Research in Focus: Early Exercise Postpartum Pelvic Floor Muscle Function and Pelvic Floor Dysfunction
Tennfjord MK, Engh ME, Bo K. The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum. Physical Therapy 2020; doi: 10.1093/ptj/pzaa084.
Existing guidelines for return to exercise for postpartum women advocate for a gradual commencement or return to physical activity as soon as medically safe. However, some clinicians have expressed concern that early return to exercise may negatively affect pelvic floor muscle function.
The purpose of this study was to investigate whether early onset of general exercise postpartum negatively effects the pelvic floor muscles (PFM) and/or increases the risk of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) 12 months postpartum.1
- Prospective Cohort Study; n=300 (recruited)
- Inclusion Criteria
- Women who were primiparous and had given birth to a singleton baby
- Understanding of Scandinavian language
- Scheduled for delivery at Akershus University Hospital between January 2010 and April 2011
- Exclusion Criteria
- Multiple pregnancies
- History of miscarriage after gestational week 16
- Preterm delivery (32 weeks gestation)
- Serious illness of mother or child
- Subsequent pregnancy of 6 week or more gestation
- Recruitment to parallel research project investigating PFM training
- Participants were classified as exercisers if they reported training ≥3times for ≥30min/week at 6 weeks post-partum
- Covariate risk data collected (based on previously published data and clinical reasoning):
- BMI, age, physically strenuous occupation, performing PFMT ≥3x/week, vacuum/forceps delivery
- Primary: Vaginal resting pressure, PFM strength and PFM endurance at 6 weeks and 12 months post-partum
- Secondary: Self-report of symptoms of SUI, POP and anal incontinence (AI)
- Outcome Measures:
- International Consultation on Incontinence Modular Questionnaire (ICIQ) Urinary Incontinence short form (ICIQ-UI Short Form), Vaginal Symptoms (ICIQ-VS), and bowel symptoms questionnaires (ICIQ-B)
- Questionnaires regarding pelvic floor dysfunction administered at:
- Gestational week 22 and 37
- 6 weeks, 6 months and 12 months post-partum
- 281 primiparous women were enrolled in the study at 6 weeks postpartum. 177 completed the study (assessed at 12 months postpartum)
- 35 were lost to follow up
- 88 were excluded due to participation in another RCT
- 31% (n=86) were classified as exercisers at 6 weeks postpartum
- 5% of all study participants engaged in high-impact exercise
- This subgroup was not different from the rest of the exerciser group in terms of VRP, PFM strength, PFM endurance or symptoms of SUI and POP, and were therefore included in the Exercisers group for analysis.
- AI was not included in the final analysis as only 2 study participants reported symptoms of AI at 12 months postpartum
- Only 34 women classified as exercisers at 6 weeks postpartum continued to exercise until 12 months postpartum
- There were no statistically significant relationships found between Exercisers and Non-Exercisers on any variable
- Women with BMI between 25 and 29.9 were 2x as likely to report SUI at 12 months postpartum
- Women with BMI > 30 were more than 3x as likely to report SUI at 12 months postpartum
- Women with physically strenuous occupations were more than 3x more likely to report POP at 12 months
“Regular general exercise performed at six weeks postpartum did not negatively influence PFM or increase the risk of symptoms of SUI or POP at 12 months postpartum.”1
“Starting regular general exercise within the first six weeks postpartum does not negatively influence the PFM, which is an important message to impart to women who are postpartum and to health care providers.”
- No power calculation had been undertaken prior to the study.
- Larger sample sizes are needed to study the impact of exercise on AI or the impact of high-intensity exercise.
- The definition of Exercisers included both high- and low-impact exercise participants. The authors caution that the findings cannot be extrapolated to women participating in high-impact exercise.
- Results should be interpreted with caution as 43% of women classified as Exercisers at 6 weeks postpartum were no longer exercising regularly at 12 months.
- A further limitation of the study is the use of self-report measures of both PFD and frequency of exercise.
Relevance to physiotherapy practice in Alberta
Promotion of routine physical activity is an important public health measure to reduce the prevalence and severity of non-communicable diseases. Among post-partum women, concerns regarding the impact of early post-partum exercise on pelvic floor function may serve as a barrier to participation. Some clinicians concerned about pelvic floor dysfunction caution against early return to physical activity. Therefore, the findings of this study are relevant to inform patient education and advice provided to this population regarding resumption of general exercise.
Disclaimer: The purpose of this summary is to highlight recently published research findings that are not openly accessible. Every effort is made to ensure accuracy and clarity of the summary. Readers are encouraged to review the published article in full for further information.