Lactation counseling for maintaining exclusive breastfeeding in adolescent mothers: a trial protocol

Abstract Background Adolescent mothers have lower rates of initiation, continuation, and exclusivity of breastfeeding, and even more so in the first pregnancy. Current interventions target adult women, and little evidence is available for breastfeeding promotion among adolescents. Methods This is a pilot study protocol with a parallel, single-blind, randomized, and controlled trial design, to evaluate the feasibility of the intervention “Lactation Counseling” in first-time adolescent mothers to maintain exclusive breastfeeding in the first 6 months of life. The control group will receive routine education in prenatal care and prenatal and childbirth classes, the experimental group will receive additionally the intervention “Lactation Counseling”, for 4 weeks, both conducted by trained nurses. Feasibility outcome includes recruitment and dropout rates, and, pilot outcomes will be the exclusive breastfeeding rate and the breastfeeding knowledge. Measurements will be taken at baseline, post-intervention, and 2, 4, and 6 months after childbirth. Discussion Exclusive breastfeeding rates could be increased in adolescent mothers through nursing counseling interventions that are previously structured and evaluated from their feasibility. This study will allow the evaluation of the feasibility of an intervention in low-income, Latin American population adolescents. Trial registration ClinicalTrials.gov NCT04655846, Registered 7 December 2020.

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Lactation Counseling for Maintaining Exclusive Breastfeeding in Adolescent Mothers: A Trial Protocol

10.21203/rs.3.rs-578613/v1 ◽

2021 ◽

Author(s):

Iliana Milena Ulloa Sabogal ◽

Claudia Consuelo Domínguez-Nariño ◽

Mary Alejandra Mendoza-Monsalve

Keyword(s):

Latin American ◽

Adolescent Mothers ◽

Low Income ◽

Exclusive Breastfeeding ◽

Controlled Trial ◽

Control Group ◽

Adult Women ◽

Post Intervention ◽

Breastfeeding Knowledge ◽

Breastfeeding Rate

Abstract Adolescent mothers have lower rates of initiation, continuation, and exclusivity of breastfeeding, and even more so in the first pregnancy. Current interventions target adult women, and little evidence is available for breastfeeding promotion among adolescents. This is a pilot study protocol with a parallel, single-blind, randomized, controlled trial design, to evaluate the effectiveness of the intervention “Lactation Counseling” in first-time adolescent mothers to maintain exclusive breastfeeding in the first six months of life. The control group will receive routine education in prenatal care and prenatal and childbirth classes and, the experimental group will receive additionally the intervention “Lactation Counseling”, for four weeks, both conducted by trained nurses. The primary outcome will be the exclusive breastfeeding rate; and the secondary, the breastfeeding knowledge. Measurements will be taken at baseline, post-intervention, and two, four and six months after childbirth. This study will allow the evaluation of the feasibility of an intervention in low-income, Latin American population adolescents.

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Effectiveness of WeChat for Improving Exclusive Breastfeeding in Huzhu County China: Randomized Controlled Trial

Journal of Medical Internet Research ◽

10.2196/23273 ◽

2020 ◽

Vol 22 (12) ◽

pp. e23273

Author(s):

Qiong Wu ◽

Yiwen Huang ◽

Zijun Liao ◽

Michelle Helena van Velthoven ◽

Wei Wang ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Pregnant Women ◽

Exclusive Breastfeeding ◽

Controlled Trial ◽

Intervention Group ◽

Mobile Technologies ◽

Control Group ◽

Randomized Controlled ◽

Breastfeeding Rate ◽

Significant Difference

Background The benefits of breastfeeding for both infants and mothers have been well recognized. However, the exclusive breastfeeding rate in China is low and decreasing. Mobile technologies have rapidly developed; communication apps such as WeChat (one of the largest social networking platforms in China) are widely used and have the potential to conveniently improve health behaviors. Objective This study aimed to assess the effectiveness of using WeChat to improve breastfeeding practices. Methods This 2-arm randomized controlled trial was conducted among pregnant women from May 2019 to April 2020 in Huzhu County, Qinghai Province, China. Pregnant women were eligible to participate if they were aged 18 years or older, were 11 to 37 weeks pregnant with a singleton fetus, had no known illness that could limit breastfeeding after childbirth, used WeChat through their smartphone, and had access to the internet. A total of 344 pregnant women were recruited at baseline, with 170 in the intervention group and 174 in the control group. Women in the intervention group received breastfeeding knowledge and promotion information weekly through a WeChat official account from their third month of pregnancy to 6 months postpartum. The primary outcome of exclusive and predominant breastfeeding rate was measured 0-1 month, 2-3 months, and 4-5 months postpartum. Results At 0-1 month postpartum, the exclusive breastfeeding rate was significantly higher in the intervention group than that in the control group (81.1% vs 63.3%; odds ratio [OR] 2.75, 95% CI 1.58-4.78; P<.001). Similarly, mothers in the intervention group were more likely to provide predominantly breast milk (OR 2.77, 95% CI 1.55-4.96; P<.001) and less likely to give dairy products to their children (OR 0.40, 95% CI 0.21-0.75; P=.005). There was no statistically significant difference for exclusive breastfeeding rate 2-3 months (P=.09) and 4-5 months postpartum (P=.27), though more children in the intervention group were exclusively breastfed than those in the control group 2-3 months postpartum (intervention: 111/152, 73.0%; control: 96/152, 63.2%) and 4-5 months postpartum(intervention: 50/108, 46.3%; control: 46/109, 42.2%). Conclusions This study is the first effort to promote exclusive breastfeeding through WeChat in China, which proved to be an effective method of promoting exclusive breastfeeding in early life. WeChat health education can be used in addition to local breastfeeding promotion programs. Trial Registration Chinese Clinical Trial Registry ChiCTR1800017364; http://www.chictr.org.cn/showproj.aspx?proj=29325 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-7676-2

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WeChat-based intervention to support breastfeeding for Chinese mothers: protocol of a randomised controlled trial

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01322-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Li Tang ◽

Andy H. Lee ◽

Colin W. Binns ◽

Lian Duan ◽

Yi Liu ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Exclusive Breastfeeding ◽

Intervention Program ◽

Controlled Trial ◽

Control Group ◽

Worst Case ◽

Breastfeeding Rate ◽

Maternity Hospitals ◽

Breastfeeding Rates ◽

Randomised Controlled

Abstract Background Exclusive breastfeeding for the first 6 months of life is the optimal way to feed infants. However, recent studies suggest that exclusive breastfeeding rates in China remain low and are well below the recommended target. There has been evidence that a lack of awareness of, or exposure to, breastfeeding information is associated with poor breastfeeding practices. WeChat, the most widely used social networking platform in China, has shown some potential to promote health behaviours. We thus hypothesised that a breastfeeding intervention program delivered via WeChat would achieve at least a 10% increase in exclusive breastfeeding prevalence at 6 months compared to the control group. Methods A two-arm, parallel, multicentre randomised controlled trial of 1000 pregnant women will be conducted at four maternity hospitals of Chengdu, China. Eligible women who consent to participate in the trial will be recruited at 28–30 weeks of gestation, and randomly allocated to either the intervention group (participants receive breastfeeding-related information from WeChat) or the control group (participants receive non-breastfeeding information from WeChat) using a central randomisation system on a 1:1 ratio at each participating site. The primary outcomes are exclusive breastfeeding rate and full breastfeeding rate at 6 months postpartum. All randomised participants will be included in the outcome analyses with missing data being imputed based on the best-case and worst-case scenarios. Multilevel mixed regression models will be used in the primary analyses to assess the effectiveness of intervention program on the breastfeeding rates. Discussion This trial uses the most widely used social media program as a means of delivering messages to mothers to increase exclusive breastfeeding in China. Increasing exclusive breastfeeding will contribute to meeting the health and environmental goals of the Sustainable Development Guidelines. Trial registration ClinicalTrials.gov, NCT04499404. Registered 5 August 2020—Retrospectively registered, https://clinicaltrials.gov/show/NCT04499404

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The Effectiveness of Using Breastfeeding Program for Father via Facebook to knowledge, Attitude, Behavior of Supporting of 6-Month Exclusive Breastfeeding in Low-Income Country

10.21203/rs.3.rs-915603/v1 ◽

2021 ◽

Author(s):

Thiwawan thepha ◽

Ampornpan Theeranut

Keyword(s):

Low Income ◽

Exclusive Breastfeeding ◽

Intervention Group ◽

Income Country ◽

Control Group ◽

P Value ◽

Low Income Country ◽

Breastfeeding Rate ◽

The Mean ◽

Attitude Behavior

Abstract Background: The six-month exclusive breastfeeding rate in the Northeast region of Thailand has recently significantly decreased in contrast to all other regions in Thailand. Facebook is world widely use to increase that knowledge, attitude and behaviour to support breastfeeding. Therefore, the aim of this study is to test the effectiveness of using 6-month breastfeeding program for father via Facebook to knowledge, attitude, behavior of supporting of breastfeeding in low-income country.Method: A quasi-experimental design was used. The study was carried out from September 2020 – August 2021. The data of experimental group and control group were conducted in two tertiary hospital in Khonkaen province, Northeast Thailand. The participants were husbands of postpartum mothers who were admitted to the Obstetrics ward , Khonkaen Hospital, 2A and 2B ward, Srinagarin Hospital. The demographic data were analyzed by distribution of frequency, mean, percentage and standard deviation. The t-test were used to analyse the mean score of knowledge, attitude and behaviour of father by SPSS version 27. Results: 72 father were included. The different mean score of knowledge, attitude, behaviors of father to support the EBF among baseline and 6-month were shown. In intervention group, the different mean score of knowledge among baseline and 6-month was significant at P-value 0.01. The mean of knowledge at 6 months (mean=19.78, SD=5.50) was higher than the mean of knowledge baseline (mean=16.42, SD=4.22). Similarly, the different mean score of attitudes among baseline and 6-month was significant at P-value 0.14. The mean of attitude at 6-month (mean=108.03, SD=19.89) was higher than the mean of behaviour at baseline (mean=101.81, SD=17.99). In addition, the different score of behaviour among baseline (mean=65.86, SD=7.01) and 6-month (mean=68.58, SD=10.42) was significant at P-value=0.16. The mean score of behavior at baseline is lower than the mean of behaviour at 6 months. In control group, these is only the different mean of behavior baseline and 6-month was significant at P-value=0.00.Conclusions: This confirm that FB is good platform to transfer the breastfeeding knowledge to father in low income country. In the future, this program can be improved and test in other country that has the same condition.

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The effectiveness of using a WeChat account to improve exclusive breastfeeding in Huzhu County Qinghai Province, China: protocol for a randomized control trial

BMC Public Health ◽

10.1186/s12889-019-7676-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Qiong Wu ◽

Yiwen Huang ◽

Michelle Helena van Velthoven ◽

Wei Wang ◽

Suying Chang ◽

...

Keyword(s):

Exclusive Breastfeeding ◽

Rural Areas ◽

Controlled Trial ◽

Severe Disease ◽

Intervention Group ◽

Mobile Technologies ◽

World Health ◽

Control Group ◽

Qinghai Province ◽

Breastfeeding Rate

Abstract Background An exclusive breastfeeding rate in the first 6 months of life of at least 50% is one of the six World Health Organization global nutrition targets for 2025. However, the exclusive breastfeeding rate in China is quite low and decreasing which makes it urgent to explore effective ways to reverse the current downward trend. As mobile technologies have rapidly developed, mobile communication apps such as WeChat (one of the largest social networking platforms in China) are well accepted and have the potential to improve health behaviors in a convenient way. The current paper describes the study protocol of a WeChat intervention that aims to promote breastfeeding in rural areas in China. Methods The study is designed as a randomized controlled trial in rural Qinghai Province, China. Women who are 14–36 weeks pregnant will be randomized to routine antenatal and postnatal care, or routine care plus the WeChat breastfeeding education. pregnant women with a severe disease and complications of pregnancy or HIV-1 will be excluded. Breastfeeding knowledge and promotion information will be delivered to the intervention group through a WeChat official account from 3 months pregnancy to 6 months postpartum. The outcome assessments are conducted at baseline through face-to-face interviews, and at one week, 1 month, 3 months and 6 months postpartum by telephone interviews. The primary outcome is difference in the exclusive breastfeeding rate at 1 month, 3 months, and 6 months postpartum between the intervention group and the control group. Secondary outcomes include the overall duration of any and exclusive breastfeeding across the first 6 months postpartum; mothers’ knowledge of breastfeeding; the proportion of early initiation of breastfeeding; and the timing of the introduction of solid food to infants. Intention-to-treat-analysis will be used. Survival analysis will be used to compare the overall duration of any and exclusive breastfeeding between groups. Discussion This study is the first effort to promote exclusive breastfeeding through WeChat in China. Our results will provide scientific evidence for the effect of health education through WeChat on breastfeeding. Thereby this may offer a comprehensive intervention to promote exclusive breastfeeding in China and other settings. Trial registration Chinese Clinical Trial Registry –ChiCTR1800017364. Registered 26 July 2018. http://www.chictr.org.cn/showproj.aspx?proj=29325

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Maternal and Perinatal Effects of Adolescent Childbearing

International Journal of Behavioral Development ◽

10.1177/016502548100400303 ◽

1981 ◽

Vol 4 (3) ◽

pp. 333-357 ◽

Cited By ~ 4

Author(s):

Nancy C. Gunter ◽

Richard C. Labarba

Keyword(s):

Prenatal Care ◽

Adolescent Mothers ◽

Low Income ◽

Control Group ◽

Average Weight ◽

Adult Women ◽

Adolescent Childbearing ◽

Prepregnancy Weight ◽

Anxiety Depression ◽

In Pregnancy

The developmental consequences of adolescent childbearing were investigated in a group of 60 low income, pregnant adolescents under the age of 18, and a low income control group of 60 pregnant adult women aged 20 to 29 with equal numbers of blacks and whites in each group. The adolescents were matched to controls of the same race and parity who initiated prenatal care at the same point in pregnancy. Antepartum and postpartum measures of state and trait anxiety, depression, and hostility were taken from both groups of mothers. Data were also obtained on the antepartum, delivery, and postpartum performance of the mothers, along with data on infant status within each maternal group. No differences were found in the incidence of either maternal or infant complications between adolescent mothers and controls. Furthermore, adolescents under the age of 17 did not differ significantly from 17 year olds on maternal and infant complications. Multiple regression analysis did indicate that an adolescent under 17 was more likely to have an infant of low birth weight if she has a low prepregnancy weight, a lower than average weight gain during pregnancy, a low delivery hemoglobin, and sought prenatal care late in pregnancy. No group differences were found on maternal emotionality measures. While maternal emotionality trait scores remained stable across antepartum and postpartum periods, maternal emotionality state scores were found to be lower in the postpartum period. Whereas, adolescents did not differ significantly from controls on emotionality, a significant age by race interaction was found for depression, with white controls showing less depression than white adolescents and black controls. Adolescents and black controls did not differ significantly. Possible explanations and implications are discussed.

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Effectiveness of WeChat for Improving Exclusive Breastfeeding in Huzhu County China: Randomized Controlled Trial (Preprint)

10.2196/preprints.23273 ◽

2020 ◽

Author(s):

Qiong Wu ◽

Yiwen Huang ◽

Zijun Liao ◽

Michelle Helena van Velthoven ◽

Wei Wang ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Pregnant Women ◽

Exclusive Breastfeeding ◽

Controlled Trial ◽

Intervention Group ◽

Mobile Technologies ◽

Control Group ◽

Randomized Controlled ◽

Breastfeeding Rate ◽

Significant Difference

BACKGROUND The benefits of breastfeeding for both infants and mothers have been well recognized. However, the exclusive breastfeeding rate in China is low and decreasing. Mobile technologies have rapidly developed; communication apps such as WeChat (one of the largest social networking platforms in China) are widely used and have the potential to conveniently improve health behaviors. OBJECTIVE This study aimed to assess the effectiveness of using WeChat to improve breastfeeding practices. METHODS This 2-arm randomized controlled trial was conducted among pregnant women from May 2019 to April 2020 in Huzhu County, Qinghai Province, China. Pregnant women were eligible to participate if they were aged 18 years or older, were 11 to 37 weeks pregnant with a singleton fetus, had no known illness that could limit breastfeeding after childbirth, used WeChat through their smartphone, and had access to the internet. A total of 344 pregnant women were recruited at baseline, with 170 in the intervention group and 174 in the control group. Women in the intervention group received breastfeeding knowledge and promotion information weekly through a WeChat official account from their third month of pregnancy to 6 months postpartum. The primary outcome of exclusive and predominant breastfeeding rate was measured 0-1 month, 2-3 months, and 4-5 months postpartum. RESULTS At 0-1 month postpartum, the exclusive breastfeeding rate was significantly higher in the intervention group than that in the control group (81.1% vs 63.3%; odds ratio [OR] 2.75, 95% CI 1.58-4.78; P<.001). Similarly, mothers in the intervention group were more likely to provide predominantly breast milk (OR 2.77, 95% CI 1.55-4.96; P<.001) and less likely to give dairy products to their children (OR 0.40, 95% CI 0.21-0.75; P=.005). There was no statistically significant difference for exclusive breastfeeding rate 2-3 months (P=.09) and 4-5 months postpartum (P=.27), though more children in the intervention group were exclusively breastfed than those in the control group 2-3 months postpartum (intervention: 111/152, 73.0%; control: 96/152, 63.2%) and 4-5 months postpartum(intervention: 50/108, 46.3%; control: 46/109, 42.2%). CONCLUSIONS This study is the first effort to promote exclusive breastfeeding through WeChat in China, which proved to be an effective method of promoting exclusive breastfeeding in early life. WeChat health education can be used in addition to local breastfeeding promotion programs. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR1800017364; http://www.chictr.org.cn/showproj.aspx?proj=29325 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s12889-019-7676-2

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A Short Mindfulness Retreat for Students to Reduce Stress and Promote Self-Compassion: Pilot Randomised Controlled Trial Exploring Both an Indoor and a Natural Outdoor Retreat Setting

Healthcare ◽

10.3390/healthcare9070910 ◽

2021 ◽

Vol 9 (7) ◽

pp. 910

Author(s):

Dorthe Djernis ◽

Mia S. O’Toole ◽

Lone O. Fjorback ◽

Helle Svenningsen ◽

Mimi Y. Mehlsen ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Effect Sizes ◽

Medium Effect ◽

Control Group ◽

Post Intervention ◽

Pilot Randomised Controlled Trial ◽

Self Compassion ◽

Randomised Controlled

Here, we developed and examined a new way of disseminating mindfulness in nature to people without meditation experience, based on the finding that mindfulness conducted in natural settings may have added benefits. We evaluated a 5-day residential programme aiming to reduce stress and improve mental health outcomes. We compared an indoor and an outdoor version of the programme to a control group in a pilot randomised controlled trial (RCT). Sixty Danish university students experiencing moderate to high levels of stress were randomised into a residential mindfulness programme indoors (n = 20), in nature (n = 22), or a control group (n = 18). Participants completed the Perceived Stress Scale and the Self-Compassion Scale (primary outcomes) along with additional secondary outcome measures at the start and end of the program and 3 months after. Stress was decreased with small to medium effect sizes post-intervention, although not statistically significant. Self-compassion increased post-intervention, but effect sizes were small and not significant. At follow-up, changes in stress were not significant, however self-compassion increased for both interventions with medium-sized effects. For the intervention groups, medium- to large-sized positive effects on trait mindfulness after a behavioural task were found post-intervention, and small- to medium-sized effects in self-reported mindfulness were seen at follow-up. Connectedness to Nature was the only outcome measure with an incremental effect in nature, exceeding the control with a medium-sized effect at follow-up. All participants in the nature arm completed the intervention, and so did 97% of the participants in all three arms. Overall, the results encourage the conduct of a larger-scale RCT, but only after adjusting some elements of the programme to better fit and take advantage of the potential benefits of the natural environment.

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Impact of a behaviourally focused nutrition education intervention on attitudes and practices related to eating habits and activity levels in Indian adolescents

Public Health Nutrition ◽

10.1017/s1368980021000203 ◽

2021 ◽

pp. 1-12

Author(s):

Panchali Moitra ◽

Jagmeet Madan ◽

Preeti Verma

Keyword(s):

Nutrition Education ◽

Eating Habits ◽

Vegetable Consumption ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Control Group ◽

Activity Levels ◽

Post Intervention ◽

Attitudes And Practices ◽

Indian Adolescents

Abstract Objective: To evaluate the effectiveness of a behaviourally focused nutrition education (NE) intervention based on the Health Belief Model (HBM) to improve knowledge, attitudes and practices (KAP) related to eating habits and activity levels in 10–12-year-old adolescents in Mumbai, India. Design: School-based cluster randomised controlled trial. The experimental group (EG) received weekly NE and three parent sessions over 12 weeks; no sessions were conducted for the control group (CG). The theoretical framework of HBM and focus group discussion results guided the development of behaviour change communication strategies and NE aids. KAP were measured using a validated survey instrument, administered at baseline and endline in EG and CG. Paired and independent t tests determined within-group and between-group changes in pre–post scores. Setting: Two aided and two private schools that were randomly allocated to either an EG or CG. Participants: Adolescent boys and girls (n 498; EG n 292 and CG n 206). Results: EG reported improvements in mean knowledge (39·3%), attitude (7·3 %), diet (9·6 %) and activity practice (9·4%) scores from pre to post intervention. No significant changes were observed in CG. Significant improvements in scores associated with perceived benefits, barriers and self-efficacy, breakfast and vegetable consumption, and moderate-to-vigorous activities were observed in EG. Conclusions: Integrating NE into the academic curriculum and adopting evidence-based lessons that entail targeted information delivery and participatory activities can improve knowledge, foster right attitudes and facilitate better eating and activity-related practices in Indian adolescents.

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Effects of Calisthenics and Pilates Exercises on Coordination and Proprioception in Adult Women: A Randomized Controlled Trial

Journal of Sport Rehabilitation ◽

10.1123/jsr.21.3.235 ◽

2012 ◽

Vol 21 (3) ◽

pp. 235-243 ◽

Cited By ~ 10

Author(s):

Derya Ozer Kaya ◽

Irem Duzgun ◽

Gul Baltaci ◽

Selma Karacan ◽

Filiz Colakoglu

Keyword(s):

Outcome Measures ◽

Repeated Measures ◽

Controlled Trial ◽

Exercise Group ◽

Lower Limbs ◽

Control Group ◽

Adult Women ◽

Kinetic Chain ◽

Randomized Controlled ◽

Closed Kinetic Chain

Objective:To assess and compare the effects of 6 mo of Pilates and calisthenics on multijoint coordination and proprioception of the lower limbs at the 3rd and 6th mo of training.Design:Randomized, controlled, assessor-blinded, repeated-measures.Setting:University research laboratory.Participants and Intervention:Healthy, sedentary, female participants age 25–50 y were recruited and randomly divided into 3 groups: a calisthenic exercise group (n = 34, mean age ± SD 40 ± 8 y, body-mass index [BMI] 31.04 ± 4.83 kg/m2), a Pilates exercise group (n = 32, mean age ± SD 37 ± 8 y, BMI 31.04 ± 4.83 kg/m2), and a control group (n = 41, mean age ± SD 41 ± 7 y, BMI 27.09 ± 4.77 kg/m2). The calisthenics and Pilates groups underwent related training programs for 6 mo, while the controls had no specific training.Main Outcome Measures:Coordination and proprioception of the lower extremities with concentric and eccentric performances in the closed kinetic chain assessed with the monitored rehab functional squat system at baseline and at the 3rd and 6th mo of training.Results:For the within-group comparison, coordinative concentric and eccentric deviation values were significantly decreased for both dominant and nondominant lower limbs at pretraining and at the 3rd and 6th mo posttraining in the calisthenics group (P < .05). In contrast, there was no improvement in the Pilates group throughout the training. However, for comparisons between groups, the baseline values of coordinative concentric and eccentric deviations were different in the calisthenics group than in Pilates and the controls (P < .05). There were no differences in the proprioception values of either visible or nonvisible movement in any group throughout the training (P > .05).Conclusions:It seems that calisthenic exercises are more likely to improve coordination of the lower extremity after 3 and 6 mo of training than Pilates exercises. Calisthenic exercises may be useful for individuals who require improved coordination.

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