EFFECTIVENESS OF PELVIC FLOOR EXERCISES VERSUS ALTERNATIVE FORMS OF EXERCISE FOR FEMALE URINARY INCONTINENCE: SYSTEMATIC REVIEW AND META-ANALYSIS

M. Kandila¹, M. Moutzouri², M. Tsekoura³, E. Konstantinidou⁴, E. Billis³

Background: Pelvic floor muscle (PFM) exercises are widely used for treating female urinary incontinence to minimize symptoms and improve women’s quality of life (QoL). Apart from PFM exercises, current literature supports other, alternative forms of exercise for improving female incontinence, such as pilates, paula exercises, deep abdominal muscle training, yoga, tai chi, breating exercises etc.

Purpose: The investigation and comparison of other forms of exercise against PFM exercises alone for the management of urinary incontinence in adult women through a systematic review and meta-analysis.

Methods: A systematic review (data sources: Medline, Science Direct, Biomed Central, Google Scholar, EMBASE, Scopus, CIHNAL και Physiotherapy Evidence Database) and meta-analysis of randomised controlled/clinical trials of PFM exercise training in adult women versus other forms of exercises performed alone or in combination with PFM exercises was conducted by two independent researchers (key words used in combination: urinary incontinence, exercises, training, alternative therapies). Methodological quality of the studies was evaluated by utilizing the Physiostherapy Evidence Database (PEDro) scale. For the meta-analysis, mean differences and 95% confidence intervals (CIs) were utilized for the quantitative evaluation of the cumulative effect of the included studies whereas, patient heterogeneity was evaluated with chi-square tests, fixed-effects model and the forest plot.

Results: systematic review and 3 studies for meta-analysis. According to PEDro, three studies were of high methodological quality (>7/10 score) and eight of moderate quality (5-6/10 score). Out of the seven studies, three were investigating Paula exercises (circular-sphincter muscle exercises), three were exploring deep abdominal exercises combined with PFM exercises and two studies explored a combination of pilates with PFM exercises. The three high quality studies explored various exercise combinations with predominant exercise patterns that of transversus abdominus (TA) with internal obliques. Paula and PFM exercises appear to improve both, urinary leakage and QoL. Pilates training appears to improve PFM strength and incontinence symptoms in a similar manner to PFM exercises. Combined exercise programmes (i.e. TA with PFMs) are superior for PFM strength and QoL to PFM training alone; however, they have similar outcomes for urinary leakage. Meta-analysis included Paula versus PFM exercises and the outcome measures utilized were QoL and the one-hour pad test. Chi square tests reported homogeneity across studies (χ2=0,84, df=2, p=0,66, I2=0%). Regarding the one-hour pad test, Paula method was marginally superior to PFM exercises (mean differences range: 0,32, 95%CI=-1.66-2.31) whereas, PFM training was marginally superior to Paula exercises for QoL (mean differences range: 1,03, 95%CI=-2.37-0.31).

Conclusion(s): Given the results, there is low quality evidence that other forms of exercise training are superior to classic PFM exercises for improving urinary incontinence amongst women. Marginal superiority is detected on Paula exercises for improving leakage and on PFM exercises for improving QoL. Clinical research is needed to further explore these exercise forms across large patient samples.

Implications: PFM exercises as well as alternative exercise forms (Paula exercises, TA etc.) are recommended for managing urinary incontinence symptoms amongst women.

Funding, acknowledgements: None

Keywords: urinary incontinence, pelvic floor exercises, althernative therapies

Topic: Pelvic, sexual and reproductive health

Did this work require ethics approval? No

Institution: Technological Educational Institute (T.E.I.) of Western Greece

Committee: Comittee of the School of Health and Caring Professions

Reason: This was a systematic review