{
  "resourceType": "ActivityDefinition",
  "id": "pfm-sustained-hold",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/pfm-sustained-hold",
  "version": "1",
  "name": "PfmSustainedHold",
  "title": "Pelvic Floor Sustained Contraction (Kegel — Endurance)",
  "status": "draft",
  "experimental": true,
  "description": "Contract the pelvic floor muscles as if stopping urine flow AND lifting the perineum upward toward the head. Hold 6–10 seconds, then fully relax for equal time. Progress hold time and positions over 12 weeks (supine → sitting → standing).",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: beginner"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "pfm-sustained-hold",
          "display": "Pelvic Floor Sustained Contraction (Kegel — Endurance)"
        }
      ]
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "8–12 reps × 3 sets/day. Progress hold to 10 s over 12 wk."
    }
  ],
  "usage": "Evidence: strong.",
  "note": [
    {
      "text": "Breathe normally throughout the hold — breath-holding signals you're substituting"
    },
    {
      "text": "If glutes or inner thighs squeeze, the contraction is wrong — relax everything else"
    },
    {
      "text": "Imagine drawing a blueberry up into the body, not just clenching"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Transversus Abdominis"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "86493009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Diaphragm"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "5798000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Internal Oblique"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "1179024003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Multifidus"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "5709001"
          }
        }
      ]
    }
  ]
}