Adapted Physical Activity Based On Trunk Stabilization And Pelvic Floor Education For Female Pelvic Floor Disorders

Effect Of An Intervention Combining Adapted Physical Activity Based On Trunk Stabilization And Pelvic Floor Education For Female Pelvic Floor Disorders

Pelvic floor disorders affect a substantial proportion of women worldwide and represent a significant public health concern due to their impact on physical function, quality of life, and psychosocial well-being. Growing interest has emerged in physical activity programs for pelvic floor disorders as a noninvasive and accessible intervention strategy.

This study aims to evaluate the effect of an intervention combining a weekly Adapted Physical Activity (APA) session focused on trunk stabilization and a monthly pelvic floor education session over a three-month period to improve self-reported pelvic floor symptoms. The secondary objectives are to investigate the effects of this intervention on quality of life, pelvic floor knowledge, stigma, care-seeking behavior, and physical activity behavior.

Participants will be randomly assigned to one of two groups for 3 months: (1) intervention APA + education or (2) waitlist. Participants in the waitlist group will receive the intervention three months after the program's launch.

This study could help provide additional data to improve education of the pelvic floor and care seeking, as well as to better understand the effect of physical activity for pelvic floor disorders.

This study will include women who reported having a pelvic floor disorder. The study will be a randomized controlled trial with three measurement time points, before and after the intervention (immediate post-test and delayed post-test at 3 months), and two groups. One group will receive Adapted Physical Activity (APA) + education intervention, and the control group will be placed on a waiting list for 3 months. Participants in the control group may then follow the program if they wish.

We hypothesize that APA program based on trunk stabilization combined with an educational intervention improves self-reported symptoms of pelvic floor disorders, knowledge, and care-seeking behavior (including physical activity) compared to a group that receives no intervention. We expect these effects to appear immediately after the intervention (immediate post-test) and to persist over time (delayed post-test at 3 months).

APA refers both to tailored exercise or sports interventions designed to promote health among people with chronic diseases, health conditions, or disabilities and to a scientific discipline that designs and studies interventions for health and educational purposes. APA provides a framework for implementing the principles of trunk stabilization in the context of pelvic floor disorders, notably through learning diaphragmatic breathing and the co-activation of the pelvic floor and the transversus abdominis, specific training to strengthen the core muscles, and incorporating dynamic exercises with light to moderate impact (jumps, side steps, etc.).

Adapted physical activity sessions based on the trunk stabilization principle will last 60 minutes and will include 15-minute warm-up (body and joint mobilizations from head to toe, and breathing exercise) followed by 30-minute main continuous session (trunk stabilization and strengthening exercises), and 15-minute cooldown for stretching and mobility exercises. The programme will be organized in three phases, to be implemented progressively: (1) learning the diaphragmatic breathing pattern, the co-activation of the pelvic floor and the transversus abdominis muscles in standing, sitting, and lying positions; (2) specifically working the engagement of the transversus abdominis muscles in static, dynamic, and balance exercises while strengthening the core muscles; (3) integrating dynamic exercises with light to moderate impact (jumping, side steps, etc.). Exercise instructions will include posture, pelvic floor engagement, and respiratory instructions on effort.

The educational sessions will last between 60 to 90 minutes. The first session will focus on the prevalence and common beliefs surrounding the pelvic floor, providing a brief introduction to common risk factors. The functioning (anatomy, function, and biomechanics) of the pelvic floor will then be presented using educational anatomical videos. In the second session, lifestyle-related risk factors and preventive measures will be discussed through a group workshop (e.g. urinary and defecatory physiologies, the impact of sport, posture, overweight and obesity, and hygiene and dietary recommendations for constipation). Participants will be invited to consider how to plan their physical activity in anticipation of the end of the program and any obstacles they may need to overcome. The final session will cover the care pathways available for pelvic floor disorders; participants will then be invited to consider how to plan for a potential future appointment with a healthcare professional and any barriers they may need to overcome.

Inclusion Criteria:

• Women over 18 years old
• At least one symptom associated with a pelvic floor disorder (urinary or faecal incontinence, a feeling of heaviness or bulging in the genital area, difficulty passing stools) which causes bother (ranging from mild to severe)
• Not already undergoing pelvic floor rehabilitation with a professional (physiotherapist or midwife)
• No major mobility limitations such as being unable to get up from a supine to standing position unassisted
• Proficient in reading, writing and speaking French
• Not pregnant
• BMI below 40
• Regardless of hormonal status (natural cycle, contraceptive pill, menopause)

Exclusion Criteria:

• Scheduled surgery during the study
• Postpartum (less than 3 months)
• Pelvic surgery in the past 3 months
• Current urinary tract infection or haematuria
• Current pelvic cancer or radiation, Interstitial cystitis
• Congenital defect leading to pelvic floor disorders