The Effects of a Pilates Exercise Program on Pain, Functional Capacity, and Quality of Life in Breast Cancer Survivors One Year Postsurgery.

OBJECTIVES: To evaluate the effects of Pilates exercises on functional capacity, pain, and quality of life in breast cancer survivors one year postsurgery. SAMPLE & SETTING: 44 breast cancer survivors who participated in a 24-session Pilates exercise program at a physiotherapy clinic in Brazil. METHODS & VARIABLES: This prospective longitudinal study evaluated breast cancer survivors who performed Pilates exercises for 60 minutes twice weekly. Functional capacity was analyzed using the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and the Shoulder Pain and Disability Index (SPADI). Pain and quality of life were also analyzed. Scores were measured on admission, after 12 sessions, and after 24 sessions. RESULTS: Median DASH and SPADI scores improved by 61% after 24 Pilates exercise sessions. The average number of breast cancer survivors who performed complex tasks without difficulty after 12 sessions and 24 sessions increased considerably. Pain scores significantly decreased, and quality of life significantly improved after all sessions. IMPLICATIONS FOR NURSING: Incorporating a Pilates exercise program can decrease pain and improve functional status and quality of life among breast cancer survivors at least one year postsurgery.

Impact of pelvic floor muscle strength on female sexual function: retrospective multicentric cross-sectional study.

INTRODUCTION AND HYPOTHESIS: The female pelvic floor muscles (PFM) play an important role in sexual function. We hypothesize that there is a relation between PFM strength and sexual function in women with and without sexual dysfunction. METHODS: Retrospective multicentric cross-sectional study including women with and without sexual dysfunction [Female Sexual Function Index (FSFI) cutoff point < 26.55], analyzed by age range, considering demographic, clinical, anthropometric and PFM strength [Modified Oxford Scale (MOS)] data. Chi-square, Mann-Whitney test and linear regression (ranks) were used, with 5% significance (SAS 9.4). RESULTS: Out of 1013 medical records, 982 women with an average age of 45.76 (± 15.25) were included in the study. Of these, 679 (69.14%) presented FSFI score < 26.55, while 303 (30.86%) presented FSFI ≥ 26.55. It was identified that the higher scores were among white women, < 45 years old, single, with higher education, family income > 4 minimum wages, body mass index < 25 kg/m2, lower parity, regular physical activity practitioner and higher PFM strength (MOS: 4-5). Desire, arousal, lubrication and orgasm domains were higher among women with MOS 4-5, while satisfaction and pain domains were higher among those with MOS 3-5. CONCLUSION: Demographic, clinical and anthropometric conditions can influence both PFM strength and female sexual function. Our findings demonstrate that women with higher PFM strength present fewer complaints about sexual dysfunction.

Can Supervised Pelvic Floor Muscle Training Through Gametherapy Relieve Urinary Incontinence Symptoms in Climacteric Women? A Feasibility Study.

OBJECTIVE: To investigate the feasibility of pelvic floor muscle training (PFMT) through gametherapy for relieving urinary symptoms of climacteric women with stress or mixed urinary incontinence (UI). METHODS: Randomized clinical trial, divided into two groups: Gametherapy (G_Game) and Control (G_Control). Both groups received recommendations about unsupervised PFMT, and G_Game also received supervised PFMT through gametherapy. After 5 consecutive weeks, the feasibility was investigated considering participant adherence, urinary symptoms (evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF] questionnaire), and pelvic floor function (PERFECT Scheme: power, endurance, repetition and fast). The Fisher exact, Kruskal-Wallis, Wilcoxon sign paired, and Mann-Whitney U tests were used by intention-to-treat analysis, using STATA 15.1 (StataCorp, College Station, TX, USA) software. RESULTS: The present study included 20 women per group and observed a higher adherence in G_Game. In the intragroup analysis, a decrease in the ICIQ-UI-SF score was observed in both groups (14.0 to 10.0; 13.5 to 0), associated with increased endurance (2.5 to 3.5; 2.5 to 4.0) in G_Control and G_Game, respectively. Moreover, there was a concomitant increase in pelvic floor muscles (PFMs) power (2.0 to 3.0), repetition (3.0 to 5.0), and fast (10.0 to 10.0) in G_Game. In the intergroup analysis, a reduction of UI was observed (p < 0.001; r = 0.8), as well an increase in PFM power (p = 0.027, r = 0.2) and endurance (p = 0.033; r = 0.3) in G_Game. CONCLUSION: The feasibility of supervised PFMT through gametherapy was identified by observing participant adherence, relief of urinary symptoms, and improvement in PFM function.

OBJETIVO: Investigar a viabilidade do treinamento dos músculos do assoalho pélvico (TMAP) por meio de gameterapia no alívio de sintomas urinários em mulheres climatéricas com incontinência urinária (IU) de esforço ou mista. MéTODOS: Ensaio clínico randomizado, dividido em dois grupos: Gameterapia (G_Game) e Controle (G_Controle). Ambos os grupos receberam recomendações sobre TMAP não supervisionado, e G_Game também recebeu TMAP supervisionado por meio de gameterapia. Após 5 semanas consecutivas, a viabilidade foi investigada considerando a aderência das participantes, sintomas urinários (avaliados pelo questionário International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF]) e função do assoalho pélvico (esquema PERFECT: power, endurance, repetition, fast). Os testes exatos de Fisher, Kruskal-Wallis, sinal de Wilcoxon pareado e Mann-Whitney U foram usados pela análise de intenção de tratar, usando o software STATA 15.1 (StataCorp, College Station, TX, EUA). RESULTADOS: O presente estudo incluiu 20 mulheres por grupo e observou uma maior adesão no G_Game. Na análise intragrupo, foi observada diminuição no escore do ICIQ-UI-SF em ambos os grupos (de 14,0 para 10,0; de 13,5 para 0), associada ao aumento da resistência (de 2,5 para 3,5; de 2,5 para 4,0) em G_Control e G_Game, respectivamente. Além disso, houve um aumento concomitante no power (de 2,0 para 3,0), repetition (de 3,0 para 5,0) e fast (de 10,0 para 10,0) dos músculos do assoalho pélvico (MAPs) no G_Game. Na análise intergrupos, foi observada redução da IU (p < 0,001; r = 0,8), assim como do power (p = 0,027; r = 0,2) e da endurance (p = 0,033; r = 0,3) dos MAPs no G_Game. CONCLUSãO: A viabilidade do TMAP supervisionado por meio de gameterapia foi identificada pela observação da aderência das participantes, pelo alívio dos sintomas urinários e pela melhora da função dos MAPs.

Can Supervised Pelvic Floor Muscle Training Through Gametherapy Relieve Urinary Incontinence Symptoms in Climacteric Women? A Feasibility Study / O treinamento por meio de gameterapia pode aliviar os sintomas de incontinência urinária em mulheres climatéricas? Um estudo de viabilidade

Abstract Objective To investigate the feasibility of pelvic floor muscle training (PFMT) through gametherapy for relieving urinary symptoms of climacteric women with stress ormixed urinary incontinence (UI). Methods Randomized clinical trial, divided into two groups: Gametherapy (G_Game) and Control (G_Control). Both groups received recommendations about unsupervised PFMT, and G_Game also received supervised PFMT through gametherapy. After 5 consecutive weeks, the feasibility was investigated considering participant adherence, urinary symptoms (evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF] questionnaire), and pelvic floor function (PERFECT Scheme: power, endurance, repetition and fast). The Fisher exact, Kruskal-Wallis, Wilcoxon sign paired, and Mann-Whitney U tests were used by intention-to-treat analysis, using STATA 15.1 (StataCorp, College Station, TX, USA) software. Results The present study included 20 women per group and observed a higher adherence in G_Game. In the intragroup analysis, a decrease in the ICIQ-UI-SF score was observed in both groups (14.0 to 10.0; 13.5 to 0), associated with increased endurance (2.5 to 3.5; 2.5 to 4.0) in G_Control and G_Game, respectively. Moreover, there was a concomitant increase in pelvic floor muscles (PFMs) power (2.0 to 3.0), repetition (3.0 to 5.0), and fast (10.0 to 10.0) in G_Game. In the intergroup analysis, a reduction of UI was observed (p<0.001; r=0.8), as well an increase in PFM power (p=0.027, r=0.2) and endurance (p=0.033; r=0.3) in G_Game. Conclusion The feasibility of supervised PFMT through gametherapy was identified by observing participant adherence, relief of urinary symptoms, and improvement in PFM function.

Resumo Objetivo Investigar a viabilidade do treinamento dos músculos do assoalho pélvico (TMAP) por meio de gameterapia no alívio de sintomas urinários em mulheres climatéricas com incontinência urinária (IU) de esforço ou mista. Métodos Ensaio clínico randomizado, dividido em dois grupos: Gameterapia (G_Game) e Controle (G_Controle). Ambos os grupos receberam recomendações sobre TMAP não supervisionado, e G_Gametambém recebeu TMAP supervisionado por meio de gameterapia. Após 5 semanas consecutivas, a viabilidade foi investigada considerando a aderência das participantes, sintomas urinários (avaliados pelo questionário International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF]) e função do assoalho pélvico (esquema PERFECT: power, endurance, repetition, fast). Os testes exatos de Fisher, Kruskal-Wallis, sinal de Wilcoxon pareado e Mann-Whitney U foram usados pela análise de intenção de tratar, usando o software STATA 15.1 (StataCorp, College Station, TX, EUA). Resultados O presente estudo incluiu 20 mulheres por grupo e observou uma maior adesão no G_Game. Na análise intragrupo, foi observada diminuição no escore do ICIQUI- SF emambos os grupos (de 14,0 para 10,0; de 13,5 para 0), associada ao aumento da resistência (de 2,5 para 3,5; de 2,5 para 4,0) em G_Control e G_Game, respectivamente. Além disso, houve um aumento concomitante no power (de 2,0 para 3,0), repetition (de 3,0 para 5,0) e fast (de 10,0 para 10,0) dosmúsculos do assoalho pélvico (MAPs) no G_Game. Na análise intergrupos, foi observada redução da IU (p<0,001; r=0,8), assim como do power (p=0,027; r=0,2) e da endurance (p=0,033; r=0,3) dos MAPs no G_Game. Conclusão A viabilidade do TMAP supervisionado por meio de gameterapia foi identificada pela observação da aderência das participantes, pelo alívio dos sintomas urinários e pela melhora da função dos MAPs.

Use of mobile apps for controlling of the urinary incontinence: A systematic review.

OBJECTIVE: The primary objective was to evaluate the impact of app use on urinary incontinence control through pelvic floor muscle training when compared to the postal treatment plan. The secondary objectives were to evaluate how app use may affect the quality of life (QoL) of users and treatment adherence. MATERIAL AND METHODS: Eight databases (PubMed, SciELO, Embase, Web of Science, LILACS, Open Gray, Open Thesis, and OATD) were used as research sources. The protocol was registered in PROSPERO (CRD 42020145709). Randomized controlled trials assessing urinary incontinence (UI) control with app use, with no restriction of year, language, and status of publication were included. The JBI Systematic Reviews Checklist for Randomized Controlled Trials assessed the risk of bias of the studies selected. The mean scores of QoL between the pre- and postintervention periods were compared through standardized mean differences, which were weighted according to the number of months between the two periods. RESULTS: Only three studies met the eligibility criteria and were included. The methodological quality of the studies was from "low" to "moderate" risk of bias. The full sample included 203 patients with app-based treatment e 203 controls of postal treatment. All studies showed the reduction of urinary symptoms. In addition, two studies showed a reduction of QoL scores specific for the condition, while one study presented increased scores. CONCLUSION: Reminder therapy seems to be a promising strategy for controlling UI.

Four-dimensional translabial ultrasound concordance with digital palpation and surface electromyography during dynamic pelvic floor muscles assessment: A cross-sectional study.

AIM: To investigate whether pelvic floor muscle (PFM) morphological changes obtained through four-dimensional translabial ultrasound (4D TLUS) correlate with a PFM contraction as evaluated by digital palpation and PFM electromyographic activity evaluated by surface electromyography (sEMG). The secondary objective was to investigate which ultrasound parameter is more strongly associated with digital palpation. METHODS: This cross-sectional study included 210 women and their PFMs were evaluated by digital palpation (graded according to the Modified Oxford Scale), sEMG and 4D TLUS. Offline analysis of ultrasound volume datasets was performed for measuring the change in levator plate angle, bladder neck elevation, hiatal area narrowing, puborectalis strain, and puborectalis muscle thickness at rest and during PFM contraction. Statistical analysis included Kruskal-Wallis, Dunn, and Spearman's tests in addition to univariate and multivariate logistic regression, adopting a significance level of 5%. RESULTS: A weak but significant correlation between the change in levator plate angle and sEMG (P = .04; r = 0.14) was found. All 4D TLUS measurements, except the puborectalis muscle thickness, significantly correlated with digital palpation (P < .0001); with the puborectalis strain and the change in levator plate angle having the strongest combined parameters associated with digital palpation (R2 = 21.77%), despite the low coefficient of determination. CONCLUSION: We found that 4D TLUS significantly correlates with digital palpation and sEMG, being the change in the levator plate angle the parameter that best correlates with both methods. While digital palpation is essential during a PFM functional assessment, 4D TLUS is recommended as a beneficial noninvasive clinical tool for a more in-depth evaluation.

Avaliação da sinergia da musculatura abdomino-pélvica em nulíparas com eletromiografia e biofeedback perineal / Evaluation of the synergy of the abdomino-pelvic musculature in nulliparouswomen with eletromyography and perineal biofeedback

OBJETIVO: verificar o comportamento da musculatura abdominal e perineal em face de alterações respiratórias induzidas em 15 nulíparas, sem história de disfunções perineais e/ou respiratórias prévias, com faixa etária de 20 a 26 anos (22,9±1,83). MÉTODOS: a atividade elétrica dos músculos abdominais e perineais foi analisada utilizando a eletromiografia de superfície, e a pressão perineal (PP) obtida mediante biofeedback digital, simultaneamente. As voluntárias foram instruídas a realizar três repetições e a execução de manobras respiratórias: inspiração máxima (PImáx), expiração máxima (PEmáx) e Valsalva (MV), em ordem aleatória. As voluntárias foram posicionadas em mesa ginecológica, com 60° de inclinação de tronco. Os sinais eletromiográficos foram coletados pelo software AqDados® (4.4) para linguagem binária ASCii, sendo posteriormente processados no software Matlab® (6.5.1). A análise estatística da envoltória (EN) do sinal foi realizada por meio da correlação de Spearman e do teste Kruskal-Wallis, com nível de significância de 5 por cento (p<0,05). RESULTADO: observou-se que a PP foi maior na PImáx (2,98±2,38), seguida da MV (29,10±10,68), sendo ambas superadas pela PEmáx (38,22±9,98) (p<0,01). Demonstrou-se ainda correlação positiva entre a PEmáx e a PP (p<0,01), bem como entre a EN da musculatura perineal e abdominal na PEmáx e PImáx (p<0,05 e p=0,03, respectivamente). Os resultados relativos às MVs não foram significativos, quando analisadas a PP e EN. CONCLUSÃO: foi possível identificar a presença de sinergia abdômino-pélvica durante a execução das manobras respiratórias, em especial em relação a PEmáx.