Effect of diaphragm and abdominal muscle training on pelvic floor strength and endurance: results of a prospective randomized trial

B Zachovajeviene,L Siupsinskas,Z Venclovas,P Zachovajevas,D Milonas

doi:10.1038/s41598-019-55724-4

B Zachovajeviene, L Siupsinskas + Show 3 more

Open Access

https://doi.org/10.1038/s41598-019-55724-4

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Abstract

Pelvic floor muscles (PFMs) play a crucial role in urinary continence. Therefore, training the PFMs remains the most popular conservative treatment for urinary incontinence (UI). The effect of training other body muscles on the PFMs is unclear and mostly hypothetical. The objective of our study was to evaluate the effectiveness of postoperative diaphragm muscle, abdominal muscle and PFM training on PFM strength (PFMS) and endurance (PFME) as well as on UI in men after radical prostatectomy (RP). Per-protocol PFMS, PFME and urine loss measurements were performed at 1, 3, and 6 months postoperatively. The primary endpoints were PFMS and PFME differences among the study groups. The secondary endpoint was the correlation between UI and PFMS and PFME. In total, 148 men were randomized to the treatment groups. An increase in PFMS and PFME was observed in all groups compared to baseline (p < 0.001). The greatest difference in PFMS was in the PFM training group, but diaphragm training had the best effect on PFME. The highest (from moderate to strong) correlation between UI and PFME and PFMS (r = −0.61 and r = −0.89, respectively) was observed in the diaphragm training group. Despite different but significant effects on PFMS and PFME, all rehabilitation-training programmes decreased UI in men after RP.

Highlights

Pelvic floor muscles (PFMs) play a crucial role in urinary continence
The latest Cochrane Review reported that the value of postoperative PFM exercise following radical prostatectomy (RP) remains conflicting[4], and the recent European Association of Urology (EAU) Guidelines recommended PFM training to speed up recovery from UI5
We have presented the results of a randomized prospective clinical trial comparing the effect of three different rehabilitation programmes (DMT vs. abdominal muscle training (AMT) vs. PFM training (PFMT)) on PFM strength (PFMS), pelvic floor muscle endurance (PFME) and urinary incontinence (UI) in men after RP resulting from clinically localized prostate cancer (PCa)

Summary

Introduction

Pelvic floor muscles (PFMs) play a crucial role in urinary continence. training the PFMs remains the most popular conservative treatment for urinary incontinence (UI). Such controversies between real clinical practice and existing study data raise the need for different views on this topic. If our hypothesis is correct, the weaknesses of the existing data could be covered: to teach and control the intensity of diaphragm and abdominal muscle training is easier than PFM training, which ensures quality control; and measuring muscle strength and endurance before and after RP will provide objective data on how different training programmes affect the PFMs and correlate with UI. We have presented the results of a randomized prospective clinical trial comparing the effect of three different rehabilitation programmes (DMT vs AMT vs PFMT) on PFMS, PFME and UI in men after RP resulting from clinically localized prostate cancer (PCa)

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