Ana Paula Magalhães Resende

Introduction and Hypothesis: The objective was to compare the effects of a Pilates exercise program performed with or without voluntary pelvic floor muscle contraction versus pelvic floor muscle training (PFMT) on urinary incontinence impact and pelvic floor muscle function in women with stress urinary incontinence. Methods: A randomized controlled trial with three parallel groups: Pilates, Pilates + voluntary pelvic floor muscle contraction (Pilates + VPFMC), and PFMT was conducted. The primary outcome was the impact of urinary incontinence assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Secondary outcomes included pelvic floor muscle strength (Modified Oxford Scale) and vaginal squeeze pressure (Peritron manometry). Participants completed 12 supervised sessions over 6 weeks. Outcomes were assessed by a blinded evaluator. Results: A significant overall effect of time was observed for ICIQ-SF scores, pelvic floor muscle strength, and vaginal squeeze pressure ( p < 0.001). The mean reduction in ICIQ-SF was −0.7 for Pilates, −0.7 for Pilates + VPFMC, and −4.4 for PFMT. PFMT demonstrated superior outcomes compared with both Pilates groups across all the outcomes assessed. Pelvic floor muscle strength increased by 0.3, 0.7, and 1.7 points (Modified Oxford Scale), and peak vaginal squeeze pressure increased by 5.7, 6.1, and 24.4 mmHg in the Pilates, Pilates + VPFMC, and PFMT groups respectively. Between the Pilates groups, a difference was observed only in muscle strength, favoring the Pilates + VPFMC group. Conclusions: Pelvic floor muscle training was superior to Pilates in reducing the impact of urinary incontinence and improving pelvic floor muscle function, regardless of the inclusion of voluntary pelvic floor muscle contraction.

Introduction and Hypothesis: Female participation in long-distance running has been increasing, raising concern about pelvic floor-related symptoms in this population. However, data on pelvic organ prolapse (POP) symptoms, particularly during running, remain limited. We hypothesized that higher training volume would be associated with greater prevalence of POP symptoms. This study aimed to determine the prevalence of POP symptoms and associated factors among Brazilian female runners. Methods: In this cross-sectional study, participants were recruited at road-running events and completed a questionnaire on demographics, health history, training characteristics, and other physical activities. POP symptoms were assessed by two questions: (1) “Do you notice a bulge or lump in your vagina in daily life situations, outside of physical exercise?” and (2) “Do you feel a sensation of pressure, bulge, or lump descending in your vagina while running?” Results: Three hundred and one women met inclusion criteria (mean age 37.2 years). Twenty-three percent reported POP symptoms during running; 58% had a history of pregnancy, with mean values of 0.77 cesarean and 0.36 vaginal deliveries. Average weekly running distance was 28.6 km, and 76% performed additional physical activity (mean 1.98 sessions/week). POP symptoms were significantly associated with weekly running distance (OR 1.03; 95% CI 1.01–1.05) and additional activities (OR 1.53; 95% CI 1.22–1.91), while cesarean delivery was inversely associated (OR 0.42; 95% CI 0.28–0.62). Conclusions: POP symptoms were more frequent during running than in daily life. Weekly running distance and engagement in additional physical activity were significant predictors, whereas cesarean delivery appeared protective.

Aims: To compare the effects of manual visceral therapy (MVT) associated with pelvic floor muscle training (PFMT) on urinary incontinence (UI) symptoms, vaginal resting pressure, and maximum voluntary contraction of the pelvic floor muscles (PFM).Methods: A double‐blinded randomized controlled trial of 5 weeks duration with two active intervention arms: PFMT + MVT and PFMT + manual sham therapy (MST). Participants were women over 18 years of age with complaint or diagnosis of UI symptoms. The primary outcome was the severity of UI symptoms, assessed by the International Consultation on Incontinence Questionnaire – Short Form. The secondary outcomes measures included the vaginal resting pressure and the maximum voluntary contraction of PFM assessed by digital manometry.Results: Fifty‐two incontinent women participated in the study. There was no significant difference between groups in UI symptoms (F (1.74, 86.9) = 0.406; p = 0.638), vaginal resting pressure (mean difference −1.5 cmH₂0 [95% confidence interval [CI] −4.5 to 1.5; p = 0.33]), and maximum voluntary contraction of PFM (median 0.0 cmH₂0 [25%–75% interquartile range 0.0–5.6; p = 0.12]) after the intervention period.Conclusions: Combining MVT with PFMT was not more effective than PFMT alone in reducing UI symptoms, in change vaginal resting pressure and maximum voluntary contraction of PFM. Due to the limitations of the study, further investigations are still needed to confirm these findings.

Introdução: Após a menopausa mulheres tem maior risco de desenvolver doenças cardiovasculares. A prática de exercício físico é um dos tratamentos para e redução da incidência dessas doenças, e o método Pilates consiste em um programa completo de condicionamento físico. Objetivos: Verificar as respostas da Monitorização Ambulatorial da Pressão Arterial (MAPA) e da Variabilidade da Pressão Arterial após uma única sessão de Mat Pilates em mulheres após a menopausa não obesas. Métodos: Este é um estudo cruzado randomizado com 15 mulheres pós-menopáusicas normotensas, que participaram de uma única sessão de Mat Pilates e de uma sessão de controle. A sessão de Pilates durou 50 minutos, com 5 minutos de aquecimento. Em cada exercício, houve 1 série de 10 repetições com 45 segundos de descanso entre as séries. A sessão controle teve a mesma duração, mas as voluntárias permaneciam sentadas. A MAPA foi avaliada durante 24 horas após a intervenção. Estatística: Utilizou-se ANOVA de dois fatores com post hoc de Newman-Keuls para análise das variáveis da MAPA e teste t de Student para análise da variabilidade de pressão arterial. Resultados: Não houve diferença significativa (p <0,05) nas respostas da pressão arterial sistólica e diastólica durante 24h, vigília e sono ou em sua variabilidade entre as sessões de Pilates e Controle. Conclusão: O Mat Pilates não reduziu os valores pressóricos da MAPA ou sua variabilidade em mulheres após a menopausa não obesas.

RESUMO O objetivo deste artigo é analisar os efeitos da drenagem linfática manual sobre os sintomas de sensação de peso, dor, edema e formigamento nos membros inferiores de gestantes, assim como na redução da perimetria. A amostra foi composta por 23 voluntárias, e foram realizados 35 atendimentos. Foram incluídas gestantes com idade gestacional acima de 26 semanas, que apresentavam sensação de peso, dor, edema e formigamento nos membros inferiores, com autorização escrita do médico obstetra para que fossem submetidas a drenagem linfática manual utilizando o método Leduc. Foram excluídas gestantes que apresentaram pressão arterial superior a 140/100mmHg no momento da realização da drenagem linfática manual, lesão de continuidade da epiderme, doenças dermatológicas, linfáticas e cardíacas, infecções e varizes volumosas e/ou sintomáticas. As avaliações foram realizadas imediatamente após a aplicação da drenagem linfática manual e duas horas depois, por meio de questionário estruturado pelas pesquisadoras. Diferenças estatisticamente significativas foram encontradas antes, imediatamente após e após duas horas da intervenção no que se refere à melhora da dor (p=0,001*), do formigamento (p=0,01*), da sensação de peso (p=0,000*) e do inchaço (p=0,000*). Em relação à perimetria antes e após o tratamento, houve diminuição na maioria das mensurações realizadas. A técnica de drenagem linfática manual tem papel fundamental na melhora da qualidade de vida da gestante devido ao relaxamento e bem-estar proporcionado, componentes considerados essenciais para redução da ansiedade e com benefícios que podem perdurar até o parto.

Aim: To verify which one improves better stress urinary incontinence (SUI) symptoms: abdominal hypopressive technique (AHT) or pelvic floor muscle training (PFMT).Methods: Randomized controlled trial. Women with SUI who had not participated of physiotherapy program before were invited. The outcome measures were 7‐day bladder diary, International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) and pelvic floor muscles (PFM) function measured by Modified Oxford grading System with vaginal palpation and manometry with Peritron. Intervention consisted by 12 weeks of exercises program including PFMT or AHT program, in groups of maximum three women, twice a week, with physiotherapist supervision.Results: AHT and PFMT groups reduced urinary leakage episodes in 7 days, −0.64 and −1.91, respectively, but PFMT was superior, whit mean difference −1.27 (95% confidence interval [CI]: −1.92 to −0,62) and effect size was 0.94 in favor to PFMT. Regarding to total score of ICIQ‐SF, both groups improved, with mean difference between groups −4.7 (95% CI: −6.90 to −2.50) and effect size was 1.04 in favor to PFMT. Manometry also presented improvement after treatment for both groups with mean difference between them of 11 (95% CI: 6.33‐15.67) and effect size was 1.15 also in favor to PFMT.Conclusion: Regarding to SUI symptoms, quality of life impact and PFM function both groups presented improvement, however, PFMT was superior to AHT among all of them.

Aims: To verify if hypopressive exercises (HEs) can improve pelvic organ prolapse (POP) symptoms equally or better than pelvic floor muscle training (PFMT).Methods: Randomized controlled trial. Symptomatic women with untreated stage II POP according to the Pelvic Organ Prolapse Quantification System (POP‐Q) having the ability to contract their pelvic floor muscles were invited. The outcome measures were POP symptoms as measured by specific questions and Prolapse Quality of Life (P‐QoL); POP severity as measured by POP‐Q; and PFM function. Intervention consisted by 12 weeks of PFMT or an HE home exercise program with bimonthly sessions with a physiotherapist. The protocol consisted of three initial sessions to learn how to perform the exercises correctly, followed by 3 months of exercise with monthly progression. Volunteers filled out exercise diaries to record their compliance.Results: PFMT presented better results in terms of the following symptoms: a bulge/lump from or in the vagina, heaviness or dragging on the lower abdomen, and stress incontinence. PFMT also presented better results regarding the Prolapse impact and role, social and personal limitations of P‐QoL. Regarding the total number of symptoms at the end, the PFMT group presented a mean of 1.7 (±1.2), and the HE group presented a mean of 2.8 (±1,1); the effect size was 1.01 in favor of the PFMT group (95%CI = 1.002‐1.021).Conclusion: Both groups exhibited improvements in POP symptoms, quality of life, prolapse severity, and PFM function. PFMT was superior to HE for all outcomes.

Background: Exercise and supplementation with isoflavones are therapies used to prevent and treat climacteric symptoms. Aim: To verify the effects of 10 weeks of combined aerobic and resistance training and isoflavone supplementation on climacteric symptoms in postmenopausal women. Methods: A randomised, double-blind, controlled clinical trial was performed. A total of 32 postmenopausal women, aged 54.4 ± 5.4 years, with a body mass index of 26.6 ± 3.0 kg/m² and 5.6 ± 4.6 years after menopause, were randomly assigned to groups: placebo and exercise (PLA + EXE, n = 15) or 100 mg of isoflavone and exercise (ISO + EXE, n = 17). At the beginning and after 10 weeks of aerobic + resistance (20 min each, moderate intensity) training, climacteric symptoms were evaluated using the Blatt–Kupperman Menopausal Index, Cervantes Scale and Menopause Rating Scale. ANCOVA was used for analysis between groups and at different times, with the covariate adjusted by the pre-value. The level of significance considered was p < 0.05. Results: A reduction in climacteric symptoms was observed in both groups, without differences between the interventions. The reductions were 45% and 50% for the Blatt–Kupperman Menopausal Index, 41% and 52% for the MRS and 39% and 39% for the Cervantes Scale in the ISO + EXE and PLA + EXE groups, respectively. In the descriptive analysis of the Blatt–Kupperman Menopausal Index values, there was an increase in the absence of symptoms from 48−77% in the ISO + EXE group and 24−58% in the PLA + EXE group. Conclusions: A period of 10 weeks of combined training was effective in improving climacteric symptoms in post-menopausal women. However, isoflavone supplementation did not promote additional effects in improving symptoms.

Introduction and hypothesis The objective was to evaluate the pelvic floor muscles (PFM) in primigravidae and compare them with those in nonpregnant nulliparous women. Methods The sample consisted of 141 women with a mean age of 22.8 years, divided into four groups: 36 nonpregnant nulliparous (C), 31 primigravidae in the first trimester (1T), 42 primigravida in the second trimester (2T), and 32 primigravidae in the third trimester (3T). The participants were examined by digital palpation for pelvic floor muscle contraction using the Modified Oxford Scale, by measuring maximal vaginal squeeze pressure with a vaginal perineometer, and by measuring PFM maximal strength using a vaginal dynamometer. The best value of three maximal strengths was considered for analysis, the Kruskal–Wallis and Mann–Whitney U tests were used and differences were considered significant at p ≤ 0.05. Results The mean values for group C were 3.2 (digital palpation), 45.6 cmH₂O (perineometry), and 11.7 N (dynamometry); for group 1T the corresponding values were 2.5, 21.1 cmH₂O, and 8.8 N; for group 2T: 2.8, 22.9 cmH₂O, and 7.8 N; and for group 3T: 2.1, 17.3 cmH₂O, and 6.8 N. Groups were compared in pairs for digital palpation, perineometry, and dynamometry. There were significant differences between group C and group 1T, and between group C and group 3T. There was a significant difference between group C and group 2T with regard to perineometry and dynamometry, but not digital palpation. Dynamometry demonstrated a difference between groups 1T and 3T, digital palpation between groups 2T and 3T. Conclusion Pelvic floor muscles in primigravidae are not as strong as those in nonpregnant nulliparous women.

We compared the maximal voluntary contraction (MVC) and strength of pelvic floor muscles (PFM) of pregnant and nonpregnant women using surface electromyography (SEMG). Fifteen pregnant primiparous women and 15 nulliparous nonpregnant women were evaluated. The healthy pregnant women were in the third trimester of pregnancy with a single fetus and did not have any neuromuscular alterations. The nonpregnant women did not present with PF dysfunctions and, as with the pregnant women, did not have any previous gynecological surgeries or degenerative neuromuscular alterations. The evaluation methods used were digital palpation (Oxford Grading Scale, which ranges from 0 to 5) and SEMG. In the EMG exam, MVC activity was evaluated, and the better of two contractions was chosen. Before the evaluation, all women received information about PFM localization and function and how to correctly contract PFM. In the EMG evaluation, MVC was significantly greater in the nonpregnant group (90.7 μv) than in the pregnant group (30 μv), with p < 0.001. The same results were observed after vaginal palpation, measured by the Oxford scale, which presented an average of 2.1 in the pregnant group and 4.5 in the nonpregnant group (p = 0.005). In comparison to nulliparous women, pregnant women demonstrated worse PFM function with decreased strength and electrical activity.