Training through gametherapy promotes coactivation of the pelvic floor and abdominal muscles in young women, nulliparous and continents

Valeria Regina Silva, Cássio Luis Zanettini Riccetto, Natalia Miguel Martinho, Joseane Marques, Leonardo Cesar Carvalho, Simone Botelho, Valeria Regina Silva, Cássio Luis Zanettini Riccetto, Natalia Miguel Martinho, Joseane Marques, Leonardo Cesar Carvalho, Simone Botelho

Abstract

Introduction and objectives: several studies have been investigated co-activation can enhance the effectveness of PFM training protocols allowing preventive and therapeutic goals in pelvic floor dysfunctions. The objective of the present study was to investigate if an abdominal-pelvic protocol of training (APT) using gametherapy would allow co-activation of PFM and transversus abdominis/oblique internal (TrA/OI) muscles.

Patients and methods: Twenty-five nulliparous, continent, young females, with median age 24.76 (±3.76) years were evaluated using digital palpation (DP) of PFM and surfasse electromyography of PFM and TrA/OI simultaneously, during maximal voluntary contraction (MVC), alternating PFM and TrA/OI contraction requests. All women participated on a supervised program of APT using gametherapy, that included exercises of pelvic mobilization associated to contraction of TrA/OI muscles oriented by virtual games, for 30 minutes, three times a week, in a total of 10 sessions. Electromyographic data were processed and analyzed by ANOVA - analysis of variance.

Results: When MVC of TrA/OI was solicited, it was observed simultaneous increase of electromyographic activity of PFM (p=0.001) following ATP. However, EMG activity did not change significantly during MVC of PFM.

Conclusion: Training using gametherapy allowed better co-activation of pelvic floor muscles in response to contraction of TrA, in young nulliparous and continent women.

Keywords: Abdominal Muscles; Electromyography; Pelvic Floor.

Conflict of interest statement

Conflicts of Interest: None declared.

Copyright© by the International Brazilian Journal of Urology.

Figures

Figure 1. Movements are performed over the…
Figure 1. Movements are performed over the platform, during virtual games.
Anteversion movement (A), retroversion (B), lateral pelvic inclination (D)
Figure 2. Calculus of percentage of variation…
Figure 2. Calculus of percentage of variation in relation to rest.

References

    1. Pereira SB, Silva JM, Pereira LC. Treinamento dos Músculos do Assoalho Pélvico. In: Palma PCR, Berghmans B, Seleme MR, Riccetto CLZ, Pereira SB, editors. Urofisioterapia. Aplicações clínicas das técnicas fisioterapêuticas nas disfunções miccionais e do assoalho pélvico. 2ª ed. Personal Link; Curitiba: 2014. pp. 353–360.
    1. Petros P, Riccetto CLZ. Aplicações clínicas da Teoria Integral da Continência. In: Palma PCR, Berghmans B, Seleme MR, Riccetto CLZ, Pereira SB, editors. Urofisioterapia. Aplicações clínicas das técnicas fisioterapêuticas nas disfunções miccionais e do assoalho pélvico. 2ª ed. Personal Link; Curitiba: 2014. pp. 43–53.
    1. Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:125–132.
    1. Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther. 2004;9:3–12.
    1. Pereira LC, Botelho S, Marques J, Amorim CF, Lanza AH, Palma P, et al. Are transversus abdominis/oblique internal and pelvic floor muscles coactivated during pregnancy and postpartum? Neurourol Urodyn. 2013;32:416–419.
    1. Palma PCR, Portugal HSP. Anatomia do Assoalho Pélvico. In: Palma PCR, Berghmans B, Seleme MR, Riccetto CLZ, Pereira SB, editors. Urofisioterapia. Aplicações clínicas das técnicas fisioterapêuticas nas disfunções miccionais e do assoalho pélvico. 2ª ed. Personal Link; Curitiba: 2014. pp. 29–41.
    1. Fozzatti MC, Palma P, Herrmann V, Dambros M. Impact of global postural reeducation for treatment of female stress urinary incontinence. Rev Assoc Med Bras. 2008;54:17–22.
    1. Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Arch Phys Med Rehabil. 2001;82:1081–1088.
    1. Bø K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J Pelvic Floor Dysfunct. 2004;15:76–84.
    1. Tamanini JT, Dambros M, D'Ancona CA, Palma PC, Rodrigues Netto N., Jr. Validation of the “International Consultation on Incontinence Questionnaire --Short Form” (ICIQ-SF) for Portuguese] Rev Saude Publica. 2004;38:438–444.
    1. Laycock J, Jerwood D. Pelvic floor muscle assessment: The PERFECT scheme. Phisyotherapy. 2001;87:631–642.
    1. Nagib ABL, Guirro EC, Palauro VA, Guirro RRJ. Avaliação da co-ativação da musculatura abdominopélvica em nulíparas com eletromiografia e biofeedback perineal. Rev Bras Ginecol Obstet. 2005;4:210–215.
    1. Hodges PW, Sapsford R, Pengel LH. Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn. 2007;26:362–371.
    1. Botelho S, Riccetto C, Herrmann V, Pereira LC, Amorim C, Palma P. Impact of delivery mode on electromyographic activity of pelvic floor: comparative prospective study. Neurourol Urodyn. 2010;29:1258–1261.
    1. Martinho NM. O treinamento por meio de realidade virtual melhora a funcionalidade dos músculos do assoalho pélvico de mulheres na pós-menopausa? Estudo controlado randomizado/ Natalia Miguel Martinho. Universidade Federal de Alfenas; MG: 2014. [tese] [s.n.]
    1. Botelho S, Martinho NM, Silva VR, Marques J, Carvalho LC, Riccetto C. Virtual reality: a proposal for pelvic floor muscle training. Int Urogynecol J. 2015;26:1709–1712.
    1. Silva VR. Comportamento dos músculos do assoalho pélvico e transverso do abdômen/oblíquo interno frente a dois programas de treinamento abdominopélvico em mulheres jovens nulíparas, continentes: estudo controlado, randomizado/Valeria Regina Silva. Universidade Estadual de Campinas; SP: 2015. [tese] [s.n.]
    1. Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56:238–248.
    1. Bø K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999;318:487–493.
    1. Piret S, Béziers M.M. A coordenação motora: aspecto mecânico da organização psicomotora do homem. São Paulo (SP): Summus; 2002. pp. 151–151.
    1. Wei JT, De Lancey JO. Functional anatomy of the pelvic floor and lower urinary tract. Clin Obstet Gynecol. 2004;47:3–17.
    1. Junginger B, Baessler K, Sapsford R, Hodges PW. Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int Urogynecol J. 2010;21:69–77.
    1. Caufriez M. Gymnastique abdominale hypopressive. Bruxelles. 1997:8–10.
    1. Stüpp L, Resende AP, Petricelli CD, Nakamura MU, Alexandre SM, Zanetti MR. Pelvic floor muscle and transversus abdominis activation in abdominal hypopressive technique through surface electromyography. Neurourol Urodyn. 2011;30:1518–1521.
    1. Kamel DM, Thabet AA, Tantawy SA, Radwan MM. Effect of abdominal versus pelvic floor muscle exercises in obese Egyptian women with mild stress urinary incontinence: A randomised controlled trial. Hong Kong Physiother J. 2012;31:12–18.
    1. Rogers RG. Clinical practice. Urinary stress incontinence in women. N Engl J Med. 2008;358:1029–1036.
    1. Peschers UM, Gingelmaier A, Jundt K, Leib B, Dimpfl T. Evaluation of pelvic floor muscle strength using four different techniques. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:27–30.
    1. Madill SJ, Harvey MA, McLean L. Women with SUI demonstrate motor control differences during voluntary pelvic floor muscle contractions. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:447–459.
    1. Bø K, Kvarstein B, Hagen RR, Larsen S. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contraction. Neurourol Urodyn. 1990;9:479–487.
    1. Nappi RE, Davis SR. The use of hormone therapy for the maintenance of urogynecological and sexual health post WHI. Climacteric. 2012;15:267–274.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться