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Mantilla Toloza SC, Villareal Cogollo AF, Peña García KM. Pelvic floor training to prevent stress urinary incontinence: A systematic review. Actas Urol Esp 2024; 48:319-327. [PMID: 38556125 DOI: 10.1016/j.acuroe.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/15/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is a common disorder in women that has a negative impact on quality of life. Pregnancy and childbirth are considered important risk factors that directly affect the pelvic floor during pregnancy and labour, increasing the risk of pelvic floor dysfunction, with prevalence rates of SUI in the postpartum period ranging from 30 to 47% during the first 12 months. OBJECTIVE To determine the effectiveness of pelvic floor muscle training (PFMT) in the prevention of SUI in women during the antenatal and postnatal period by reviewing and evaluating the available scientific literature. METHODS This is a systematic review, using only randomised controlled trials. We searched the databases Pubmed, Scopus, Cochrane and PEDro. We reviewed 7 prospective studies in English and Portuguese, which included 1,401 pregnant women of legal age who underwent PFMT to prevent SUI. RESULTS The results allowed us to establish that PFMT is used for pelvic floor muscles and that this intervention, applied with the appropriate methodology, can prevent or cure SUI. CONCLUSIONS The application of PFMT in an early stage of pregnancy has positive effects on the continence capacity after delivery.
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Affiliation(s)
- S C Mantilla Toloza
- Departamento de Fisioterapia, Facultad de Salud, Universidad de Pamplona, Pamplona, Colombia.
| | - A F Villareal Cogollo
- Departamento de Fisioterapia, Facultad de Salud, Universidad de Pamplona, Pamplona, Colombia
| | - K M Peña García
- Departamento de Fisioterapia, Facultad de Salud, Universidad de Pamplona, Pamplona, Colombia
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Fank F, Artismo RS, de Santana MG, Esteves AM, Matte DL, Mazo GZ. Effects of combined exercise training with sleep education in older adults with obstructive sleep apnea: protocol for a randomized clinical trial. Front Psychol 2024; 15:1322545. [PMID: 38425564 PMCID: PMC10902716 DOI: 10.3389/fpsyg.2024.1322545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Background Obstructive sleep apnea (OSA) is a common disorder that affects approximately 1 billion people worldwide. Advanced age is a significant risk factor. Various treatment options have been explored to reduce the severity of OSA symptoms and physical exercise has emerged as a potential alternative therapy. Therefore, this study aims to investigate the effects of a combined exercise program with sleep education on sleep quality and on the severity of OSA in older adults. Methods This is a randomized clinical trial with two parallel groups that will involve individuals of both genders aged between 60 and 79 years who have an apnea-hypopnea index (AHI) of more than 15 events per hour and who have not received or are currently undergoing treatment for OSA. Older adults who have engaged in regular exercise in the last six months and individuals with contraindications to exercise will be excluded. The study will assess outcomes related to OSA, including AHI, oxygen desaturation index, minimum and mean oxyhemoglobin saturation, sleep efficiency, sleep latency, and the type of respiratory events. Additionally, sleep quality-related outcomes, daytime sleepiness, physical activity, physical fitness, aerobic capacity, cognitive status, anthropometric measures, and health-related quality of life will be analyzed. Participants will be randomized to two groups: a combined exercise group (involving both resistance and aerobic training) with sleep education, and a control group that will receive only educational recommendations for managing OSA. The intervention will last 12 weeks and will consist of three sessions per week, totaling 36 exercise sessions. Sample size calculation indicates a minimum number of 36 participants. Discussion If the hypothesis is confirmed, this clinical trial will indicate an effective non-pharmacological intervention for treating OSA in older adults. This intervention could be used as an adjunct to existing approaches designed to improve OSA management. Clinical trail registration Brazil Clinical Trials Registry (ReBEC), identifier RBR-9hk6pgz.
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Affiliation(s)
- Felipe Fank
- Laboratory of Gerontology, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
| | - Regiana Santos Artismo
- Teaching, Research and Extension Center in Physiotherapy in the Pre- and Post-Operation of Major Surgeries, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
| | | | - Andrea Maculano Esteves
- Laboratory of Sleep and Exercise, School of Applied Sciences, State University of Campinas, Campinas, Brazil
| | - Darlan Laurício Matte
- Teaching, Research and Extension Center in Physiotherapy in the Pre- and Post-Operation of Major Surgeries, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
| | - Giovana Zarpellon Mazo
- Laboratory of Gerontology, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
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Bonaldi L, Mascolini MV, Todesco M, Zara A, Rossato C, Fede C, Fontanella CG, Stecco C. Urinary Incontinence and Other Pelvic Floor Dysfunctions as Underestimated Problems in People under Forty Years: What Is Their Relationship with Sport? Life (Basel) 2023; 14:67. [PMID: 38255682 PMCID: PMC10817452 DOI: 10.3390/life14010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Urinary incontinence is still an underestimated problem due to its anatomical complexity and social taboo. Most of the time, it is believed to affect predominantly the elderly female population, and the literature still lacks data on its presence in the younger and male populations. Its relationship with other pelvic floor dysfunctions (PFDs) and sport activity remains an open topic. Thus, the present study surveyed 342 subjects of both genders, ranging from 18 to 39 y/o and with different sport activity levels, to understand the prevalence of PFDs (such as haemorrhoids, anal fissures, involuntary urinary/faecal leakage, and urgency). The results also showed a significative prevalence in younger, sporty, and male people. Approximately one third of the population had urinary incontinence mostly during stress activities (sport activity: 17%, cough/sneeze: 13%). The statistical analysis confirmed a higher prevalence in the cases of a light (32%) and intense (41%) sport activity level and a protective role of sport if practiced between 5 and 10 h/week, with bodybuilding/CrossFit and running seeming to be the riskiest sports. The relationship with the other PFDs showed a statistically significant dependence with most of them, confirming that urinary incontinence cannot be considered a separate problem from the other PFDs.
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Affiliation(s)
- Lorenza Bonaldi
- Department of Civil, Environmental and Architectural Engineering, University of Padova, Via F. Marzolo 9, 35131 Padova, Italy;
| | - Maria Vittoria Mascolini
- Department of Industrial Engineering, University of Padova, Via Venezia 1, 35121 Padova, Italy; (M.V.M.); (C.G.F.)
| | - Martina Todesco
- Department of Civil, Environmental and Architectural Engineering, University of Padova, Via F. Marzolo 9, 35131 Padova, Italy;
| | - Anna Zara
- Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35121 Padova, Italy; (A.Z.); (C.R.); (C.F.); (C.S.)
| | - Camilla Rossato
- Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35121 Padova, Italy; (A.Z.); (C.R.); (C.F.); (C.S.)
| | - Caterina Fede
- Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35121 Padova, Italy; (A.Z.); (C.R.); (C.F.); (C.S.)
| | - Chiara Giulia Fontanella
- Department of Industrial Engineering, University of Padova, Via Venezia 1, 35121 Padova, Italy; (M.V.M.); (C.G.F.)
- Centre for Mechanics of Biological Material (CMBM), University of Padova, Via F. Marzolo 9, 35131 Padova, Italy
| | - Carla Stecco
- Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35121 Padova, Italy; (A.Z.); (C.R.); (C.F.); (C.S.)
- Centre for Mechanics of Biological Material (CMBM), University of Padova, Via F. Marzolo 9, 35131 Padova, Italy
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Cross D, Kirshbaum MN, Wikander L, Tan JY(B, Moss S, Gahreman D. Does a Kegel Exercise Program Prior to Resistance Training Reduce the Risk of Stress Urinary Incontinence? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1481. [PMID: 36674234 PMCID: PMC9859385 DOI: 10.3390/ijerph20021481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance training (RT), to reduce the risk of stress urinary incontinence (SUI) compared to a group of women without prior Kegel exercises (KE). Incontinence severity index (ISI) score, pelvic floor muscle strength (PFMS), and body composition (such as body mass index (BMI), fat, and muscle mass), were obtained pre and post intervention. Results demonstrated that RT reduced SUI to a significantly greater extent only if preceded by KE as was observed in the Kegel exercise plus RT group (KE + RT) over time. The improvements in total ISI in both the KE + RT and RT groups were large (d = 1.50 and d = 1.17 respectively). A two-way ANOVA indicated a statistically significant improvement in average PFMS within the KE + RT group over time and between the two groups. A positive correlation was found between the average strength of pelvic floor muscles and SUI. Participants in KE + RT group demonstrated a significant increase in muscle mass (p ≤ 0.001) and concomitant reduction in fat mass (p = 0.018). This study determined a dedicated program of KE preceding a RT program improved average pelvic floor muscle strength and was effective in reducing SUI among incontinent women.
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Affiliation(s)
- Donelle Cross
- Faculty of Health, Charles Darwin University, Darwin, NT 0909, Australia
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
| | | | - Lolita Wikander
- Faculty of Health, Charles Darwin University, Darwin, NT 0909, Australia
| | - Jing-Yu (Benjamin) Tan
- Faculty of Health, Charles Darwin University, Darwin, NT 0909, Australia
- Research and Innovation, Charles Darwin University, Darwin, NT 0909, Australia
| | - Simon Moss
- Research and Innovation, Charles Darwin University, Darwin, NT 0909, Australia
| | - Daniel Gahreman
- Faculty of Health, Charles Darwin University, Darwin, NT 0909, Australia
- Department of Sport, Exercise, Recreation and Kinesiology, East Tennessee State University, Johnson City, TN 37614, USA
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The feasibility of a multimodal exercise program for sedentary postmenopausal women with urinary incontinence: A pilot randomized controlled trial. Maturitas 2023; 167:90-98. [DOI: 10.1016/j.maturitas.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/12/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
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Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:S1-S19. [PMID: 36548636 DOI: 10.1097/spv.0000000000001272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Overactive bladder (OAB) is prevalent in older adults in whom management is complicated by comorbidities and greater vulnerability to the cognitive effects of antimuscarinic medications. OBJECTIVES The aim of this study is to provide a comprehensive evidence-based summary of the 2021 State-of-the-Science (SOS) conference and a multidisciplinary expert literature review on OAB and cognitive impairment. STUDY DESIGN The American Urogynecologic Society and the Pelvic Floor Disorders Research Foundation convened a 3-day collaborative conference. Experts from multidisciplinary fields examined cognitive function, higher neural control of the OAB patient, risk factors for cognitive impairment in older patients, cognitive effects of antimuscarinic medications for OAB treatment, OAB phenotyping, conservative and advanced OAB therapies, and the need for a multidisciplinary approach to person-centered treatment. Translational topics included the blood-brain barrier, purine metabolome, mechanotransduction, and gene therapy for OAB targets. RESULTS Research surrounding OAB treatment efficacy in cognitively impaired individuals is limited. Short- and long-term outcomes regarding antimuscarinic effects on cognition are mixed; however, greater anticholinergic burden and duration of use influence risk. Oxybutynin is most consistently associated with negative cognitive effects in short-term, prospective studies. Although data are limited, beta-adrenergic agonists do not appear to confer the same cognitive risk. CONCLUSIONS The 2021 SOS summary report provides a comprehensive review of the fundamental, translational, and clinical research on OAB with emphasis on cognitive impairment risks to antimuscarinic medications. Duration of use and antimuscarinic type, specifically oxybutynin when examining OAB treatments, appears to have the most cognitive impact; however, conclusions are limited by the primarily cognitively intact population studied. Given current evidence, it appears prudent to minimize anticholinergic burden by emphasizing nonantimuscarinic therapeutic regimens in the older population and/or those with cognitive impairment.
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Zhu H, Zhang D, Gao L, Liu H, Di Y, Xie B, Jiao W, Sun X. Effect of Pelvic Floor Workout on Pelvic Floor Muscle Function Recovery of Postpartum Women: Protocol for a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191711073. [PMID: 36078788 PMCID: PMC9517758 DOI: 10.3390/ijerph191711073] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 05/15/2023]
Abstract
BACKGROUND There is a risk of pelvic floor dysfunction (PFD) from baby delivery. Many clinical guidelines recommend pelvic floor muscle training (PFMT) as the conservative treatment for PFD because pelvic floor muscles (PFMs) play a crucial role in development of PFD. However, there is disagreement about the method and intensity of PFM training and the relevant measurements. To pilot the study in PFM training, we designed a Pelvic Floor Workout (PEFLOW) for women to train their pelvic through entire body exercises, and we planned a trial to evaluate its effectiveness through comparing the outcomes from a group of postpartum women who perform PELFLOW at home under professional guidance online with the control group. METHODS/DESIGN The randomized controlled trial was projected to be conducted from November 2021 to March 2023. A total of 260 postpartum women would be recruited from the obstetrics departments of the study hospital and women would be eligible for participation randomized into experimental or control groups (EG/CG) if their PFM strength are scaled by less than Modified Oxford grading Scale (MOS) to be less than grade 3. Women in EG would perform a 12-week PEFLOW online under the supervision and guidance of a physiotherapist, while women in CG would have no interventions. Assessments would be conducted at enrollment, post intervention (for EG) or 18th to 24th week postpartum (for CG), and 1 year postpartum. Assessment would be performed in terms of pelvic floor symptoms, including MOS, cough stress test, urinary leakage symptoms, pelvic organ prolapse quantitation (POP-Q), and vaginal relaxation, clinic examinations including Pelvic floor electrophysiological test, Pelvic floor ultrasound and Spine X-ray, overall body test including trunk endurance test, handgrip test, body composition test, and questionnaires including International Physical Activity Questionnaire Score-Short Form(IPAQ-SF), Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), the 6-item Female Sexual Function Index (FSFI-6), and the Pittsburgh Sleep Quality Index (PSQI). Primary analysis will be performed to test our main hypothesis that PEFLOW is effective with respect to strengthen PFM strength. DISCUSSION This trial will demonstrate that pelvic floor-care is accessible to most women and clinical practice on PFD may change relevantly should this study find that Online PEFLOW approach is effective to improve PFMs. TRIAL REGISTRATION ClinicalTrials.gov, NCT05218239.
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Affiliation(s)
- Hongmei Zhu
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- Department of Sports medicine and rehabilitation, Beijing Sports University, No.48, Xin Xi Road, Hai Dian District, Beijing 100084, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Di Zhang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Lei Gao
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Huixin Liu
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Yonghui Di
- Department of Sports medicine and rehabilitation, Beijing Sports University, No.48, Xin Xi Road, Hai Dian District, Beijing 100084, China
| | - Bing Xie
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Wei Jiao
- Department of Sports medicine and rehabilitation, Beijing Sports University, No.48, Xin Xi Road, Hai Dian District, Beijing 100084, China
- Correspondence: (W.J.); (X.S.)
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
- Correspondence: (W.J.); (X.S.)
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Buyuk A, Cetin SY, Sakinci M. The Effects of Pelvic Floor Muscle Training and Behavioral Training on Sexual Dysfunction, Incontinence, Physical Activity Level and Quality of Life in the Elderly. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09684-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Mazo GZ, Santos KMD, Freitas CSD, Cielo A, Braz MM, Pivetta HMF. Correlação entre incontinência urinária, disfunção sexual e avaliação subjetiva da contração muscular perineal em idosas fisicamente ativas. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/21000528012021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Incontinência urinária (IU) e disfunção sexual feminina (DSF) são disfunções que afetam a qualidade de vida. Com a mudança na pirâmide etária brasileira, a prevalência de tais disfunções tende a aumentar. O objetivo deste estudo foi estabelecer a relação entre a IU, a DSF e a contração muscular perineal em idosas ativas fisicamente. Trata-se de estudo transversal, do qual participaram 35 idosas ≥60 anos. Inicialmente foram aplicados a ficha diagnóstica e os questionários International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF) e Female Sexual Function Index (FSFI). Em seguida foram avaliados os músculos do assoalho pélvico (MAP) por meio do toque vaginal, de acordo com o que propõe o esquema perfect. Entre as idosas, 20% apresentaram ambas as disfunções dos MAP. No total, 17 (48,6%) apresentavam IU e 16 (45,7%) DSF. Observou-se diferença significativa no número de partos vaginais (p=0,028) e no item rapidez do esquema perfect (p=0,033) entre as idosas com e sem DSF. Não houve diferença estatística entre os grupos com e sem IU. A análise apontou uma correlação inversamente proporcional entre a gravidade da IU e a função sexual nas idosas incontinentes (p=0,008; r=−0,622), de forma que, para cada aumento na gravidade da IU pelo ICIQ-SF, diminuiu-se 0,507 de função sexual avaliada pelo FSFI (p=0,034; r=0,516). Há uma associação entre IU e DSF em idosas fisicamente ativas. Algumas idosas apresentam ambas as disfunções dos MAP, apesar de serem ativas fisicamente. Dessa forma, é necessário reforçar a importância de avaliações minuciosas, da atividade física orientada e da atuação multiprofissional em saúde.
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Effects of resistance exercise in prostate cancer patients : A systematic review update as of March 2020. Wien Klin Wochenschr 2020; 132:452-463. [PMID: 32681360 PMCID: PMC7445198 DOI: 10.1007/s00508-020-01713-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/27/2020] [Indexed: 02/08/2023]
Abstract
Purpose The aim of this systematic review is to provide an update on the effects of resistance exercise (RE) in patients with prostate cancer (PCa), with special attention to the effects on sexual health. Methods A systematic search of the literature was conducted in March 2020 using the databases PubMed, MEDLINE, EMBASE, SCOPUS and the Cochrane Library. Only randomized, controlled trials published after 31 December 2016 were included in this update. Additionally, articles from current and previous reviews were utilized to provide a brief summary of the effects on sexual health. Results A total of 10 articles met the inclusion criteria, of which 5 were identified as independent studies. The remaining five articles presented additional data for studies, which have already been included. The identified studies further strengthened the evidence for positive effects on muscle strength, body composition and physical function. Positive effects on bone mineral density were apparent only when RE was combined with impact training. One article reported an improvement in fatigue and health-related quality of life. Only one study examined the effects of RE in isolation and three articles indicated positive effects of exercise on sexual health. Conclusion Recent evidence supports the use of RE in PCa patient rehabilitation as a countermeasure for treatment side effects. Further research is necessary to ascertain the optimal delivery methods and illuminate the effects on health-related quality of life (HRQOL), fatigue and sexual health.
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Pelvic Floor Muscle Training for Older Women with Urinary Incontinence. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00316-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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