One day course
|de Jong JH1,2, Bø K3, Hodges P4, Luginbuehl H5, Mota P6,7|
1University of Bern, Graduate School for Health Sciences, Bern, Switzerland, 2SOMT Physiotherapy University, Amersfoort, Netherlands, 3The Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway, 4University of Queensland, Clinical Centre for Research Excellence in Spinal Pain, Injury and Health, Brisbane, Australia, 5Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland, 6ESTeSL, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal, 7Univ Lisboa, Fac Motricidade Humana, CIPER, LBMF, Lisbon, Portugal
Learning objective 1: To understand the effect of different types and levels of exercise on the pelvis in general, and specifically the pelvic floor
The World Health Organization (WHO) recommends daily moderate to vigorous-intensity physical activity throughout our lifetime since this has significant health benefits and helps prevent some noncommunicable diseases (1).
The International Organization of Physical Therapists in Women´s Health (IOPTWH) and Pelvisuisse recognise the potential impact of some exercises and sport on the pelvis and pelvic floor. If physiotherapists are to advise their service users on appropriate physical activity, then we must consider the possible impact on pelvic health and any current or potential dysfunctions.
There are two opposing hypotheses on the effect of physical activity and strenuous exercise on the pelvic floor. The first is that general exercise training strengthens the pelvic floor muscles (PFM) and decreases the levator hiatus. This could decrease the risk, or reduce symptoms of, urinary incontinence, faecal incontinence and pelvic organ prolapse, but might have a negative influence on vaginal delivery with prolonged labour and more difficult births. The other hypothesis is that general exercise training overloads, stretches and weakens the pelvic floor. This would have the potential to cause or increase urinary incontinence, faecal incontinence and pelvic organ prolapse, but also potentially make birth easier. Such debate is undoubtedly confusing for all concerned and requires evidence-based clarification (2,3,4).
The involuntary loss of urine on effort or physical exertion (stress urinary incontinence [SUI]) is associated with high impact situations which happen within milliseconds and with high forces. Fast, involuntary reflexive PFM contractions are necessary to guarantee continence. SUI is common in athletes and in non-competitive sportswomen, with high impact activities showing the highest prevalence (5). PFM training is effective and recommended for women experiencing SUI, but to date it has focused on voluntary contractions. Researchers are now considering the role of involuntary reflexive PFM training as part of a rehabilitation programme (6).
With high intensity physical activity intra-abdominal pressure (IAP) is elevated in conjunction with control of the trunk during forceful exertions of the limbs, forces directly applied to the trunk and in association with breathing (7). IAP is modulated even with quiet breathing and is exaggerated when respiration is increased in exercise. Each of these tasks requires controlled balance of activation between the pelvic floor, abdominal, and diaphragm muscles. This balance can be compromised in women and men with incontinence, and either exaggerated abdominal or deficient pelvic floor muscle activation may be involved.
Many women continue or even begin to exercise during pregnancy. Postnatally women are encouraged to resume abdominal exercises to restore their figure and fitness. Diastasis recti abdominis (DRA) or increased inter rectus distance (IRD) is characterized by the separation of the rectus abdominis muscles, with onset during pregnancy or soon after childbirth.(8) However, little evidence is available on the effect and safety of different abdominal exercises during and after pregnancy. Drawing in exercises have been found to widen the IRD in postpartum women whilst abdominal crunch narrowed the IRD both during pregnancy and postpartum (9). There is an urgent need for more basic and experimental studies to understand the mechanisms of different abdominal exercises so physiotherapists can offer appropriate and effective advice to women during pregnancy and postpartum.
The ageing of populations is presenting challenges worldwide. Active ageing allows people to realize their potential for physical, social and mental wellbeing (1). Alongside cognition, balance and mobility deficits, urinary symptoms have a negative impact on quality of life and can be associated with falls in older adults. Studies suggest that appropriate exercise can have a positive effect on all such deficits and dysfunctions (10)
The World Confederation for Physical Therapy (WCPT) identifies physical therapists as the ideal professionals to promote, guide, prescribe and manage exercise activities. In many countries pelvic physiotherapy is a rapidly growing specialty. In addition, musculoskeletal, sports and other physical therapists require an understanding of the impact of their exercise advice on pelvic health. Yet there remain controversies concerning the effect of different exercises. This workshop will address these issues discussing the evidence available and offering practical advice for clinicians.
|Target Audience: Women's health and pelvic physiotherapists. Any physiotherapists with an interest in sport and exercise advice.|
|Key-Words: Pelvic floor; Pelvis; Exercise|