Leg stiffness and muscle power vs manometer in sportswomen with symptoms of stress urinary incontinence.

BACKGROUND: Pelvic floor muscle training can cure or alleviate stress urinary incontinence. This study aimed to evaluate maximum voluntary contractions of the pelvic floor muscle in sportswomen and verify the association with leg stiffness and muscle power, both maximal and submaximal. METHODS: The sample consisted of 41 sportswomen between 18 and 42 years of age. Pelvic floor muscle strength was measured by the manometer. The sportswomen were instructed to perform 3 maximum voluntary contractions of the perineum, held for 3 seconds. Maximal and submaximal leg stiffness and muscle power were measured with a force platform, in two conditions: 1st condition was the sub-maximal, double leg hop test, which was performed allowing sportswomen to self-select their preferred frequency and 2nd condition was the maximal double leg hop test, which was performed asking athletes to maximize hop height and minimize contact time on the top of the force platform for 6 consecutive hops. FINDINGS: Maximal and submaximal leg stiffness values increase with increasing age, weight, height, and body mass index, showing positive and significant (p <0.05) or close correlations. There are strong positive correlations between maximal and submaximal leg stiffness (r = 0.759) and between maximal and submaximal muscle power. Maximum voluntary contractions values decrease with increasing leg stiffness: the correlation is significant with maximal leg stiffness. INTERPRETATION: Maximum voluntary contractions values decrease with increasing leg stiffness and increase with increasing muscle power values. If the training program aims to increase muscle power, it may also increase maximum voluntary contractions.

Effects of auditory or visual stimuli on gait in Parkinsonic patients: a systematic review.

BACKGROUND: External stimuli can improve gait performance in Parkinsons Disease (PD): auditory stimuli can increase velocity and visual stimuli may act at step length. OBJECTIVE: To systematize the scientific evidence about the effects of auditory or visual stimuli on gait in patients with PD. METHODS: From January 2016 to December 2018, a systematic literature research was conducted in the PubMed/Medline and Web of Science databases. Study designs considered were randomized controlled trials (RCTs) and observational studies, which evaluated the effects of auditory or visual stimuli on gait in PD. The methodological quality was assessed by the Critical Appraisal Skills Program. RESULTS: Five articles were included with 232 participants and a methodological rank of mean of 10.3 on the cohort studies (n = 3), 8 on the case control studies (n = 1), and 6 on the RCTs (n = 1). Although 3 evaluated the effects of auditory stimuli on gait in PD, 2 analyzed those of visual stimuli. Based on these, it was verified a significant improvement of diverse gait parameters. CONCLUSION: The application of auditory or visual stimuli have beneficial effects on gait parameters. Further investigation is required.

Inspiratory muscle training on lung function of male roller hockey players: a randomized controlled trial pilot study.

BACKGROUND: There is evidence that inspiratory muscle training (IMT) increases the athlete's performance by decreasing the work of the respiratory muscles during exercise. IMT has shown positive results in the pulmonary function of athletes, and it was hypothesized that 4 weeks of intervention could increase lung function at rest. Investigate the influence of IMT on lung function of male roller hockey players. METHODS: Eleven male roller hockey players were randomized and allocated in the experimental group (EG) or control group (CG). Forced expiratory volume in first second, forced vital capacity, and peak expiratory flow (PEF) were assessed with spirometry, in the beginning of the study and 4 weeks later. The EG (n = 6) was submitted to an IMT using a threshold during 4 weeks, 3 times a week, 30 repetitions with 50% of maximal inspiratory pressure. The CG (n = 5) was not submitted to any intervention. RESULTS: Baseline pulmonary variables, forced expiratory volume in first second, forced vital capacity, and PEF, sociodemographic, and anthropometric characteristics were not significantly different among EG and CG. Significant increase on PEF (P = .033) was found in the EG after IMT. CONCLUSION: IMT with threshold seems to have a positive impact on PEF in roller hockey players. These findings may be corroborated by further controlled randomized studies.

Effects of pelvic floor muscle training in pregnant women.

OBJECTIVE: The aim is to verify the effectiveness of the pelvic floor muscle training (PFMT) program in pregnant women, by analyzing the amount of urine leakage. DESIGN: Experimental study. LOCATION: Care units in the Vila Real district, Portugal. PARTICIPANTS: Forty-three pregnant women divided into an experimental group (EG) (n = 22) and a control group (CG) (n = 21). INTERVENTIONS: Both groups were evaluated in a predelivery stage (initial) and 6 months after delivery (final). The EG was given a PFMT exercise protocol with a duration of 6 weeks, applicable in classes and at home, another PFMT protocol for 9 weeks. MAIN MEASUREMENTS: The strength of the pelvic floor muscle was measured by the Oxford Grading Scale and the amount of urine was assessed with a Pad test. Quality of life was measured by the King's Health Questionnaire and self-efficacy by the Broome Pelvic Muscle Self-Efficacy Scale. RESULTS: The loss of urine, significantly reduced from 0.86 ±â€Š0.83 to 0.50 ±â€Š0.67 in the EG (P = .021), whereas in the CG no significant change was observed. The degree of muscle contraction increased by 4.82 ±â€Š0.39 in EG and 3.95 ±â€Š0.67 in CG. The quality of life observed significant improvements in both groups (P < .05). As for self-efficacy, for the EG it improved significantly - initial (P = .001), final (P = .031), and for the CG the values remained the same. CONCLUSIONS: This PFMT protocol reduced urinary incontinence in pregnant women. The program allowed significant improvement in the quantity of urinary leakage and an increase in the strength of the pelvic floor muscle.

Prevalence of Urinary Incontinence in High-Impact Sport Athletes: A Systematic Review and Meta-Analysis.

The aim of this study was to systematize the scientific evidence that assessed the prevalence of urinary incontinence in female athletes and determine which modality is most predisposed to stress urinary incontinence. From September to December 2018, a systematic literature search of current interventional studies of stress urinary incontinence of the last ten years was performed using PubMed, EMBASE, Scopus and Web of Science databases. The methodological quality was assessed by the Downs and Black scale, while the data collected from the studies were analyzed through meta-analysis. Nine studies met the eligibility criteria, meaning they included reports of urinary incontinence in different sports. The meta-analysis showed 25.9% prevalence of urinary incontinence in female athletes in different sports, as well as 20.7% prevalence of stress urinary incontinence. The most prevalent high impact sport was volleyball, with the value of 75.6%. The prevalence of urinary incontinence can be high in female athletes, with high-impact sports potentially increasing the risk for stress urinary incontinence. Further research is needed regarding the potential risk factors related to the onset of urinary incontinence.

Assessment of pelvic floor muscles in sportswomen: Quality of life and related factors.

OBJECTIVES: To evaluate Maximum Voluntary Contraction (MVC) of the Pelvic Floor Muscles (PFM) in sportswomen, to observe the urinary symptoms and their impact on the Quality of Life (QoL). DESIGN: Observational cross-sectional study. SETTING: Gyms and teams in the North of Portugal. PARTICIPANTS: Sportswomen (n = 197). MAIN OUTCOME MEASURES: The measurement was performed using a manometer. The sportswomen were instructed to perform 3 MVC of the perineum, held for 3 s. The Kings Health Questionnaire (KHQ) was used to evaluate urinary symptoms and the QoL of the sportswomen. RESULTS: Age significantly influenced (p < 0.05) the QoL in all domains. An increase in BMI was also significantly associated with a decrease in the QoL. MVC values had a highly significant effect on the overall QoL and all domains, including a reduction in urinary symptoms. The weekly time of physical activity was associated with a better QoL in symptomatology. The practice of high-impact activities decreased the QoL (compared to low-impact activities). The vaginal resting pressure values ranged from 1.60 to 59.80 (24.34 ± 11.00). CONCLUSIONS: Age, BMI and high-impact sports appear to be the leading factors that promote the onset of SUI, which in turn decrease the QoL in sportswomen. There was a positive association between MVC and weekly time of physical activity in the QoL.

Pelvic Floor Muscle Training in Female Athletes: A Randomized Controlled Pilot Study.

The aim of this study was to investigate the effects of pelvic floor muscles training in elite female volleyball athletes and whether it is an effective therapy for stress urinary incontinence. Fourteen athletes, both continent and incontinent, between 18 and 30 years of age, were randomly assigned to an experimental group or a control group. The experimental group received a protocol for pelvic floor muscle training for 4 months. This consisted of three phases: awareness/stabilization, strength training and power. The control group was not subject to any intervention during the same period. Measures were collected at the initial and final phase for both groups. Maximum voluntary contractions were evaluated with a perineometer, involuntary urine loss with a Pad test and quality of life with the King's Health Questionnaire. Baseline sociodemographic and anthropometric characteristics were not significantly different. Comparing the two groups, the experimental group improved maximum voluntary pelvic contractions (p<0.001) and reduced urine loss (p=0.025), indicating the existence of significant differences between groups in the variation from the initial and final phases. The percentage of urine loss decreased in the experimental group, from 71.4-42.9%, suggesting that the protocol intervention for 16 weeks may help athletes with stress urinary incontinence.

Evaluation of the pelvic floor muscles training in older women with urinary incontinence: a systematic review.

BACKGROUND: Urinary incontinence (UI) is defined as any involuntary urine loss that predominantly affects older women. There is evidence that pelvic floor muscles training (PFMT) program is effective on the treatment of pelvic floor (PF) dysfunctions and is considered to be first-line treatment. The evaluation of pelvic floor muscles (PFM) function and strength is central to validate the effectiveness of the training protocol in UI decrease. The Oxford Grading Scale and manometry are fundamental to evaluate the PFM function and strength. OBJECTIVE: The aim of the study was to systematize the scientific evidence about the effects of PFMT in older women, assessing the PF function and strength through Oxford Grading Scale and manometry. METHODS: The research of randomized controlled clinical trials was performed through B-on, EBSCO, PEDro, Pubmed, and SciELO data carried out from 2003 to 2016. RESULTS: A total of 35 studies were identified, 26 of these were selected and fully analyzed. From the analyzed studies (n = 26), 20 were excluded for not meeting the criteria for inclusion, and only 6 studies were classified as high methodological quality, scoring an overall 4 points according the PEDro scale. CONCLUSION: The PFMT seems to be effective in treating UI in older women; the Oxford Grading Scale and manometry are considered the most reliable in the random and controlled clinical trials results. However, future investigations with high methodological quality with older women are necessary to support these results.

The influence of inspiratory muscle training on lung function in female basketball players - a randomized controlled trial.

Inspiratory muscle fatigue may inhibit healthy athletes to achieve maximum performance, compromising blood flow and perfusion on locomotor muscles. Recent studies have showed irregular influence of inspiratory muscle training (IMT) on resting lung function. It was hypothesized that a 4-week IMT protocol would improve pulmonary function of basketball players. Twenty-one female basketball players were randomly assigned to an experimental group (EG) (n = 11) or a control group (CG) (n = 10). Pre- and post-forced expiratory volume in first second (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF) were assessed with spirometry in the beginning of the sport's season, at the first day of protocol and four weeks after. The EG (22.00 ± 5.00 years) was submitted to IMT using a threshold, 5 times a week, for a 4-week protocol (30 maximal repetitions (RM) against a pressure threshold load equivalent to 50% of maximal inspiratory pressure), while the CG (18.50 ± 5.75 years) was not subjected to any intervention during the same period. Baseline sociodemographic and anthropometric characteristics were not significantly different with the exception of age (p = 0.036). No significant differences were found in baseline pulmonary volumes (0.173 ≤ p ≤ 0.848) neither in predicted pulmonary variables (0.223 ≤ p ≤ 0.654). Significant increase on FEV1, FVC and PEF was found in the EG post-protocol (p < 0.001). In the CG, an improvement of PEF was found (p = 0.042). This type of specific inspiratory training appears to improve pulmonary function. Results suggest that the applied IMT protocol is effective. Further research is needed to assess the sustainability of the findings and to conclude the short and long term effects of IMT on basketball players.

Adaptation and validation of the King's Health Questionnaire in Portuguese women with urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) in women is a problem of public health with psychological repercussions in various contexts of life. The aim of this study was to adapt and validate the King's Health Questionnaire (KHQ) in women with UI to Portugal. METHODS: For the adaptation, a multistep forward-back translation protocol was used. The Positive and Negative Affect Schedule and the Satisfaction with Life Scale were used to validate the KHQ. The evaluation of the psychometric properties involved the assessment of validity, reliability, and test-retest stability in 103 women. A factor analysis was conducted to explore the underlying factor structure of KHQ. Inter-domain correlation was calculated for convergent and discriminant validity assessment. RESULTS: Exploratory factor analysis identified three factors "personal limitations and daily life", "emotions and social relationships" and "urinary symptoms". Indicators of test-retest stability showed almost perfect agreement with a mean intraclass correlation coefficient (ICC) of 0.937. Internal consistency was found to be high (Cronbach's alfa > 0.7). Furthermore, the Portuguese version of the KHQ significantly correlates with the Positive and Negative Affect Schedule, supporting construct validity. CONCLUSIONS: The Portuguese version of the KHQ was found to be a valid and reliable measure of the quality of life in women with UI in Portugal, being relevant to both clinical practice and research.

Spontaneous rupture of renal angiomyolipoma during pregnancy.

Renal angiomyolipoma is a benign tumor, composed of adipocytes, smooth muscle cells and blood vessels. The association with pregnancy is rare and related with an increased risk of complications, including rupture with massive retroperitoneal hemorrhage. The follow-up is controversial because of the lack of known cases, but the priorities are: timely diagnosis in urgent cases and a conservative treatment when possible. The mode of delivery is not consensual and should be individualized to each case. We report a case of a pregnant woman with 18 weeks of gestation admitted in the emergency room with an acute right low back pain with no other symptoms. The diagnosis of rupture of renal angiomyolipoma was established by ultrasound and, due to hemodynamically stability, conservative treatment with imaging and clinical monitoring was chosen. At 35 weeks of gestation, it was performed elective cesarean section without complications for both mother and fetus.

Spontaneous rupture of renal angiomyolipoma during pregnancy / Rotura espontânea de um angiomiolipoma durante a gravidez

Renal angiomyolipoma is a benign tumor, composed of adipocytes, smooth muscle cells and blood vessels. The association with pregnancy is rare and related with an increased risk of complications, including rupture with massive retroperitoneal hemorrhage. The follow-up is controversial because of the lack of known cases, but the priorities are: timely diagnosis in urgent cases and a conservative treatment when possible. The mode of delivery is not consensual and should be individualized to each case. We report a case of a pregnant woman with 18 weeks of gestation admitted in the emergency room with an acute right low back pain with no other symptoms. The diagnosis of rupture of renal angiomyolipoma was established by ultrasound and, due to hemodinamically stability, conservative treatment with imaging and clinical monitoring was chosen. At 35 weeks of gestation, it was performed elective cesarean section without complications for both mother and fetus.

O angiomiolipoma é um tumor benigno, constituído por adipócitos, células de músculo liso e vasos sanguíneos. Sua associação com a gravidez é rara e está relacionada com um aumento de complicações, nomeadamente rotura com hemorragia retroperitoneal maciça. O follow-up é controverso em razão do escasso número de casos descritos, no entanto as prioridades são: diagnóstico atempado nas situações urgentes e, sempre que possível, tratamento conservador. O tipo de parto não é consensual e deve ser individualizado caso a caso. Relatamos um caso de uma grávida com 18 semanas de gestação que recorreu ao serviço de urgência por lombalgia direita aguda, sem outros sintomas relevantes. Diagnosticou-se ecograficamente rotura de angiomiolipoma renal e, em decorrência da estabilidade hemodinâmica do quadro, procedeu-se ao tratamento conservador com monitorização imagiológica e clínica. Às 35 semanas de gestação, realizou-se uma cesariana eletiva que decorreu sem complicações maternas ou fetais.

Pelvic floor muscle training to improve urinary incontinence in young, nulliparous sport students: a pilot study.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is prevalent in sport students. We hypothesized that pelvic floor muscle training (PFMT) can improve pelvic floor muscle (PFM) strength and symptoms of UI in this group of physically active women. METHODS: Sixteen sport students with UI participated in this pre-post test pilot study. However, only seven of them, mean age 20.0 ± 0.8 years, completed the 8-week program. Activity level was measured by the International Physical Activity Questionnaire-Short Form (IPAQ-SF). The outcome measure was the International Consultation on Incontinence Questionnaire-Short Form (ICIQ UI SF). PFM strength was measured by manometry as maximum voluntary contraction (MVC). RESULTS: Vaginal resting pressure improved by 17.4 cmH(2)O (SD 6.7), p = 0.04 and MVC by 16.4 cmH(2)O (SD 5.8), p = 0.04. ICIQ UI SF score, frequency, and amount of leakage showed statistically significant improvement. CONCLUSIONS: PFMT increased PFM strength and reduced frequency and amount of UI episodes in sport students that completed an 8-week PFMT program. Randomized controlled trials are warranted to confirm these results.

The source of error in the estimation of intertwin birth weight discordance.

OBJECTIVE: to assess the accuracy of paired estimated fetal weights (EFWs) to predict three levels of twin birth weight discordance (>15%, >20% and >25%). METHOD: a cohort of twin pairs underwent ultrasound examinations within 2 weeks from birth. We calculated the frequency of under- and overestimation of the actual birth weight (< or >10%, respectively) in the entire cohort as well in the subset of mono- and dichorionic pairs. RESULTS: discordance was largely underestimated (observed 10.4 ± 0.8% compared to actual 19.2 ± 1.1%, P=0.001) because the larger twin was more frequently underestimated [30.6 vs. 17.7%, odds ratio (OR) 2.0, 95% confidence interval (CI) 1.1, 3.9 in the entire cohort, and 34.2 vs. 13.1%, OR 3.4, 95% CI 1.4, 8.4 in the dichorionic pairs]. Overall, the specificity for detecting the three levels of discordance was adequate (91.5-94.2%) but the sensitivity was poor (11.1-17.8%) and tended to decrease with increasing discordance level. CONCLUSION: the poor ability of paired EFWs to diagnose birth weight discordance results from underestimation of the larger twin.

Desfecho da gravidez nas jovens adolescentes / Teenage pregnancy outcome

OBJETIVO: comparar parto e seguimento de gravidez entre grávidas adolescentes e não-adolescentes que pariram num hospital terciário da região de Lisboa (Portugal). MÉTODOS: estudo retrospectivo com 10.656 partos. Foram avaliados: seguimento da gravidez, idade gestacional no parto, tipo de parto, necessidade de episiotomia e lacerações graves, índice de Apgar no quinto minuto e peso ao nascer. As grávidas foram divididas em dois grupos, acima e abaixo dos 20 anos. O grupo abaixo dos 20 anos foi depois subdividido entre grávidas com menos ou mais de 16 anos. Foi usado o teste do χ2 para análise estatística. RESULTADOS: as adolescentes tiveram pior seguimento: primeira consulta após as 12 semanas (46,4 versus 26,3 por cento) e menos de quatro consultas (8,1 versus 3,1 por cento), menos distocia (21,5 versus 35,1 por cento), menos cesarianas (10,6 versus 20,7 por cento) e menor necessidade de indução do trabalho de parto (16,5 versus 26,5 por cento). Não houve diferença significativa para idade gestacional no parto e taxa de recém-nascidos de baixo peso. Entre adolescentes, as menores de 16 anos tiveram mais recém-nascidos de baixo peso (12 versus 7,4 por cento) e mais partos entre 34 e 37 semanas (10,8 versus 4,2 por cento). CONCLUSÕES: num hospital com serviço dedicado a grávidas adolescentes com apoio social e psicológico, apesar de pior seguimento pré-natal vigilância, o seu desempenho não foi pior. Uma atenção especial deve, no entanto, ser dada a grávidas abaixo dos 16 anos.

PURPOSE: to compare delivery and pregnancy follow-up among adolescent and non-adolescent pregnant women whose delivery occurred in a tertiary hospital from Região de Lisboa (Portugal). METHODS: retrospective study with 10,656 deliveries. Pregnancy follow-up, delivery type, need of episiotomy and severe lacerations, Apgar index at the fifth minute and the delivery weight have been evaluated. The pregnant women were divided into two groups, over and under 20 years old. The group with women under 20 was further subdivided in pregnant women under or over 16. The χ2 test has been used for statistical analysis. RESULTS: adolescents presented worse follow-up: first appointment after 12 weeks (46.4 versus 26.3 percent) and less than four appointments (8.1 versus 3.1 percent), less dystocia (21.5 versus 35.1 percent), less caesarian sections (10.6 versus 20.7 percent), and lower need for inducing labor (16.5 versus 26.5 percent). There was no significant difference concerning gestational age at delivery and ratio of low weight newborns. Among adolescents, the ones under 16 had more low weight newborns (12 versus 7.4 percent) and more deliveries between 34 and 37 weeks (10.8 versus 4.2 percent). CONCLUSIONS: in a hospital attending adolescents with social and psychological support, the fact of them having had a worse follow-up in the pre-natal phase, their performance has not been worse. Nevertheless, special attention might be given to pregnant women under 16.

[Teenage pregnancy outcome]. / Desfecho da gravidez nas jovens adolescentes.

PURPOSE: to compare delivery and pregnancy follow-up among adolescent and non-adolescent pregnant women whose delivery occurred in a tertiary hospital from Região de Lisboa (Portugal). METHODS: retrospective study with 10,656 deliveries. Pregnancy follow-up, delivery type, need of episiotomy and severe lacerations, Apgar index at the fifth minute and the delivery weight have been evaluated. The pregnant women were divided into two groups, over and under 20 years old. The group with women under 20 was further subdivided in pregnant women under or over 16. The chi2 test has been used for statistical analysis. RESULTS: adolescents presented worse follow-up: first appointment after 12 weeks (46.4 versus 26.3%) and less than four appointments (8.1 versus 3.1%), less dystocia (21.5 versus 35.1%), less caesarian sections (10.6 versus 20.7%), and lower need for inducing labor (16.5 versus 26.5%). There was no significant difference concerning gestational age at delivery and ratio of low weight newborns. Among adolescents, the ones under 16 had more low weight newborns (12 versus 7.4%) and more deliveries between 34 and 37 weeks (10.8 versus 4.2%). CONCLUSIONS: in a hospital attending adolescents with social and psychological support, the fact of them having had a worse follow-up in the pre-natal phase, their performance has not been worse. Nevertheless, special attention might be given to pregnant women under 16.

Cystocele - vaginal approach to repairing paravaginal fascial defects.

The objective of this study is to determine the efficacy and safety of vaginal approach to repair paravaginal defects in patients with symptomatic cystocele. This was a retrospective study of 66 women with a diagnosis of symptomatic cystocele grade 2 to 4, referred to our unit between January 2002 and March 2005. A clinical evaluation was carried out using the Baden-Walker classification before and after the surgery. The same surgical team performed every surgery. The repair of paravaginal fascial defects was carried out through a vaginal approach, exposing the arcus tendineus. The paravaginal fascial defects were corrected through suspension of vesicovaginal fascia to the arcus tendineus with nonreabsorbable Ethibond 0 sutures. Women were seen for follow-up at 3, 6, and 12 months. The presence of well-demarcated vaginal lateral sulci at grade 0, firmly apposed to the lateral pelvic sidewalls and no anterior relaxation with Valsalva maneuver, were used as criteria for cure. Grade 2 cystocele was diagnosed preoperatively in most women. The mean duration of complaints due to prolapse was 64.6 months. There were no major intraoperative complications. Mean time of inpatient stay was of 4.9 days. The cure rate at 12 months was 91.6%. There were five cases of recurrence of cystocele 6 months after surgery. Surgical repair of symptomatic cystocele through a paravaginal approach is a safe and efficacious technique. Vaginal approach to repair paravaginal fascia defects had a low postoperative morbidity and high cure rate at 12 months (91.6%).