A Pilates exercise program with pelvic floor muscle contraction: Is it effective for pregnant women? A randomized controlled trial

Effect of Pilates combined with pelvic floor muscle training on continence of post-prostatectomy incontinence in patients with different body mass index

BACKGROUND

Urinary incontinence symptoms severely affect older people with different body mass index (BMI).To compare the efficacy of the pelvic floor muscle training (PFMT) in patients with post-prostatectomy incontinence with different BMI.

METHODS

Thirty-seven patients with post-prostatectomy incontinence were included. They were divided into group A (BMI ≤ 25,12), group B (26 ≤ BMI ≤ 30,14), and group C (BMI ≥ 31,11) based on difference BMI. Three groups of patients underwent the same Pilates combined with kegel training. Participants were assessed with 1-hour pad test, the number of incontinence episodes, International Consultation on Incontinence Questionnaire and Oxford Grading Scale.

RESULTS

In the 1-hour pad test, the differences before and after training were statistically significant in all three groups of participants. Group A decreased from 81.83 ± 8.79 to 31.08 ± 5.64 g (P < 0.01). Group B decreased from 80.57 ± 8.87 to 35.85 ± 5.66 g (P < 0.01). Group C decreased from 83.55 ± 10.24 to 40.18 ± 7.01 g (P < 0.01). The number of incontinent episodes in group A decreased from 9.33 ± 1.07 to 3.25 ± 0.62 (P < 0.01). Group B decreased from 8.86 ± 1.09 to 3.79 ± 0.80 (P < 0.01). Group C decreased from 9.27 ± 1.10 to 4.09 ± 0.70 (P < 0.01). The correlation between the three groups of participants and the 1-hour pad test, with an R2 of 0.51. The correlation between the three groups of participants and the number of urinary incontinence episodes with a R2 of 0.43.

CONCLUSIONS

Pelvic floor muscle training can affect the recovery of urinary continence in patients with different BMI. Maintaining a lower BMI can be beneficial for improving urinary control.

TRIAL REGISTRATION

Date of trial registration: November 27, 2023.

The effect of Pilates exercise during pregnancy on delivery outcomes: a systematic review and meta-analysis

A systematic review and meta-analysis were conducted to investigate the effectiveness of the Pilates exercise program during pregnancy on different delivery outcomes. Various databases were searched from inception until November 2022. The included studies compared Pilates exercise to routine antenatal care in pregnant women. The primary outcomes assessed were vaginal and cesarean delivery rates, as well as labor duration. Secondary outcomes included episiotomy incidence, Apgar scores, and epidural analgesia. Seven studies met the inclusion criteria, involving a total of 1,003 patients. Results indicated a significant increase in the vaginal delivery rate among the Pilates exercise group compared to the control group (p < .001). Moreover, the Pilates exercise group exhibited significantly reduced rates of cesarean delivery and shorter labor duration. Pilates exercise was associated with a significant decline in the incidence of episiotomy and the number of women requiring epidural analgesia during delivery (p < .001 & p = .008). In addition, Apgar scores at one and five minutes were significantly higher in the Pilates exercise group compared to the control group (p < .001). In conclusion, Pilates exercise during pregnancy has a positive effect on maternal outcomes and Apgar scores. However, more trials are needed to confirm these findings.

Effect of Internet combined with pelvic floor muscle training on postpartum urinary incontinence

INTRODUCTION AND HYPOTHESIS

Urinary incontinence is one of the most common complications associated with parturition or child delivery. The Internet combined with pelvic floor training may be a good way to reduce the spread of the epidemic and treat postpartum incontinence.

METHODS

A total of 38 participants were randomly assigned to Kegel alone (group A = 14), Internet plus Kegel (group B = 12), or Internet plus Pilates (group C = 12). We used the 1-h pad test, the number of episodes of incontinence, the number of pads used, the Oxford Scale, and The International Consultation Incontinence Questionnaire for evaluation.

RESULTS

In the 1-h pad test (g), group A decreased from 40.93 ± 4.66 to 24.00 ± 3.94, group B from 41.75 ± 3.62 to 20.67 ± 3.89, and group C from 40.33 ± 3.89 to 18.67 ± 3.55. In the number of episodes of incontinence, group A decreased from 4.71 ± 1.13 to 2.93 ± 0.62, group B from 4.92 ± 1.16 to 2.42 ± 0.52, and group C from 4.92 ± 1.08 to 2.08 ± 0.52. In the use of urinary pads, group A decreased from 7.14 ± 0.95 to 3.50 ± 0.52, group B from 7.25 ± 0.75 to 3.00 ± 0.95, and group C from 7.42 ± 1.08 to 2.50 ± 0.67. In the Oxford Scale and International Consultation Incontinence Questionnaire Short Form, the difference among the three groups before and after treatment was statistically significant. After 6 weeks of pelvic floor muscle training, most patients achieved grade 3 or higher muscle strength on the Oxford scale.

CONCLUSIONS

The Internet combined with pelvic floor training is a good choice during the current pandemic. Pelvic floor exercises can improve urinary incontinence symptoms.

Obstetric, maternal, and neonatal outcomes after Pilates exercise during pregnancy: A systematic review and meta-analysis

BACKGROUND

One of the major exercises to improve the psychological and physical functions of pregnant women is Pilate's exercises. The aim of this study is to collect evidence about Pilates exercise effects on many consequences in pregnant women, such as maternal and neonatal outcomes and obstetric outcomes.

METHODS

PubMed, Clinical Key, Cochrane Library, Scopus, Embase, and Web of Science were scoured from their inception. Research comparing Pilates during pregnancy to other methods, or to the control was included. For randomized controlled trials (RCTs), The researcher utilized the Cochrane risk of bias tool; for non-RCTs, risk of bias tool to assess non-randomized studies of interventions, was used for cohort studies, and the national heart, lung, and blood institute tool. Meta-analysis was done using the Review manager 5.4. For continuous data, calculated the mean difference and 95% confidence interval (CI), and the risk ratio (RR) and 95% CI for dichotomous data.

RESULTS

Finally, 13 studies included with a total number of 719 pregnant women. The analysis showed that the Pilates group was significantly more likely to deliver vaginally than the control group (RR = 1.21, 95% CI [1.05 to 1.41], P value = .009). Women in the Pilates group were significantly lower than the control group to have Cesarean delivery (RR = 0.67, 95% CI [0.48-0.94], P value = .02). Moreover, Pilates-treated women were less likely to gain weight during pregnancy than control (mean difference = -3.48, 95% CI [-6.17 to -0.79], P value = .01).

CONCLUSION

Pilates exercise improved the outcomes of pregnant women. It decreases the rate of Cesarean delivery and the time of delivery. Moreover, Pilates has a role in decreasing weight gain in pregnant women. As a result, that may improve the pregnancy experience for women. However, more RCTs needed with larger sample sizes to assess the Pilates effect on neonatal outcomes.

Effect of exercise on female pelvic floor morphology and muscle function: a systematic review

INTRODUCTION AND HYPOTHESIS

The objective was to synthesize the scientific evidence on the relationship of exercise with morphology and muscle function parameters of the female pelvic floor. The design was a systematic review.

METHODS

Searches were performed in MEDLINE, PubMed, CINAHL, Web of Science, SCOPUS, SportDiscuss, and Google Scholar up to April 2021. Observational and experimental studies evaluating the morphology and/or function of the pelvic floor muscles (PFMs) in women were eligible. Studies reporting exercise or sports disciplines as exposure/intervention were included.

RESULTS

Twenty-five studies were included. Compared with the control group, women performing vigorous and high-impact exercises exhibited lower maximum voluntary contraction of the PFM and those performing moderate exercise had better maximum voluntary contraction. Exercise practitioners had a larger hiatal area at rest, during contraction, and during Valsalva, and greater bladder neck descent than the control group.

CONCLUSIONS

The results of this review demonstrate an inverse relationship of PFM maximum voluntary contraction with exercise intensity. Qualitative synthesis showed that the studies found favorable outcomes for the control group in terms of hiatal area during contraction and Valsalva and bladder neck displacement.

Can Group Exercise Programs Improve Health Outcomes in Pregnant Women? An Updated Systematic Review

Current scientific evidence supports the recommendation to initiate or continue physical exercise in healthy pregnant women. Group exercise programs have positive effects on improving health, well-being, and social support. In 2015, a systematic review was provided to evaluate the evidence on the effectiveness of group exercise programs in improving pregnant women's and newborns' health outcomes and to assess the content of the programs. This review aims to update this knowledge between 2015 and 2020. The exercise program designs were analyzed with the Consensus of Exercise Reporting Template (CERT) model, the compliance with the current guidelines, and effectiveness in the maternal health and fitness parameters. Three databases were used to conduct literature searches. Thirty-one randomized control trials were selected for analysis. All studies followed a supervised group exercise program including aerobic, resistance, pelvic floor training, stretching, and relaxation sections. Group interventions during pregnancy improved health and fitness outcomes for the women and newborns, although some gaps were identified in the interventions. Multidisciplinary teams of exercise and health professionals should advise pregnant women that group exercise improves a wide range of health outcomes for them and their newborns.

The Effects of the Pilates Method on Pelvic Floor Injuries during Pregnancy and Childbirth: A Quasi-Experimental Study

The perineal injuries suffered during childbirth have a great impact on the quality of life of the female population. Evidence suggests that the Pilates method is used by pregnant women to improve the physical and psychological outcomes of pregnancy. The aim of this study was to investigate the influence of the Pilates Method during pregnancy on the incidence and degree of intrapartum perineal trauma. A quasi-experimental study was carried out between November 2018 and December 2019 at different health centers in two health districts. Participants were 72 pregnant women attending the antenatal program, who were assigned to a Pilates group or a control group (48 and 24 pregnant women, respectively). The main outcome measurement was perineal trauma during childbirth. After participating in the Pilates program, the women in the experimental group were significantly less likely to suffer perineal trauma in spontaneous deliveries compared to the women in the control group. After evaluating these results, it is concluded that health center managers should promote the training of midwives in the prevention and treatment of pelvic floor injuries during pregnancy and should consider strategies to enhance adhesion and participation with respect to pelvic floor exercise programs throughout pregnancy by means of Apps and other digital media specifically aimed at this phase.

Pilates for low risk pregnant women: Study protocol for a randomized controlled trial

BACKGROUND

Pilates has growing appeal to pregnant women, as a form of exercise and relaxation. It is purported to benefit lumbo-pelvic stability, as well as motor control, strength and endurance. Some suggest that modified Pilates exercises may assist low risk pregnant women to enjoy a healthier pregnancy and prepare for the physical demands of labour and birth. The feasibility and safety of Pilates during pregnancy is poorly understood. We describe the protocol for a feasibility study designed to compare a midwife-led 6-week community-based Pilates intervention with standard antenatal care.

METHODS

A convenience sample of 30 low-risk pregnant women will be recruited from private obstetric clinics in Melbourne, Australia. Participants shall be randomly allocated to a six-week, 1-h weekly Pilates exercises group session or to usual care. The Pilates exercise class will have a warm-up phase, Pilates exercises, breathing exercises, and a cool down phase. Exercises have been designed to prepare for active birth. The primary outcome will be feasibility of implementation, determined by recruitment, retention, adherence and safety. Secondary outcomes include women's health (quality of life, pain, mobility for daily activities, lower extremity performance, abdominal separation, continence) and labour and birth outcomes (duration of first stage and second stage labour, analgesia used, mode of birth). Validated questionnaires will include the Quality of life 12-item short form survey; Pregnancy Mobility Index, and International Consultation on Incontinence Questionnaire. Lower extremity performance and abdominal separation will also be measured.

DISCUSSION

This trial will provide preliminary data regarding the feasibility and safety of Pilates exercise in healthy pregnant women. It will also provide preliminary outcome data used to inform the design of a future large scale, multi-centre RCT.

TRIAL REGISTRATION

This clinical trial has been registered with the Australian and New Zealand Clinical Trials Registry 2016 (ACTRN12616000809437).

Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women

BACKGROUND

About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017.

OBJECTIVES

To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations.

SEARCH METHODS

We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies.

SELECTION CRITERIA

We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment).

DATA COLLECTION AND ANALYSIS

We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE.

MAIN RESULTS

We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it.

AUTHORS' CONCLUSIONS

This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for this are unclear. A population-based approach for delivering postnatal PFMT is not likely to reduce UI. Uncertainty surrounds the effects of PFMT as a treatment for UI in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches, and in certain groups of women. Hypothetically, for instance, women with a high body mass index (BMI) are at risk of UI. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups, and how much PFMT women in both groups do, to increase understanding of what works and for whom. Few data exist on FI and it is important that this is included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence. In addition to further clinical studies, economic evaluations assessing the cost-effectiveness of different management strategies for FI and UI are needed.

Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises

The aim of this study was to compare the effect of pelvic floor muscle training with surface electromyographic (sEMG) biofeedback (BF group) and Pilates exercises (P group) on the bioelectrical activity of pelvic floor muscles in women with stress urinary incontinence. The other aim aim was to compare changes in voiding diaries and scores on quality of life questionnaire against baseline values and between the groups. Women in the BF group (n = 18) participated in pelvic floor muscle training with sEMG biofeedback; the P group (n = 13) participated in basic level Pilates workouts. Both protocols were continued for eight weeks. Voiding diary, quality of life and electromyographic characteristics of the pelvic floor muscles were assessed at the three-time points: at baseline, after eight weeks’ training, and at month six post-training. The sEMG activity of the pelvic floor muscles was tested during five trials in two positions. There was no marked improvement in bioelectrical activity of the pelvic floor muscles during contraction following training with sEMG biofeedback or Pilates exercises. Following eight weeks of sEMG biofeedback training, a decrease was noted in resting bioelectrical activity of pelvic floor muscles and during relaxation after sustained contraction but only in supine-lying. No such effect was observed in the Pilates group. In the BF group, the number of incontinence episodes after end of treatment (timpepoints: 1vs. 2) and at six month follow-up (timpepoints: 1vs. 3) decreased by 68.5% and 89.3%, respectively. The respective values in the P group were 78.6%, and 86.4%. The intergroup differences did not reach the level of statistical significance. As regards the quality of life, the questionnaire demonstrated that Pilates exercises had significantly better effects compared to biofeedback training both at the end of the eight-week exercise program and (p = 0.003) and at six month follow-up (p = 0.0009). The International Consultation on Incontinence Questionnaire—Short Form (ICIQ- SF) showed comparable efficacy of Pilates exercises and training with sEMG biofeedback. Intragroup improvements in micturition frequency, incontinence (leakage) episodes, and nocturia frequency were comparable. Alleviation of urinary incontinence symptoms was comparable in both groups, whereas the improvement in the quality of life was more notable in the Pilates group. The obtained results failed to demonstrate the superiority of any of the two methods regarding the bioelectrical activity of pelvic floor muscles in patients with stress urinary incontinence.