Kari Bø

Norwegian version of this page Department of Sports Medicine

Professor

Email: karib@nih.no
Phone: +4723262008
Mobile phone: +4799047363

Press photo

Projects

Research

Pelvic floor (function, dysfunction, measurement, prevalence in different groups, prevention, treatment, athletes), women's health, exercise during pregnancy and after childbirth, low back and pelvic girdle pain, diastasis recti abdominis.

Teaching

Research methodology master and PhD level, pelvic floor, muscle-skeletal, ergonomics, exercise and music, exercise during pregnancy and in the postpartum period.

Short biography

Kari Bø is a trained physical therapist and exercise scientist. She had her PhD (doctor of science) in 1990 and was appointed full professor of exercise science in 1997. She was elected pro-rector (vice head) of NIH (a specialized university) 1998-2001 and rector (head) of the NIH 2013-2017. She was the first vice president of the International Organization of Physical Therapists in Women’s Health, World Physiotherapy 1999-2007, and has been the vice president of the Norwegian Council for Physical Activity for 8 years, giving direct advice to the Norwegian Minister of Health on physical activity, inactivity, fitness and health. In addition, professor Bø has been the vice president of the Norwegian Physiotherapy Association subgroup for Sport Physiotherapy 2003-2007. She holds a 20% position as project leader at Akershus University Hospital, Norway, Department of Obstetrics and Gynecology and is a board member of “The pelvic floor Center” at the same hospital.

Professor Bø has published/in press/submitted/in manuscript > 330 peer review scientific papers on pelvic floor dysfunction, treatment of incontinence and low back- and pelvic girdle pain, exercise during pregnancy and after childbirth, diastasis recti abdominis, measurement methodology, fitness and women’s health and has given > 340 invited international keynote presentations worldwide. She has supervised 21 completed PhD candidates and numerous master students and has 12 PhD students currently under supervision. In addition, she has published numerous articles, videos/dvds and books about the pelvic floor, fitness, pregnancy and physical activity, and women’s health in general for the lay public, among these the two bestselling training videos in Norway published by KK, the biggest women’s magazine in Norway. She is the first editor of the international textbook: Evidence based physical therapy for the pelvic floor. Bridging science and clinical practice.

She has developed and overseen the post-graduate course for physiotherapy for pelvic floor dysfunction on behalf of the Norwegian Physiotherapist Federation since the early 1990ies and has given numerous postgraduate courses for physiotherapists internationally. She was an appointed member of the Program committee for Clinical Research at the Norwegian Research Council for 3 years and an appointed member from the Norwegian Research Council in Science Europe, EU. Professor Bø was appointed by the Swedish government as board member of the Swedish School of Exercise and Health 2017-2020. She has been a visiting fellow to Stanford University, USA, and a visiting professor at the University of Dunedin, New Zealand, University of Melbourne, Australia, The Ministry of Health, Singapore, The George Institute for Public Health, Sydney, Australia, Bristol Urology Institute, England, Monash University, Melbourne, Australia and Auckland University, New Zealand. Bø has been a guest professor at the University of Sao Paolo, Ribeirao Preto, Medical School, Brazil for > 10 years.

She is appointed honorary member of the Norwegian Physiotherapy Association's Subgroup of Women's health, the Brazilian Physiotherapy Association for Women's Health and the Chilean Physiotherapy Association for Women's Health. In 2014, one of her randomized controlled trials on pelvic floor muscle training was ranked and awarded one of 15 top trials in physiotherapy among >25.000 studies in the PEDro database. In 2015, she was awarded with the Mildred Elson Award, the most prestige's international award from the World Confederation of Physiotherapy (WCPT), for her contribution to research and education in pelvic floor dysfunction and women's health. In 2016 she was awarded the International Continence Society Lifelong Achievement Award for her research and education on the pelvic floor and incontinence. In 2019 she was awarded honorary member of the Norwegian Physiotherapy Association for her work for physiotherapy in Norway and worldwide.

Kari has a background as dancer (jazz and contemporary), rhythmical gymnast (Nordic champion in team) and sport model showing Norwegian sport clothes in a dance and gymnastic show in Norway, Las Vegas USA, Germany and France. In 1989 she developed the Norwegian Aerobic Fitness Model, an 80 hours course for aerobic instructors and a 60 min exercise class for health enhancing training for women (containing aerobic dance, flexibility, strength training and relaxation). She has >34 years of practice teaching this exercise class for > 40 women twice a week at her local sports club.

Bø, Kari; Lillegård, Ragnhild Haug & Skaug, Kristina Lindquist (2024). Pelvic Floor Muscle Training on Stress Urinary Incontinence in Power- and Weightlifters: a Pilot Study. International Urogynecology Journal. ISSN 0937-3462. p. 1–8. doi: 10.1007/s00192-024-05801-8.
Donnelly, G.M.; Bø, Kari; Forner, L.B.; Rankin, A. & Moore, I.S. (2024). Up for the tackle? The pelvic floor and rugby. A review. European Journal of Sport Science (EJSS). ISSN 1746-1391. doi: 10.1002/ejsc.12121.
Theodorsen, Nina-Margrethe Tennebekk; Bø, Kari; Fersum, Kjartan Vibe; Haukenes, Inger & Moe-Nilssen, Rolf (2024). Pregnant women may exercise both abdominal and pelvic floor muscles during pregnancy without increasing the diastasis recti abdominis: a randomised trial. Journal of Physiotherapy. ISSN 1836-9553. 70(2), p. 142–148. doi: 10.1016/j.jphys.2024.02.002.
Skaug, Kristina Lindquist; Engh, Anna Marie Ellström & Bø, Kari (2024). Pelvic floor muscle training in female functional fitness exercisers: An assessor-blinded randomised controlled trial . British Journal of Sports Medicine. ISSN 0306-3674. p. 1–8. doi: 10.1136/bjsports-2023-107365.
McCarthy-Ryan, Molly; Perkins, Joanna; Donnelly, Gráinne M.; Caithriona, Yeomans; Liston, Mairead & Leahy, Karina [Show all 9 contributors for this article] (2024). Stress urinary incontinence prevalence and risk factors in female rugby players: a common health problem across four nations. BMJ Open sport & exercise medicine. ISSN 2055-7647. 10(1). doi: 10.1136/bmjsem-2023-001832. Show summary
Objectives: Female athletes engaging in high-impact sports have a higher prevalence of experiencing stress urinary incontinence (SUI). However, the prevalence of sport-specific SUI and associated risk factors in female rugby players is relatively unknown. We aimed to determine the prevalence of general and rugby-related SUI and identify associated risk factors and inciting events in female rugby players. Methods: Observational, cross-sectional study of 396 female rugby players (age 28±8 years, mass 80±18 kg, height 1.90±0.19m, playing years 7±6 years) participating in rugby across UK and Ireland completed an electronic questionnaire regardless of SUI status. Results: 63 to 88% of players had SUI, and 43% had rugby-related SUI. There was an association with players reporting a change in incontinence status due to playing rugby (p
Siafarikas, Franziska; Stær-Jensen, Jette; Reimers, Cathrine; Bø, Kari & Engh, Anna Marie Ellström (2024). Levator ani muscle avulsion and subsequent vaginal delivery: 8-year longitudinal follow-up. Ultrasound in Obstetrics and Gynecology. ISSN 0960-7692. doi: 10.1002/uog.27599. Show summary
Objectives: The aim of this study is to assess the evolution of levator avulsion from 1 year to 8 years after first delivery in women with subsequent vaginal deliveries compared to women without subsequent vaginal deliveries. Further, we aim to assess whether women with full and partial avulsion 8 years after first delivery have larger levator hiatus area and more symptoms of pelvic organ prolapse compared to women with normal levator insertion. Methods: In this single center longitudinal study 195 initially primiparous women were included and underwent transperineal ultrasound 1 year and 8 years after first delivery. Muscle insertion was assessed by tomographic ultrasound imaging in the axial plane. Full levator avulsion was defined as abnormal muscle insertion in all three central slices. Partial levator avulsion was defined as abnormal muscle insertion in one but less than three central slices. Eight years after first delivery levator hiatus area was assessed at rest, during maximum pelvic floor muscle contraction, and maximum Valsalva maneuver. To assess symptoms of pelvic organ prolapse the vaginal symptoms module from the International Consultation on Incontinence Questionnaire was used. Results: At 1 year follow-up, 25 women (12.8%) showed signs of avulsion, 20 women fulfilled sonographic criteria for full avulsion and 5 women fulfilled sonographic criteria for partial avulsion. Eight years after first delivery, 35 (17.9%) women were diagnosed with avulsion, of them 25 women were diagnosed with full avulsion and 10 women were diagnosed with partial avulsion. No women with partial and full avulsion at 1 year improved on their avulsion status at 8-year follow-up. In the subsequent vaginal delivery group, 21 women (14%) were diagnosed with partial and full levator avulsion 1 year after first delivery, and 31 women (20.7%) were diagnosed with partial and full avulsion 8 years after first delivery. Of the 45 women without subsequent vaginal delivery, one woman with partial avulsion 1 year after first delivery was diagnosed as full avulsion at 8-year follow-up. All women with full avulsion at 1-year follow-up were diagnosed as full avulsion at 8 years regardless of subsequent vaginal delivery. At 8-year follow-up women with full avulsion had statistically significant larger levator hiatus area compared to women with normal muscle insertion. Vaginal symptoms scores ranged between 5.5 (SD 5.7) and 6.0 (SD 4.0) and vaginal symptom quality of life scores ranged between 0.9 (SD 1.4) and 1.5 (SD 2.2) and did not differ statistically significantly between women with normal muscle insertion and women with partial and full avulsion at 8-year follow-up. Conclusion: More avulsions 8 years after first delivery compared to one year after first delivery were found in women with subsequent vaginal delivery. Except one primipara, none of the women without subsequent vaginal delivery changed on their levator status from 1 to 8 years after first delivery. Larger levator hiatus area was found in women with full avulsion compared to women with normal muscle insertion at 8-year follow-up. Vaginal symptoms scores were low and did not differ between women with normal muscle insertion, partial and full avulsion at 8-year follow-up.
Bø, Kari (2024). Is there evidence for pelvic floor muscle relaxation training in nonneurogenic female bladder outlet obstruction?—A narrative review. Neurourology and Urodynamics. ISSN 0733-2467. doi: 10.1002/nau.25241. Show summary
Introduction: Functional bladder outlet obstruction (BOO) in women ispostulated to be caused by pelvic floor muscle (PFM) dyssynergia or increased tone. The aim of the present review was to investigate the effect of PFM relaxation training on PFM tone and female BOO symptoms. Materials and Methods: This was a narrative review using an open searchstrategy on PubMed with the search terms “Bladder outlet obstruction” AND “female” AND (“pelvic floor muscles” OR “Kegel”). The risk of bias of the randomized controlled trials (RCTs) was scored with the Physiotherapy Evidence Database (PEDro) scale (0–10). Results: Only three RCTs were found. All three RCTs compared differenttypes of exercise, and no trial compared relaxation training with no or sham treatment. None of the trials reported the effect between groups on the reduction of PFM tone. There was a tendency toward positive effect of PFM relaxation training to improve BOO symptoms in women. PEDro score varied between 4 and 7. Few studies yielded information on the immediate effect ofany type of PFM relaxation technique on PFM tone. Conclusion: Few RCTs have been conducted on the effect of PFM relaxation training on PFM tone and functional female BOO symptoms. There is an urgent need for RCTs with high methodological and interventional quality in addition to basic research on mechanisms of different relaxation techniqueson PFM activity.
Risløkken, Jeanette; Macedo, Marthe Dalevoll; Bø, Kari; Engh, Anna Marie Ellström & Siafarikas, Franziska (2024). The severity of second-degree perineal tears and perineal pain during three months postpartum: A prospective cohort study. Midwifery. ISSN 0266-6138. 131. doi: 10.1016/j.midw.2024.103930. Full text in Research Archive
Deering, Rita E.; Donnelly, Gráinne; Brockwell, Emma; Bø, Kari; Davenport, Margie H & De Vivo, Marlize [Show all 12 contributors for this article] (2024). Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2023-107490. Show summary
Returning to running postpartum presents challenges such as musculoskeletal pain and pelvic floor dysfunction for some females, but there is little guidance on developing and progressing postpartum training programmes. This study aims to establish expert consensus recommendations on designing and modifying a postpartum return-to-running training programme, highlight costs and access to qualified professionals as potential barriers and discuss clinical, research and sports policy implications. A three-round Delphi survey of clinical and exercise professionals working with postpartum runners was conducted. Round I consisted of open-ended questions related to designing the training plan, modifications based on biopsychosocial factors, key muscle groups to train and referral and payment sources. Rounds II and III involved Likert-scale voting to identify consensus (≥75% agreement). 118 participants completed Round I, 107 completed Round II (response rate 90.6%) and 95 completed Round III (response rate 80.5%). Consensus was reached in 42/47 (89%) statements, including recommendations for a period of relative rest, gradual increases in duration and intensity, starting with a walk-run protocol and incorporating strength training. Training should be modified based on musculoskeletal or pelvic symptoms, sleep, mental health, lactation or energy availability concerns. Cost and access to experienced postpartum running professionals were identified as potential barriers for runners to receive care. Consensus recommendations for a postpartum return-to-running programme include an individualised exercise prescription, gradual increases in physical activity, walk-run protocols and targeted muscle strengthening. Further research and improved access to clinical and exercise professionals are needed to inform and facilitate best practices.
Jorge, Christine Homsi; Bø, Kari; Catai, Camila Chiazuta; Brito, Luiz gustavo Oliveira; Driusso, Patricia & Tennfjord, Merete Kolberg (2024). Pelvic floor muscle training as treatment for female sexual dysfunction: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology MFM (AJOG MFM). ISSN 2589-9333. doi: 10.1016/j.ajog.2024.01.001. Show summary
Objectives: To investigate the efficacy of pelvic floor muscle training (PFMT) in treating female sexual dysfunction. Data Sources: A systematic review of databases, including PubMed, Ovid Medline, CINAHL, Embase, BVSalud, Scopus, and Cochrane Library, was performed in July 2021 and updated in May 2023. Study eligibility criteria: Full-text articles of randomized controlled trials (RCTs) comparing PFMT and no intervention or another conservative treatment in at least one arm to improve women’s sexual function or treat sexual dysfunction were included. Study appraisal and synthesis methods: The data for this review was extracted and analyzed by two independent reviewers. Data on the characteristics of each intervention was extracted using the Consensus on Exercise Reporting Template (CERT). The risk of bias and certainty of evidence was assessed using the Physiotherapy Evidence Database (PEDro) scale and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria, respectively. A meta-analysis was conducted considering the post-treatment mean score difference of female sexual function index (FSFI) between the control and treatment groups. Results: Twenty-one RCTs were included in this review. The CERT revealed a varying quality of the PFMT protocols. Four studies were included in the meta-analysis showing that PFMT improved arousal (1.49; 95% confidence interval [CI]: 0.13 to 2.85), orgasm (1.55; 95%CI: 0.13 to 2.96), satisfaction (1.46; 95%CI: 0.14 to 2.77), pain (0.74; 95%CI: 0.11 to 1.37), and the FSFI overall score (7.67; 95%CI: 0.77 to 14.57). The GRADE showed a very low certainty of evidence due to the data’s high clinical and statistical heterogeneity. No side effects of the interventions were reported. Conclusion: This systematic review with meta-analysis showed that PFMT improved female FSFI total score and several subscales; however, the certainty of the evidence is low.
Christopher, Shefali Mathur; Donnelly, Gráinne; Brockwell, Emma; Bø, Kari; Davenport, Margie H & De Vivo, Marlize [Show all 12 contributors for this article] (2023). Clinical and exercise professional opinion of return-to-running readiness after childbirth: An international Delphi study and consensus statement. British Journal of Sports Medicine. ISSN 0306-3674. 58(6), p. 299–312. doi: 10.1136/bjsports-2023-107489. Show summary
Female athletes have identified a lack of guidance as a barrier to successfully returning to running postpartum, and existing guidelines are vague. Our aim was to define the current practice of determining postpartum run-readiness through a consensus survey of international clinicians and exercise professionals in postpartum exercise to assist clinicians and inform sport policy changes. A three-round Delphi approach was used to gain international consensus from clinicians and exercise professionals on run-readiness postpartum. Professionals who work with postpartum runners participated in an online survey to answer open-ended questions about the following postpartum return-to-running topics: definitions (runner and postpartum), key biopsychosocial milestones that runners need to meet, recommended screening, timeline to initiate running, support items, education topics and factors that contribute to advising against running. Consensus was defined as ≥75% participant agreement. One hundred and eighteen professionals participated in round I, 107 participated in round II (response rate 90.6%) and 95 participated in round III (response rate 80.5%). Responses indicated that, following a minimum 3-week period of rest and recovery, an individualised timeline and gradual return to running progression can be considered. Screening for medical and psychological concerns, current physical capacity, and prior training history is recommended prior to a return to running. This study proposes recommendations for the initial guidance on return-to-running postpartum, framed in the context of current research and consensus from professionals. Future research is needed to strengthen and validate specific recommendations and develop guidelines for best practice when returning-to-running after childbirth.
Zhang, Dingfeng; Bø, Kari; Montejo, Rocío; Sánchez-Polán, Miguel; Silva-José, Cristina & Palacio, Montse [Show all 7 contributors for this article] (2023). Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third- or fourth-degree perineal tear: Systematic review and meta-analysis of randomized clinical trials. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. doi: 10.1111/aogs.14744. Show summary
Introduction: The complex process of pregnancy and childbirth significantly influences the well-being of both mother and child. Today all pregnant women without medical contraindications are recommended to start or continue regular aerobic and strength training for at least 150 min per week to prevent pregnancy-related diseases and conditions. Urinary incontinence in pregnancy, episiotomy and third- or fourth-degree perineal tear during labor can greatly impact womens’ health, quality of life and ability to be physically active. The aim of this study was to examine the efficacy of pelvic floor muscle training (PFMT) during pregnancy in the prevention of urinary incontinence, episiotomy, and third- or fourth-degree perineal tear. Material and methods: A systematic review and meta-analysis (CRD42022370600) was performed. Only randomized clinical trials published between 2010 and 2023 were included. The following databases were examined: EBSCO (including Academic Search Premier, Education Resources Information Center, MEDLINE, SPORTDiscus and OpenDissertations databases), Clinicaltrials.gov, Web of Science, Scopus, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database (PEDro). Three meta-analyses to investigate the effect of PFMT exclusively or implemented as a section within a physical activity program during pregnancy on urinary incontinence, episiotomy, and third- or fourth-degree perineal tear were conducted. Results: Thirty studies were analyzed (N = 6691). An effective preventive action of PFMT was found for urinary incontinence (z = 3.46; p < 0.0005; relative risk [RR] = 0.72, 95% confidence interval [CI]: 0.59, 0.87, I2 = 59%) and third- or fourth-degree perineal tear (z = 2.89; p = 0.004; RR = 0.50, 95% CI: 0.31, 0.80, I2 = 48%) but not for episiotomy (z = 0.80; p = 0.42; RR = 0.95, 95% CI: 0.85, 1.07, I2 = 75%). Conclusions: PFMT during pregnancy proves to be an effective preventive intervention for reducing the risk of urinary incontinence and the occurrence of third- or fourth-degree perineal tears. These findings highlight the importance of incorporating PFMT into antenatal care and training programs to improve maternal well-being and overall childbirth outcomes.
Haakstad, Lene Annette Hagen; Benvenuti, Maria Beatrice; Dalhaug, Emilie Frederikke Mass & Bø, Kari (2023). Lumbopelvic pain and sick leave during pregnancy: A comparison of Italy and Norway. Women's Health.. ISSN 1745-5057. 19. doi: 10.1177/17455057231218197. Full text in Research Archive Show summary
Background: Pregnancy-related lumbopelvic pain is a frequently reported musculoskeletal disorder, but few studies have compared data between countries. Objectives: Examine prevalence, severity, and sick leave and explore potential risk factors associated with pregnancy-related lumbopelvic pain in Italian women and compare the results to a similar study in Norway, utilizing the same questionnaire. Design: Cross-sectional Methods: Italian (n = 481) and Norwegian women (n = 435) were allocated from two public hospitals in Rome (Fatebenefratelli San Giovanni Calibita-Isola Tiberina) and Oslo (Oslo University Hospital), as well as four antenatal clinics in Modena (Italy). The questionnaire was completed between gestation weeks 32 and 36, addressing women’s experiences of pregnancy-related lumbopelvic pain and sick leave in current week, and retrospectively for prepregnancy, first and second trimesters. Results: In Italy and Norway, 39% and 57% of pregnant women reported pregnancy-related lumbopelvic pain, respectively, with 11% and 25% experiencing severe pregnancy-related lumbopelvic pain. Pregnancy-related lumbopelvic pain was associated with sick leave in Norway (p < 0.01), but not in Italy (p = 0.66) at late gestation. In both countries, women with pregnancy-related lumbopelvic pain versus those with no pregnancy-related lumbopelvic pain were more likely to be multiparous (Italy: 40% versus 31%, p = 0.06 and Norway: 53% versus 38%, p < 0.01), and have gestational weight gain above guidelines (Italy: 21% versus 13%, p = 0.02% and Norway: 27% versus 14%, p < 0.01) and previous experience of pregnancy-related lumbopelvic pain (Italy: 15% versus 2%, p < 0.01 and Norway: 31% versus 4%, p < 0.01). Maternal exercise (⩾2 times weekly) was associated with less pregnancy-related lumbopelvic pain (Italy: odds ratio = 0.33, 95% confidence interval = 0.11–1.0, p = 0.05 and Norway: odds ratio = 0.55, 95% confidence interval = 0.29–1.0, p = 0.06). Conclusion: We observed high rates of pregnancy-related lumbopelvic pain in Italy and Norway, with Norwegian women reporting the highest prevalence and severity level. While both countries had similar rates of sick leave in late gestation, an association between pregnancy-related lumbopelvic pain and sick leave was observed among Norwegian women only. Health care providers should be proactive in addressing pregnancy-related lumbopelvic pain through open communication and seeking input from pregnant individuals. However, it is essential to acknowledge that the current evidence on effective treatments remains limited and inconclusive, highlighting the need for further research in this field.
Theodorsen, Nina-Margrethe Tennebekk; Moe-Nilssen, Rolf; Bø, Kari & Haukenes, Inger (2023). Effect of exercise on the inter-rectus distance in pregnant women with diastasis recti abdominis: an experimental longitudinal study. Physiotherapy. ISSN 0031-9406. 121, p. 13–20. doi: 10.1016/j.physio.2023.08.001. Full text in Research Archive Show summary
Objective: To investigate the effect of acute contraction of the pelvic floor muscles (PFM) and abdominal exercises on the inter-rectus distance (IRD) compared to resting values, and differences between gestation weeks 27 and 37, in pregnant women with diastasis recti abdominis (DRA). Design: Experimental longitudinal design. Setting: Physiotherapy clinic, primary health care. Participants: Thirty-eight pregnant women with DRA ≥ 2.8 cm. Interventions: Two-dimensional ultrasound images of IRD 2 cm above and below the umbilicus were taken at rest and during PFM and abdominal exercises at gestation week 27 and 37. Repeated measures analyses of variance (ANOVAs) with post hoc tests was performed for each exercise for both locations and timepoints. Main Outcome measures: Change in IRD. Results: There was a mean increase of the IRD from rest during a PFM contraction (2 mm, 95% CI: 2, 3), drawing-in (4 mm, 95% CI: 3, 5) and a combination of these (5 mm, 95% CI: 4, 6) There was a mean decrease of the IRD from rest during the headlift (-3 mm, 95% CI: -4, -2), the curl-up (-3 mm, 95% CI: -4, -2) and the diagonal curl up (-4 mm, 95% CI: -5, -3). Effect of time from gestation week 27 to 37 was a mean increase of 8 mm (95% CI: 6, 9). Conclusion: Pelvic floor and drawing-in exercise increased the IRD, whilst headlift, curl up and diagonal curl up decreased the IRD in pregnant women with DRA at gestation week 27 and 37.
Skaug, Kristina Lindquist; Engh, Anna Marie Ellström & Bø, Kari (2023). Acute Effect of Heavy Weightlifting on the Pelvic Floor Muscles in Strength-Trained Women: An Experimental Crossover Study. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 56(1), p. 37–43. doi: 10.1249/MSS.0000000000003275. Full text in Research Archive Show summary
Introduction/Purpose: Heavy lifting may produce strain on the pelvic floor muscles (PFM) due to high increases in intraabdominal pressure, but knowledge of the impact of weightlifting on the PFM is lacking. Therefore, this study aimed to investigate acute effects of heavy weightlifting on the PFM in strength-trained women and whether general strength in whole-body exercises correlated to PFM strength. Methods: Forty-seven nulliparous women between 18-35 years who regularly performed weightlifting and were able to lift their own body weight x 1.2 in back squat and 1.5 in deadlift were included in this experimental crossover study. They participated in baseline evaluations (questionnaire/measurements of background characteristics and pelvic floor disorders, 1 repetition maximum (1RM) tests in back squat and deadlift) and one test day where they were randomized to start with 60 minutes of weightlifting (4 sets of 4 repetitions at 75-85% of 1RM in back squat and deadlift) or seated rest of 60 minutes. Vaginal pressure measurements of PFM resting pressure, strength, and endurance and sEMG-measurements of PFM resting activity were performed before/after weightlifting and rest. Results: No statistically significant differences were found when comparing the change in PFM resting pressure, strength, endurance, and resting activity after heavy weightlifting and rest. There were no statistically significant correlations between PFM strength and maximum (1RM) or relative strength (1RM/bodyweight) in either back squat or deadlift. Conclusions: Our results imply that heavy weightlifting is well tolerated by the PFM in short-term among young, nulliparous, and strength-trained women. Strength in whole-body exercises was not correlated to PFM strength.
Moore, Isabel S.; Crossley, Kay M.; Bø, Kari; Mountjoy, Margo; Ackerman, Kathryn E. & Antero, Juliana da Silva [Show all 25 contributors for this article] (2023). Female athlete health domains: A supplement to the International Olympic Committee consensus statement on methods for recording and reporting epidemiological data on injury and illness in sport. British Journal of Sports Medicine. ISSN 0306-3674. 57(18), p. 1164–1174. doi: 10.1136/bjsports-2022-106620. Full text in Research Archive Show summary
The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan; (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) to female athlete health data. In May 2021, five researchers and clinicians with expertise in sports medicine, epidemiology and female athlete health convened to form a consensus working group, which identified key themes. Twenty additional experts were invited and an iterative process involving all authors was then used to extend the IOC consensus statement, to include issues which affect female athletes. Ten domains of female health for categorising health problems according to biological, life stage or environmental factors that affect females in sport were identified: menstrual and gynaecological health; preconception and assisted reproduction; pregnancy; postpartum; menopause; breast health; pelvic floor health; breast feeding, parenting and caregiving; mental health and sport environments. This paper extends the IOC consensus statement to include 10 domains of female health, which may affect female athletes across the lifespan, from adolescence through young adulthood, to mid-age and older age. Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies.
Farag, Fawzy; Sakalis, Vasileios I.; Arteaga, Serenella Monagas; Sihra, Néha; Karavitakis, Markos & Arlandis, Salvador [Show all 20 contributors for this article] (2023). What Are the Short-term Benefits and Potential Harms of Therapeutic Modalities for the Management of Overactive Bladder Syndrome in Women? A Review of Evidence Under the Auspices of the European Association of Urology, Female Non-neurogenic Lower Urinary Tract Symptoms Guidelines Panel. European Urology. ISSN 0302-2838. 84(3), p. 302–312. doi: 10.1016/j.eururo.2023.05.014. Show summary
Context: Overactive bladder syndrome (OAB) is highly prevalent among women and has a negative impact on their quality of life. The current available treatments for OAB symptoms include conservative, pharmacological, or surgical modalities. Objective: To provide an updated contemporary evidence document regarding OAB treatment options and determine the short-term effectiveness, safety, and potential harms of the available treatment modalities for women with OAB syndrome. Evidence acquisition: The Medline, Embase, and Cochrane controlled trial databases and clinicaltrial.gov were searched for all relevant publications up to May 2022. The risk of bias assessment followed the recommended tool in the Cochrane Handbook for Systematic Reviews of Interventions, and quality of evidence was assessed using the modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A meta-analysis was performed where appropriate. Evidence synthesis: Antimuscarinics and beta-3 agonists were significantly more effective than placebo across most outcomes, with beta-3 agonists being more effective at reducing nocturia episodes and antimuscarinics causing significantly higher adverse events. Onabotulinumtoxin-A (Onabot-A) was more effective than placebo across most outcomes, but with significantly higher rates of acute urinary retention/clean intermittent self-catheterisation (six to eight times) and urinary tract infections (UTIs; two to three times). Onabot-A was also significantly better than antimuscarinics in the cure of urgency urinary incontinence (UUI) but not in the reduction of mean UUI episodes. Success rates of sacral nerve stimulation (SNS) were significantly higher than those of antimuscarinics (61% vs 42%, p = 0.02), with similar rates of adverse events. SNS and Onabot-A were not significantly different in efficacy outcomes. Satisfaction rates were higher with Onabot-A, but with a higher rate of recurrent UTIs (24% vs 10%). SNS was associated with 9% removal rate and 3% revision rate. Conclusions: Overactive bladder is a manageable condition, with first-line treatment options including antimuscarinics, beta-3 agonists, and posterior tibial nerve stimulation. Second-line options include Onabot-A bladder injections or SNS. The choice of therapies should be guided by individual patient factors. Patient summary: Overactive bladder is a manageable condition. All patients should be informed and advised on conservative treatment measures in the first instance. The first-line treatment options for its management include antimuscarinics or beta-3 agonists medication, and posterior tibial nerve stimulation procedures. The second-line options include onabotulinumtoxin-A bladder injections or sacral nerve stimulation procedure. The therapy should be chosen based on individual patient factors.
Gluppe, Sandra L.; Engh, Anna Marie Ellström & Bø, Kari (2023). Curl-up exercises improve abdominal muscle strength without worsening inter-recti distance in women with diastasis recti abdominis postpartum: a randomised controlled trial. Journal of Physiotherapy. ISSN 1836-9553. 69(3), p. 160–167. doi: 10.1016/j.jphys.2023.05.017. Full text in Research Archive Show summary
Question: What is the effect of a 12-week, home-based, abdominal exercise program containing head lifts and abdominal curl-ups on inter-recti distance (IRD) in women with diastasis recti abdominis (DRA) 6 to 12 months postpartum? What is the effect of the program on: observed abdominal movement during a curl-up; global perceived change; rectus abdominis thickness; abdominal muscle strength and endurance; pelvic floor disorders; and low back, pelvic girdle and abdominal pain? Design: This was a two-arm, parallel-group, randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants: Seventy primiparous or multiparous women 6 to 12 months postpartum, having a single or multiple pregnancy following any mode of delivery, with a diagnosis of DRA (IRD > 28 mm at rest or > 25 mm during a curl-up). Intervention: The experimental group was prescribed a 12-week standardised exercise program including head lifts, abdominal curl-ups and twisted abdominal curl-ups 5 days a week. The control group received no intervention. Outcome measures: The primary outcome measure was change in IRD measured with ultrasonography. Secondary outcomes were: observed abdominal movement during a curl-up; global perceived change; rectus abdominis thickness; abdominal muscle strength and endurance; pelvic floor disorders; and low back, pelvic girdle and abdominal pain. Results: The exercise program did not improve or worsen IRD (eg, MD 1 mm at rest 2 cm above the umbilicus, 95% CI –1 to 4). The program improved rectus abdominis thickness (MD 0.7 mm, 95% CI 0.1 to 1.3) and strength (MD 9 Nm, 95% CI 3 to 16) at 10 deg; its effects on other secondary outcomes were trivial or unclear. Conclusion: An exercise program containing curl-ups for women with DRA did not worsen IRD or change the severity of pelvic floor disorders or low back, pelvic girdle or abdominal pain, but it did increase abdominal muscle strength and thickness.
Bø, Kari; Driusso, Patricia & Jorge, Cristine Homsi (2023). Can you breathe yourself to a better pelvic floor? A systematic review. Neurourology and Urodynamics. ISSN 0733-2467. 42(6), p. 1261–1276. doi: 10.1002/nau.25218. Full text in Research Archive Show summary
Introduction: Some authors suggest that breathing exercises should be recommended instead of or in combination with pelvic floor muscle training (PFMT) to prevent and treat urinary incontinence (UI) and pelvic organ prolapse (POP). Aims: The primary aim of the present study was to investigate the evidence for breathing as an intervention alone or in addition to PFM contraction in treatment of UI and POP. Materials & Methods: This systematic review included short-term experimental studies and randomize controlled trials (RCTs) indexed on PubMed, EMBASE, and PEDro database. A form was used to extract data that was analyzed qualitatively due to the heterogeneity in interventions and outcome measures of the included studies. The individual methodological quality of RCTs was analyzed using the PEDro scale. Results: A total of 18 studies were included, 374 participants from short-term experimental studies and 765 from nine RCTs. PEDro score varied from 4 to 8. Activation of the PFM during expiration was significantly less than during a PFM contraction. In general, the RCTs showed that training the PFM is significantly more effective to improve PFM variables and UI and POP than breathing exercises, and that adding breathing exercises to PFMT have no additional effect. Conclusion: This systematic review indicates that the evidence for incorporating breathing exercise in clinical practice in addition to or instead of PFMT is scant or non-existing, both based on short-term experimental studies and small RCTs.
Mota, Patrícia; Theodorsen, Nina-Margrethe Tennebekk; Gluppe, Sandra L. & Bø, Kari (2023). On "The Impact of Hypopressive Abdominal Exercise on Linea Alba Morphology in Women Who Are Postpartum: A Short-Term Cross-Sectional Study." Arranz-Martín B, Navarro-Brazález B, Sánchez-Sánchez B, McLean L, Carazo-Díaz C, Torres-Lacomba M. Phys Ther. 2022;102:pzac086. https://doi.org/10.1093/ptj/pzac086. Physical Therapy. ISSN 0031-9023. 103(4). doi: 10.1093/ptj/pzad018.
Ramachandra, Preetha; Kumar, Pratap; Bø, Kari & Maiya, G. Arun (2023). Comparison of static postural sway characteristics between pregnant and non-pregnant women. Journal of Biomechanics. ISSN 0021-9290. 154. doi: 10.1016/j.jbiomech.2023.111618. Show summary
The present study aimed to compare the postural sway between pregnant and non-pregnant women during eight different sensory conditions including those in which vision, proprioception, and base of support are compromised. Forty primigravidae at the 32nd week of pregnancy and forty non-pregnant women who were matched for age and anthropometric measurements participated in this cross-sectional comparison study. Static posturography equipment was used to record the anteroposterior sway velocity, mediolateral sway velocity, and velocity moment during normal stance and when vision, proprioception, and base of support were compromised. Pregnant women (mean age: 25.4) demonstrated a larger median velocity moment and mean anteroposterior sway velocity compared to non–pregnant women (mean age:24.4) across all tested sensory conditions (p<0.05). Although mediolateral sway velocity did not show any statistically significant difference, the ANCOVA results suggested that there was a statistically significant difference in mediolateral sway velocity in Eyes open feet apart condition on the firm surface [F (1,77, p=0.030, ηp2=0.121] and Eyes closed feet apart condition on the firm surface [F (1,77, p=0.015, ηp2=0.15] between pregnant and non-pregnant women. There was a larger velocity moment and anteroposterior postural sway velocity in pregnant women in their third trimester compared to non-pregnant women when exposed to different sensory conditions.
Mota, Patrícia; Costa, Ana; Santos, Diana; Santo, Susana; Barros, Joana G. & Bø, Kari (2023). Pelvic floor muscle function after grade II tears—Surface electromyography test–retest and differences between nulliparous and primiparous. Neurourology and Urodynamics. ISSN 0733-2467. 42(5), p. 1162–1168. doi: 10.1002/nau.25180. Full text in Research Archive Show summary
Background: Vaginal birth is a risk factor for weakening of the pelvic floor muscles (PFM) and development of pelvic floor dysfunction (PFD). Perineal tears may decrease PFM function. PFM tone can be assessed with surface EMG (sEMG), but reliability studies of sEMG in women with perineal tears are lacking. The aims of this study were to evaluate test–retest and intrarater reliability of sEMG and compare PFM activation between nulliparous and primiparous. Methods: A sEMG test–retest was performed in 21 women (12 nulliparous and 9 primiparous with grade II tears) to assess intra-rater reliability during rest and maximal voluntary contraction (MVC) of the PFM. Intraclass Correlation Coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were tested. A comparison between nulliparous' and primiparous' PFM activation during rest and MVC was performed. Results: sEMG demonstrated fair reliability in nulliparous (ICC: 0.239; SEM: 5.2; MDC: 14.5) and moderate reliability in primiparous (ICC: 0.409; SEM: 1.5; MDC: 4.2) during rest. For peak MVC very good intrarater reliability was found in nulliparous (ICC: 0.92; SEM: 8.0; MDC: 22.2) and in primiparous (ICC: 0.823; SEM: 8.0; MDC: 22.2). Statistically significant lower PFM activation was found in primiparous women with perineal tear grade II than in nulliparous at rest (mean difference 9.1 µV, 95% confidence interval [CI] 3.0–19.0, p = 0.001), and during MVCpeak (mean difference 50.0 µV, 95% CI 10.0–120.0 p = 0.021). Conclusions: sEMG is reliable when measuring PFM activation in primiparous women with perineal tears grade II. Women with perineal tears grade II have lower PFM activation both during rest and MVC.
Sigurdardottir, Thorgerdur; Steingrimsdóttir, Thora; Geirsson, Reynir T.; Halldorsson, Thorhallur I.; Aspelund, Thor & Bø, Kari (2023). Postpartum pelvic organ prolapse and pelvic floor muscle training: secondary analysis of a randomized controlled trial of primiparous women. International Urogynecology Journal. ISSN 0937-3462. 34, p. 1319–1326. doi: 10.1007/s00192-023-05502-8. Full text in Research Archive Show summary
Introduction and Hypothesis: Pelvic floor dysfunction is common after childbirth. We hypothesize that physiotherapist-guided pelvic floor muscle training (PFMT) is effective regarding pelvic organ prolapse (POP) symptoms during the first postpartum year. Methods: This was a secondary analysis from a randomized controlled trial (RCT), carried out at a physiotherapy clinic, Reykjavik. Participants were eighty-four primiparous women with a singleton delivery. They were screened for eligibility 6–13 weeks postpartum. Women in a training group conducted 12 weekly individual sessions with a physiotherapist within an RCT, starting on average 9 weeks postpartum. Outcomes were assessed after the last session (short term) and at approximately 12 months postpartum (long term). The control group received no instructions after the initial assessment. Main outcome measures were self-evaluated POP symptoms by the Australian Pelvic Floor Questionnaire. Results: Forty-one and 43 women were in the training and control groups, respectively. At recruitment, 17 (42.5%) of the training group and 15 (37%) of the control group reported prolapse symptoms (p = 0.6). Five (13%) from the training group and nine (21%) controls were bothered by the symptoms (p = 0.3). There was a gradual decrease in the number of women with symptoms and no significant short-term (p = 0.08) or long-term (p = 0.6) differences between the groups regarding rates of women with POP symptoms. The difference between groups regarding bother in the short (p = 0.3) or longer term (p = 0.4) was not significant. Repeated-measures analyses using Proc Genmod in SAS did not indicate a significant effect of the intervention over time (p > 0.05). Conclusions: There was an overall decrease in postpartum symptoms of POP and bother during the first year. Physiotherapist-led PFMT did not change the outcomes.
Bø, Kari; Anglès-Acedo, Sònia; Batra, Achla; Brækken, Ingeborg Hoff; Chan, Yi Ling & Jorge, Cristine Homsi [Show all 9 contributors for this article] (2023). Strenuous physical activity, exercise, and pelvic organ prolapse: a narrative scoping review. International Urogynecology Journal. ISSN 0937-3462. 34, p. 1153–1164. doi: 10.1007/s00192-023-05450-3. Full text in Research Archive Show summary
Introduction and hypothesis: High-intensity physical activity and exercise have been listed as possible risk factors for pelvic organ prolapse (POP). The aim of the present study is to conduct a literature review on the prevalence and incidence of POP in women who engage in regular physical activity. In addition, we review the effects of a single exercise or a single session of exercise on pelvic floor support. Finally, the effect of exercises on POP in the early postpartum period is reviewed. Methods: This is a narrative scoping review. We searched PubMed and Ovid Medline, the Physiotherapy Evidence Database (PEDro), and the Cochrane Database of Systematic Reviews up to May 2022 with the following MeSH terms: “physical activity” AND “exercise” AND “pelvic floor” AND “pelvic organ prolapse”. Results: Eight prevalence studies were retrieved. Prevalence rates of symptomatic POP varied between 0 (small study within different sports) and 23% (Olympic weightlifters and power lifters). Parity was the only factor associated with POP in most studies. Three studies evaluated the pelvic floor after a single exercise or one session of exercise and found increased vaginal descent or increased POP symptoms. One prospective cohort study reported the development of POP after 6 weeks of military parashot training, and one randomized trial reported increased POP symptoms after transverse abdominal training. There is scant knowledge on exercise and POP in the postpartum period. Conclusions: Prevalence of POP in sports varies widely. Experimental and prospective studies indicate that strenuous exercise increased POP symptoms and reduced pelvic floor support.
Bø, Kari (2023). Pelvic floor muscle training with and without biofeedback for urinary incontinence and pelvic organ prolapse. In Azadi, Ali; Cornella, Jeffery L.; Dwyer, Peter & Felicia, Lane L. (Ed.), Ostergard’s Textbook of Urogynecology. Wolters Kluwer. ISSN 9781975162337. p. 244–250.
Hilde, Gunvor; Stær-Jensen, Jette; Siafarikas, Franziska; Engh, Anna Marie Ellström & Bø, Kari (2022). Postpartum pelvic floor muscle training, levator ani avulsion and levator hiatus area: a randomized trial. International Urogynecology Journal. ISSN 0937-3462. p. 1–11. doi: 10.1007/s00192-022-05406-z. Full text in Research Archive Show summary
Introduction and hypothesis Vaginal delivery may lead to tearing of the levator ani (LA) muscle from its bony insertions (complete LA avulsion) and increased levator hiatus (LH) area, both risk factors for pelvic foor dysfunctions. Early active rehabilitation is standard treatment after musculo-skeletal injury. We hypothesized that pelvic foor muscle training (PFMT) early postpartum would reduce the presence of LA avulsions and reduce LH area. Methods We carried out a planned secondary analysis from a randomized controlled study. Primiparous women (n=175) giving birth vaginally were included 6 weeks postpartum, stratifed on complete LA avulsion, and thereafter randomized to PFMT or control. The training participants (n=87) attended a supervised PFMT class once a week and performed home-based PFMT daily for 16 weeks. The control participants (n=88) received no intervention. Presence of complete LA avulsion, LH area at rest, maximal contraction, and maximal Valsalva maneuver were assessed by transperineal ultrasound. Betweengroup comparisons were analyzed by analysis of covariance for continuous data, and relative risk (RR) for categorical data. Results Six months postpartum, the number of women who had complete LA avulsion was reduced from 27 to 14 within the PFMT group (44% reduction) and from 28 to 17 within the control group (39% reduction). The between-group diference was not signifcant, RR 0.85 (95% CI 0.53 to 1.37). Further, no signifcant between-group diferences were found for LH area at rest, during contraction, or Valsalva. Conclusions Supervised PFMT class combined with home exercise early postpartum did not reduce the presence of complete LA avulsion or LH area more than natural remission.
Bø, Kari; Anglès‑Acedo, Sònia; Batra, Achla; Brækken, Ingeborg Hoff; Chan, Yi Ling & Jorge, Cristine Homsi [Show all 9 contributors for this article] (2022). Are hypopressive and other exercise programs effective for the treatment of pelvic organ prolapse? International Urogynecology Journal. ISSN 0937-3462. 34(1), p. 43–52. doi: 10.1007/s00192-022-05407-y. Full text in Research Archive Show summary
Introduction and hypothesis: Pelvic floor muscle training (PFMT) is effective for the treatment of pelvic organ prolapse (POP), but other exercise programs have also been promoted and used. The aim of this review was to evaluate the effect of hypopressive and other exercise programs besides PFMT for POP. Methods: A literature search was conducted on Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro, and Scopus databases from January 1996 to 30 December 2021. Only randomized controlled trials (RCTs) were included. The keywords were combinations of “pelvic organ prolapse” or “urogenital prolapse,” and “exercise therapy,” “hypopressive exercise,” “Kegel,” “pelvic floor muscle training,” “pelvic floor muscle exercises,” “Pilates,” “treatment,” “yoga,” “Tai Chi.” Methodological quality was assessed using the PEDro rating scale (0–10). Results: Seven RCTs containing hypopressive exercise, yoga or breathing and hip muscle exercises in an inverted position were retrieved and analyzed. PEDro score ranged from 4 to 7. There was no additional effect of adding hypopressive exercise to PFMT, and PFMT was more effective than hypopressive exercise alone. The studies that included the term “yoga” included regular PFMT and thus can be classified as PFMT. Hip exercises in an inverted position added to PFMT vs PFMT alone showed better improvement in some secondary outcomes but not in the primary outcome, POP stage. Conclusions: There are few RCTs assessing the effects of other exercise programs besides PFMT in the treatment of POP. To date, there is no evidence that other exercise programs are more effective than PFMT for POP.
Gluppe, Sandra L.; Engh, Anna Marie Ellström & Bø, Kari (2022). Primiparous women’s knowledge of diastasis recti abdominis, concerns about abdominal appearance, treatments, and perceived abdominal muscle strength 6–8 months postpartum. A cross sectional comparison study. BMC Women's Health. ISSN 1472-6874. 22, p. 1–11. doi: 10.1186/s12905-022-02009-0. Full text in Research Archive Show summary
Background: Diastasis recti abdominis (DRA) is a prevalent condition in the postpartum period. To date, there is scant knowledge on how DRA influences physical, mental, and emotional health. This study investigates primiparous women`s knowledge about DRA, concerns about abdominal appearance, and perceived abdominal muscle strength, comparing women with and without reported DRA. Methods: This was a cross-sectional comparison study. Data were collected by a web-based questionnaire, mainly through social media in Norway. To be included in the study women had to be primiparous 6–8 months postpartum. The questionnaire contained questions regarding women`s knowledge about DRA, perceived protrusion, received treatment, concerns with abdominal appearance and muscle strength. Abdominal body image was measured through the shape concern questions from The Eating Disorder Examination questionnaire (EDE-Q 6.0). Demographic and other descriptive variables are presented as means with standard deviations (SD) or as frequencies with percentages. Chi-square test of independence and independent sample t-tests were used to compare differences between women with and without abdominal protrusion for categorical and continuous variables, respectively. Results: Our sample consisted of 460 women. Knowledge about DRA was reported by 415/440 (94.3%) women. A total of 73.3% reported to have been worried during pregnancy about abdominal appearance postpartum. Mean degree of concern about present abdominal appearance was 5.5/10 (SD 2.4). Almost 80% experienced weaker abdominal muscles than pre-pregnancy. Ninety-six women (20.9%) reported a protrusion along the midline of their abdomen. Significantly more women with protrusion reported weaker abdominal muscles than women without protrusion. The most frequent treatment women with protrusion reported were exercises for the abdominal muscles (92.6%). Mean score on the EDE-Q, shape concern questions, was higher in women with reported protrusion (mean score: 2.37 (SD 1.6) than women without protrusion (mean score: 2.14 (SD 1.4), p = 0.175. Conclusion: Primiparous women are concerned about abdominal appearance both during pregnancy and after birth. Those reporting abdominal protrusion are less satisfied with their abdominal appearance and they report weaker abdominal muscles than women without protrusion. This study may contribute to improved knowledge about women`s health concerns, and assessment of DRA should be part of routine follow-up of postpartum women.
Bø, Kari; Næss, Karoline; Stær-Jensen, Jette; Siafarikas, Franziska; Engh, Anna Marie Ellström & Hilde, Gunvor (2022). Recovery of pelvic floor muscle strength and endurance 6 and 12 months postpartum in primiparous women—a prospective cohort study. International Urogynecology Journal. ISSN 0937-3462. 33(12), p. 3455–3464. doi: 10.1007/s00192-022-05334-y. Full text in Research Archive Show summary
Introduction and hypothesis: To date there has been scant knowledge on the natural recovery of the pelvic floor muscles (PFMs) after childbirth. The aims of the present study were to investigate whether PFM variables at 6 and 12 months postpartum had returned to mid-pregnancy levels and assess risk factors for reduced recovery at 12 months postpartum. Methods: This was a prospective cohort study following 235 nulliparous pregnant women from mid-pregnancy to 12 months postpartum. Vaginal resting pressure (VRP), PFM strength and endurance were assessed by manometry at 22 weeks, 6 and 12 months postpartum. Multiple linear regression was used to address factors influencing PFM variables beyond birth mode. Results: Cesarean section was protective for change in PFM variables. From mid-pregnancy to 12 months postpartum there was a 20% reduction in VRP (p<0.001) and a 7.5 % reduction in PFM strength (p=0.007), and an increase of 9% in PFM endurance (p=0.002) in the normal vaginal birth. The instrumental vaginal group had a decline in VRP of 21% (p<0.001) and PFM strength of 15% (p=0.011), but no significant change in PFM endurance. Higher BMI at 12 months postpartum, longer second stage of labor, and major tears of the levator ani muscle had a negative influence on the PFM recovery beyond delivery mode. Conclusions: At 12 months postpartum following vaginal delivery, the PFMs are not fully recovered compared with mid-pregnancy values. More follow-up physical therapy may be warranted in the postpartum period, especially for women with complicated vaginal births and higher BMI.
Culleton-Quinn, Elizabeth; Bø, Kari; Fleming, Neil; Mockler, David; Cusack, Cinny & Daly, Deirdre (2022). Elite female athletes’ experiences of symptoms of pelvic floor dysfunction: A systematic review. International Urogynecology Journal. ISSN 0937-3462. 33(10), p. 2681–2711. doi: 10.1007/s00192-022-05302-6. Full text in Research Archive Show summary
Introduction and aims: Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and conditions affecting the pelvic floor and urinary incontinence (UI) is the most common type of PFD. Recent systematic reviews have indicated a higher prevalence of UI among female athletes compared to their non-athletic counterparts. To date, no review has been undertaken to investigate female athletes’ experiences of PFD. This review aims to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report elite female athletes’ experiences of symptoms of PFD. Methods: The review protocol was registered in PROSPERO in August 2020. A systematic search was conducted in Embase, MEDLINE (OVID), Cochrane Library, CINAHL, PsycINFO and Web of Science for studies published in the English language reporting elite female athletes’ experiences of symptoms of PFD. This review included primary research studies that involved elite female athletes of any age or ethnicity. Results: Of the 1922 citations retrieved in the search, 32 studies met the methodological criteria for data extraction and analysis. Five main themes emerged: (1) triggers for symptoms of PFD; (2) strategies adopted by athletes to manage/mitigate symptoms of PFD; (3) impact on QOL/daily life; (4) impact on performance; (5) impact on emotions. Conclusions: The findings of this review suggest a need to further explore the experiences of PFD among elite female athletes and it is suggested that future research should adopt qualitative methods or incorporate a qualitative component.
Bø, Kari; Anglès-Acedo, Sònia; Batra, Achla; Brækken, Ingeborg Hoff; Chan, Yi Ling & Jorge, Cristine Homsi [Show all 9 contributors for this article] (2022). International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training. International Urogynecology Journal. ISSN 0937-3462. 33(10), p. 2633–2667. doi: 10.1007/s00192-022-05324-0. Full text in Research Archive Show summary
Introduction and hypothesis: This manuscript from Chapter 3 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) describes the current evidence and suggests future directions for research on the effect of pelvic floor muscle training (PFMT) in prevention and treatment of POP. Methods: An international group of four physical therapists, four urogynecologists and one midwife/basic science researcher performed a search of the literature using pre-specified search terms on randomized controlled trials (RCTs) in Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro and Scopus databases for publications between 1996 and 2021. Full publications or expanded abstracts in English or in other languages with abstracts in English were included. The PEDro rating scale (0–10) was used to evaluate study quality. Included RCTs were reviewed to summarize the evidence in six key sections: (1) evidence for PFMT in prevention of POP in the general female population; (2) evidence for early intervention of PFMT in the peripartum period for prevention and treatment of POP; (3) evidence for PFMT in treatment of POP in the general female population; (4) evidence for perioperative PFMT; (5) evidence for PFMT on associated conditions in women with POP; (6) evidence for the long-term effect of PFMT on POP. Full publications in English or in other languages with abstracts in English and expanded abstracts presented at international condition specific societies were included. Internal validity was examined by the PEDro rating scale (0–10). Results: After exclusion of duplicates and irrelevant trials, we classified and included 2 preventive trials, 4 trials in the post-partum period, 11 treatment trials of PFMT for POP in the general female population in comparison with no treatment or lifestyle interventions, 10 on PFMT as an adjunct treatment to POP surgery and 9 long-term treatment trials. Only three treatment studies compared PFMT with the use of a pessary. The RCTs scored between 4 and 8 on the PEDro scale. No primary prevention studies were found, and there is sparse and inconsistent evidence for early intervention in the postpartum period. There is good evidence/recommendations from 11 RCTs that PFMT is effective in reducing POP symptoms and/or improving POP stage (by one stage) in women with POP-Q stage I, II and III in the general female population, but no evidence from 9/10 RCTs that adding PFMT pre- and post -surgery for POP is effective. There are few long-term follow-up studies, and results are inconsistent. There are no serious adverse effects or complications reported related to PFMT. Conclusions: There are few studies on prevention and in the postpartum period, and the effect is inconclusive. There is high-level evidence from 11 RCTs to recommend PFMT as first-line treatment for POP in the general female population. PFMT pre- and post-POP surgery does not seem to have any additional effect on POP. PFMT is effective and safe but needs thorough instruction and supervision to be effective.
Siafarikas, Franziska; Halle, Tuva Kristine Toresdatter; Saltyte Benth, Jurate; Stær-Jensen, Jette; Reimers, Cathrine & Bø, Kari [Show all 7 contributors for this article] (2022). Pelvic floor symptoms from first pregnancy up to 8 years after the first delivery: a longitudinal study. American Journal of Obstetrics and Gynecology. ISSN 0002-9378. 227(4), p. 613.e1–613.e15. doi: 10.1016/j.ajog.2022.06.020. Show summary
Background: Despite the strong association between vaginal childbirth and pelvic floor dysfunction, genetic factors, pregnancy, advancing age, and lifestyle also play a role. The pelvic floor undergoes substantial changes during pregnancy which may contribute to pelvic floor dysfunction. On the other hand, these changes may be favorable to allow for vaginal delivery. However, there is a lack of studies assessing pelvic floor symptoms over time according to delivery mode, which includes women prior to delivery. Objective: The aim of this study was to describe urinary incontinence, vaginal symptoms, and bowel control symptoms from 21 weeks of gestation in the first pregnancy and up to 8 years after the first delivery, stratified by delivery mode. Study design: This is a longitudinal observational cohort study. 300 nulliparous women were recruited during their first pregnancy. Pelvic floor symptoms were assessed at 21 and 37 weeks of gestation, and 6 weeks, 6 months, 12 months and 8 years after first delivery using the International Consultation on Incontinence Questionnaire (ICIQ) modules: the urinary incontinence sum score; the weighted vaginal symptom sum score; the vaginal-associated quality of life score; the bowel control sum score; and the bowel-associated quality of life sum score. Delivery mode at first delivery defined delivery groups as: normal vaginal, operative vaginal and cesarean delivery. A linear mixed model analysis was used to assess symptom scores over time and to assess the differences in symptom scores between the delivery groups. Results: Of the 300 women included in the study, of which 193 attended the 8-year follow-up. Pelvic floor symptoms differed in women with vaginal and cesarean delivery. The symptom scores showed a non-linear statistically significant trend. In women, who delivered vaginally, there was an increase of urinary incontinence and vaginal symptom scores already during pregnancy. In women, who later delivered by cesarean, there was a decrease of symptoms scores during pregnancy, and overall lower symptom scores compared to women with vaginal delivery until 12 months after first delivery. Pelvic floor symptoms scores increased from 12 months to 8 years after the first delivery and exceeded pregnancy levels in all delivery groups, however overall symptom scores were low. Differences between delivery groups were not statistically significant. Conclusion: Pelvic floor symptoms differed in women with vaginal and cesarean delivery from the first pregnancy up to 8 years after the first delivery. These differences were recognizable already prior to first delivery.
Arlandis, Salvador; Bø, Kari; Cobussen-Boekhorst, Hanny; Costantini, Elisabetta; de Heide, Monica & Farag, Fawzy [Show all 24 contributors for this article] (2022). European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia. European Urology. ISSN 0302-2838. 82(1), p. 60–70. doi: 10.1016/j.eururo.2022.01.044. Show summary
Context: Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guidelines expand the remit to include these symptoms and conditions. Objective: To summarise the management of underactive bladder (UAB), bladder outlet obstruction (BOO), and nocturia in females. Evidence acquisition: The literature search was updated in September 2021 and evidence synthesis was conducted using modified GRADE approach as outlined for all EAU guidelines. A new systematic review on BOO was carried out by the panel for purposes of this guideline. Evidence synthesis: The important considerations for informing guideline recommendations are presented, along with a summary of all the guideline recommendations. Conclusions: Non-neurogenic female LUTS are an important presentation of urological dysfunction. Initial evaluation, diagnosis, and management should be carried out in a structured and logical fashion on the basis of the best available evidence. This guideline serves to present this evidence to practising urologists and other health care providers in an easily accessible and digestible format.
Theodorsen, Nina-Margrethe Tennebekk; Fersum, Kjartan Vibe; Moe-Nilssen, Rolf; Bø, Kari & Haukenes, Inger (2022). Effect of a specific exercise programme during pregnancy on diastasis recti abdominis: study protocol for a randomised controlled trial. BMJ Open. ISSN 2044-6055. 12(2). doi: 10.1136/bmjopen-2021-056558.
Nambiar, Arjun K.; Arlandis, Salvador; Bø, Kari; Cobussen-Boekhorst, Hanny; Costantini, Elisabetta & de Heide, Monica [Show all 24 contributors for this article] (2022). European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence. European Urology. ISSN 0302-2838. 82(1), p. 49–59. doi: 10.1016/j.eururo.2022.01.045. Show summary
Context: Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guideline expands the remit to include these symptoms and conditions. Objective: To summarise the diagnostic section of the non-neurogenic female LUTS guideline and the management of female overactive bladder (OAB), stress urinary incontinence (SUI), and mixed urinary incontinence (MUI). Evidence acquisition: New literature searches were carried out in September 2021 and evidence synthesis was conducted using the modified GRADE criteria as outlined for all EAU guidelines. A new systematic review (SR) on OAB was carried out by the panel for the purposes of this guideline. Evidence synthesis: The important considerations for informing guideline recommendations are presented, along with a summary of all the guideline recommendations. Conclusions: Non-neurogenic female LUTS are an important cause of urological dysfunction. Initial evaluation, diagnosis, and management should be carried out in a structured and logical fashion based on the best available evidence. This guideline serves to present this evidence to health care providers in an easily accessible and digestible format.
Barcellini, Amelia; Dominoni, Mattia; Mas, Francesca Dal; Biancuzzi, Helena; Venturini, Sara Carla & Gardella, Barbara [Show all 8 contributors for this article] (2022). Sexual Health Dysfunction After Radiotherapy for Gynecological Cancer: Role of Physical Rehabilitation Including Pelvic Floor Muscle Training. Frontiers in medicine. ISSN 2296-858X. 8. doi: 10.3389/fmed.2021.813352. Full text in Research Archive Show summary
Introduction: The present study aims to describe: 1. How the side effects of radiotherapy (RT) could impact sexual health in women; 2. The effectiveness of physical rehabilitation including pelvic floor muscle training (PFMT) in the management of sexual dysfunction after RT. Materials and Methods: Search keys on PubMed, Web of Science, Scopus, PEDro, and Cochrane were used to identify studies on women treated with radical or adjuvant RT and/or brachytherapy for gynecological cancers with an emphasis on vulvo-vaginal toxicities and PFMT studies on sexual dysfunction for this group of women. Results: Regarding the first key question, we analyzed 19 studies including a total of 2,739 women who reported vaginal dryness, stenosis, and pain as the most common side effects. Reports of dosimetric risk factors and dose-effect data for vaginal and vulvar post-RT toxicities are scant. Only five studies, including three randomized controlled trials (RCTs), were found to report the effect of PFMT alone or in combination with other treatments. The results showed some evidence for the effect of training modalities including PFMT, but to date, there is insufficient evidence from high-quality studies to draw any conclusion of a possible effect. Conclusions: Gynecological toxicities after RT are common, and their management is challenging. The few data available for a rehabilitative approach on post-actinic vulvo-vaginal side effects are encouraging. Large and well-designed RCTs with the long-term follow-up that investigate the effect of PFMT on vulvo-vaginal tissues and pelvic floor muscle function are needed to provide further guidance for clinical management.
Antônio, Flávia Ignácio; Bø, Kari; Pena, Caroline C.; Bueno, Sabrina M.; Mateus-Vasconcelos, Elaine Cristine Lemes & Fernandes, Ana Carolina Nociti Lopes [Show all 7 contributors for this article] (2021). Intravaginal electrical stimulation increases voluntarily pelvic floor muscle contractions in women who are unable to voluntarily contract their pelvic floor muscles: a randomised trial. Journal of Physiotherapy. ISSN 1836-9553. 68, p. 37–42. doi: 10.1016/j.jphys.2021.12.004. Full text in Research Archive Show summary
Question: In women who are unable to contract their pelvic floor muscles voluntarily, what is the effect of an intravaginal electrical stimulation regimen on their ability to contract the pelvic floor muscles and on self-reported urinary incontinence? Design: Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. Participants: Sixty-four women with pelvic floor muscle function assessed by bi-digital palpation to be grade 0 or 1 on the Modified Oxford Scale. Intervention: For 8 weeks, participants randomised to the experimental group received weekly 20-minute sessions of intravaginal electrical stimulation with instructions to attempt pelvic floor muscle contractions during the bursts of electrical stimulation in the final 10 minutes of each session. The control group received no intervention. Outcome measures: The primary outcome was ability to voluntarily contract the pelvic floor muscles, evaluated through vaginal palpation using the Modified Oxford Scale. Secondary outcomes were prevalence and severity of urinary incontinence symptoms assessed by the International Consultation on Incontinence Questionnaire on Urinary Incontinence-Short Form (ICIQ-UI-SF) score from 0 to 21. Results: Sixty-one participants provided outcome data. After the intervention, the ability to contract the pelvic floor muscles was acquired by 36% of the experimental group and 12% of the control group (absolute risk difference 0.24, 95% CI 0.02 to 0.43). The experimental group also improved by a mean of 2 points more than the control group on the ICIQ-UI-SF score (95% CI 0.02 to 3.97). Conclusion: In women who are unable to contract their pelvic floor muscles voluntarily, 8 weeks of intravaginal electrical stimulation with voluntary contraction attempts improved their ability to contract their pelvic floor muscles and reduced the overall severity and impact of urinary incontinence on quality of life. Although the main estimates of these effects indicate that the effects are large enough to be worthwhile, the precision of these estimates was low, so it is not possible to confirm whether the effects are trivial or worthwhile.
Dantas, Lucas Ogura; Carvalho, Cristiano; Pena, Caroline C.; Breda, Carolina Carreira; Driusso, Patricia & Ferreira, Cristine Homsi Jorge [Show all 7 contributors for this article] (2021). Mobile health technologies for the monitoring of menstrual cycle: A systematic review of online stores in Brazil. Journal of Obstetrics and Gynaecology Research. ISSN 1341-8076. 48(1), p. 5–14. doi: 10.1111/jog.15082. Show summary
Aim: To perform a systematic review of available mHealth apps for menstrual cycle monitoring in Brazil. Methods: A search for menstrual cycle mHealth apps from the Google Play Store and AppStore in Brazil was performed by two independent reviewers on October 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS). Results: Our review identified 2400 potentially relevant mHealth apps, of which 56 were eligible for inclusion. The majority of the apps offered tools to track menstruation symptoms (63%) and educational content for users (32%). The mean ( ±SD) MARS app quality score for the 28 evaluated apps in Android was 3.5 ± 0.6 on a 0–5 scale. For the 28 evaluated apps in iOS, the mean app quality score was 3.8 ± 0.4. Most of the included apps, for both systems, scored average for credibility, user interface, and engagement. Conclusion: The majority of available tools in Brazil are of moderate quality and limited functionality for menstrual cycle monitoring. This study highlights the top three mHealth apps available on each online store for individuals seeking menstrual cycle monitoring options.
Peyronnet, Benoit; Lapitan, Marie Carmela; Tzelves, Lazaros; O'Connor, Eabhann; Nic An Ríogh, Aisling & Manso, Margarida [Show all 17 contributors for this article] (2021). Benefits and Harms of Conservative, Pharmacological, and Surgical Management Options for Women with Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel. European Urology Focus. ISSN 2405-4569. doi: 10.1016/j.euf.2021.10.006. Show summary
Context: While the management of bladder outlet obstruction (BOO) in men has been a topic of several systematic reviews and meta-analyses, no such evidence base exists for female BOO. Objective: The aim of this systematic review was to evaluate the benefits and harms of therapeutic interventions for the management of BOO in women. Evidence acquisition: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The study protocol was registered with PROSPERO (CRD42020183839). A systematic literature search was performed and updated by a research librarian in May 2021. The study population consisted of adult female patients diagnosed with BOO, who underwent treatment. Evidence synthesis: Out of 6344 records, we identified 33 studies enrolling 1222 participants, of which only six randomized controlled trials (RCTs) were found. One placebo-controlled crossover randomized trial assessed the role of baclofen in 60 female patients with dysfunctional voiding. The trial met its primary endpoint with a significantly greater decrease in the number of voids per day in the baclofen group (–5.53 vs –2.70; p = 0.001). The adverse events were mild and comparable in both groups (25% vs 20%). One placebo-controlled crossover randomized trial assessed the role of sildenafil in 20 women with Fowler’s syndrome. There were significant improvements from baseline in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR), but with no statistically significant difference when compared with placebo. In a large RCT including 197 female patients with functional BOO, the alpha-blocker alfuzosin significantly improved IPSS, Qmax, and PVR compared with baseline, but the differences were not statistically significant compared with the placebo group. Several small single-arm prospective series reported improvement of BOO-related symptoms and voiding parameters with urethroplasty, sling revision, urethral dilation, vaginal pessary, and pelvic organ prolapse repair. Conclusions: Evidence to support the use of conservative, pharmacological, and surgical treatments for BOO is scarce.
Pang, Karl H.; Campi, Riccardo; Arlandis, Salvador; Bø, Kari; Chapple, Christopher R. & Costantini, Elisabetta [Show all 25 contributors for this article] (2021). Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel. European Urology Focus. ISSN 2405-4569. doi: 10.1016/j.euf.2021.09.003. Full text in Research Archive Show summary
Context: Female bladder outlet obstruction (fBOO) is a relatively uncommon condition compared with its male counterpart. Several criteria have been proposed to define fBOO, but the comparative diagnostic accuracy of these remains uncertain. Objective: To identify and compare different tests to diagnose fBOO through a systematic review process. Evidence acquisition: A systematic review of the literature was performed according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The EMBASE/MEDLINE/Cochrane databases were searched up to August 4, 2020. Studies on women ≥18 yr of age with suspected bladder outlet obstruction (BOO) involving diagnostic tests were included. Pressure-flow studies or fluoroscopy was used as the reference standard where possible. Two reviewers independently screened all articles, searched reference lists of retrieved articles, and performed data extraction. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Evidence synthesis: Overall, 28 nonrandomised studies involving 10 248 patients were included in the qualitative analysis. There was significant heterogeneity regarding the characteristics of women included in BOO cohorts (ie, mixed cohorts including both anatomical and functional BOO). Pressure-flow studies ± fluoroscopy was evaluated in 25 studies. Transperineal Doppler ultrasound was used to evaluate bladder neck dynamics in two studies. One study tested the efficacy of transvaginal ultrasound. The urodynamic definition of fBOO also varied amongst studies with different parameters and thresholds used, which precluded a meta-analysis. Three studies derived nomograms using the maximum flow rate (Qmax) and voiding detrusor pressure at Qmax. The sensitivity, specificity, and overall accuracy ranges were 54.6–92.5%, 64.6–93.9%, and 64.1–92.2%, respectively. Conclusions_ The available evidence on diagnostic tests for fBOO is limited and heterogeneous. Pressure-flow studies ± fluoroscopy remains the current standard for diagnosing fBOO.
Gluppe, Sandra L.; Engh, Anna Marie Ellström & Bø, Kari (2021). What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Brazilian Journal of Physical Therapy. ISSN 1413-3555. 25(6), p. 664–675. doi: 10.1016/j.bjpt.2021.06.006. Full text in Research Archive Show summary
Background: Diastasis recti abdominis (DRA) affects a significant number of women in the post- partum period. Objective: To systematically review whether abdominal and pelvic floor muscle (PFM) exercise programs are effective in the treatment of DRA postpartum. Methods: Electronic search was conducted from inception to March 2020. Randomized controlled tri- als (RCT) or pilot RCTs that compared abdominal training, PFM training, or a combination of both in at least one arm of the trial were included. The primary outcome was presence of DRA (numbers/per- centage) or inter-recti distance (IRD) change. GRADE was used to rate the overall quality of evidence. Pooled effect sizes were expressed as mean difference (MD) with 95% confidence intervals (CI). Results: Seven RCTs totaling 381 women were included. Two studies comparing transversus abdominis (TrA) training with minimal intervention provided data to be included in a meta-analy- sis. The results provided very low level quality evidence that TrA training reduced IRD (MD = - 0.63 cm, 95% confidence interval: -1.25, -0.01, I2 = 0%). Two studies included curl-up exercises as part of their intervention. Level of evidence based on single trials of high risk of bias show very low evidence that curl-up training is more effective than minimal intervention for treating DRA. Similarly, analyses based on single trials provided low to very low quality evidence that PFM training is not more effective than minimal intervention for treating DRA. Conclusion: There is currently very low-quality scientific evidence to recommend specific exer- cise programs in the treatment of DRA postpartum
Frawley, Helena C.; Shelly, Beth; Morin, Melanie; Bernard, Stéphanie; Bø, Kari & Digesu, Giuseppe Alessandro [Show all 14 contributors for this article] (2021). An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourology and Urodynamics. ISSN 0733-2467. 40(5), p. 1217–1260. doi: 10.1002/nau.24658. Show summary
Introduction: The terminology for female and male pelvic floor muscle (PFM) assessment has expanded considerably since the first PFM function and dysfunction standardization of terminology document in 2005. New terms have entered assessment reports, and new investigations to measure PFM function and dysfunction have been developed. An update of this terminology was required to comprehensively document the terms and their definitions, and to describe the assessment method and interpretation of the finding, to standardize assessment procedures and aid diagnostic decision making. Methods: This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) Working Group 16, with contributions from recognized experts in the field and external referees. A logical, sequential, clinically directed assessment framework was created against which the assessment process was mapped. Within categories and subclassifications, each term was assigned a numeric coding. A transparent process of 12 rounds of full working group and external review was undertaken to exhaustively examine each definition, plus additional extensive internal development, with decision making by collective opinion (consensus). Results: A Terminology Report for the symptoms, signs, investigations, and diagnoses associated with PFM function and dysfunction, encompassing 185 separate definitions/descriptors, has been developed. It is clinically based with the most common assessment processes defined. Clarity and user‐friendliness have been key aims to make it interpretable by clinicians and researchers of different disciplines. Conclusion: A consensus‐based Terminology Report for assessment of PFM function and dysfunction has been produced to aid clinical practice and be a stimulus for research.
Brækken, Ingeborg Hoff; Stuge, Britt; Tveter, Anne Therese & Bø, Kari (2021). Reliability, validity and responsiveness of pelvic floor muscle surface electromyography and manometry. International Urogynecology Journal. ISSN 0937-3462. 32, p. 3267–3274. doi: 10.1007/s00192-021-04881-0. Full text in Research Archive Show summary
Introduction and hypothesis: Vaginal surface electromyography (sEMG) is commonly used to assess pelvic floor muscle (PFM) function and dysfunction but there is a lack of studies regarding the assessment properties. The aim of the study was to test the hypotheses that sEMG has good test-retest intratester reliability, good criterion validity and is responsive to changes compared to manometry. Methods: PFM resting tone, maximum voluntary contraction (MVC) and endurance were measured in 66 women with pelvic floor dysfunction. One assessment by manometry was followed by two testing sessions with sEMG at baseline. After 4 to 42 weeks of supervised PFM strength training, 29 participants were retested with both devices. Results: Median age of the participants was 41 years (range 24-83) and parity 2 (range 0-10). Very good test-retest intratester reliability was found for all three sEMG measurements. The correlation between sEMG and manometry was moderate for vaginal resting tone (r = 0.42, n = 66, p < 0.001) and strong for MVC (r = 0.66, n = 66, p < 0.001) and endurance (r = 0.67, n = 66, p < 0.001). Following the strength training period, participants demonstrated increased MVC and endurance measured with manometry, but not with sEMG. A significant reduction in resting tone was found only with sEMG. Conclusion: sEMG is reliable and correlates well with manometry. However, sEMG is not as responsive as manometry for changes in PFM MVC and endurance. For measurement of PFM resting tone, sEMG seems more responsive than manometry, but this requires further investigation.
Benvenuti, Maria Beatrice; Bø, Kari; Draghi, Simonetta; Tandoi, Elisabetta & Haakstad, Lene Annette Hagen (2021). The weight of motherhood: Identifying obesity, gestational weight gain and physical activity level of Italian pregnant women. Women's Health.. ISSN 1745-5057. 17. doi: 10.1177/17455065211016136. Full text in Research Archive Show summary
Objective: Pre-pregnancy obesity and suboptimal gestational weight gain are on the rise globally and are independently associated with several maternal and neonatal complications. A healthy lifestyle, including regular physical activity, may improve health and reduce these complications, but many women are less active and willing to engage in physical activity with advancing gestation. Therefore, the inclusion of a wider range of physical activity such as domestic chore, occupational activity and active commuting may help pregnant women to meet the physical activity recommendations of 150 min/week. Very little is known about these issues in Italy, a country with strong traditional roles regarding pregnancy and motherhood, including “la famiglia” (the family). Primary objective describes health and lifestyle behavior of pregnant Italian women. Secondary objective reports total physical activity level, recreational exercise and context of these activities from pre-pregnancy and throughout gestation in regard to gestational weight gain management. Study design: Cross-sectional study performed in one public hospital and four antenatal clinics in Italy. Participants (n = 513) completed a validated self-administered questionnaire, the Physical Activity Pregnancy Questionnaire, in gestation week 36.01 (standard deviation 2.0). Pre-pregnancy body weight (kg) was self-reported, whereas maternal weight (kg) was measured at gestation week 36. In line with current American College of Obstetricians and Gynecologists guidelines (2020), participants were categorized into regular physical activity (⩾150 min/week) or non-regular physical activity (<150 min/week). Results: Mean pre-pregnancy body-mass index was 22.8 kg/m2 (standard deviation 3.9), with 14.4% of women entering motherhood overweight and 5.3% obese. Mean gestational weight gain was 11.9 kg (standard deviation 4.1). Among those with a body-mass index ⩾25, 46.5% gained above the Institute of Medicine recommendations. With respect to recreational exercise/sport, 4.7% were active according to guidelines, whereas 82.7% accumulated ⩾150 min/week when combining exercise/sport with daily-life physical activity (commuting and occupational). Exercising ⩾150 min/week and working 100% in third trimester were associated with gestational weight gain within Institute of Medicine recommendations (p = 0.06 and p = 0.03). Conclusion: Italian pregnant women have a low exercise level, still over 80% achieved a total physical activity level ⩾150 min/week when adding occupational and commuting activities. Nearly 50% of overweight and obese women exceeded the recommended gestational weight gain during pregnancy.
Sigurdardottir, Thorgerdur; Bø, Kari; Steingrimsdóttir, Thora; Halldórsson, Thorhallur Ingi; Aspelund, Thor & Geirsson, Reynir T. (2021). Cross-sectional study of early postpartum pelvic floor dysfunction and related bother in primiparous women 6–10 weeks postpartum. International Urogynecology Journal. ISSN 0937-3462. 32(7), p. 1847–1855. doi: 10.1007/s00192-021-04813-y. Show summary
Introduction and hypothesis: To study the prevalence of pelvic floor dysfunction and related bother in primiparous women 6–10 weeks postpartum, comparing vaginal and cesarean delivery. Methods: Cross-sectional study of 721 mothers with singleton births in Reykjavik, Iceland, 2015 to 2017, using an electronic questionnaire. Information on urinary and anal incontinence, pelvic organ prolapse and sexual dysfunction with related bother (trouble, nuisance, worry, annoyance) was collected. Main outcome measures were prevalence of pelvic floor dysfunction and related bother. Results: The overall prevalence of urinary and anal incontinence was 48% and 60%, respectively. Bother regarding urinary symptoms was experienced by 27% and for anal symptoms by 56%. Pelvic organ prolapse was noted by 29%, with less than half finding this bothersome. Fifty-five percent were sexually active, of whom 66% reported coital pain. Of all the women, 48% considered sexual issues bothersome. Urinary incontinence and pelvic organ prolapse were more prevalent in women who delivered vaginally compared to cesarean section, but no differences were observed for anal incontinence and coital pain. Compared to women with BMI < 25, obesity was a predictor for urinary incontinence after vaginal delivery (OR 1.94; 95% CI 1.20–3.14). Birthweight > 50th percentile was predictive for urgency incontinence after vaginal delivery (OR 1.53; 95% CI 1.05–2.21). Episiotomy predicted more anal incontinence (OR 2.19; 95% CI 1.30–3.67). No associations between maternal and delivery characteristics were found for pelvic floor dysfunction after cesarean section. Conclusions: Bothersome pelvic floor dysfunction symptoms are prevalent among first-time mothers in the immediate postpartum period.
Skaug, Kristina Lindquist; Engh, Marie Ellström; Frawley, Helena C. & Bø, Kari (2021). Urinary and anal incontinence among female gymnasts and cheerleaders—bother and associated factors. A cross-sectional study. International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-021-04696-z. Full text in Research Archive Show summary
Introduction and hypothesis: Artistic gymnastics, team gymnastics and cheerleading are sports including high-impact activities. It is presumed that the athletes' pelvic floor must be functioning well to prevent urinary (UI) and anal incontinence (AI) during sports. The aim of this study was to investigate the prevalence and risk factors for UI and AI in female artistic gymnasts, team gymnasts and cheerleaders; the influence of UI and AI on daily living and sport performance; and the athletes' knowledge about the pelvic floor muscles (PFM). Methods: All female athletes ≥ 12 years of age competing in ≥ 1 National Championship in artistic gymnastics, team gymnastics or cheerleading in 2018/2019 were invited. International Consensus on Incontinence Questionnaires were used to assess the prevalence/bother of UI and AI. Results: Among the 319 gymnasts and cheerleaders who participated, the prevalence of UI and AI was 67% and 84%, respectively. Age, training ≥ 4 days/week and straining to void were significantly associated with stress urinary incontinence (SUI) and years of training with AI. Eighty-three percent of athletes with SUI reported a negative effect on sports performance, 22% would occasionally avoid training or specific exercises because of leakage, and 28% used pads for protection. Forty-one percent of the athletes had never heard about the PFM, and 74% reported an interest in PFM training to prevent/treat UI or AI. Conclusions: UI and AI were prevalent in female gymnasts and cheerleaders, and SUI negatively influenced sport performance. The athletes' knowledge about the PFM was limited.
Gluppe, Sandra L.; Engh, Marie Ellström & Bø, Kari (2021). Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis. Physiotherapy. ISSN 0031-9406. 111, p. 57–65. doi: 10.1016/j.physio.2021.01.008. Show summary
Objective: To investigate whether women with diastasis recti abdominis (DRA) have weaker abdominal muscles and higher prevalence of pelvic floor disorders (PFD), low back, pelvic girdle and abdominal pain than women without DRA. Design: Cross sectional study of women with and without DRA. Setting: University study. Participants: Seventy-two parity and age matched women with and without DRA. Main outcome measures: Maximal abdominal muscle strength and endurance were assessed with a dynamometer and with a curl-up test. Women reported whether they experienced PFD, low back pain, pelvic girdle pain or abdominal pain. Those experiencing PFD or pain completed the Pelvic Floor Distress Inventory-short form 20 (PFDI-20), the Oswestry Disability Index (ODI), the Pelvic Girdle Questionnaire (PGQ) or questions about abdominal pain, respectively. Results: Maximal abdominal strength standing with 30° hip flexion was significantly lower in women with DRA (mean difference −12.9 Nm, 95%CI: −24.4 to −1.5; P = 0.028), but adjusted analyses showed no significant difference (mean difference −11.9 Nm, 95%CI: −26.5 to 2.6; P = 0.106). Adjusted analyses showed significant higher prevalence of abdominal pain in women with DRA (OR: 0.02, 95%CI: 0.00 to 0.61, P = 0.026). There was no difference between the groups in PFD, low back and pelvic girdle pain. Conclusion: Women with DRA tend to have weaker abdominal muscles and higher prevalence of abdominal pain, but no higher prevalence of PFD, low back or pelvic girdle pain than women without DRA.
Pena, Caroline C.; Bø, Kari; de la Ossa, Aura M.P.; Fernandes, Ana Carolina Nociti Lopes; Aleixo, Devechio N. & de Oliveira, Flávia M.F. [Show all 7 contributors for this article] (2021). Are visual inspection and digital palpation reliable methods to assess ability to perform a pelvic floor muscle contraction? An intra‐rater study. Neurourology and Urodynamics. ISSN 0733-2467. 40(2), p. 680–687. doi: 10.1002/nau.24609. Show summary
Aims: To investigate the intrarater reliability of visual inspection and digital palpation to classify women's ability to perform a voluntary pelvic floor muscle (PFM) contraction and the association between the two methods. Methods: This was a test–retest clinical study including 44 women. The ability to perform a PFM voluntary contraction was evaluated two times in all participants using visual inspection and digital palpation. All analyzed participants were assessed with a 7‐day interval between the two assessments and by the same examiner. Kappa's agreement coefficient was used to estimate the intrarater reliability, and Fisher's exact test was used to analyze association between the two methods. Results: This study found a substantial intrarater reliability of visual inspection (k = 0.73; p < .001) and digital palpation (k = 0.74; p < .001). A significant association between visual inspection and digital palpation was found at both time points (p < .001). Conclusion: Both visual inspection and digital palpation have substantial intrarater reliability and visual inspection can be recommended when vaginal palpation is not tolerated.
Bø, Kari; Haakstad, Lene Annette Hagen; Paulsen, Gøran & Rustaden, Anne Mette (2021). Does regular strength training cause urinary incontinence in overweight inactive women? : A randomized controlled trial. International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-021-04739-5. Full text in Research Archive Show summary
Introduction and hypothesis: Urinary incontinence (UI) is common in women who exercise. We aimed to investigate new onset UI in formerly inactive, overweight or obese women (BMI > 25) participating in three different strength training modalities compared with a non-exercising control group. Methods: This was a secondary analysis of an assessor blinded randomized controlled trial investigating the effect of 12 weeks of three strength training concepts for women on muscle strength and body composition. None of the programs included pelvic floor muscle training. International Consensus on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was used to investigate primary outcome; new onset UI, and secondary outcome; ICIQ-UI-SF sum score. Suissa and Shuster’s exact unconditional test was used to analyze difference in new onset UI. Difference in ICIQ-UI-SF sum score is presented as mean with 95% CI. Results: At baseline 40 out of 128 (31.2%) participants reported UI. Three out of 27, 2 out of 17, 2 out of 23, and 0 out of 21 women in the three training and control groups respectively had new onset UI. There were no statistically significant differences in new onset UI across the groups or when collapsing new onset UI in the intervention groups compared with the controls (7 out of 67 vs 0 out of 21), p = 0.124. After the intervention the control group reported worse ICIQ-UI-SF sum score than any of the training groups; mean difference − 6.6 (95% CI: −11.9, −1.27), p = 0.012, but there was no difference in change from baseline to 12 weeks between the groups p = 0.145). Conclusions: There was no statistically significant change in UI after strength training.
Dantas, Lucas Ogura; Carvalho, Cristiano; Santos, Beatriz Laryssa de Jesus; Ferreira, Cristine Homsi Jorge; Bø, Kari & Driusso, Patricia (2021). Mobile health technologies for the management of urinary incontinence: A systematic review of online stores in Brazil. Brazilian Journal of Physical Therapy. ISSN 1413-3555. 25(4), p. 387–395. doi: 10.1016/j.bjpt.2021.01.001. Show summary
Background: Urinary incontinence (UI) is a serious condition for which often times insufficient non-surgical treatment options are provided or sought. Mobile health (mHealth) applications (apps) offer potential to assist with the self-management of UI. Objective: To perform a systematic review of available mHealth apps for UI in Brazil. Methods: A search for UI mHealth apps from the Google Play Store and AppStore in Brazil was performed by two independent reviewers on June 4 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS). Results: Of the 1111 mHealth apps found, 12 were eligible for inclusion. Four offered exclusively exercise programs, six offered exercise and educational content, and two offered tools to track patient-reported symptoms. The included apps scored poorly on the MARS quality scale, with a mean ± standard deviation score of 2.7 ± 0.6 on a 0–5 scale. Most apps scored poorly based on credibility, user interface and experience, and engagement. Conclusion: Although there is growing interest in the development of mHealth technologies to support patients with UI, currently available tools in Brazil are of poor quality and limited functionality. Effective collaboration between industry and research is needed to develop new user-centered mHealth apps that can empower patients with UI.
Haakstad, Lene Annette Hagen; Kissel, Iselin Haugland & Bø, Kari (2021). Long-term effects of participation in a prenatal exercise intervention on body weight, body mass index, and physical activity level: a 6-year follow-up study of a randomized controlled trial. Journal of Maternal-Fetal & Neonatal Medicine. ISSN 1476-7058. 34(9), p. 1347–1355. doi: 10.1080/14767058.2019.1636028. Full text in Research Archive Show summary
Background: Growing evidence supports that physical activity and exercise during pregnancy is favorable for the mother, with persisting benefits in the postpartum period. However, there is scant knowledge of the effect of a prenatal exercise program on long-term health and lifestyle habits. Objectives: This 6-year follow-up study of a randomized controlled trial had two aims: (1) compare body weight, weight retention and body mass index (BMI) in the intervention group and control group, and (2) evaluate effects on physical activity level and recreational exercise. Materials and methods: Out of 105 participants initially randomized to either an intervention group, n = 52 (twice weekly group-exercises and physical activity counselling) or control group, n = 53 (standard prenatal care), 80 women (76.2%) participated in the present long-term follow-up study, performed in a general community in Oslo, Norway. Data were collected through a standardized telephone interview based on the baseline protocol and a modified Physical Activity and Pregnancy Questionnaire (PAPQ). Body weight at 6 years follow-up was self-reported (kg), and calculation of current BMI (kg/m2) was based on self-reported weight and measured height at study inclusion. Investigators were unaware of the original randomization at the time of the interviews. Analyses of covariance were used to examine the difference in change in body weight and BMI between the groups. Even though the MET-values were not normally distributed, differences were examined using a two-sided independent sample t-test due to large sample size (n ≥ 30). Results: At 6 years follow-up there were no differences in mean BMI (kg/m2) (24.0 ± 3.8 versus 24.8 ± 4.0, p = .37), physical activity level (4167 ± 2638 versus 3925 ± 3075 MET-min/week, p = .67) or recreational exercise (630 ± 1290 versus 720 ± 1005 MET-min/week, p = .88) between the intervention and control group, respectively. Subgroup analysis of participants with high adherence during the intervention 6 years ago (≥24 prenatal exercise classes), showed a positive intervention effect at long-term follow up in body weight (kg) (62.8 ± 7.9 versus 70.8 ± 11.8, p = .03) and BMI (kg/m2) (22.5 ± 3.1 versus 24.8 ± 4.0, p = .05), and none (versus 11 in the control group) had gained ≥5 kg compared to prepregnancy weight (p = .02). Conclusions: Women who adhered to the original prenatal exercise intervention demonstrated significantly lower body weight and BMI at 6-year follow-up. Otherwise, no long-term intervention effect was observed.
Skaug, Kristina Lindquist; Engh, Marie Ellström; Frawley, Helena & Bø, Kari (2020). Prevalence of Pelvic Floor Dysfunction, Bother, and Risk Factors and Knowledge of the Pelvic Floor Muscles in Norwegian Male and Female Powerlifters and Olympic Weightlifters. Journal of Strength and Conditioning Research. ISSN 1064-8011. 36(10), p. 2800–2807. doi: 10.1519/JSC.0000000000003919. Show summary
Strenuous exercise has been suggested as a risk factor of pelvic floor dysfunction (PFD). Powerlifters and Olympic weightlifters compete with high external loads. To date, knowledge of PFD in these athletes has been sparse. The aim of this study was to investigate prevalence, risk factors, and bother of PFD in powerlifters and Olympic weightlifters and their knowledge of the pelvic floor muscles (PFM). All athletes aged ≥18 years competing in ≥1 National Championship in powerlifting or Olympic weightlifting in 2018/2019 were invited. The International Consensus on Incontinence Questionnaires were used to assess PFD. One hundred eighty women and 204 men participated. The prevalence of urinary incontinence (UI), anal incontinence (AI), and pelvic organ prolapse in women was 50.0, 80.0, and 23.3%, respectively. Stress UI (SUI) was reported by 41.7% of the women and 87.8% reported a negative influence on sport performance. The prevalence of UI and AI in men was 9.3 and 61.8%. In women, increasing body mass index was significantly associated with SUI (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.01–1.17) and international level of competition (OR: 3.27, 95% CI: 1.32–8.07) and weightlifting ≥4 d·wk−1 (OR: 0.26, 95% CI: 0.08–0.86) with AI. In men, increasing age (OR: 1.03, 95% CI: 1.00–1.07) and frequently straining to void (OR: 4.84, 95% CI: 1.02–22.94) were significantly associated with AI. Forty-three percent of the women and 74% of the men did not know why and 44.4 and 72.5% how to train the PFM. In conclusion, the prevalence of PFD was high, and the athletes had limited knowledge of the PFM.
Hoogeboom, Thomas J; Kousemaker, Martijn C; Van Meeteren, Nico; Howe, Tracey; Bø, Kari & Tugwell, Peter [Show all 10 contributors for this article] (2020). I-CONTENT tool for assessing therapeutic quality of exercise programs employed in randomised clinical trials. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2019-101630. Full text in Research Archive Show summary
Objective: When appraising the quality of randomised clinical trial (RCTs) on the merits of exercise therapy, we typically limit our assessment to the quality of the methods. However, heterogeneity across studies can also be caused by differences in the quality of the exercise interventions (ie, ‘the potential effectiveness of a specific intervention given the potential target group of patients’)—a challenging concept to assess. We propose an internationally developed, consensus-based tool that aims to assess the quality of exercise therapy programmes studied in RCTs: the international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool. Methods: Forty-nine experts (from 12 different countries) in the field of physical and exercise therapy participated in a four-stage Delphi approach to develop the i-CONTENT tool: (1) item generation (Delphi round 1), (2) item selection (Delphi rounds 2 and 3), (3) item specification (focus group discussion) and (4) tool development and refinement (working group discussion and piloting). Results: Out of the 61 items generated in the first Delphi round, consensus was reached on 17 items, resulting in seven final items that form the i-CONTENT tool: (1) patient selection; (2) qualified supervisor; (3) type and timing of outcome assessment; (4) dosage parameters (frequency, intensity, time); (5) type of exercise; (6) safety of the exercise programme and (7) adherence to the exercise programme. Conclusion: The i-CONTENT-tool is a step towards transparent assessment of the quality of exercise therapy programmes studied in RCTs, and ultimately, towards the development of future, higher quality, exercise interventions.
Gluppe, Sandra L.; Engh, Marie Ellström & Bø, Kari (2020). Immediate Effect of Abdominal and Pelvic Floor Muscle Exercises on Interrecti Distance in Women With Diastasis Recti Abdominis Who Were Parous. Physical Therapy. ISSN 0031-9023. 100(8), p. 1372–1383. doi: 10.1093/ptj/pzaa070. Show summary
Objective: There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study was to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous. Methods: In this cross-sectional study, 38 women who were parous, with a mean age of 36.2 years (SD = 5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported. Results: Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10 mm (95% CI = 7 to 13.2), whereas during twisted curl-up it was 9.4 mm (95% CI = 6.3 to 12.5). Below the umbilicus, the corresponding values were 6.1 mm (95% CI = 3.2 to 8.9) and 3.5 mm (95% CI = 0.5 to 6.4), respectively, but PFM contraction, maximal in-drawing, and PFM contraction + maximal in-drawing increased the IRD (mean difference = −2.8 mm [95% CI = −5.2 to 0.5], −4.7 mm [95% CI = −7.2 to −2.1], and − 5.0 mm [95% CI = −7.9 to −2.1], respectively). Conclusions: Head lift and twisted curl-up exercises decreased the IRD both above and below the umbilicus, whereas maximal in-drawing and PFM contraction exercises only increased the IRD below the umbilicus. A randomized controlled trial is needed to investigate whether head lift and twisted curl-up exercises are effective in permanently narrowing the IRD. Impact: To date there is scant scientific knowledge of which exercises to recommend in the treatment of DRA. In-drawing and PFM contraction leads to an acute increase in IRD, while head lift and twisted curl-up leads to an acute decrease in IRD in postpartum women. There is a need for high-quality randomized controlled trials to investigate if there is a long-term reduction in IRD by doing these exercises over time. The acute IRD increase and decrease during the different exercises is also present in a sample of women with larger separations.
Gram, Marte Charlotte Dobbertin; Clarsen, Benjamin Matthew & Bø, Kari (2020). Injuries and illnesses among competitive Norwegian rhythmic gymnasts during preseason: a prospective cohort study of prevalence, incidence and risk factors. British Journal of Sports Medicine. ISSN 0306-3674. 55, p. 231–236. doi: 10.1136/bjsports-2020-102315. Full text in Research Archive Show summary
Objectives: Rhythmic gymnastics is an Olympic sport that demands high training volume from early age. We investigated the extent of, and risk factors for, injuries among competitive Norwegian rhythmic gymnasts. Methods: One hundred and seven of 133 (80.5%) female rhythmic gymnasts (mean age: 14.5 years (SD 1.6), mean body mass index: 18.9 (SD 2.2)) participated. All gymnasts completed a baseline questionnaire and the ‘Triad-Specific Self-Report Questionnaire’. Injuries, illnesses and training hours were recorded prospectively for 15 weeks during preseason using the ‘Oslo Sports Trauma Research Center Questionnaire on Health Problems’ (OSTRC-H2). Results: Response rate to OSTRC-H2 was 97%. Mean overuse and acute injury prevalence were 37% (95% CI: 36% to 39%) and 5% (95% CI: 4% to 6%), respectively. Incidence was 4.2 overuse injuries (95% CI: 3.6 to 4.9) and 1.0 acute injuries (95% CI: 0.5 to 1.6) per gymnast per year. Overuse injuries in knees, lower back and hip/groin represented the greatest burdens. Previous injury increased the odds of injury (OR 30.38, (95% CI: 5.04 to 183.25)), while increased age (OR 0.61 per year, (95% CI: 0.39 to 0.97)) and presence of menarche (OR: 0.20, (95% CI: 0.06 to 0.71)) reduced the odds of all injuries and substantial injuries, respectively. Conclusions: Overuse injuries were common among Norwegian rhythmic gymnasts. Younger gymnasts had higher all-injury risk. Gymnasts who were not menstruating had higher substantial injury risk. Injury prevention interventions should start at an early age and focus on preventing knee, lower back and hip/groin injuries.
Bø, Kari (2020). Physiotherapy management of urinary incontinence in females. Journal of Physiotherapy. ISSN 1836-9553. doi: 10.1016/j.jphys.2020.06.011. Full text in Research Archive Show summary
Urinary incontinence (UI) is a prevalent and bothersome condition affecting women of all ages.1 UI can be treated with lifestyle interventions, bladder training, electrical stimulation, surgery and pelvic floor muscle training (PFMT) with or without biofeedback. There is some evidence that lifestyle interventions (such as weight reduction in obese women) and bladder training may have some effect in reducing UI.2,3 The evidence for electrical stimulation is debated.4 Surgery carries a risk of complications and the long-term outcome is questionable.2 This leaves PFMT as the main physiotherapy intervention for UI. The NICE guideline states that PFMT is just as effective as surgery for around half of women with stress urinary incontinence.2 There is Level 1 evidence (recommendation A) that PFMT should be first-line treatment for UI in females.2,3,5 This review summarises: the burden of UI for individuals and the healthcare system; background information about how PFMT can prevent and treat UI; the evidence about the effects of PFMT on female UI, with a special focus of the effect of group PFMT; and future directions for research and practice.
Haakstad, Lene Annette Hagen & Bø, Kari (2020). The marathon of labour—Does regular exercise training influence course of labour and mode of delivery?: Secondary analysis from a randomized controlled trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology. ISSN 0301-2115. 251, p. 8–13. doi: 10.1016/j.ejogrb.2020.05.014. Full text in Research Archive Show summary
Objectives: Today all pregnant women are recommended to participate in moderate intensity aerobic and resistance-based physical activity/exercise ≥150 min/week. However, there are still controversies and scant knowledge on the role of regular exercise on delivery outcomes, including mode of delivery and length of active labour. In addition, nutritional counselling have often been examined together with exercise, which may independently effect the outcomes. Hence, the aims of the present study were to investigate the sole effect of supervised group exercise, including pelvic floor muscle training on course of labour and mode of delivery. Study design: A single blind, randomized controlled trial, performed in the municipality of Oslo, Norway. Out of 105 healthy, inactive nulliparous women, initially enrolled (gestation week 17.7 ± 4.2) to study the effect regular aerobic exercise (60 min 2/week) on health benefits for both mother and her baby, 90 (85.7%) completed postpartum follow-up (7.7 ± 1.7) on labour outcomes (exercise: 43 and control: 47). Data were collected via standardized interviews and birth partographs from hospital records, reported on the postpartum visit (weeks after labour 7.6 ± 1.6). The primary investigator was unaware of the original randomization at the time of the interviews. The principal analysis was done on an intention to treat basis (ITT). For the planned subgroup analyses (per protocol), acceptable intervention adherence was defined as attending ≥ 80% of the recommended exercise program (≥ 19 exercise sessions). Results: There were no differences between the exercise and control groups in induction of labour, use of analgesia, duration of active labour or prolonged labour, according to ITT. Per protocol analyses, showed a shorter duration of total active labour in the exercise group (6.8 ± 5.5 h) than the control group (9.8 ± 5.4 h), with a mean between group difference of 3.1 h (95% CI 0.31–5.9, p = 0.029). Rate of normal vaginal delivery was 85.7% among adherent participants and 62.3% in the control group (p = 0.051). Conclusions: Regular exercise during pregnancy decreased duration of total active labour and showed a trend towards more normal vaginal deliveries among participants who adhered to the prescribed program.
Tennfjord, Merete Kolberg; Engh, Marie Ellström & Bø, Kari (2020). The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum. Physical Therapy. ISSN 0031-9023. 100(9), p. 1681–1689. doi: 10.1093/ptj/pzaa084. Full text in Research Archive Show summary
Objective: There is limited knowledge on how exercise impacts the pelvic floor muscles (PFM) and prevalence of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) postpartum. The purpose of this study was to investigate whether early onset of general exercise postpartum negatively affects the PFM and/or increases the risk of SUI and POP 12 months postpartum. Methods: This study used a prospective cohort design. At 6 weeks postpartum, 57 women classified as exercisers (exercising ≥3 times at ≥30 min/week) were compared with 120 nonexercisers (mean age = 29 y, SD = 4.3). Manometry was used to measure vaginal resting pressure (VRP), PFM strength, and PFM endurance, and symptoms of SUI and POP were assessed using questionnaires. Data were presented as standardized beta coefficients (B) and odds ratios (OR). Results: No differences were found between exercisers (n = 57) and nonexercisers (n = 120) at 6 weeks postpartum on VRP (B = −0.04 [95% CI = −3.4 to 2.1]), PFM strength (B = 0.03 [95% CI = −4.7 to 7.4]), PFM endurance (B = −0.02 [95% CI = −59 to 46]), or symptoms of SUI (OR = 0.51 [95% CI = 0.25 to 1.1]) or POP (OR = 0.62 [95% CI = 0.26 to 1.5]) measured at 12 months postpartum. Adjusting for covariates, women with body mass index between 25 and 29.9 and > 30 were more likely to report SUI 12 months postpartum (OR = 2.2 [95% CI = 1.0 to 4.7] and OR = 3.3 [95% CI = 1.2 to 9.4], respectively). Women with physically strenuous occupations were more likely to report POP 12 months postpartum (OR = 3.0 [95%CI: 1.2 to 7.3]). Conclusions: This study suggests that regular exercise 6 weeks postpartum has no negative effect on PFM function or on SUI or POP. Being overweight, however, was associated with more SUI, and women with physically strenuous occupations reported more POP. Impact: Results from this study suggest that first time mothers should be encouraged to start general exercise within the first 6 weeks after giving birth. Women at risk for PFD should be advised accordingly and potentially modifiable risk factors should be addressed prior to delivery.
Halle, Tuva Kristine Toresdatter; Stær-Jensen, Jette; Hilde, Gunvor; Bø, Kari; Engh, Marie Ellström & Siafarikas, Franziska (2020). Change in prevalence of major levator ani muscle defects from 6 weeks to 1 year postpartum, and maternal and obstetric risk factors: A longitudinal ultrasound study. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 99(10), p. 1403–1410. doi: 10.1111/aogs.13878. Full text in Research Archive Show summary
Introduction: The present study aimed first to investigate the change in prevalence of major levator ani muscle (LAM) defects, also called avulsions, from 6 weeks to 1 year postpartum, and second to assess maternal and obstetric risk factors for having persistent major LAM defects/avulsions at 1 year postpartum. Material and methods: This is a secondary analysis of data from a prospective cohort study including 300 nulliparous women at 17-19 weeks of gestation. Major LAM defects were diagnosed at 6 weeks and 1 year postpartum using transperineal ultrasonography. We defined persistent major LAM defects as a defect diagnosed both at 6 weeks and 1 year postpartum. Maternal and obstetric data were obtained from the hospital's electronic birth records. Pelvic floor muscle function was measured vaginally by manometer at 21 weeks of gestation. The main outcome measurement was change in prevalence of major LAM defects. Maternal and obstetric risk factors for having persistent major LAM defect were also assessed. Results: Prevalence of major LAM defects was 19.4% at 6 weeks and 10.4% at 1 year postpartum. No new major LAM defects were diagnosed at 1 year postpartum. Persisting major LAM defects were associated with longer second stage of labor (median 74.5 minutes vs median 48.0 minutes, P = .012) and higher neonatal birthweight (mean difference of 232.3 g, 95% confidence interval [CI] 21.5-443.1). Vacuum delivery was independently associated with persistent major LAM defects, adjusted OR 3.0 (95% CI 1.0-9.0). Conclusions: There was a 50% reduction of sonographically diagnosed major LAM defects from 6 weeks to 1 year postpartum. This finding suggests that assessment of the major LAM 6 weeks postpartum may be too early to diagnose defects/avulsions. Long second stage of labor, high neonatal birthweight and vacuum delivery were associated with persistent major LAM defects/avulsions.
Rustaden, Anne Mette; Gjestvang, Christina; Bø, Kari; Haakstad, Lene Annette Hagen & Paulsen, Gøran (2020). Similar Energy Expenditure During BodyPump and Heavy Load Resistance Exercise in Overweight Women. Frontiers in Physiology. ISSN 1664-042X. 11. doi: 10.3389/fphys.2020.00570. Full text in Research Archive Show summary
Purpose: High-repetition, low-load resistance exercise in group class settings has gained popularity in recent years, with BodyPump as a prime example. For individuals using exercise for body-weight management, the energy expenditure during exercise is of interest. Therefore, we herein aimed to estimate the energy expenditure during a session of BodyPump and a time-matched session of heavy load resistance training in overweight women (BMI ≥ 25.0). Methods: Eighteen women participated in the study (mean age 35.4 years ± 10.2, BMI 30.4 kg/m2 ± 4.8), 10 exercising BodyPump (50–100 repetitions each muscle group) and eight performed a heavy load session (eight repetition maximum × three sets). The energy expenditure was assessed with indirect calorimetry during the sessions and for two intervals at rest during the recovery phase: 0–20 and 120–140 min after the sessions. Results: The BodyPump group lifted significantly more loads than the heavy load group (19,485 kg ± 2258 vs 15,616 kg ± 2976, p = 0.006), while energy expenditure was similar with 302 kcal ± 67 and 289 kcal ± 69 in BodyPump and heavy load group, respectively (p = 0.69). With no group differences, the resting metabolic rate (RMR) was elevated with 15–22% 2 h after exercise. Conclusion: Overweight women achieved an energy expenditure of approximately 300 kcal (4.7 kcal per min) during a single session of BodyPump, which was similar with the women performing a single session of heavy load resistance exercise.
Haakstad, Lene Annette Hagen; Gjestvang, Christina; Lamerton, Tayla & Bø, Kari (2020). Urinary incontinence in a fitness club setting?is it a workout problem? International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-020-04253-0. Full text in Research Archive Show summary
Introduction: The aims of the present study were to report longitudinal data on the prevalence of urinary incontinence (UI) in a fitness club setting and to investigate whether gym members are educated about and exercise their pelvic floor muscles. Methods: New members (125 women) from 25 fitness clubs in Oslo, Norway, filled in a 25-min online questionnaire (SurveyXact) at four time points (onset, 3, 6 and 12 months of fitness club membership). The questionnaire covered background/health information, membership dropout and exercise habits, including pelvic floor muscle training (PFMT). A modified Subjective Health Complaints Inventory (SHC Inventory) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were used to gather repeated measures of UI. Results: At onset, 3, 6 and 12 months of fitness club membership, 16.8%, 13.8%, 19.6% and 18.7% reported UI, respectively (p = 0.11). Of these, 57.1% to 76.2% reported leakage during exercise and perceived the UI to be slight. Less than 8% had received information about PFMT by the fitness club staff. Adherence to regular exercise and PFMT throughout the follow-up period (minimum two sessions/week) did not show any association with absent or present UI at 12 months (p = 0.48 and p = 0.63) and was reported by 30% and 22.2% of the participants, respectively. Conclusions: About 17% reported UI at onset of fitness club membership, with no changes in proportions throughout the first year. Adherence to regular exercise and PFMT did not show any association with absent or present UI at 12 months. Few had been taught PFMT.
Duarte, Thaiana Bezerra; Bø, Kari; Brito, Luiz Gustavo O.; Bueno, Sabrina M.; Barcelos, Thays M.R. & Bonacin, Marília A.P. [Show all 7 contributors for this article] (2020). Perioperative pelvic floor muscle training did not improve outcomes in women undergoing pelvic organ prolapse surgery: a randomised trial. Journal of Physiotherapy. ISSN 1836-9553. doi: 10.1016/j.jphys.2019.11.013. Full text in Research Archive Show summary
Question: In women undergoing surgery for pelvic organ prolapse (POP), what is the average effect of the addition of perioperative pelvic floor muscle training on pelvic organ prolapse symptoms, pelvic floor muscle strength, quality of life, sexual function and perceived improvement after surgery? Design: Randomised controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. Participants: Ninety-six women with an indication for POP surgery. Intervention: The experimental group received a 9-week pelvic floor muscle training protocol with four sessions before the surgery and seven sessions after the surgery. The control group received surgery only. Outcome measures: Symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20), which is scored from 0 ‘unaffected’ to 300 ‘worst affected’. Secondary outcomes were assessed using vaginal manometry, validated questionnaires and Patient Global Impression of Improvement, which is scored from 1 ‘very much better’ to 7 ‘very much worse’. All participants were evaluated 15 days before surgery, and at Days 40 and 90 after surgery. Results: There was no substantial difference in POP symptoms between the experimental and control groups at Day 40 (31 (SD 24) versus 38 (SD 42), adjusted mean difference −6, 95% CI −25 to 13) or Day 90 (27 (SD 27) versus 33 (SD 33), adjusted mean difference −4, 95% CI −23 to 14). The experimental group perceived marginally greater global improvement than the control group; mean difference −0.4 (95% CI −0.8 to −0.1) at Day 90. However, the estimated effect of additional perioperative pelvic floor muscle training was estimated to be not beneficial enough to be considered worthwhile for any other secondary outcomes. Conclusion: In women undergoing POP surgery, additional perioperative pelvic floor muscle training had negligibly small effects on POP symptoms, pelvic floor muscle strength, quality of life or sexual function.
Uechi, Natalia; Fernandes, Ana Carolina Nociti Lopes; Bø, Kari; de Freitas, Leticia Maciel; de la Ossa, Aura M.P. & Bueno, Sabrina M. [Show all 7 contributors for this article] (2020). Do women have an accurate perception of their pelvic floor muscle contraction? A cross-sectional study. Neurourology and Urodynamics. ISSN 0733-2467. doi: 10.1002/nau.24214. Show summary
Aims: To assess women’s self‐perception of their pelvic floor muscle (PFM) contraction and its agreement with an assessed PFM contraction. Further, to assess a possible correlation between women’s self‐perception and reports of urinary incontinence (UI) and between PFM contraction and severity of UI. Methods: A cross‐sectional observational study including 82 women. The study was conducted in a basic healthcare unit in Brazil. PFM contraction was assessed by a physiotherapist and estimated by women using the Modified Oxford Scale (MOS). UI symptoms were assessed using a validated questionnaire (ICIQ‐UI‐SF). A descriptive analysis of the data was performed. The weighted κ coefficient, Spearman’s correlation coefficient, and Fisher’s exact test were used to analyze data. Results: Eighty‐two women with a mean age of 46.83 (±17.94) were analyzed. The majority (98.8%) believed they were able to voluntarily contract their PFM, but only 33% correctly estimated their PFM considering the examiner assessment as reference. No agreement (κ = 0.139, P = .087) was found between the examiner’s classification and the women’s estimation of their PFM contraction. Women’s self‐perception did not correlate with the ICIQ‐IU‐SF (r’s = .011, P = .922). A moderate negative correlation was found between the assessed PFM contraction and the ICIQ‐UI‐SF score (r’s = −.406, P = .00). Conclusion: Most of the women did not show an accurate self‐perception of PFM contraction. No correlation between women’s self‐perception and the ICIQ‐UI‐SF score was found, but a negative correlation was found between the assessed PFM contraction and the ICIQ‐UI‐SF score.
Bø, Kari & Nygaard, Ingrid Elisabeth (2019). Is physical activity good or bad for the female pelvic floor? A narrative review. Sports Medicine. ISSN 0112-1642. doi: 10.1007/s40279-019-01243-1. Full text in Research Archive Show summary
More women participate in sports than ever before and the proportion of women athletes at the Olympic Games is nearly 50%. The pelvic floor in women may be the only area of the body where the positive effect of physical activity has been questioned. The aim of this narrative review is to present two widely held opposing hypotheses on the effect of general exercise on the pelvic floor and to discuss the evidence for each. Hypothesis 1: by strengthening the pelvic floor muscles (PFM) and decreasing the levator hiatus, exercise decreases the risk of urinary incontinence, anal incontinence and pelvic organ prolapse, but negatively affects the ease and safety of childbirth. Hypothesis 2: by overloading and stretching the PFM, exercise not only increases the risk of these disorders, but also makes labor and childbirth easier, as the PFM do not obstruct the exit of the fetus. Key findings of this review endorse aspects of both hypotheses. Exercising women generally have similar or stronger PFM strength and larger levator ani muscles than non-exercising women, but this does not seem to have a greater risk of obstructed labor or childbirth. Additionally, women that specifically train their PFM while pregnant are not more likely to have outcomes associated with obstructed labor. Mild-to-moderate physical activity, such as walking, decreases the risk of urinary incontinence but female athletes are about three times more likely to have urinary incontinence compared to controls. There is some evidence that strenuous exercise may cause and worsen pelvic organ prolapse, but data are inconsistent. Both intra-abdominal pressure associated with exercise and PFM strength vary between activities and between women; thus the threshold for optimal or negative effects on the pelvic floor almost certainly differs from person to person. Our review highlights many knowledge gaps that need to be understood to understand the full effects of strenuous and non-strenuous activities on pelvic floor health.
Sigurdardottir, Torgerdur; Steingrimsdottir, Thora; Geirsson, Reynir T.; Halldorsson, Thorhallur Ingi; Aspelund, Thor & Bø, Kari (2019). Can postpartum pelvic floor muscle training reduce urinary and anal incontinence?: An assessor-blinded randomized controlled trial. American Journal of Obstetrics and Gynecology. ISSN 0002-9378. doi: 10.1016/j.ajog.2019.09.011. Show summary
Background: Pelvic floor dysfunction, including urinary and anal incontinence, is a common postpartum complaint and likely to reduce quality of life. Objective: To study the effects of individualized physical therapist–guided pelvic floor muscle training in the early postpartum period on urinary and anal incontinence and related bother, as well as pelvic floor muscle strength and endurance. Materials and Methods: This was an assessor-blinded, parallel-group, randomized controlled trial evaluating effects of pelvic floor muscle training by a physical therapist on the rate of urinary and/or anal leakage (primary outcomes); related bother and muscle strength and endurance in the pelvic floor were secondary outcomes. Between 2016 and 2017, primiparous women giving birth at Landspitali University Hospital in Reykjavik, Iceland, were screened for eligibilty 6–10 weeks after childbirth. Of those identified as urinary incontinent, 95 were invited to participate, of whom 84 agreed. The intervention, starting at ∼9 weeks postpartum consisted of 12 weekly sessions with a physical therapist, after which the main outcomes were assessed (endpoint, ∼6 months postpartum). Additional follow-up was conducted at ∼12 months postpartum. The control group received no instructions after the initial assessment. The Fisher exact test was used to test differences in the proportion of women with urinary and anal incontinence between the intervention and control groups, and independent-sample t tests were used for mean differences in muscle strength and endurance. Significance levels were set as α = 0.05. Results: A total of 41 and 43 women were randomized to the intervention and control groups, respectively. Three participants and 1 participant withdrew from these respective groups. Measurement variables and main delivery outcomes were not different at recruitment. At the endpoint, urinary incontinence was less frequent in the intervention group, with 21 participants (57%) still symptomatic, compared to 31 controls (82%) (P = .03), as was bladder-related bother with 10 participants (27%) in the intervention vs 23 (60%) in the control group (P = .005). Anal incontinence was not influenced by pelvic floor muscle training (P = .33), nor was bowel-related bother (P = .82). The mean differences between groups in measured pelvic floor muscle strength changes at endpoint was 5 hPa (95% confidence interval, 2–8; P = .003), and for pelvic floor muscle endurance changes, 50 hPa/s (95% confidence interval, 23–77; P = .001), both in favor of the intervention group. The mean between-group differences for anal sphincter strength changes was 10 hPa (95% confidence interval, 2–18; P = .01) and for anal sphincter endurance changes 95 hPa/s (95% confidence interval, 16–173; P = .02), both in favor of the intervention. At the follow-up visit 12 months postpartum, no differences were observed between the groups regarding rates of urinary and anal incontinence and related bother. Pelvic floor- and anal muscle strength and endurance favoring the intervention group were maintained. Conclusion: Postpartum pelvic floor mucle training decreased the rate of urinary incontinence and related bother 6 months postpartum and increased muscle strength and endurance.
Gram, Marte Charlotte Dobbertin & Bø, Kari (2019). High level rhythmic gymnasts and urinary incontinence: Prevalence, risk factors, and influence on performance. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. doi: 10.1111/sms.13548. Full text in Research Archive Show summary
Urinary incontinence (UI) is common among exercising women, but no studies have been found in rhythmic gymnasts. The aims of the present study were to investigate the prevalence and risk factors for UI in rhythmic gymnasts and the impact of UI on performance. This was a cross‐sectional study including all rhythmic gymnasts competing at the highest national and international level in Norway. One hundred and thirty‐three gymnasts from 22 sports clubs were invited to participate. Background data and possible risk factors were collected via electronic questionnaires. UI was assessed by Urinary Incontinence short form (ICIQ‐UI SF). The "Triad‐specific self‐ report questionnaire" was applied to assess the female athlete triad. Joint mobility was assessed by Beighton score. Logistic regression analysis was used to assess possible risk factors. One hundred and seven nulliparous rhythmic gymnasts (80.5% response rate) from 21 sports clubs, with mean age of 14.5 (SD 1.6) years, participated in the study. Thirty‐four (31.8%) reported UI with 21 (61.8%), 3 (8.8%), 6 (17.6%), and 4 (11.8%) reporting stress, urgency, mixed urinary incontinence, and leakage for no obvious reason, respectively. BMI, hypermobility, menarche, disordered eating, and hours of training were not found to be risk factors for stress urinary incontinence. Twenty‐four gymnasts with UI (70.6%) reported incontinence to influence sports performance; 10 (29.4%) reported to be afraid of visible leakage and 5 (14.7%) that the leakage would happen again. Seventy‐four (69.1%) had never heard about the pelvic floor. In conclusion, UI is common in rhythmic gymnasts and may influence sports performance.
Haakstad, Lene Annette Hagen; Voldner, Nanna & Bø, Kari (2019). Pregnancy and advanced maternal age — The associations between regular exercise and maternal and newborn health variables. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. doi: 10.1111/aogs.13738. Full text in Research Archive Show summary
Introduction: Despite the associations between delayed childbearing and poorer maternal and perinatal outcomes, little is known about these issues in regular exercisers and in women with healthy lifestyles. The aims of the present study were to : (a) compare lifestyle variables and exercise, pregnancy and birth outcomes in women ≥35 years and women <35 years of age, and (b) investigate the associations between regular exercise and maternal health and newborn variables in women of advanced maternal age. Material and methods: Healthy pregnant women (≥35 years, n = 104 and <35 years, n = 362) were allocated to the study from Rikshospitalet, Oslo University Hospital, Norway. The participants completed a validated self‐administered questionnaire, the Physical Activity Pregnancy Questionnaire (PAPQ) in gestational weeks 32‐36. Prepregnancy body weight (kg) was self‐reported, whereas maternal weight (kg) was measured at gestational weeks 14‐16, 22‐24, 30‐32, and 36‐38. Details of the delivery (gestational week at delivery, mode of delivery, Apgar score) and birthweight (g) were obtained from the hospital’s medical records. Results: More women <35 than ≥35 years of age reported to have exercised prepregnancy (83.7% vs 74.0%, P = 0.04) and in the 1st trimester (71.2% vs 61.5%, P = 0.05). At gestational week 36, fewer than 50% were exercising regularly, with no group differences (P = 0.74). Current alcohol use (10.5% vs 3.3%, P = 0.02) and tobacco use (5.8% vs 1.7%, P = 0.02) were higher among women ≥35 than women <35 years, whereas for healthy diet the result was reversed (<35 years 67.1% and ≥35 years 80.8%, P = 0.02). There were higher rates of post‐term birth (13.5% vs 6.4%, P = 0.02) and induction of labor (40.5% vs 27.9%, P = 0.02) in the ≥35 years group, otherwise no other differences were observed in perinatal outcomes. In women with advanced maternal age, exercising ≥2 times weekly was associated with less pelvic girdle pain (40.0% vs 61.1%, P = 0.02), lower gestational weight gain (12.7 ± 4.0 kg vs 15.5 ± 5.5 kg, P < 0.01), fewer had gestational weight gain ≥16 kg (22.0% vs 51.9%, P < 0.01) and a newborn with macrosomia (10.0% vs 37.0%, P < 0.01). The results were unchanged after adjusting for recognized confounders.
Bø, Kari; Fernandes, Ana Carolina Nociti Lopes; Duarte, Thaiana Bezerra; Brito, L. G. O. & Ferreira, Cristine H.J. (2019). Is pelvic floor muscle training effective for symptoms of overactive bladder in women?: A systematic review. Physiotherapy. ISSN 0031-9406. 106, p. 65–76. doi: 10.1016/j.physio.2019.08.011. Show summary
Background: Overactive bladder (OAB) syndrome can be very bothersome and is associated with impaired quality of life and work productivity. Objective: To evaluate the effect of pelvic floor muscle training (PFMT) on OAB symptoms in women. Furthermore, to assess the influence of PFMT on pelvic floor muscle (PFM) function, satisfaction with treatment, side effects, adherence and the quality of exercise reporting. Data sources: Systematic review of randomized controlled trials (RCTs). Electronic search was conducted on MEDLINE/PubMed, Embase, CINAHL, SciELO, SCOPUS, Web of Science and Physiotherapy Evidence Database (PEDro). The risk of bias was assessed using the PEDro scale. The Consensus on Exercise Reporting Template (CERT) was used to assess the quality of exercise reporting. Study selection: Full text RCTs including non-pregnant female participants, investigating PFMT versus inactive control or usual care, other life style modifications or other interventions. Synthesis methods: descriptive analysis Results: Eleven RCTs were included. There was considerable heterogeneity of PFMT protocols, outcome measures and follow-up periods. Hence, a qualitative analysis was undertaken. PFMT provided a significant reduction of OAB symptoms in five studies with a reduction in urinary frequency (n = 1), and urgency urinary incontinence (n = 4). PFM function was assessed in three studies, and two studies found improvement in favor of PFMT. Limitations: a meta-analysis was not possible due to huge heterogeneity of included studies. Conclusion: PFMT might reduce OAB symptoms, however, due to many limitations of the published studies it is not possible to clearly determine the effect of PFMT on OAB symptoms and PFM function.
Næss, Ingrid; Frawley, Helena C. & Bø, Kari (2019). Motor Function and Perception of Health in Women with Provoked Vestibulodynia. Journal of Sexual Medicine. ISSN 1743-6095. 16(7), p. 1060–1067. doi: 10.1016/j.jsxm.2019.04.016. Full text in Research Archive Show summary
Background Provoked vestibulodynia (PVD) is a prevalent and disabling condition in women that may be associated with reduced quality of life and impairment of physical functioning. Aim To investigate whether women with PVD have different motor functions, posture and breathing patterns, and whether they perceive their physical health differently, compared with asymptomatic controls. Methods and Main Outcome Measure The Standardized Mensendieck Test (SMT) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were used to assess differences between 35 women with PVD and 35 healthy controls. Results There were no statistically significant differences in any of the 5 motor domains of the SMT between the women with PVD and those without PVD: standing posture, 4.0 (0.6) vs 5.0 (0.6); gait, 4.7 (0.6) vs 4.8 (0.6); movement, 4.8 (0.8) vs 5.1 (0.6); sitting posture, 4.7 (1.0) vs 4.9 (0.8); respiration, 4.7 (1.0) vs 4.7 (0.9). Women with PVD scored significantly lower in all domains on the SF-36 (adjusted Bonferroni P = .002) except physical functioning. Clinical Implications Given the lack of difference in the SF-36 physical functioning domain and in all 5 domains of the SMT between women with PVD and those without PVD, the value of interventions focusing on general physical function is unclear. Strengths & Limitations A study strength is the use of an assessor-blinded case-control design, trained physiotherapists to conduct the tests, and valid and reliable outcome measures. A limitation is the homogeneity of the sample of young nulliparous women, which limits the generalizability of our findings to other study populations. Conclusion Young nulliparous women with PVD did not score differently from a group of healthy controls on assessment of overall physical functioning or on standing posture, gait, movement, sitting posture, and respiration. However, the score for perception of general health was lower in the women with PVD compared with controls.
Theodorsen, Nina-Margrethe Tennebekk; Strand, Liv Inger & Bø, Kari (2019). Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study. Physiotherapy. ISSN 0031-9406. 105, p. 315–320. doi: 10.1016/j.physio.2018.08.009. Show summary
Objectives: To investigate the effect of acute isometric contraction of the pelvic floor muscles (PFM) and transversus abdominis muscle (TrAM) on inter-rectus distance (IRD) from resting values in postpartum women with diastasis rectus abdominis (DRA). Design: Cross sectional experimental study. Setting: Physiotherapy clinic. Participants: Thirty eight postpartum women presenting with DRA of at least two finger widths. Methods: Two dimensional ultrasound images of IRD were recorded using a linear probe (5 to 10 MHz) at rest, during PFM contraction, during TrAM contraction, and during combined PFM and TrAM contraction. IRD data were normally distributed. Main outcome measure: Change in IRD. Results: There was a significant increase in IRD during PFM and TrAM contraction compared with IRD at rest. At 2 cm above the umbilicus, mean PFM was 26.9 [standard deviation (SD) 8.8] mm vs rest 25.7 (SD 8.5) mm {mean difference 1.2 [95% confidence interval (CI) 0.7 to 1.7] mm}; and mean TrAM was 28.4 (SD 9.0) mm vs rest 25.7 (SD 8.5) mm [mean difference 2.8 (95% CI 1.9 to 3.6) mm]. Similarly, 2 cm below the umbilicus, mean PFM was 22 (SD 8.3) mm vs rest 21 (SD 7.9) mm [mean difference 0.9 (95% CI 0.4 to 1.6) mm]; and mean TrAM was 23.3 (SD 8.7) mm vs rest 21 (SD 7.9) mm [mean difference 2.3 (95% CI 1.5 to 3.1) mm]. Combined TrAM and PFM contraction measured 2 cm above the umbilicus caused the greatest increase in IRD: mean PFM + TrAM 29.6 (SD 9.4) mm vs rest 25.7 (SD 8.5) mm [mean difference 3.9 (95% CI 2.8 to 5.0) mm]. Conclusion: Both PFM and TrAM contraction, and combined PFM and TrAM contraction increased IRD in postpartum women with DRA.
Rustaden, Anne Mette; Haakstad, Lene Annette Hagen; Paulsen, Gøran & Bø, Kari (2019). Does low and heavy load resistance training affect musculoskeletal pain in overweight and obese women? Secondary analysis of a randomized controlled trial. Brazilian Journal of Physical Therapy. ISSN 1413-3555. doi: 10.1016/j.bjpt.2019.01.005. Full text in Research Archive Show summary
Background: Overweight and obesity are associated with musculoskeletal pain, particularly in the female population. However, regular resistance training may positively affect these complaints. Objective: The present study aimed to investigate between group differences in musculoskeletal pain in previously inactive women, allocated to three different resistance-training modalities available in health- and fitness clubs. Methods: This is secondary analysis from a single-blinded randomized controlled trial, including healthy women (aged 18–65) with a BMI (kg/m2) ≥25. The participants were allocated to 12 weeks (3 times/weekly) of either BodyPump (high-repetition low-load group session) (n = 24), heavy load resistance training with a personal trainer (n = 28), non-supervised heavy load resistance training (n = 19) or non-exercising controls (n = 21). Primary outcome was self-reported musculoskeletal pain in ten different body parts, measured with the Standardized Nordic Pain Questionnaire, at baseline and post-test. In addition, the study included sub-analyses of the participants when they were divided into high (≥28 of 36 sessions, n = 38) and low (≤27 of 36 sessions, n = 22) exercise adherence. Results: The analysis revealed no between group differences in musculoskeletal pain in any of the ten body parts. The results did not change when the participants were divided into high versus low adherence. Conclusions: Twelve weeks of BodyPump, heavy load resistance training with a personal trainer and non-supervised heavy load resistance training did not show any effect on self-reported musculoskeletal pain in overweight women.
Kruger, Jennifer; Budgett, Richard; Goodman, Jonathan & Bø, Kari (2018). Can you train the pelvic floor muscles by contracting other related muscles? Neurourology and Urodynamics. ISSN 0733-2467. doi: 10.1002/nau.23890. Show summary
Aims: The aim of this study is to assess whether contraction of muscles other than the pelvic floor muscles (PFM) would be of sufficient magnitude to provide a “training” effect for the pelvic floor. Methods: Women were recruited via advertisement from a convenience sample of pelvic floor physiotherapists. A thin flexible array of pressure sensors (FemFit) was self-inserted into the vagina. Participants performed three maximum pelvic floor contractions and completed a randomized exercise protocol. Maximum pressures were determined for each sensor, for each exercise. Wilcoxon paired tests were used to ascertain the difference in pelvic floor muscle pressure between exercises, and between the pressures from the pelvic floor muscles sensors and those measuring abdominal pressure. Bonferroni correction α 0.005. Results: Data was obtained from nineteen participants. Mean age 43 ± 11 years, BMI 22.4 ± 3.2 kg m−2. Mean PFM pressure for pelvic floor muscle contractions was 16.3 ± 12.2 mmHg. Pressure in the region of the pelvic floor was significantly higher during a targeted contraction compared to that for all other exercises, except for cough and curl-ups (P = 0.009, P = 0.013 respectively). PFM pressure was significantly higher than abdominal for PFMC, internal rotators and gluteals (P < 0.001). Conclusion: Targeted PFM contractions develop higher pressures compared to abdominal pressure than any exercise tested in this study. The Femfit device was able to distinguish between abdominal and pelvic floor muscle pressures simultaneously. Exercising accessory muscles in an attempt to activate the pelvic floor sufficiently to illicit a training effect is not recommended.
de Freitas, Leticia Maciel; Bø, Kari; Fernandes, Ana Carolina Nociti Lopes; Uechi, Natalia; Duarte, Thaiana Bezerra & Ferreira, Cristine Homsi Jorge (2018). Pelvic floor muscle knowledge and relationship with muscle strength in Brazilian women: a cross-sectional study. International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-018-3824-y. Show summary
Introduction and hypothesis: There seems to be little knowledge about pelvic floor muscles (PFMs) in the general population; however, literature confirming this assertion is scarce, especially in developing countries. The present study hypothesized a low level of knowledge about PFMs in a sample of Brazilian women and a positive relationship between that knowledge and the ability to contract the PFMs, strength, and urinary continence. Methods: This was a cross-sectional study including 133 women. A questionnaire assessing knowledge about PFMs and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) were applied. Vaginal palpation and manometry were used to assess PFM condition. Pearson’s correlation coefficient was used to test the association between PFM knowledge and continuous variables, and Fisher’s exact test was used to compare the women’s PFM knowledge with the categorical variables. Results: A low level of PFM knowledge was observed in this sample, with a mean total score of 0.48 (±0.97). Vaginal manometry peak, mean, and duration values were 39.1 cmH2O (±23.7), 25.5 cmH2O (±16.1), and 21.1 s (±20.8) respectively. The ICIQ-UI-SF mean score was 7.1 (± 6.8). There were weak correlations between PFM knowledge and age (r −0.2044/ p = 0.01), and parity (r −0.19568/p = 0.02). PFM knowledge was higher among women with higher education levels (p = 0.0012) and those who had previously performed PFM training (p <0.001). Conclusion: The participants showed a low level of PFM knowledge. No relationship between PFM knowledge and ability to contract or prevalence of UI was observed.
Carvalhais, Alice; Da Roza, Thuane; Vilela, Sofia; Jorge, Renato Natal & Bø, Kari (2018). Association Between Physical Activity Level and Pelvic Floor Muscle Variables in Women. International Journal of Sports Medicine (IJSM). ISSN 0172-4622. 39(13), p. 995–1000. doi: 10.1055/a-0596-7531. Show summary
In order to investigate the potential impact of physical activity (PA) on pelvic floor muscle (PFM) function, a cross-sectional study was made to analyse the association between PA level and vaginal resting pressure (VRP) and PFM strength and endurance. Thirty-eight continent women and 20 women with stress urinary incontinence (SUI) aged 19 to 49 years were enrolled in the study. PFM variables were assessed by manometry. The PA level was assessed through the International Physical Activity Questionnaire – Short Form. The International Consultation on Incontinence Questionnaire-Urinary Incontinence – Short Form was applied to identify SUI. Pearson’s correlation coefficients were applied to estimate the association between PA and PFM variables. Incontinent women were classified as having a high PA level compared to the continent ones (65.0% vs 34.2%, respectively; p = 0.030). There was a positive weak association between PA and VRP in continent (r = 0.377) and an inverse association in incontinent women (r = − 0.458). No associations were found between PA and PFM strength and endurance. Further studies are needed in order to identify a causal association between PA and SUI.
Sigurdardottir, Torgerdur; Steingrimsdottir, Thora; Geirsson, Reynir Tomas; Halldorsson, Thorhallur Ingi; Aspelund, Thor & Bø, Kari (2018). Do female elite athletes experience more complicated childbirth than non-athletes? A case–control study. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2018-099447. Full text in Research Archive Show summary
Objective: Previous studies have suggested that female athletes might be at higher risk of experiencing complications such as caesarean sections and perineal tears during labour than non-athletes. Our aim was to study delivery outcomes, including emergency caesarean section rates, length of the first and second stages of labour and severe perineal tears, in first-time pregnant elite athletes compared with non-athletes. Methods: This is a retrospective case–control study comparing birth outcomes of primiparous female elite athletes engaging in high-impact and low-impact sports compared with non-athletic controls. The athletes had prior to birth competed at a national team level or equivalent. Participant characteristics and frequency of training for at least 3 years before a first pregnancy were collected via a self-administered questionnaire. Information on delivery outcome was retrieved from the Icelandic Medical Birth Registry. Results: In total, 248 participated, 118 controls, 41 low-impact and 89 high-impact elite athletes. No significant differences were found between the groups with regard to incidence of emergency caesarean section or length of the first and second stages of labour. The incidence of third-degree to fourth-degree perineal tears was significantly higher (23.7%) among low-impact athletes than in the high-impact group (5.1%, p=0.01), but no significant differences were seen when the athletes were compared with the controls (12%; p=0.09 for low-impact and p=0.12 for high-impact athletes). Conclusion: Participation in competitive sports at the elite level was not related to adverse delivery outcome, including length of labour, the need for caesarean section during delivery and severe perineal tears.
Carvalhais, Alice; Araújo, Joana; Jorge, Renato Natal & Bø, Kari (2018). Urinary incontinence and disordered eating in female elite athletes. Journal of Science and Medicine in Sport. ISSN 1440-2440. 22(2), p. 140–144. doi: 10.1016/j.jsams.2018.07.008. Show summary
Objectives: To evaluate the association between urinary incontinence and disordered eating, in elite female athletes. Design: This cross-sectional study included 744 young and healthy Portuguese women: 372 elite athletes and 372 age-matched non-athletes, mean age 21 ± 5.3 years. Methods: Data regarding clinical, demographic, and sport practice characteristics were collected by questionnaire. The International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form was applied to identify urinary incontinence. The Eating Disorder Examination Questionnaire was applied to identify disordered eating. Odds ratios with 95% confidence intervals (95% CI) were used to estimate the association between UI and disordered eating. Results: The prevalence of urinary incontinence in athletes and non-athletes was 29.3% and 13.4%, p < 0.001, respectively. No difference in prevalence of disordered eating was found between athletes (17.7%) and non-athletes (20.2%), p = 0.435. Urinary incontinence was associated with disordered eating only in the athletes. After adjustment for age, type of sport, smoking and alcohol intake, athletes with disordered eating presented increased odds of urinary incontinence of any type over athletes without disordered eating (OR = 3.09; 95% CI: 1.74–5.50). Conclusions: Athletes with disordered eating were three times more likely to present urinary incontinence than women without disordered eating. There is a need for further studies to elaborate on mechanisms for this association.
Rise, Eirin Nygaard; Bø, Kari & Nystad, Wenche (2018). Is there any association between abdominal strength training before and during pregnancy and delivery outcome? The Norwegian Mother and Child Cohort Study. Brazilian Journal of Physical Therapy. ISSN 1413-3555. 23(2), p. 108–115. doi: 10.1016/j.bjpt.2018.06.006. Show summary
Background: Abdominal strength training before and during pregnancy has been recommended to enhance normal vaginal birth by enabling increased force needed for active pushing. However, to date there is little research addressing this hypothesis. Objective: To investigate whether nulliparous pregnant women reporting regular abdominal strength training prior to and at two time points during pregnancy have reduced risk of cesarean section, instrumental assisted vaginal delivery and third- and fourth-degree perineal tears. Methods: Analysis of 36 124 nulliparous pregnant women participating in the Norwegian Mother and Child Cohort Study during the period 1999–2009 who responded to questions regards the main exposure; regular abdominal strength training. Data on delivery outcomes were retrieved from the Medical Birth Registry of Norway. Logistic regression analyses were used to evaluate the association between exposure and outcome before pregnancy and at gestational weeks 17 and 30. Results: Amongst participants, 66.9% reported doing abdominal strength training exercises before pregnancy, declining to 31.2% at gestational week 30. The adjusted odds ratios were 0.97 (95% CI 0.79–1.19) for acute cesarean section, among those training with the same frequency before and during pregnancy compared to those that never trained. The results were similar for instrumental assisted vaginal delivery and third- and fourth-degree perineal tear. Conclusion: There was no association between the report of regular abdominal strength training before and during pregnancy and delivery outcomes in this prospective population-based cohort.
Antônio, Flávia Ignácio; Herbert, Robert D.; Bø, Kari; Rosa-e-Silva, Ana Carolina Japur Sa; Lara, Lucia Alves da Silva & Franco, Maíra Menezes [Show all 7 contributors for this article] (2018). Pelvic floor muscle training increases pelvic floor muscle strength more in post-menopausal women who are not using hormone therapy than in women who are using hormone therapy: a randomised trial. Journal of Physiotherapy. ISSN 1836-9553. 64(3), p. 166–171. doi: 10.1016/j.jphys.2018.05.002. Show summary
Question: Are there differences in the effectiveness of pelvic floor muscle training on pelvic floor muscle strength and urinary incontinence symptoms in postmenopausal women who are and are not using hormone therapy? Design: Randomised, controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. Participants: Ninety-nine postmenopausal women, 38 of whom were using daily systemic oestrogen/progestogen therapy. Intervention: The experimental group (n = 51) received an intensive supervised pelvic floor muscle training protocol, and the control group (n = 48) received no intervention. The randomisation was stratified by hormone therapy use. Outcome measures: Change in pelvic floor muscle strength assessed with manometry at 12 weeks. Prevalence and severity of urinary incontinence symptoms were assessed using questionnaires. Results: Eighty-eight women provided data that could be included in the analysis. Pelvic floor muscle training increased pelvic floor muscle strength by 8.0 cmH2O (95% CI 3.4 to 12.6) in women not using hormone therapy and by –0.9 cmH20 (95% CI –6.5 to 4.8) in women using hormone therapy (interaction p = 0.018). A sensitivity analysis showed that the greater training effect in women who were not using hormone therapy was still apparent if the analysis was conducted on percentage change in strength rather than absolute change in strength. There was also a significantly greater effect of training in women not using hormone therapy on prevalence of urinary incontinence symptoms (ratio of odds ratios = 7.4; interaction p = 0.028). The difference in effects on severity of urinary incontinence symptoms was not statistically significant (interaction p = 0.37). Conclusion: Pelvic floor muscle training increases pelvic floor muscle strength more in women who are not using hormone therapy than in women using hormone therapy.
Bø, Kari; Artal, Raul; Barakat, Ruben; Brown, Wendy J.; Davies, Gregory A.L. & Dooley, Michael [Show all 15 contributors for this article] (2018). Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2018-099351. Full text in Research Archive
Herbert, Robert D.; Kasza, Jessica & Bø, Kari (2018). Analysis of randomised trials with long-term follow-up. BMC Medical Research Methodology. ISSN 1471-2288. 18(48). doi: 10.1186/s12874-018-0499-5. Full text in Research Archive Show summary
Randomised trials with long-term follow-up can provide estimates of the long-term effects of health interventions. However, analysis of long-term outcomes in randomised trials may be complicated by problems with the administration of treatment such as non-adherence, treatment switching and co-intervention, and problems obtaining outcome measurements arising from loss to follow-up and death of participants. Methods for dealing with these issues that involve conditioning on post-randomisation variables are unsatisfactory because they may involve the comparison of non-exchangeable groups and generate estimates that do not have a valid causal interpretation. We describe approaches to analysis that potentially provide estimates of causal effects when such issues arise. Brief descriptions are provided of the use of instrumental variable and propensity score methods in trials with imperfect adherence, marginal structural models and g-estimation in trials with treatment switching, mixed longitudinal models and multiple imputation in trials with loss to follow-up, and a sensitivity analysis that can be used when trial follow-up is truncated by death or other events. Clinical trialists might consider these methods both at the design and analysis stages of randomised trials with long-term follow-up.
Reimers, Cathrine; Siafarikas, Franziska; Stær-Jensen, Jette; Småstuen, Milada Cvancarova; Bø, Kari & Engh, Marie Ellström (2018). Risk factors for anatomic pelvic organ prolapse at 6 weeks postpartum: a prospective observational study. International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-018-3650-2. Full text in Research Archive Show summary
Introduction and hypothesis: The objective was to identify risk factors for postpartum anatomic pelvic organ prolapse (aPOP) by comparing women with and without aPOP at 6 weeks postpartum with regard to pelvic floor measurements antepartum and obstetrical characteristics. Methods: We carried out a prospective observational cohort study including nulliparous pregnant women in a Norwegian university hospital. Participants underwent clinical examinations, including pelvic organ prolapse quantification system (POP-Q) and transperineal ultrasound at gestational week 21 and at 6 weeks postpartum. Background and obstetrical information was obtained from an electronic questionnaire and from the patient’s electronic medical file respectively. Associations were estimated using logistic regression analyses. The dependent variable was aPOP, defined as POP-Q stage ≥2 at 6 weeks postpartum. Independent variables were mid-pregnancy measurements of selected POP-Q variables and levator hiatus area (LHarea), delivery route, and the presence of major levator ani muscle (LAM) injuries at 6 weeks postpartum. Results: A larger LHarea, a more distensible LAM, a longer distance from the meatus urethra to the anus (Gh + Pb) and a more caudal position of the anterior vaginal wall (Ba) at mid-pregnancy were risk factors for aPOP at 6 weeks postpartum, whereas delivery route and the presence of major LAM injuries were not. Conclusion: Prelabor differences in the pelvic floor rather than obstetrical events were risk factors for aPOP at 6 weeks postpartum.

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Bø, Kari; Berghmans, Bary; Mørkved, Siv & Van Kampen, Marijke (2023). Evidence-Based Physical Therapy for the Pelvic Floor Bridging Science and Clinical Practice. Elsevier. ISBN 9780702083082. 772 p.

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Bø, Kari (2024). Reply to: Uncertainties of the Impacts of Strenuous Physical Activity, Exercise, and Parity on Pelvic Organ Prolapse. International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-024-05751-1.
Gabrielsen, Rakel; Engh, Anna Marie Ellström; Bø, Kari & Tennfjord, Merete Kolberg (2023). Spectrum of symptoms among women suffering endometriosis and the relationship with physical activity and exercise.
Tennfjord, Merete Kolberg; Bø, Kari; Engh, Marie Ellström & Gabrielsen, Rakel (2023). Women’s health physiotherapists clinical practice and endometriosis patients views of general exercise - a mixed-methods study.
Tennfjord, Merete Kolberg; Bø, Kari; Engh, Marie Ellström & Gabrielsen, Rakel (2023). Women’s health physiotherapists clinical practice and endometriosis patients views of general exercise – a mixed-methods study.
Gram, Marte Charlotte Dobbertin; Clarsen, Benjamin Matthew & Bø, Kari (2021). Injuries and illnesses among competitive Norwegian rhythmic gymnasts during preseason - a prospective cohort study of prevalence, incidence and risk factors.
Gram, Marte Charlotte Dobbertin; Clarsen, Benjamin Matthew & Bø, Kari (2021). Injuries and illnesses among competitive Norwegian rhythmic gymnasts during preseason - a prospective cohort study of prevalence, incidence and risk factors. British Journal of Sports Medicine. ISSN 0306-3674. 55. doi: 10.1136/bjsports-2021-IOC.25.
Mota, Patrícia & Bø, Kari (2021). ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstetrics and Gynecology. ISSN 0029-7844. 137(2), p. 376–376. doi: 10.1097/AOG.0000000000004267.
Antônio, Flávia Ignácio; Herbert, Robert D; Bø, Kari; Japur Sá Rosa-e-Silva, Ana Carolina; Silva Lara, Lúcia Alves & de Menezes Franco, Maira [Show all 7 contributors for this article] (2020). Erratum to ‘Pelvic floor muscle training increases pelvic floor muscle strength more in post-menopausal women who are not using hormone therapy than in women who are using hormone therapy: a randomised trial’ (Journal of Physiotherapy (2018) 64(3) (166–171), (S1836955318300523), (10.1016/j.jphys.2018.05.002)). Journal of Physiotherapy. ISSN 1836-9553. 66(1), p. 7–8. doi: 10.1016/j.jphys.2019.11.001.
Bø, Kari & Tennfjord, Merete Kolberg (2020). Are There Alternative Exercises to Pelvic Floor Muscle Training to Treat Female Stress Urinary Incontinence? .
Bø, Kari; Dumoulin, Chantale; Hay-Smith, Jean; Ferreira, Cristine Homsi Jorge; Frawley, Helena C. & Mørkved, Siv [Show all 8 contributors for this article] (2019). Comment and Questions to Mottola et al. (2018): 2018 Canadian Guideline for Physical Activity Throughout Pregnancy. Journal of Obstetrics and Gynaecology Canada. ISSN 1701-2163. 41(10), p. 1404–1405. doi: 10.1016/j.jogc.2019.05.008.
Pascoal, Augusto Gil; Stuge, Britt; Mota, Patrícia; Hilde, Gunvor & Bø, Kari (2019). Therapeutic Exercise Regarding Musculoskeletal Health of the Pregnant Exerciser and Athlete. In Santos-Rocha, Rita (Eds.), Exercise and Sporting Activity During Pregnancy : Evidence-Based Guidelines. Springer. ISSN 9783319910314. p. 309–326. doi: 10.1007/978-3-319-91032-1_10.
Bø, Kari; Stuge, Britt & Hilde, Gunvor (2019). Specific Musculoskeletal Adaptations in Pregnancy : Pelvic Floor, Pelvic Girdle, and Low Back Pain : Implications for Physical Activity and Exercise. In Santos-Rocha, Rita (Eds.), Exercise and Sporting Activity During Pregnancy : Evidence-Based Guidelines. Springer. ISSN 9783319910314. p. 135–155. doi: 10.1007/978-3-319-91032-1_6.
Tennfjord, Merete Kolberg; Engh, Marie Ellström & Bø, Kari (2019). General exercise training six weeks postpartum did not influence pelvic floor muscle function or pelvic floor dysfunction at 12 months postpartum: a prospective cohort study. Show summary
Background: There is scant knowledge whether early onset of postpartum general physical activity/ exercise training affect the pelvic floor muscles and increase the risk of SUI and POP. Aim: To investigate how general exercise training six weeks postpartum impact on the PFM and symptoms of SUI and POP 12 months postpartum. Method: In this prospective cohort study, at six weeks postpartum, 70 primiparous women characterised as regular exercisers (≥3 times ≥30 min/week) were compared to 97 non-exercisers. Mean age 29 (SD 4.3). Twelve months postpartum vaginal resting pressure (VRP), PFM strength and PFM endurance were measured by vaginal manometer and symptoms of SUI and POP were assessed by questionnaire (ICIQ). Results: Twelve months postpartum no differences were found between exercisers (n=70) and non-exercisers (n=97) performed six weeks postpartum on VRP (B: -0.04 (95%CI: -3.39, 2.07), PFM strength (B: 0.06, 95%CI: -3.66, 8.04), PFM endurance (B: 0.03, 95%CI: -39.17, 61,45) or symptoms of SUI (OR: 0.35 , 95%CI: 0.41, 1.62) or POP (OR: 1.23, 95%CI: 0.29, 1.42). After adjusting the findings for possible covariates having SUI at mid-pregnancy and BMI >30 were associated with increased risk of having SUI 12 months postpartum: OR=16.46, (95%CI: 2.62, 15.85) and OR=4.59, (95%CI: 1.11, 11.30), respectively. Having POP at mid-pregnancy was associated with increased risk of having POP 12 months postpartum (OR=10.16, 95%CI: 1.87, 13.83). Conclusion: Starting regular, general exercise training six weeks postpartum does not negatively influence the PFM or PFD 12 months postpartum.
Tennfjord, Merete Kolberg; Engh, Marie Ellström & Bø, Kari (2019). Does early onset of exercise training postpartum negatively affect pelvic floor muscle function and prevalence of pelvic floor dysfunction 12 months postpartum? Show summary
Background: There is scant knowledge whether early onset of postpartum general physical activity/ exercise training affect the pelvic floor muscles and increase the risk of SUI and POP. Aim: To investigate how general exercise training six weeks postpartum impact on the PFM and symptoms of SUI and POP 12 months postpartum. Method: In this prospective cohort study, at six weeks postpartum, 70 primiparous women characterised as regular exercisers (≥3 times ≥30 min/week) were compared to 97 non-exercisers. Mean age 29 (SD 4.3). Twelve months postpartum vaginal resting pressure (VRP), PFM strength and PFM endurance were measured by vaginal manometer and symptoms of SUI and POP were assessed by questionnaire (ICIQ). Results: Twelve months postpartum no differences were found between exercisers (n=70) and non-exercisers (n=97) performed six weeks postpartum on VRP (B: -0.04 (95%CI: -3.39, 2.07), PFM strength (B: 0.06, 95%CI: -3.66, 8.04), PFM endurance (B: 0.03, 95%CI: -39.17, 61,45) or symptoms of SUI (OR: 0.35 , 95%CI: 0.41, 1.62) or POP (OR: 1.23, 95%CI: 0.29, 1.42). After adjusting the findings for possible covariates having SUI at mid-pregnancy and BMI >30 were associated with increased risk of having SUI 12 months postpartum: OR=16.46, (95%CI: 2.62, 15.85) and OR=4.59, (95%CI: 1.11, 11.30), respectively. Having POP at mid-pregnancy was associated with increased risk of having POP 12 months postpartum (OR=10.16, 95%CI: 1.87, 13.83). Conclusion: Starting regular, general exercise training six weeks postpartum does not negatively influence the PFM or PFD 12 months postpartum.
Antônio, Flávia Ignácio; Herbert, Robert D.; Bø, Kari; Rosa-e-Silva, Ana Carolina Japur Sá; Lara, Lúcia Alves Silva & Franco, Maira de Menezes [Show all 7 contributors for this article] (2019). Correspondence: Author response to Ariie. Journal of Physiotherapy. ISSN 1836-9553. 65(2), p. 117–117. doi: 10.1016/j.jphys.2019.01.010.
Ferreira, Cristine Homsi Jorge; Driusso, Patricia & Bø, Kari (2019). The Brazilian Journal of Physical Therapy (BJPT) Special Issue on Women's Health Physical Therapy. Brazilian Journal of Physical Therapy. ISSN 1413-3555. 23(2), p. 77–78. doi: 10.1016/j.bjpt.2019.02.015.
Bø, Kari; Frawley, Helena C.; Haylen, Bernard T.; Morin, Melanie & Shelly, Elizabeth (2018). Response to comment on the IUGA/ICS joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourology and Urodynamics. ISSN 0733-2467. 37(2), p. 877–878. doi: 10.1002/nau.23355.
Reimers, Cathrine; Stær-Jensen, Jette; Siafarikas, Franziska; Bø, Kari & Engh, Marie Ellström (2018). Correction to: Association between vaginal bulge and anatomical pelvic organ prolapse during pregnancy and postpartum: an observational study. International Urogynecology Journal. ISSN 0937-3462. 29(3), p. 449–449. doi: 10.1007/s00192-018-3564-z.

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Published Oct. 17, 2023 1:10 PM - Last modified Dec. 13, 2023 2:34 PM

Kari Bø

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