I am sitting here on my back porch basking in the glorious (now Autumn) sunshine thinking about how this will soon change and I’ll be rugged up in track pants, a hoodie and probably a blanket in a couple of months time.
It’s been a crazy month since we last connected and I have projects coming out of my ears, but I love sharing research with you so I wanted to make sure you had this landing in your inbox on the 1st of the month as promised.
If you missed last month’s email, I shared a paper comparing hip and pelvic floor muscle strength in women with and without urinary urgency and frequency symptoms… NOT incontinence. It was a great read BUT… an even better listen! Head over to my podcast and catch up on the episode where I recap on the research and talk more about it.
Click here to listen → Episode 36: Hip strength and symptoms of urgency and frequency.
Also just a favour to ask on that note… If you listen to the show and you find it valuable, please share with your colleagues. I am on a mission to enhance how us exercise professionals are seen in the women’s health sector and the more people I can reach the better chance we have at changing this.
Don’t forget to have a listen to all the mindset and self development I share over there as well. This stuff is a game changer if you work for yourself or just want to be the best version of you in and out of your work.
This month’s paper → Shaw J, Hamad N, Coleman T, Egger M, Hsu Y, Hitchcock R, Nygaard I. Intra-abdominal pressures during activity in women using an intra-vaginal pressure transducer. J Sports Sci. 2014 June ; 32(12): 1176–1185. doi:10.1080/02640414.2014.889845. Sportd
I have chosen this paper because I hear too often ‘what exercises are pelvic floor safe’ and there is not a definitive list we can give out for clients who have pelvic floor dysfunction.
The primary purpose of this study was to explore the association between physical activity and intra-abdominal pressure and determine if strenuous activities increased the risk of pelvic floor dysfunction. Second to this the study was designed to compare pressure measures between activities with varying levels of intensity as well as compare pressure measures obtained during specific strenuous activities to coughing as this is the standard for eliciting high amounts of intra-abdominal pressure.
Before we dive into more specifics of the paper if you aren’t already aware, intra abdominal pressure (IAP) describes the steady state pressure concealed within the abdominal cavity and results from the interaction between the abdominal wall and viscera. IAP oscillates according to the respiratory phase and abdominal wall resistance and is a crucial component to pelvic health as high amounts of pressure will generally increase forces down onto the pelvic structures increasing the risk of prolapse and urinary leakage.
Back to the paper…
What did the study do?
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- 57 women who engage in vigorous exercise at least 3 times per week were recruited into the study.
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- A wireless intra-vaginal pressure transducer was inserted into the upper vagina for the duration of the tests. Imagine a special gel filled tampon with a sensor sealed inside inserted into the vagina with an antenna externally attached to the abdomen to communicate wirelessly with the laboratory equipment.
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- Women performed 31 activities that included a range of clinical assessments, light, moderate and vigorous intensity exercise tasks and routine household activities.
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- Instructions were given in regard to either a number of reps, or to continue performing the exercise for a 30 second time interval. The session took about 1 hour involving a gradual warm up progressing to higher intensity activities followed by easier tasks to reduce heart rate and then ending with stretching activities.
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- Supine pelvic floor muscle contractions were also measured at the end to ensure intra-abdominal pressure was being measured and not pelvic muscle contraction pressure in the event the transducer had fallen down into the lower vagina.
- Outcomes measured were
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- Maximal pressure during the activity
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- Area under the curve – to reflect the amplitude and duration of pressure
- First moment of the area – to overcome the limitation of being able to distinguish long duration/low pressure activities from short duration/high pressure activities
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- Outcomes measured were
The one thing I hate about some research papers is when they discuss an ‘exercise protocol’ but fail to tell you which exact exercises they did within the protocol. This paper included a table of all 31 of the activities charting the results of each measure and this is what I loved!
So I’ll share the list of exercises with you so you can get an idea of how this information is relevant to your programming.
Clinical Assessment:
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- Coughing
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- Lying valsalva
- Seated Valsalva
Aerobic Activities:
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- Walking at 4.8km/h at 0% incline
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- Walking at 4.8km/h at 7% incline
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- Walking at 5.6km/h at 7% incline
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- Walking at 4.3km/h at 0% incline with 11.4kg weight
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- Run 8-9.7km/h 0% incline
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- Stepping 20cm step
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- Seated cycling 300kg/m/min
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- Seated cycling 600kg/m/min
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- Standing cycling 900kg/m/min
Household activities:
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- Erasing board, dusting
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- Scrubbing floor on hands and knees
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- Stand to sit
Lifting Tasks:
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- Lift 13.6kg floor to counter and back
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- Lift 18.2kg floor to counter and back
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- Seated shoulder press 3.6kg
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- Seated shoulder press 4.5kg
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- Seated shoulder press 5.5kg
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- Seated shoulder press 6.8kg
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- Seated shoulder press 9.1kg
Calisthenic Activities:
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- Abdominal curl up
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- Full sit ups with feet held
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- Isometric side bridge
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- Modified superman
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- Push-ups from knees
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- Jumping
Stretching activities
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- Seated hamstring stretch
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- Lower back stretch
- Side lying quadriceps stretch
As you can see there are many exercises to compare pressure changes in especially when we are comparing 3 measures of pressure between all exercises.
So I won’t dive into the nitty gritty of where statistical differences were between types of activities or between exercises of varying intensity. If you want to read more about this I would recommend heading to the actual paper and reading the results.
But one really relevant finding from this study that I think is the key takeaway was the wide range of intra-abdominal pressures amongst different women doing the same activity. It was noted that the greatest degree of variability was actually in the more novel exercises where participants were required to control their level of effort. E.G. Valsalva, jumping and standing cycling had the greatest variability among participants whereas walking, a more familiar exercise, had very little variability among women.
This is such an important piece of information for us exercise professionals.
Why?
Because most times in musculoskeletal rehab we would program clients with particular thresholds that keep clients within a ‘safe’ zone that optimizes adaptation. When it comes to pelvic floor health we usually term exercises as low or high IAP generating activities and this is what classifies an exercise as pelvic floor safe or not. The large variability in pressure measures within this study shows that if we were to blanket rule certain exercises as high or low pressure we could actually be unnecessarily restricting exercises that aren’t problematic for the individual but more helpful, or vice versa.
From this it is important to understand that the level of effort and perhaps the familiarity of the exercise is what is important for pressure generation and HOW the person is performing the exercise rather than the exercise itself.
Clinically I have seen this in my consults. Women who have better pressure management in more advanced exercises and yet struggle to perform basic bird dogs with good pelvic floor and abdominal wall control. This is something that needs to be considered when looking at ‘what is safe for that individual’ versus ‘what exercises are pelvic floor safe’?
As exercise professionals I think the hardest part about prescribing pelvic floor safe exercise for an individual is knowing what an exercise should look and feel like when pressure is managed well. Being able to watch an exercise and see any signs of poor pressure management as well as be able to explain how the movement should be performed to reduce unnecessary rises in IAP.
This is something we cover in the practical components inside the mentorship. Workshopping exercises and understanding the importance of technique, pressure management and how to regress or progress appropriately for the individual.
The mentorship won’t be open for application until next year, but I have had requests for smaller bite size education so make sure you are subscribed to our email list to here all the updates on new courses and programs.
That is it for this month’s research spotlight, I hope this gives you food for thought the next time someone asks what exercises are pelvic floor safe.