Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150-300 min of moderate-intensity, or 75-150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018-2030 and to strengthen surveillance systems that track progress towards national and global targets.

https://bjsm.bmj.com/content/bjsports/54/24/1451.full.pdf

World Health Organization 2020 guidelines on physical activity and sedentary behaviour

Introduction and hypothesis Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report. Methods This report combines the input of members of the Standardization and Terminology Committees of two Inter

http://bethshelly.com/docs/standardization-2009-IUGA-ICS-Terminology-PF-dysfunction.pdf

An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction

/pdf/chapter-4-european-guidelines-for-the-management-of-chronic-4lrtve55lo.pdf

Chapter 4. European guidelines for the management of chronic nonspecific low back pain.

Sponsors asked the IOM's Food and Nutrition Board and the Division of Behavioral and Social Sciences and Education Board on Children, Youth, and Families to review and update the IOM (1990) recommendations for weight gain during pregnancy and recommend ways to encourage their adoption through consumer education, strategies to assist practitioners, and public health strategies.The committee was asked to address the following tasks: 1. Review evidence on the relationship between weight gain patterns before, during, and after pregnancy and maternal and child health outcomes, with particular attention to the prevalence of maternal obesity racial/ethnic and age differences, components of GWG, and implications of weight during pregnancy on postpartum weight retention, maternal and child obesity, and later child health. 2. Within a life-stage framework consider factors in relation to GWG that are associated with maternal health outcomes such as lactation performance, postpartum weight retention, cardiovascular disease, metabolic processes including glucose and insulin-related issues, and risk of other chronic diseases; for infants and children, in addition to low birth weight, consider early developmental impacts and obesity-related consequences (e.g., mental health, diabetes). 3. Recommend revisions to the existing guidelines, where necessary, including the need for specific pregnancy weight guidelines for underweight, normal weight, and overweight and obese women and adolescents and women carrying twins or higher-order multiples. 4. Consider a range of approaches to promote appropriate weight gain, including: individual (behavior), psychosocial, community, health care, and health systems; timing and components of interventions; and ways to enhance awareness and adoption of the guidelines, including interdisciplinary approaches, consumer education to men and women, strategies to assist practitioners to use the guidelines, and public health strategies. 5. Identify gaps in knowledge and recommend research priorities.

/pdf/weight-gain-during-pregnancy-reexamining-the-guidelines-54naat6auf.pdf

Weight Gain During Pregnancy: Reexamining the Guidelines

Peter Craig, MRC Population Health Sciences Research Network Paul Dieppe, Nuffield Department of Orthopaedic Surgery, University of Oxford Sally Macintyre, MRC Social and Public Health Sciences Unit Susan Michie, Centre for Outcomes Research and Effectiveness, University College London Irwin Nazareth, MRC General Practice Research Framework Mark Petticrew, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine

Developing and Evaluating Complex Interventions: New Guidance

Talasz et al. [1] comment that the report Blacks relevant and well-established scientific findings regarding pelvic floor muscle (PFM) physiology and function accumulated over the past 15 years,^ citing Hodges et al., Laycock et al., and Talasz et al. The authors do not explain how these references would fit into the report and further change the terminology. This Terminology Report [2] was a definitional document. A wide range of sources were accessed to identify the best definitions; in some cases, the Oxford Dictionary was used for Bexisting definitions of established terms from general medicine^ [ 2]; however, it was not referred to as the Bfinal authority,^ as stated by Talasz et al. [1]. The aim was not to explore PFM physiology, nor to make recommendations regarding the level of evidence for any of the terms cited in the document. Terms related to the observation of PFM activity in response to respiration or postural adjustments can be found under Bsigns,^ e.g., BCo-ordination: property of movement characterized by the smooth and harmonious action of groups of muscles working together to produce a desired motion^ and under Btreatment^: BCoordination training: the ability to use different parts of the body together smoothly and efficiently. Talasz et al. [1] suggest that Bcorrect PFM function, i.e., contraction and relaxation at appropriate times, will most likely not be restored without recognizing the dynamic integration of the PFMs from a holistic perspective within the human body.^ To be recommended as an evidence-based intervention, findings from a randomized controlled trial would be required. Clinical practice should not be changed based on findings from clinical observation and laboratory studies [3, 4]. The IUGA/ICS joint report group was based on application from an open invitation to the membership of both socie t ies , fo l lowed by an elec t ion of members representing different countries, disciplines, and clinical practices. The process of selecting and defining terms involved nine rounds of intense review, discussion, and agreement by consensus. Five experts from different disciplines provided comments, followed by a draft posted on the ICS website inviting comments from members and subsequently published. Talasz et al. [1] refer to the Messelink et al. paper from 2005 [5]. Messelink et al. [5] have been cited several times in our manuscript. This paper is now under revision by an international multidisciplinary group, and several of the definitions are expected to change. We welcome comments on this next paper when it has reached that stage of its development. Institution at which the work was performed: Norwegian School of Sport Sciences, Oslo, Norway.

Response to comment on the IUGA/ICS joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction.

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

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

Author response to Liebergall.

Effekt av bekkenbunnstrening på stressinkontinens

Background/aim: Several epidemiological studies have found a high prevalence of Pelvic Floor Dysfunction (PFD) among female athletes. However, according to several authors, these data could even be underestimated, both in research and clinical practice. Screening for potential PFD is often delayed and risk factors are not often evaluated. As a consequence, withdrawal from sport, negative influence on performance, worsening symptoms and unrecognized diagnosis may occur. The aim of our research is to develop a screening tool for pelvic floor dysfunction in female athletes useful for clinicians (musculoskeletal/sport physiotherapists, sports medicine physicians, team physicians) to guide referral to a PFD expert (e.g. pelvic floor/women's health physiotherapist, gynecologist, uro-gynecologist, urologist). Methods: A 2-round modified Delphi study will be conducted to ascertain expert opinion on which combination of variables and risk factors should be included in the screening tool. Conclusion: The implementation of the present screening tool into clinical practice may facilitate the referral to a PFD expert for further assessment of the pelvic floor and therefore, to identify potential dysfunction and, eventually, the related treatment pathway.

https://www.medrxiv.org/content/medrxiv/early/2022/01/12/2022.01.12.22269000.full.pdf

Kari Bø

Papers

Response to comment on the IUGA/ICS joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction.

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

Author response to Liebergall.

Effekt av bekkenbunnstrening på stressinkontinens

Development of a screening tool for pelvic floor dysfunction in female athletes: protocol of a Delphi consensus