Training through gametherapy promotes coactivation of the pelvic floor and abdominal muscles in young women, nulliparous and continents

Abstract

Introduction and objectives:Several studies have been investigated co-activation can enhance the effectveness of PFM training protocols allowing preventive and therapeutic goals in pelvic floor dysfunctions. The objective of the present study was to investigate if an abdominal-pelvic protocol of training (APT) using gametherapy would allow co-activation of PFM and transversus abdominis/oblique internal (TrA/OI) muscles.Patients and methods:Twenty-five nulliparous, continent, young females, with median age 24.76 (±3.76) years were evaluated using digital palpation (DP) of PFM and surface electromyography of PFM and TrA/OI simultaneously, during maximal voluntary contraction (MVC), alternating PFM and TrA/OI contraction requests. All women participated on a supervised program of APT using gametherapy, that included exercises of pelvic mobilization associated to contraction of TrA/OI muscles oriented by virtual games, for 30 minutes, three times a week, in a total of 10 sessions. Electromyographic data were processed and analyzed by ANOVA - analysis of variance.Results:When MVC of TrA/OI was solicited, it was observed simultaneous increase of electromyographic activity of PFM (p=0.001) following ATP. However, EMG activity did not change significantly during MVC of PFM.Conclusion:Training using gametherapy allowed better co-activation of pelvic floor muscles in response to contraction of TrA, in young nulliparous and continent women.

Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis

“…Figure 1 presents the PRISMA flow diagram for identifying eligible studies based on title and abstract screening. After the assessment of 93 full texts, we included 20 studies included in the systematic review with a subset of data provided by one RCT (22), one prospective (23) and 18 cross-sectional studies (8,9,24-39) with a total of 468 participants. The interobserver agreement for screening was substantial (kappa 0.82).…”

“…Fifteen studies (8,9,22-24,26,28,31-37,39) reported the MVC of the PFMs. Three studies (23,27,34) considered the standing position for the assessment of the coactivity, and another eleven studies considered the supine position (8,9,22,25,29-31,35-38). Four studies (28,32,33,39) considered different positions – standing, sitting and supine, and one did not report the position for the assessment of coactivity (26).…”

“…Four studies (28,32,33,39) considered different positions – standing, sitting and supine, and one did not report the position for the assessment of coactivity (26). Fifteen studies (8,9,23,25,26,28,30-35,37-39) measured the contraction by EMG, four studies (22,24,27,36) measured the contraction by US, and one study (29) measured the contraction by visual inspection and digital palpation scale (Table 2).…”

The immediate effectiveness of mobile game-based instruction with an extracorporeal biofeedback device for an exercise program to improve pelvic floor muscle contraction in healthy subjects

“…The EBD education group showed a significant increase in displacement of the PFM elevation from 5.93±4.03 mm to 7.62±3.77 mm (p<0.05), with a mean rate of change of 38%. Silva et al [13] applied game therapy for contraction training of the PFM and abdominal muscles in young women and reported that coactivation of the PFM using electromyography increased significantly from 127.27 to 147.84.…”

Can Supervised Pelvic Floor Muscle Training Through Gametherapy Relieve Urinary Incontinence Symptoms in Climacteric Women? A Feasibility Study

“…10 Elliott et al 11 showed the feasibility of PFMT for MUI through a virtual environment, using a computer with a dance game program (StepMania). Martinho et al, 10 Botelho et al 12 and Silva et al 13 developed a protocol capable of stimulating PFMs contractions during the execution of pelvic movements, induced by gametherapy.…”