number of training sets) × 100%; and (2) the proportion of participants who perform active training on at least 4 days per week, with each training day defined as completing at least 50% of the planned sets. The mean adherence rate and the proportion of adherent participants will be reported for the intervention group.
Pelvic floor muscle strength assessed by the Modified Oxford Grading Scale.
The Modified Oxford Grading Scale evaluates pelvic floor muscle contraction strength via vaginal palpation, with grades ranging from 0 (no contraction) to 5 (strong contraction). Median and interquartile range will be reported for each group, and the Mann-Whitney U test will be used for comparison.
Change in self-efficacy for pelvic floor exercises, assessed by the Pelvic Floor Exercise Self-Efficacy Scale
The Pelvic Floor Exercise Self-Efficacy Scale is a validated self-report instrument that measures the participant's confidence in adhering to pelvic floor exercise. Total scores range from 0 to 100, with higher scores indicating greater self-efficacy. Assessments will be performed at three time points: enrolment, 37 weeks of gestation, and 42 days postpartum. Mean ± standard deviation of scores and change from baseline will be reported for each group. Repeated-measures analysis of variance (ANOVA) will be used to compare differences between groups.
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Yu xin Qian
Lead sponsor
Guangzhou University of Chinese Medicine
Sponsor institution
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