Showing papers by "Kari Bø published in 2011"

Exercise in pregnant women and birth weight: a randomized controlled trial

Abstract: Birth weight plays an important role in infant mortality and morbidity, childhood development, and adult health. To date there are contradictory results regarding the role of physical activity on birth weight. In addition, it is questioned whether exercise during second and third trimesters of pregnancy might affect gestational age and increase the risk of preterm delivery. Hence, the purpose of this study was to examine the effect of a supervised exercise-program on birth weight, gestational age at delivery and Apgar-score. Sedentary, nulliparous pregnant women (N = 105), mean age 30.7 ± 4.0 years, pre-pregnancy BMI 23.8 ± 4.3 were randomized to either an exercise group (EG, n = 52) or a control group (CG, n = 53). The exercise program consisted of supervised aerobic dance and strength training for 60 minutes, twice per week for a minimum of 12 weeks, with an additional 30 minutes of self-imposed physical activity on the non-supervised week-days. There was no statistically significant difference between groups in mean birth weight, low birth weight (< 2500 g) or macrosomia (≥ 4000 g). Per protocol analyses showed higher Apgar score (1 min) in the EG compared with the CG (p = 0.02). No difference was seen in length of gestation. Aerobic-dance exercise was not associated with reduction in birth weight, preterm birth rate or neonatal well-being. ClinicalTrials.gov: NCT00617149

Effect of regular exercise on prevention of excessive weight gain in pregnancy: a randomised controlled trial

Abstract: Objectives To assess whether a 12-week supervised exercise-programme with an additional 30 min of moderate self-imposed physical activity on the non-supervised weekdays prevents excessive weight gain in pregnancy, as well as postpartum weight retention.Methods One hundred and five sedentary, nulliparous pregnant women with a mean age of 30.7 ± 4.0 years and a pre-pregnancy body mass index of 23.8 ± 4.3 kg/m2 were randomised to either an exercise group (EG, n = 52) or a control group (CG, n = 53). The exercise programme consisted of 60 min supervised aerobic dance and strength training for 60 min, at least twice per week for a minimum of 12 weeks.Results Drop-out rates were 19% and 21% in the EG and CG, respectively. Fewer women in the EG than in the CG exceeded the Institute of Medicine recommendations; however, only EG participants who attended 24 exercise sessions (n = 14) differed significantly from controls (p = 0.006) with regard to weight gain during pregnancy (11.0 ± 2.3 vs. 13.8 ± 3.8 kg, p < 0.01...

Incontinence Improves in Older Women After Intensive Pelvic Floor Muscle Training: An Assessor-Blinded Randomized Controlled Trial

Abstract: Aims To test the hypotheses that high intensity pelvic floor muscle training (PFMT) is effective in relief of stress urinary incontinence in community dwelling older women, and that intense PFMT improves stress urinary incontinence more than bladder training (BT) in this population. Methods A two-center, assessor-blinded randomized controlled trial of 20 weeks duration with two active intervention arms: PFMT and BT. Assessments and interventions were undertaken at two metropolitan tertiary hospitals. Participants were community dwelling women over 65 years of age with urodynamic stress incontinence. Primary outcome measure was urinary leakage during a cough stress test. Secondary outcome measures included symptoms and bother (ICIQ-UI SF), participant global perception of change, leakage episodes (7-day accident diary), degree of “bother” (VAS) and health related quality of life (AQoL). Results Eighty-three Caucasian women, 71.8 (SD 5.3) years participated in the study. Both groups improved over the intervention period; however, the PFMT group reported significantly lower amounts of leakage on the stress test [PFMT median 0.0 g, 95% CI: 0.2–0.9; BT median 0.3 g, 95% CI: 0.2–1.7, P = 0.006], improved symptoms and bother [PFMT mean 5.9, 95% CI: 4.8–7.1; BT group mean 8.5, 95% CI: 7.1–9.9 and greater perception of change [PFMT 28 (73.6%); BT 12 (36.4%) (P = 0.002)] after 5 months than the BT group. Conclusions High intensity PFMT is effective in managing stress urinary incontinence and is more effective than BT in healthy older women. Neurourol. Urodynam. 30:317–324, 2011. © 2011 Wiley-Liss, Inc.

Effect of pelvic floor muscle training on labour and newborn outcomes: a randomized controlled trial

Abstract: BACKGROUND: The use of the pelvic floor muscle training for urinary incontinence treatment is well established but little is known about its effects in labor and newborn outcomes. OBJECTIVES: To evaluate the effects of antenatal pelvic floor muscle training and strength in labor and newborn outcomes in low-income pregnant women. METHODS: This is a randomized controlled trial that recruited forty-two nulliparous healthy pregnant women aged between 18-36 years old and able to contract the pelvic floor muscles. The participants were included in the study with 20 weeks of gestational age and had their pelvic floor muscles measured by vaginal squeeze pressure. They were randomly allocated into two groups: training group and a non-intervention control group. Then, all participants had their labor and newborn outcomes evaluated through consultation of medical records by a blinded researcher. RESULTS: There were no statistically significant differences between the groups regarding gestational age at birth, type of labor, duration of the second stage of labor, total time of labor, prevalence of laceration, weight and size of the baby, and Apgar score. No correlation was observed between pelvic floor muscle strength and the second stage or the total length of labor. CONCLUSIONS: This randomized controlled trial did not find any effect of pelvic floor muscle training or pelvic floor muscle strength on labor and newborn outcomes.

Pelvic floor muscle function before and after first childbirth

Abstract: Pregnancy and vaginal delivery are considered to be the main risk factors for development of pelvic floor dysfunction. We hypothesize that; 1) pelvic floor muscle (PFM) strength and endurance is significantly reduced by first delivery in general, and 2) changes in PFM strength and endurance are influenced by mode of delivery. Prospective repeated measures observational study. Thirty-six women completed the study. PFM function was measured as vaginal squeeze pressure. Paired t-test was used to compare PFM function before and after first childbirth for all participants as a group. One-way ANOVA was used to compare changes between different modes of delivery. A significant reduction in PFM strength (p < 0.0001) and endurance (p < 0.0001) was found for all participants after first childbirth. The reduction in strength was 20.1 hPa (CI:16.2; 24.1), 31.4 hPa (CI: 7.4; 55.2) 5.2 hPa (CI: −6.6; 17.0) in the normal vaginal, instrumental vaginal and acute cesarean groups, respectively. The difference was significant between normal vaginal and acute cesarean birth (p = 0.028) and instrumental vaginal and acute cesarean birth (p = 0.003). PFM strength is significantly reduced after vaginal delivery, both normal and instrumental, 6 to 12 weeks postpartum. Acute cesarean section resulted in significantly less muscle strength reduction.

Can the Paula method facilitate co-contraction of the pelvic floor muscles?: a 4D ultrasound study

Abstract: The aim was to compare constriction of the levator hiatus (LH) and reduction of pelvic floor muscle (PFM) length during instruction of the Paula method (contraction of ring musculature of the mouth) and contraction of the PFM. Seventeen pregnant or postpartum women, mean age 28.6 (range 20–35) participated. A Voluson E8 ultrasound machine with 4–8 MHz curved array 3D/4D transducer (RAB 4-7l/obstetric) was used. Measurements were performed in the axial plane of minimal hiatal dimensions. Muscle length was calculated as circumference of the LH minus the suprapubic arch. Differences between groups were analyzed using Wilcoxon signed rank test. Significance level was set to 0.05. There was a significant reduction of the LH area (p < 0.001) and muscle length (p < 0.001) during PFM contraction, but not during contraction according to the Paula method, p = 0.51 and p = 0.31, respectively. The Paula method did not facilitate PFM contraction.

Reflex contraction of pelvic floor muscles during cough cannot be measured with vaginal pressure devices.

Abstract: Letter to the editor concerning: Madill SJ, McLean L: Intravaginal pressure generated during voluntary pelvic floor muscle contractions and during coughing: The effect of age and continence status. Neurourol Urodyn 2010; 29:437–442. Dear Editor in Chief Professor Chris Chapple, The above-mentioned article by Madill and McLean about measurement of intra-vaginal pressure to assess pelvic floor muscle maximal voluntary contraction (MVC) and response to coughing underscores some important points that need to be noted. It has been argued that intra-vaginal pressure measurements are complex and there is the possibility that variations in intra-abdominal pressure and co-contractions of the outer pelvic muscles such as hip adductor, external rotators, gluteals, and abdominal muscles can influence the measurements. Indeed increases in intra-abdominal pressures caused by coughing and Valsalva invariably modulate intravaginal pressure and can confound the accuracy of measurements of PFM contraction and strength. Interpretation of vaginal pressure measurements during attempts of MVCmust therefore be used with vigilance, and we caution that vaginal pressure measurements is only valid if confirmed with there is a simultaneous observation of inward movement of the perineum or measurement device. If the perineum or probe is moving inwards, there it is unlikely that there is significant increase in intra-abdominal pressure and a correct contraction with squeeze and inward/forward lift is accomplished. Clearly, substantial time and training is needed to teach the patients not to co-contract other muscles such as abdominals, adductor, and gluteal muscles that can influences intravaginal pressure as well . Examination of Madill and McLean paper highlights the importance of imparting awareness to the subjects during evaluation, and suggests caution needs to be exercised in interpreting the results on MVC, endurance, and rise time during contraction. In considering the results of this paper we urge vigilance in their interpretation as there is major concern relating to additional confounding factors introduced in the measurement of PFM reflex response to coughing. Measurement of abdominal pressures, particularly in cases of co-contractions, can vary depending on sensor location and its configuration and are unlikely to uniquely reflect the PFM response. These factors need to be explicitly monitored in any protocol. It should be stressed that pressure as a measurement tool constitutes the summation of signals originating from cocontractions or feed-forward contractions. Indeed the reflex alone is too slow for this purpose and it happens before or at least at the same time rendering it difficult to distinguish possible co-contractions from the PFM during coughing and the increases in intra-vaginal pressure due to increases in intra-abdominal pressure caused by the cough itself . Clearly the measurement of the response of PFM to changes in intraabdominal pressure and during physical activity is emerging as an important area for future research requiring the design of smart abdominal pressure sensors and the quantification of imaging from dynamic MRI and ultra-sonographic scanning.

Impact of childbirth and mode of delivery on pelvic floor muscle strength: A comparative prospective study.

Abstract: 1. Norwegian School of Sports Sciences, Department of Sports Medicine, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynaecology, Lørenskog, Norway, 2. Akershus University Hospital, Department of Obstetrics and Gynaecology, Lørenskog, Norway, 3. Norwegian School of Sports Sciences, Department of Sports Medicine, Oslo, Norway, 4. Akershus University Hospital, Department of Obstetrics and Gynaecology, Lørenskog, Norway; Faculty Division Akershus University Hospital, University of Oslo, Norway

Fit women are not able to use the whole aerobic capacity during aerobic dance.

Abstract: Edvardsen, E, Ingjer, F, and Bo, K. Fit women are not able to use the whole aerobic capacity during aerobic dance. J Strength Cond Res 25(12): 3479-3485, 2011-This study compared the aerobic capacity during maximal aerobic dance and treadmill running in fit women. Thirteen well-trained female aerobic dance instructors aged 30 ± 8.17 years (mean ± SD) exercised to exhaustion by running on a treadmill for measurement of maximal oxygen uptake (VO(2)max) and peak heart rate (HRpeak). Additionally, all subjects performed aerobic dancing until exhaustion after a choreographed videotaped routine trying to reach the same HRpeak as during maximal running. The p value for statistical significance between running and aerobic dance was set to ≤0.05. The results (mean ± SD) showed a lower VO(2)max in aerobic dance (52.2 ± 4.02 ml·kg·min) compared with treadmill running (55.9 ± 5.03 ml·kg·min) (p = 0.0003). Further, the mean ± SD HRpeak was 182 ± 9.15 b·min in aerobic dance and 192 ± 9.62 b·min in treadmill running, giving no difference in oxygen pulse between the 2 exercise forms (p = 0.32). There was no difference in peak ventilation (aerobic dance: 108 ± 10.81 L·min vs. running: 113 ± 11.49 L·min). In conclusion, aerobic dance does not seem to be able to use the whole aerobic capacity as in running. For well endurance-trained women, this may result in a lower total workload at maximal intensities. Aerobic dance may therefore not be as suitable as running during maximal intensities in well-trained females.

Intra- and inter-rater reliability study of diagnosing major defects of the pubovisceral muscle on 3D/4D ultrasound in primiparous women six weeks after vaginal delivery.

Abstract: 1. Akershus University Hospital, Department of Obstetrics and Gynaecology, Lørenskog, Norway, 2. Faculty Division Akershus University Hospital, University of Oslo, Oslo, Norway; Faculty Division Akershus University Hospital, University of Oslo, Norway, 3. Norwegian School of Sports Sciences, Department of Sports Medicine, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynaecology, Lørenskog, Norway, 4. Norwegian School of Sports Sciences, Department of Sports Medicine, Oslo, Norway, 5. Akershus University Hospital, Department of Obstetrics and Gynaecology, Lørenskog, Norway; Faculty Division Akershus University Hospital, University of Oslo, Norway

The Paula method and the pelvic floor: reply by the authors 1

Abstract: Dear Editor, We thank Michal Liebergall-Wischnitzer for the comments and discussion of our study [1]. In their original study, claim that the theory behind the Paula method is “exercising the ring muscles in a certain area of the body will result in strengthening the circular muscles of other areas”. They also measured PFM strength before and after treatment using both vaginal palpation and a perineometer; however, they found no effect. The Paula method claims to co-activate the PFM (which is not the same as exercising for improved strength). Ultrasound does not measure strength, but constriction of the levator hiatus. The only muscle group that can constrict the levator hiatus is the PFM. Liebergall-Wischnitzer [2] questions the validity of ultrasonography for our research question. The validity of a measurement method is defined as “measuring what it is supposed to measure”. We would argue that ultrasonography is the most valid method to measure co-activation of the PFM during the instruction of other manoeuvres. In his letter to the editor, LiebergallWischnitzer [2] now claims that co-activation of the PFM is no longer the main goal of their method and that we missed the main goal. However, he proposes no alternative hypothesis on how contracting ring muscles of the face can work. All physical activity methods provide an immediate response, and this can be measured during the activity or immediately after, for instance, oxygen consumption, contraction, stretching, and relaxation. If there is no response during the activity, it is unlikely that there will be any effect of the repeated exercise. Meaning, if there is no co-contraction during attempts of the Paula method, how can we expect that doing repeated non-working “Paulas” should be effective? And yes, it is logical to assess the immediate effect of tai chi and yoga before we go on to RCTs to see if there is a permanent improvement over time. Liebergall-Wischnitzer [2] refers to a study on Pilates using certified instructors. We have used certified PTs and gynaecologists and question the need for additional courses to ask women to close their eyes and mouth. The reference to the Culligan study [3] gives us the opportunity to address the fact that this study cannot be used to promote Pilates instead of PFMT. This is because: (1) in real life, participants in Pilates classes do not have a vaginal examination before they enter the class, (2) the class included PFMT, and (3) the comparison to the PFMT protocol used was not evidence based. It is interesting that the two new studies published in this journal [1, 4], finding that nothing happened during the Paula method, were carried out independently by totally different research groups from two different countries using a different design and measurement methods. The results from these two studies support each other and find that the Paula method does not facilitate PFM contraction as suggested in the theory promoting the method. Based on these studies, asking the patients to contract the ring muscles of the mouth and eyes, expecting a response in the PFM, is a waste of time and not an evidence-based practice. K. Bø :G. Hilde : J. S. Jensen : I. H. Brækken Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway

Long term effect of pelvic floor muscle training for female stress and mixed urinary incontinence- a systematic review

Abstract: Hypothesis / aims of study Today there is level 1, grade A evidence that pelvic floor muscle training (PFMT) is effective in treatment of stress urinary (SUI) and mixed urinary incontinence (MUI), and PFMT is recommended as first line treatment for these conditions (1,2,3). There has, however, been scant focus on systematically literature search, analysis and report of long term follow-up studies, and the evidence for long term effect has been questioned (1,2,3). The aim of the present systematic review was to evaluate the long term effect of PFMT for female SUI and MUI with predominately SUI symptoms.

Major defects of the pubovisceral muscle, levator hiatus dimensions and pelvic floor function, a three and four dimensional transperineal study.

Abstract: Hypothesis / aims of study The relationship between pelvic organ prolapse (POP) and vaginal deliveries has long been known. Using MRI, and more recently 3D/ 4D ultrasound, it is possible to identify defects in the pelvic floor muscles (PFM) and specifically the pubovisceral (PV) muscle in women who have delivered vaginally. The link between PV muscle defects and POP is not completely understood. The aims of the present study were to investigate the relationship between major pubovisceral muscle defects, changes in levator hiatus dimensions during contraction and Valsalva, and pelvic floor muscle strength and endurance.

Learning and inter-rater reliability study of three and four dimensional transperineal ultrasound imaging

Abstract: Hypothesis / aims of study To include three and four dimensional (3D/4D) transperineal ultrasound in clinical routine, the technique must be easy to perform, and the imaging reliable and easy to interpret. Both test-retest, intraand inter-rater repeatability for the analyses of recorded 3D/4D ultrasound volumes have been found acceptable (1,2), but as far as we have ascertained there are no studies monitoring the learning process, including investigating the reliability of the whole procedure with instructions to the patient, recording and analysing of the ultrasound volumes. The primary aim of the present study was to study the learning process of performing a 3D/4D transperineal ultrasound examination and analysing the imaging. A second aim was to perform an interrater reliability study between two independent ultrasound examiners.

Effect of pelvic floor muscle training on labour and newborn outcomes: a randomized controlled trial Efeitos do treinamento da musculatura do assoalho pélvico sobre o parto e recém-nascido: estudo controlado randomizado

Abstract: Background: The use of the pelvic floor muscle training for urinary incontinence treatment is well established but little is known about its effects in labor and newborn outcomes. Objectives: To evaluate the effects of antenatal pelvic floor muscle training and strength in labor and newborn outcomes in low-income pregnant women. Methods: This is a randomized controlled trial that recruited forty-two nulliparous healthy pregnant women aged between 18-36 years old and able to contract the pelvic floor muscles. The participants were included in the study with 20 weeks of gestational age and had their pelvic floor muscles measured by vaginal squeeze pressure. They were randomly allocated into two groups: training group and a non-intervention control group. Then, all participants had their labor and newborn outcomes evaluated through consultation of medical records by a blinded researcher. Results: There were no statistically significant differences between the groups regarding gestational age at birth, type of labor, duration of the second stage of labor, total time of labor, prevalence of laceration, weight and size of the baby, and Apgar score. No correlation was observed between pelvic floor muscle strength and the second stage or the total length of labor. Conclusions: This randomized controlled trial did not find any effect of pelvic floor muscle training or pelvic floor muscle strength on labor and newborn outcomes. Article registered in the Australian New Zeeland Clinical Trials Registry (ANZCTR) under number ACTRN 12609001005246.

Does a ring pessary in situ improve pelvic floor muscle function in women with pelvic organ prolapse

Abstract: Hypothesis / aims of study Pelvic organ prolapse (POP) is a prevalent condition in women, and mechanical symptoms such as heaviness and bulging may greatly impair quality of life and restrict participation in physical activities. POP has been associated with weak pelvic floor muscles (PFM) (1) and PFM training has demonstrated to be effective in strengthening the muscles, reduce muscle length, increase muscle thickness and reduce hiatal dimensions in a randomized controlled trial (RCT) (2). It has been suggested that pessary support may result in improved PFM function, but so far there is no data to support this hypothesis (3). To date there is no consensus to whether or not the prolapse should be repositioned during measurement and PFM training. The aim of the present study was to evaluate whether there is a difference in vaginal resting pressure, PFM strength and endurance measured with and without a ring pessary in situ in women with grade II – IV POP.