// Collaboration for the better: fitness and the pelvic floor
by Lisa Champion & Margaret Sherburn, PhD
On 1 December, 2009 the Continence Foundation of Australia (www.continence.org.au) held a forum entitled ‘Fitness and the Pelvic Floor.’ The aim of the forum was to explore the link between exercise and pelvic floor dysfunction, in order to identify collaborative strategies to raise awareness of and prevent this issue.
Two speakers, Dr Margaret Sherburn from the University of Melbourne and Melbourne’s Royal Women’s Hospital and Lisa Champion from Australian Fitness Network addressed the group.
The 30 forum participants, half from the fitness sector and half from the women’s health sector, first heard from Dr Sherburn about the prevalence of stress incontinence among women, and how readily pelvic floor muscles can be weakened by certain exercises and habits. Lisa Champion then spoke about how fitness professionals are trained (both at entry level and with continuing education) and presented the results of a survey conducted on current levels of knowledge and understanding about pelvic floor issues within the fitness industry. She also discussed issues specific to the fitness industry such as the wide range of education and experience within exercise professionals, the variability in education (both training and continuing) related to core anatomy, function and training, the need for improved screening and dialogue, the problem of the demographic of personal trainers not matching that of the client, the lack of knowledge about how to teach pelvic floor activation/exercises, the problem of trainers perceiving pelvic floor exercises as too slow, too complicated, too personal, and the strong culture of abdominal bracing within the industry. A primary goal, after the two presentations, was to facilitate discussion between the continence and fitness sectors to identify strategies to educate fitness professionals about the links between exercise and incontinence. This was done through a professional facilitator and the result was a list of potential action-strategies that the CFA is hoping to put into place in 2010 and beyond.
WHAT IS THE LINK BETWEEN EXERCISE AND INCONTINENCE?
Dr Sherburn explained that well-working pelvic floor muscles play a key role in the maintenance of urinary continence, and are implicated in the prevention and treatment of stress incontinence (the involuntary leakage of urine on effort or exertion) – the most common type of urinary incontinence. In Australia, incontinence aff ects 3.8 million people, 79 per cent of whom are women. That’s close to 3 million women, many of whom are in key life stages (e.g. child bearing and menopause) related to developing incontinence and may be, coincidentally, participating in myriad forms of exercise.
The Continence sector promotes pelvic floor exercises as a preventative strategy for incontinence. Clinical trials have proven that pelvic floor muscle training (PFMT) is effective in treating stress incontinence, with cure rates of up to 84 per cent. Despite this, many women are still unaware that stress incontinence can be eff ectively treated by qualified health professionals such as continence and women’s health physiotherapists or continence nurse advisors (referred to collectively as continence professionals), and their symptoms are often ignored or dismissed as a normal part of having a baby or ageing.
There has been a growing concern among continence professionals that certain exercises (i.e., those that increase intra-abdominal pressure) can contribute to pelvic floor dysfunction and incontinence. In addition, repeated stress on the pelvic floor caused by certain exercises performed in group classes, running, certain types of weight training and certain types of abdominal work can worsen the symptoms of stress incontinence.
The common phrase ‘brace your abdominals’, used indiscriminately as a solution to controlling the core area, also leads to an increase in intra-abdominal pressure. When these exercises or cues lead to leaking, it can present a barrier for women making them more likely to stop exercising.
When you consider that 64 per cent of fitness customers are women between the ages of 25 to 44* and 60 per cent of new fi tness centre members leave their gym within the first year of joining*, it begs the question: could one reason women leave gyms be because they begin to leak during their exercise sessions and feel embarrassed?
* Data taken from a 2008 Fitness Industry profile and a 2009 Fitness Industry Economic profi le commissioned by Fitness Australia.
The link between exercise and pelvic floor dysfunction/incontinence presents a dilemma for health professionals who treat incontinence. These professionals understand that those working in the fitness industry have an ideal opportunity to address this issue due to the fact that women undertake fitness programs to get back in shape after having children, to off set age-related body changes, and/or to lose weight (53 per cent of Australian women are now overweight or obese – a major risk factor for incontinence). The fitness setting presents an opportunity for early screening and referral for this at-risk population. However, fitness professionals need a better understanding of the link between exercise and incontinence. They need more knowledge, the right tools, and the correct strategies to help the many, many women who are embarrassed by, and suffer in silence from, incontinence.
They have not yet finalised their plans, but ideas that were discussed include:
• Liaising with the National Fitness Industry Training Package committee to have competency statements related to women’s health issues included at all levels of fitness instructor training.
• Developing teaching resources related to incontinence that could be distributed to all registered training organisations that delivering fitness instructor training.
• Producing printed materials that fitness professionals could distribute to their clients (directed specifically at exercising women) related to the issues of exercise and incontinence.
• Producing articles related to fitness training and the pelvic floor for industry publications.
• Developing screening tools that fitness professionals can use to broach the delicate issue of incontinence with their clients and providing a referral pathway for fitness professionals to use to ensure these women are assessed and treated by an appropriate health professional.
• Developing more web-based resources for both fitness professionals and their clients.
• Working to increase collaboration between continence and women’s health physios/continence nurse advisors and fitness professionals at a local level, so there is a well working and widely acknowledged referral system
• Liaising with major fitness-centre chains regarding education and information for their female members.
• Sponsoring fitness convention presentations on continence issues delivered by continence health professionals.
• Developing strategies to increase the awareness of the CFA and specifically its Helpline. The National Continence Helpline freecall™ 1800 33 00 66 is a free service that provides confidential information and advice about continence issues. The Helpline is staff ed by continence nurse advisors and is a perfect starting point for clients with continence issues or fitness professionals wanting more information about incontinence.
• Developing an online training course specifically related to exercise and pelvic fl oor dysfunction. This training course would be suitable for all fitness professionals, provide CEC/PDP credits, and include screening tools, strategies, exercise do’s and don’ts and other crucial information for every fitness professional who works with women.
According to Barry Cahill, CEO of the Continence Foundation of Australia, ‘the exercise and pelvic floor dysfunction forum was a first step in what the CFA sees as a much longer term collaboration between the continence and fitness sectors. We are committed to doing all we can to ensure that fitness professionals have the tools and resources they need to help the many women in Australia who suffer from incontinence.’
Australian Fitness Network is also committed to doing all it can to raise awareness and educate fitness professionals about this very important issue.
Lisa Champion, MSc & Margaret Sherburn, PhD
Lisa is an exercise therapist specialising in posture and core control. She is the co-creator of the PERFECT PRACTICE™ training system for performance maximisation and injury minimisation. Margaret is one of Australia’s leading women’s health physiotherapists. She is a key researcher at the University of Melbourne and head of the Physiotherapy Department at the Royal Women’s Hospital in Melbourne.
NETWORK MAGAZINE • AUTUMN 2010 • PP49-51