To test the hypothesis that longer and more intense exercise will enhance long-term weight loss, 201 sedentary women 27 to 40 years of age were enrolled in a randomized trial. The participants, whose baseline body mass index ranged from 27 to 40 kg/m 2 , were in a university-based weight control program. They were assigned to 1 of 4 groups that exercised at moderate or vigorous intensity for a moderate to long duration. Estimated energy expenditure was 1000 or 2000 kcal per week. All women were asked to reduce their energy intake to 1200 to 1500 kcal per day and their dietary fat intake to 20% to 30% of total energy intake. Nearly 95% of participants completed 12 months in the study. All participants were sedentary at the outset, exercising less than 3 days per week for less than 20 minutes. They were instructed to exercise, unsupervised, for 5 days a week, primarily by walking; motorized treadmills were provided. Bouts of exercise lasting at least 10 minutes were prescribed in terms of both percentage of age-predicted maximal heart rate and perceived exertion using the Borg scale. The women attended an average of 79% of group sessions in the first 6 months and 71% over the entire 12-month study period. Mean weight loss was significant in all groups, ranging from 8.9 kg with long-lasting vigorous exercise to 6.3 kg with moderate exercise of moderate duration. There were no significant between-group differences. Mean cardiorespiratory fitness also increased significantly in all groups, most markedly (22%) with vigorous, high-duration exercise. The least improvement, an increase of 13.5%, was in the group exercising at moderate intensity for a moderate time. Again, there were no differences between groups. Weight loss at 12 months correlated with the level of physical activity at both 6 and 12 months. Women exercising less than 150 minutes per week lost a mean of 4.7% body weight, contrasting with 13.6% for those exercising at least 200 minutes per week. There were no significant group differences in energy intake. The authors recommend that sedentary adults who are overweight begin by exercising at moderate intensity for at least 150 minutes per week. When appropriate, higher exercise levels should be adopted, aiming at an hour a day as advised by the Institute of Medicine.

Effect of Exercise Duration and Intensity on Weight Loss in Overweight, Sedentary Women: A Randomized Trial

Our purpose with this study was to verify the restriction of the urinary incontinence (UI) in a woman's daily life, considering the type of incontinence, and find out how women deal with that. It is a secondary analysis of data taken from a previous study that were obtained using open and closed questions. Interviews were held with 164 incontinent inpatients of gynecological and urological clinics of two hospital schools in the city of Campinas, in the State of Sao Paulo, with ages ranging from 25 to 85 years. Of this universe, 104 (64%) indicated one or more restrictions regarding their daily life activities, such as altered sexual (40.9%), social (33.5%), domestic (18.9%) and occupational activities (15.2%). Mixed urinary incon-tinence and urge incontinence were mentioned as that affected the most women's daily life. The disposable pad system was the most utilized strategy in dealing with UI. It was concluded that UI has a negative impact on the daily life of these women.

Urinary Incontinence Restrictions In Women's Life [restrições Causadas Pela Incontinência Urinária A Vida Da Mulher.]

Objective To determine whether women engaged in strenuous, provocative exercise are more likely to be incontinent in future life than similarly fit women who participated in less provocative exercise. Methods In this retrospective cohort study, female American Olympians who competed in swimming (low-impact group) and in gymnastics and track and field (high-impact group) between 1960 and 1976 completed a structured questionnaire. Primary outcome measures included the prevalence of the symptoms of stress and urge incontinence. Statistical analyses of results included χ 2 , Fisher exact test, two-tailed t tests, Wilcoxon rank sum test, and stepwise multiple logistic regression. P Results One hundred four women responded (response rate 51.2%). High-impact athletes were older (46.2 compared with 42.4 years) and were more likely to report incontinence when they were doing their sport as Olympians (35.8% compared with 4.5%) than low-impact athletes; low-impact athletes were more likely to be parous (83.3% compared with 60.7%). There was no difference in the prevalence of the symptom of stress incontinence between the highversus low-impact groups: any incontinence, 41.1% compared with 50%; daily or weekly incontinence, 10.7% compared with 8.3%; and incontinence that bothered them moderately or greatly, 10.7% compared with 4.2%. With our sample size, this study had 80% power to detect a fourfold difference in daily or weekly incontinence between groups, but only a 30% power to detect a twofold difference, given a baseline prevalence of 10%. When age, body mass index (BMI), parity, Olympic sport group, and incontinence during Olympic sport were entered into stepwise logistic regression analyses, only BMI was significantly associated with regular stress or urge incontinence symptoms. Conclusion Participation in regular, strenuous, highimpact activity when younger did not predispose women to a markedly higher rate of clinically significant urinary incontinence in later life.

Does prolonged high-impact activity contribute to later urinary incontinence? A retrospective cohort study of female olympians

More women participate in sports than ever before and the proportion of women athletes at the Olympic Games is nearly 50%. The pelvic floor in women may be the only area of the body where the positive effect of physical activity has been questioned. The aim of this narrative review is to present two widely held opposing hypotheses on the effect of general exercise on the pelvic floor and to discuss the evidence for each. Hypothesis 1: by strengthening the pelvic floor muscles (PFM) and decreasing the levator hiatus, exercise decreases the risk of urinary incontinence, anal incontinence and pelvic organ prolapse, but negatively affects the ease and safety of childbirth. Hypothesis 2: by overloading and stretching the PFM, exercise not only increases the risk of these disorders, but also makes labor and childbirth easier, as the PFM do not obstruct the exit of the fetus. Key findings of this review endorse aspects of both hypotheses. Exercising women generally have similar or stronger PFM strength and larger levator ani muscles than non-exercising women, but this does not seem to have a greater risk of obstructed labor or childbirth. Additionally, women that specifically train their PFM while pregnant are not more likely to have outcomes associated with obstructed labor. Mild-to-moderate physical activity, such as walking, decreases the risk of urinary incontinence but female athletes are about three times more likely to have urinary incontinence compared to controls. There is some evidence that strenuous exercise may cause and worsen pelvic organ prolapse, but data are inconsistent. Both intra-abdominal pressure associated with exercise and PFM strength vary between activities and between women; thus the threshold for optimal or negative effects on the pelvic floor almost certainly differs from person to person. Our review highlights many knowledge gaps that need to be understood to understand the full effects of strenuous and non-strenuous activities on pelvic floor health.

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Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review

Background: Lymphedema is known as a secondary complication of breast cancer treatment, caused by reduction on lymphatic flow and lymph accumulation on interstitial space. The Kinesio Taping (KT) h...

Effects of Kinesio Taping on breast cancer-related lymphedema: A meta-analysis in clinical trials

Urinary incontinence (UI) is any involuntary loss of urine. In female athletes, physical exercise may be a risk factor for UI because of increased intra-abdominal pressure generated during high-impact exercises, which overloads the pelvic organs, predisposing them to UI. This is a systematic review of the prevalence of UI in female athletes in different sports. A search for articles was carried out in the PEDro, Scopus, Cinahl, PubMed, LILACS, SciELO, Science Direct, Web of Science, Embase, and Cochrane databases as well as a manual search of the references of studies already published on the subject with the keywords “athlete,” “urinary incontinence,” and “women” in Portuguese and English. Only articles published from 2000 to 2016 were included. Observational studies assessing the prevalence of UI in female athletes were selected. Methodological quality was assessed using the Downs and Black scale, and the data collected from the studies were analyzed through meta-analysis. Eight studies met the eligibility criteria. Meta-analysis showed a 36% prevalence of UI in female athletes in different sports, and compared with sedentary women, the athletes had a 177% higher risk of presenting with UI. There is a higher prevalence of UI in female athletes compared with sedentary women. There have been reports of UI in different sports.

Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis

Urinary Incontinence (UI) in women is a condition that becomes more common with age. Pelvic floor muscle training (PFMT) is recommended as a first option of treatment for women with symptoms of stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and for some with symptoms of urge urinary incontinence (UUI). PFMT can be performed in groups, individually, and at home, and there is no consensus as to which of the approaches is more efficient for the conservative treatment of UI. The objective was to perform a systematic review comparing the effects of group PFMT vs individual or home training in the treatment of women with UI. Cochrane’s recommendations for systematic reviews were followed. The inclusion criteria were that the studies had been carried out in adult women who suffered from UI and who underwent PFMT in a group. Ten studies that fit the criteria previously mentioned were included in this systematic review. The meta-analysis showed that there was no difference when comparing PFMT in groups vs individual PFMT. However, when comparing PFMT in groups vs PFMT at home, the group intervention was more efficient in the treatment of UI. PFMT is an efficient technique for the improvement of the symptoms of female UI. When PFMT was supervised by a physiotherapist, no significant difference was noted when comparing group with individual approaches.

Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis.

Stress urinary incontinence (SUI) is the most common urinary complaint among women and is defined by the International Continence Society as any involuntary loss of urine due to physical effort, sneezing or coughing. Many women with SUI state that the loss of urine occurs after performing repetitive movements, which may suggest that it is the result of fatigue of the pelvic floor muscles (PFM). Thus, we performed the systematic review of the literature on the influence of PFM fatigue on the development or worsening of the symptoms of SUI in women. The PubMed, Scopus, EMBASE, PEDro, LILACS, SciELO, Cochrane Library, Google Scholar, CINAHL and Periodicos CAPES databases were searched for articles using the keywords “fatigue”, “pelvic floor”, “stress urinary incontinence” and “women”, in Portuguese and in English. Methodological quality was assessed using the Downs and Black scale, and the data collected from the studies were analyzed descriptively. Of the 2,010 articles found, five met the inclusion criteria and were analyzed. They were published between 2004 and 2015, and included a total of 30,320 women with ages ranging from 24 to 53.6 years. Of the studies analyzed, three showed an association between fatigue and SUI, and two did not show such an association. This study confirmed that PFM fatigue can influence the development and/or worsening of SUI.

Influence of pelvic floor muscle fatigue on stress urinary incontinence: a systematic review.

The Pilates method is a form of physical exercise that improves the control of the core muscles, improving the conditioning of all the muscle groups that comprise the core, including the pelvic floor muscles (PFM). Thus, this study had the goal of verifying the existence of differences in the functioning of the PFM in women who practice the Pilates method and sedentary women. This was an observational, cross-sectional pilot study. A sample size calculation was performed using preliminary data and it determined that the sample should have at least 24 individuals in each group. The participants were 60 women aged 20 to 40 years; 30 women practiced the Pilates method (PMG) and 30 were sedentary (SG). An anamnesis file was used to collect personal data and assess the knowledge and perception of the PFM. The Perina® perineometer and vaginal palpation were used to determine the functionality of the PFM. There was no significant difference between the PMG and the SG in any of the variables analyzed. We concluded that the functionality of the PFM in younger women who practice the Pilates method is not different from that of sedentary women.

Comparison of the functionality of pelvic floor muscles in women who practice the Pilates method and sedentary women: a pilot study

Introduction: The training of the pelvic floor muscles is widely used for treating pelvic floor dysfunctions, like urinary incontinence. During the training, abdominal contractions are avoided; however several studies support the use of the synergy between these muscle groups. Objective: Carrying out a systematic review of studies that seek to identify the presence of synergy between the muscles of the abdomen and the pelvic floor and its functionality in women without pelvic floor dysfunction. Methodology: To conduct the review, we have followed the recommendations proposed by the Cochrane Collaboration for systematic reviews. The literature search included the databases SCIELO, PEDro, MEDLINE, Cochrane CENTRAL and EMBASE, and manual research, the starting date of the databases until August 2013. We included cross observational studies with healthy women who were assessed to find the presence of synergy between the abdominal muscles and the pelvic floor. Results: We included 10 articles and they all showed the existence of synergy between the abdominal and pelvic floor muscles in healthy women in the supine, sitting and standing positions. Conclusion: Thus, we can conclude that there is synergy between the muscles of the abdomen and the pelvic floor in healthy women. Better understanding the behavior of these muscles and synergy may favor the development of strategies for the prevention and treatment of disorders of the female pelvic floor muscles.

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Luciana Laureano Paiva

Papers

Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis

Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis.

Influence of pelvic floor muscle fatigue on stress urinary incontinence: a systematic review.

Comparison of the functionality of pelvic floor muscles in women who practice the Pilates method and sedentary women: a pilot study

Synergism between abdominal and pelvic floor muscles in healthy women: a systematic review of observational studies