Women's health across the lifespan: An integrative role of physiotherapy in pelvic health and other health conditions Fátima Santos, Mário Esteves, Clarinda S. D. S. F. Festas, Sara Viana, Diana Bernardo, et al. Holistic Approaches to Health Recovery, 2025 Physiotherapists can contribute significantly to women's pelvic health and other health conditions throughout the life stages, including adolescence, adulthood, pregnancy, childbirth, postpartum, menopause, and post-menopause. Their roles encompass education, rehabilitation, counselling, and empowerment, promoting health and facilitating recovery in various women's health conditions. The chapter underscores physiotherapy interventions during pregnancy and postpartum recovery, along with rehabilitation for pelvic floor and oncological conditions, emphasising the importance of tailored physical activity and exercise prescriptions. Additionally, it addresses physiotherapy's role in managing often underrepresented conditions, such as dysmenorrhoea and endometriosis. Emphasising a holistic approach, the chapter highlights physiotherapy's important role in supporting lifelong wellness and addressing the unique health needs of women within a collaborative, multidisciplinary healthcare team.
Leg stiffness and muscle power vs manometer in sportswomen with symptoms of stress urinary incontinence Telma Pires, Patrícia Pires, Helena Moreira, Ronaldo Gabriel, Arsénio Reis, et al. Clinical Biomechanics, 2021 BACKGROUND Pelvic floor muscle training can cure or alleviate stress urinary incontinence. This study aimed to evaluate maximum voluntary contractions of the pelvic floor muscle in sportswomen and verify the association with leg stiffness and muscle power, both maximal and submaximal. METHODS The sample consisted of 41 sportswomen between 18 and 42 years of age. Pelvic floor muscle strength was measured by the manometer. The sportswomen were instructed to perform 3 maximum voluntary contractions of the perineum, held for 3 seconds. Maximal and submaximal leg stiffness and muscle power were measured with a force platform, in two conditions: 1st condition was the sub-maximal, double leg hop test, which was performed allowing sportswomen to self-select their preferred frequency and 2nd condition was the maximal double leg hop test, which was performed asking athletes to maximize hop height and minimize contact time on the top of the force platform for 6 consecutive hops. FINDINGS Maximal and submaximal leg stiffness values increase with increasing age, weight, height, and body mass index, showing positive and significant (p <0.05) or close correlations. There are strong positive correlations between maximal and submaximal leg stiffness (r = 0.759) and between maximal and submaximal muscle power. Maximum voluntary contractions values decrease with increasing leg stiffness: the correlation is significant with maximal leg stiffness. INTERPRETATION Maximum voluntary contractions values decrease with increasing leg stiffness and increase with increasing muscle power values. If the training program aims to increase muscle power, it may also increase maximum voluntary contractions.
DYNAMIC CHANGES OF THE PELVIC FLOOR IN ELITE ATHLETES OF DIFFERENT SPORTS T. Pires, P. Pires, H. Moreira, R. Gabriel, Yi-ming Fan, et al. Millenium Journal of Education Technologies and Health, 2020 Introduction: One of the functions of the pelvic floor muscles (PFM) is to support the pelvic organs and continence. This continence mechanism tends to change when PFM are exposed to high-impact exercises. Objetives: To describe the dynamic changes in the pelvic floor (PF) in elite nulliparous athletes. Methods: Translabial two and three-dimensional ultrasound was used to assess PF anatomy and function in athletes (n=8). This ultrasonography was performed after voiding and in the supine position, using a vaginal probe. The descent of the pelvic organs was assessed on a maximum Valsalva maneuver, whilst the volume datasets were acquired at rest, during maximum voluntary contraction (MVC) and during a Valsalva maneuver. The athletes performed each maneuver at least 3 times, with the most effective being used for evaluation. Results: The bladder neck descent was 14 mm for the javelin thrower, being the highest value when compared to the remaining participants. Three athletes featured the rectocele (swimming, gymnastics and javelin throw) and 4 participants presented a paravaginal defect (volleyball, horsemanship, javelin throw and printer). The volleyball athlete had the highest value of the levator hiatal area in MVC value. Conclusions: The athletes present minimal differences in the evaluated parameters. The sample is small to generalize the results, but there is a tendency for athletes of high-impact exercises to have a lower CMV value. Further studies are needed to corroborate these results.
Assessment of pelvic floor muscles in sportswomen: Quality of life and related factors Telma Pires, Patrícia Pires, Helena Moreira, Ronaldo Gabriel, Sara Viana, et al. Physical Therapy in Sport, 2020 OBJECTIVES To evaluate Maximum Voluntary Contraction (MVC) of the Pelvic Floor Muscles (PFM) in sportswomen, to observe the urinary symptoms and their impact on the Quality of Life (QoL). DESIGN Observational cross-sectional study. SETTING Gyms and teams in the North of Portugal. PARTICIPANTS Sportswomen (n = 197). MAIN OUTCOME MEASURES The measurement was performed using a manometer. The sportswomen were instructed to perform 3 MVC of the perineum, held for 3 s. The Kings Health Questionnaire (KHQ) was used to evaluate urinary symptoms and the QoL of the sportswomen. RESULTS Age significantly influenced (p < 0.05) the QoL in all domains. An increase in BMI was also significantly associated with a decrease in the QoL. MVC values had a highly significant effect on the overall QoL and all domains, including a reduction in urinary symptoms. The weekly time of physical activity was associated with a better QoL in symptomatology. The practice of high-impact activities decreased the QoL (compared to low-impact activities). The vaginal resting pressure values ranged from 1.60 to 59.80 (24.34 ± 11.00). CONCLUSIONS Age, BMI and high-impact sports appear to be the leading factors that promote the onset of SUI, which in turn decrease the QoL in sportswomen. There was a positive association between MVC and weekly time of physical activity in the QoL.
Pelvic Floor Muscle Training in Female Athletes: A Randomized Controlled Pilot Study Telma Filipa Pires, Patricia Maria Pires, Maria Helena Moreira, Ronaldo Eugênio Calçadas Dias Gabriel, Paulo Vicente João, et al. International Journal of Sports Medicine, 2020 The aim of this study was to investigate the effects of pelvic floor muscles training in elite female volleyball athletes and whether it is an effective therapy for stress urinary incontinence. Fourteen athletes, both continent and incontinent, between 18 and 30 years of age, were randomly assigned to an experimental group or a control group. The experimental group received a protocol for pelvic floor muscle training for 4 months. This consisted of three phases: awareness/stabilization, strength training and power. The control group was not subject to any intervention during the same period. Measures were collected at the initial and final phase for both groups. Maximum voluntary contractions were evaluated with a perineometer, involuntary urine loss with a Pad test and quality of life with the King’s Health Questionnaire. Baseline sociodemographic and anthropometric characteristics were not significantly different. Comparing the two groups, the experimental group improved maximum voluntary pelvic contractions (p<0.001) and reduced urine loss (p=0.025), indicating the existence of significant differences between groups in the variation from the initial and final phases. The percentage of urine loss decreased in the experimental group, from 71.4–42.9%, suggesting that the protocol intervention for 16 weeks may help athletes with stress urinary incontinence.
Adaptation and validation of the King’s Health Questionnaire in Portuguese women with urinary incontinence Rui Viana, Sara Viana, Félix Neto, Teresa Mascarenhas International Urogynecology Journal and Pelvic Floor Dysfunction, 2015 Introduction and hypothesisUrinary incontinence (UI) in women is a problem of public health with psychological repercussions in various contexts of life. The aim of this study was to adapt and validate the King’s Health Questionnaire (KHQ) in women with UI to Portugal.MethodsFor the adaptation, a multistep forward–back translation protocol was used. The Positive and Negative Affect Schedule and the Satisfaction with Life Scale were used to validate the KHQ. The evaluation of the psychometric properties involved the assessment of validity, reliability, and test–retest stability in 103 women. A factor analysis was conducted to explore the underlying factor structure of KHQ. Inter-domain correlation was calculated for convergent and discriminant validity assessment.ResultsExploratory factor analysis identified three factors “personal limitations and daily life”, “emotions and social relationships” and “urinary symptoms”. Indicators of test–retest stability showed almost perfect agreement with a mean intraclass correlation coefficient (ICC) of 0.937. Internal consistency was found to be high (Cronbach’s alfa > 0.7). Furthermore, the Portuguese version of the KHQ significantly correlates with the Positive and Negative Affect Schedule, supporting construct validity.ConclusionsThe Portuguese version of the KHQ was found to be a valid and reliable measure of the quality of life in women with UI in Portugal, being relevant to both clinical practice and research.
