Assessing exercises recommended for women at risk of pelvic floor disorders using multivariate statistical techniques

Tian, Tania Y.; Budgett, Stephanie; Smalldridge, Jackie; Hayward, Lynsey; Stinear, James W.; Kruger, Jennifer

doi:10.1007/s00192-017-3473-6

Cited by 13 publications

(8 citation statements)

References 17 publications

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“…As expected, in the present study the increase in IAP was minimal during PFM contractions and higher during abdominal curl‐ups and cough. This is broadly in agreement with results of other studies using manometry and dynamometers . Neumann and Gill (2002) measured IAP with a sensor made of fluid‐filled silicon positioned in the posterior fornix of the vagina in four participants.…”

Section: Discussionsupporting

confidence: 88%

“…During other exercises, Newmann and Gill reported the mean IAP was 27 mmHg (range 11‐34) during abdominal crunch, 36 mmHg (range 33‐52) during forced expiration, and 46 mmHg (37‐55) during cough . Tian et al (2016) reported a mean IAP of 17.25 mmHg during a curl‐up . Our results measured a significantly lower IAP during curl‐up 8.8 mmHg (±7.33) and expiration 6.12 mmHg (±4.91), but a comparable increase during a cough 40.99 mmHg (±7.33) suggesting that the previous measurements may have included both PFM activation and abdominal pressure measurements.…”

Section: Discussionsupporting

confidence: 57%

“…The definition of stress urinary incontinence as “the complaint of involuntary loss of urine on effort or physical exertion (eg, sporting activities), or on sneezing or coughing,” implies that leakage may occur during any rise in IAP . Hence, measurement of IAP during different activities and exercises known to cause urinary incontinence has been the focus of several studies . However, none of the instruments used in these studies were able to measure simultaneously the pressures developed along the length of the vagina, including IAP and pressures developed by the muscles surrounding the vagina, predominately the pelvic floor muscles.…”

Section: Introductionmentioning

confidence: 99%

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Can you train the pelvic floor muscles by contracting other related muscles?

Kruger

Budgett

Goodman

et al. 2018

Neurourology and Urodynamics

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Aims The aim of this study is to assess whether contraction of muscles other than the pelvic floor muscles (PFM) would be of sufficient magnitude to provide a “training” effect for the pelvic floor. Methods Women were recruited via advertisement from a convenience sample of pelvic floor physiotherapists. A thin flexible array of pressure sensors (FemFit) was self‐inserted into the vagina. Participants performed three maximum pelvic floor contractions and completed a randomized exercise protocol. Maximum pressures were determined for each sensor, for each exercise. Wilcoxon paired tests were used to ascertain the difference in pelvic floor muscle pressure between exercises, and between the pressures from the pelvic floor muscles sensors and those measuring abdominal pressure. Bonferroni correction α 0.005. Results Data was obtained from nineteen participants. Mean age 43 ± 11 years, BMI 22.4 ± 3.2 kg m−2. Mean PFM pressure for pelvic floor muscle contractions was 16.3 ± 12.2 mmHg. Pressure in the region of the pelvic floor was significantly higher during a targeted contraction compared to that for all other exercises, except for cough and curl‐ups (P = 0.009, P = 0.013 respectively). PFM pressure was significantly higher than abdominal for PFMC, internal rotators and gluteals (P < 0.001). Conclusion Targeted PFM contractions develop higher pressures compared to abdominal pressure than any exercise tested in this study. The Femfit device was able to distinguish between abdominal and pelvic floor muscle pressures simultaneously. Exercising accessory muscles in an attempt to activate the pelvic floor sufficiently to illicit a training effect is not recommended.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Can you train the pelvic floor muscles by contracting other related muscles?

Kruger

Budgett

Goodman

et al. 2018

Neurourology and Urodynamics

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“…Examples of IAPs during dynamic activities and abdominal training are summarized in Tables 1 and 2. In an interesting study challenging the widely held belief that pelvic floor "safe" exercises generate lower IAPs than corresponding conventional exercises, no differences in IAPs were found between the recommended and discouraged versions of half the exercises, including ball rotations, lunges, core, push-ups and squats [30]. Others have also pointed out that activities generally restricted after surgery may generate lower IAPs than unrestricted activities.…”

Section: How Do Specific Exercises Influencementioning

confidence: 91%

Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review

2019

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More women participate in sports than ever before and the proportion of women athletes at the Olympic Games is nearly 50%. The pelvic floor in women may be the only area of the body where the positive effect of physical activity has been questioned. The aim of this narrative review is to present two widely held opposing hypotheses on the effect of general exercise on the pelvic floor and to discuss the evidence for each. Hypothesis 1: by strengthening the pelvic floor muscles (PFM) and decreasing the levator hiatus, exercise decreases the risk of urinary incontinence, anal incontinence and pelvic organ prolapse, but negatively affects the ease and safety of childbirth. Hypothesis 2: by overloading and stretching the PFM, exercise not only increases the risk of these disorders, but also makes labor and childbirth easier, as the PFM do not obstruct the exit of the fetus. Key findings of this review endorse aspects of both hypotheses. Exercising women generally have similar or stronger PFM strength and larger levator ani muscles than non-exercising women, but this does not seem to have a greater risk of obstructed labor or childbirth. Additionally, women that specifically train their PFM while pregnant are not more likely to have outcomes associated with obstructed labor. Mild-to-moderate physical activity, such as walking, decreases the risk of urinary incontinence but female athletes are about three times more likely to have urinary incontinence compared to controls. There is some evidence that strenuous exercise may cause and worsen pelvic organ prolapse, but data are inconsistent. Both intra-abdominal pressure associated with exercise and PFM strength vary between activities and between women; thus the threshold for optimal or negative effects on the pelvic floor almost certainly differs from person to person. Our review highlights many knowledge gaps that need to be understood to understand the full effects of strenuous and non-strenuous activities on pelvic floor health.

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“…14 Um outro estudo comparou a PIA durante exercícios 'normais' com planos alternativos considerados seguros para o pavimento pélvico e não encontrou diferenças significativas. 45 Na mesma revisão, 14 os autores propõem que a PIA possa ter impacto nos MPP não pelo seu valor absoluto de carga sobre o pavimento pélvico mas por esta ser aplicada repetidamente e com carácter dinâmico.…”

Section: Discussionunclassified

A Incontinência Urinária em Mulheres Praticantes de Exercício Recreativo: Um Estudo Transversal

et al. 2021

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Introduction: Urinary incontinence affects up to one third of women in Portugal. Exercise can be a precipitating/aggravating factor but also protective, if appropriate. The aim of this study was to determine the prevalence of urinary incontinence in women who practice recreational exercise, to assess its relationship with the type of exercise and other coexisting risk factors, and assess whether the topic is addressed in gyms.Material and Methods: Cross-sectional study using self-reported questionnaires in gyms in Porto and Vila Nova de Gaia, Portugal.Results: Two hundred and ninety women completed the questionnaires. From these, 67.6% were under 40 years old, 25.2% reported incontinence, and 53.4% had at least one risk factor unrelated to exercise. There was a statistically significant association (p < 0.05) between incontinence, obesity and constipation. High impact exercises were included in the training of 62.1% continent and 50.9% incontinent women. The topic of incontinence and strengthening of the pelvic floor muscles was addressed in only 5.5% in the initial assessment, 9.7% in collective training, and in 13.5% of the 37 women with individualized training.Discussion: The higher proportion of continent women - compared to incontinent - who practiced strenuous exercise suggests that this might be a provocative factor for some, although there was no statistically significant association between incontinence and type of exercise.Conclusion: Urinary incontinence affects women who practice recreational exercise, regardless of age and exercise characteristics. It is rarely addressed in gyms, and it is necessary to raise the awareness of professionals to enhance the preventive/therapeutic effects of exercise on the function of the pelvic floor and in the control of modifiable risk factors.

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Assessing exercises recommended for women at risk of pelvic floor disorders using multivariate statistical techniques

Cited by 13 publications

References 17 publications

Can you train the pelvic floor muscles by contracting other related muscles?

Can you train the pelvic floor muscles by contracting other related muscles?

Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review

A Incontinência Urinária em Mulheres Praticantes de Exercício Recreativo: Um Estudo Transversal

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