Abstract
Background: Pregnancy and high-impact activity are considered as risk factors for pelvic floor dysfunctions, including urinary incontinence.Aim: To investigate whether a structured exercise program, including high- and low-impact aerobics and supported by pelvic floor muscle exercises, improves the neuromuscular activity of the pelvic floor and does not reduce the quality of life in terms of urinary incontinence in healthy pregnant women.Methods: This was a randomized control trial among 97 Caucasian healthy nulliparas in uncomplicated pregnancies (age 30 ± 4 years, 21 ± 5 weeks of gestation; mean ± SD). Women were assessed for pelvic floor muscle functions with surface electromyography (EMG) using vaginal probes and using the Incontinence Impact Questionnaire (IIQ). Only women able to contract pelvic floor muscles and with good quality of life based on IIQ were included for the study. Seventy women in the experimental group took part in a supervised exercise program including high-low impact aerobics and pelvic floor muscle exercises three times a week. Twenty-seven controls did not receive any exercise intervention. After 6 weeks both groups were re-tested with EMG and IIQ. Post- and pre-exercise program changes in each group were analyzed using a repeated-measures ANOVA.Results: Women in the experimental group improved the neuromuscular activity of the pelvic floor in some motor tasks without any adverse outcomes of the intervention. After the exercise program we observed in the experimental group significantly higher EMG amplitude in the pelvic floor muscles during 3-s contractions (p = 0.014). We also noticed a beneficial trend in the increase of neuromuscular activity during 10- and 60-s contractions, but the changes were not statistically significant. The exercising women substantially improved their abilities for relaxation following 3- and 10-s contractions (p = 0.013 and p < 0.001). In controls, we reported no statistically significant improvement in either of the motor tasks. All study participants maintained good quality of life related to urinary incontinence.Conclusion: Prenatal exercise programs that include high- and low-impact aerobics and are supported by pelvic floor muscle exercises should be recommended for pregnant women, especially those who are accustomed to higher exercise intensity before pregnancy. Nevertheless, these recommendations can be directed to continent women who can properly contract pelvic floor muscles.ISRCTN. DOI: 10.1186/ISRCTN92265528: “Pelvic floor muscle training with surface electromyography”, retrospectively registered on the 25th of July, 2016.
Highlights
Official guidelines on exercise in pregnancy from different countries recommend aerobics for women as a form of cardio exercise, some of them limit this recommendation to low-impact aerobics (Szumilewicz et al, 2015)
Exclusion criteria were as follows: any present or previous pelvic floor dysfunctions diagnosed by health professionals, history of miscarriages over 12 weeks gestation and/or more than two successive miscarriages in the first trimester, any contraindications to physical activity according to ACOG (The American College of Obstetricians, and Gynecologists [ACOG], 2015), allergy to any materials used during the study procedure, and presence of a condition or abnormality that in the opinion of the investigator would compromise the safety of the participant or the quality of the data
After 6 weeks of the high- and low-impact exercise program, supported by complex pelvic floor muscle exercises in the intervention group, we noticed a significant increase in the EMG amplitude of quick flicks (p = 0.014) and a decrease in EMG amplitude in the following relaxations (p = 0.013)
Summary
Official guidelines on exercise in pregnancy from different countries recommend aerobics for women as a form of cardio exercise, some of them limit this recommendation to low-impact aerobics (Szumilewicz et al, 2015). Classes mixing high- and low-impact movements are labeled as highlow aerobics (Kennedy-Armbruster and Yoke, 2014). Not much data are available on the influence of high-impact aerobics on the pelvic floor muscle functions in pregnant women. Pregnancy and increased loading on the pelvic floor are risk factors for pelvic floor dysfunctions (Delancey et al, 2008; Sangsawang and Sangsawang, 2013), including bladder and bowel dysfunction, pelvic organ prolapse, sexual dysfunction and pelvic pain (Bo et al, 2017). Pregnancy and high-impact activity are considered as risk factors for pelvic floor dysfunctions, including urinary incontinence
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