Pelvic floor muscle activity during different running speeds—an exploratory and reliability study

Abstract

insight into PFM contraction characteristics and develop more specific PFM training regimens for SUI patients (SUIP). The aim of this systematic review was to evaluate and summarize existing studies investigating PFM activation and strength components influencing continence and SUI. Methods: This systematic review was conducted following the PRISMA guidelines and the study protocol was registered at PROSPERO. The databases PubMed, Embase and Cochrane were systematically searched for literature from 01.01.1980 to 30.11.2013. Cross-sectional observational studies comparing (SUIP) with healthy controls and intervention studies with SUIP reporting on the association between PFM activation and strength components and continence and SUI were selected. Two researchers independently extracted trial characteristics, measurement methods, evaluated PFM components and their definitions and study outcomes. The quality of the selected studies was assessed by the same investigators using the Cochrane risk of bias tool. Based on the high heterogeneity of the retrieved data the analysis was restricted to a systematic review and an initially planned meta-analysis was not conducted. Results:The literature search identified 2630 abstracts for consideration. After removal of duplicates and application of inclusion/exclusion criteria 121 studies entered the full-text review. From those, 107 were excluded mainly because of not fulfilling inclusion/exclusion criteria and hence 14 studies were selected for further analysis. Group differences in favor of continent women compared to SUIP were found for PFM maximal strength, mean strength, sustained contraction and PFM activation. A significant improvement of PFM strength and decrease in urine loss after physical therapy interventions was observed in SUIP. Conclusion(s): In summary, higher maximal, mean, endured and increase of PFM strength and earlier onset of PFM activation had a beneficial effect on female urinary continence. However, a high variation of testing procedures, measurement methods and terminology as well as definitions of the evaluated PFM activation and strength components and their characteristics were found among the selected studies. The heterogeneity of the measured PFM activation and strength components, the lack of information on the exact intervention given to the study participants and the intervention’s standardization limit the comparison of the outcomes across the studies. Implications: This systematic review underscores the need for a standardized PFM components’ terminology related to muscle function, similar to the commonly used terminology in training science. Together with the use of standardized instructions of patients’ test behavior provoking the respective PFM component this would enable the development of well-matched diagnostic instruments and specific PFM training protocols for SUI patients.