Pelvic floor fitness for your clients
The female pelvic floor and incontinence during physical activity has for too long been a 'hush-hush' topic. By implementing a program of safe exercise progressions, you can help members and clients workout with a newfound confidence, write Troy Morgan and Carol Archer.
When our team at Willows Health & Lifestyle Centre tackled the elephant in the room of women's fitness – the pelvic floor – something amazing happened. We discovered a huge number of women waiting silently for help, a vast number of women believing that exercise was destined to be uncomfortable for them, and an amazing number of allied health professionals seeking networks of support for their patients.
In the next training session or group exercise class you conduct, pause to look around at the women before you. Did you know that, according to clinical research findings, almost half of your female exercisers may leak urine when they exercise? Of the women who have given birth, one in three could, statistically, suffer urinary incontinence, and one in two may have some form of pelvic organ prolapse1. These health issues will have a significant impact on safe exercise choices for these women.
Add to these research recently presented at the Pelvic Floor First workshop2 in Melbourne as part of the Continence Foundation of Australia's national conference. The presenters included Professor Kari Bø, a highly respected international researcher in pelvic floor dysfunction from the Norwegian School of Sports Sciences.
Some of the statistics cited by Professor Bø, from results of clinical studies, included:
- 49 per cent of female exercisers experienced urinary incontinence (Urwin and Urwin 2003)
- 41 per cent of female athletes had stress incontinence, and 16 per cent had urge incontinence (Bø 2001)
- 26 per cent of female group fitness instructors, including Pilates and yoga instructors, reported urinary incontinence (Bø 2011).
Professor Bø indicated that, when consciously contracting the pelvic floor muscles:
- 25 per cent of women bear down, instead of lifting the pelvic floor muscles
- Between 30 and 45 per cent of women are unable to contract the pelvic floor correctly.
Furthermore, she revealed, two out of three sedentary women with urinary incontinence had withdrawn from exercise because of it (Bø, 1989).
How many of the women who cancel their gym memberships or personal training sessions would tell us that their reason for leaving is a weak bladder; that they leak urine when they jump and run, or are embarrassed about having to rush to the toilet in the middle of their favourite class? How many women during a personal training session or exercise class cite the reason for their inability to perform a particular exercise as being because they leak or feel pressure in their bladder?
Yet some of the most challenging exercises for the pelvic floor are some of the most popular exercises prescribed by fitness professionals:
- Abdominal curls or crunches
- Double leg lifts
- Medicine ball rotations
- Squats and lunges
- Lifting weights
- Any exercise with both feet off the floor
- Push ups and plank exercises on the toes
- Running, jumping, skipping and boxing3.
Establishing a safe exercise program for women
Looking at this information and statistics prompted the team at Willows Health & Lifestyle Centre to start a journey which gave rise to our Safe Exercise for Women program. It continues to surprise and inspire us with the stories of hope and achievement it produces.
Our starting point was to talk to our current female clients to understand the extent of the issue in our centre and to start developing pathways that provided safe exercise progressions for them. We began to talk to women's health professionals in our community, with experts throughout Australia to seek guidance, and we connected with the Pelvic Floor First project (www.pelvicfloorfirst.org.au) to help provide solutions.
We connected with women not by focusing on the problems that a weakened pelvic floor may cause to their life, health and exercise, but rather by bringing to life the possibilities that safe exercise can bring. We also provided appropriate movement and referral pathways.
The women within our centre began to connect with the allied health professionals in the community through the pathways we provided, and a 'tribe' quickly grew within our centre (Godin 2008)4. This tribe is managed by our full time Safe Exercise for Women coach, Carol Archer, who provides the connection between general memberships, personal trainers, allied health and our safe exercise programs.
The speed at which referrals started to feed into the program was amazing, and the program and pathways build each day. In 2011, the success of the Safe Exercise for Women program was recognised when Willows won Continence Foundation of Australia's World Continence Week promotion competition.
The program has taught us that, as fitness professionals, we are positioned perfectly to raise awareness about the pelvic floor and exercise, to encourage women to address their pelvic floor health, and to provide exercise programs that not only protect these multi-purpose muscles, but actively encourage pelvic floor fitness.
The big question is; 'how can fitness professionals introduce pelvic floor-safe exercise successfully, to ensure that their female clients and class participants are exercising appropriately?'
The following tips will help you get started:
- Learn about the pelvic floor and exercise, and why pelvic floor-safe exercise is important for all women
- Explore the Pelvic Floor First website at www.pelvicfloorfirst.org.au
- Do the two-part Pelvic Floor First pelvic floor online CEC course available through Australian Fitness Network5.
- Talk enthusiastically about pelvic floor facts, statistics and 'something I read' to everyone; your colleagues, female clients and exercise class participants. Have Pelvic Floor First resources on hand to distribute.
- Work within your scope of professional practice. Women's health physiotherapists assess pelvic floor action, teach correct muscle activation and prescribe specialised pelvic floor training exercises. The fitness professional's role includes raising awareness about the pelvic floor and exercise, implementing pre-exercise pelvic floor risk screening and referral procedures, and providing pelvic floor-safe exercise options.
- Contact the Continence Helpline on 1800 33 00 66 to find Women's Health and Continence professionals in your area. Pass on this information to your female clients.
- Connect with your local women's health professionals. Have your own pelvic floor assessed, and practice pelvic floor muscle exercises every day. Explain to local physiotherapists your interest in providing pelvic floor-safe exercise for women, and initiate the idea of a referral network.
- Add the Pelvic Floor First 'Pelvic Floor Screening Tool' to your pre-exercise screening for female clients. It includes clear indicators for referral of women with pelvic floor risk. Encourage your clients to be proactive, and explain why a visit to a women's health professional is important for their pelvic floor health and exercise safety. Tell them that bladder leakage will not go away – and that it could get worse – if they do nothing. There is something they can do about it: consult a women's health physio.
- Understand that for women with pelvic floor risk, general gym programs and exercise classes for fitness are not suitable. To provide elvic floor-safe exercise for these women, you will need to modify exercises, or find alternatives, that adhere to the Pelvic Floor First guidelines. This should be ongoing, not just for a few weeks.
- Order the free 'Pelvic floor and exercise' resources for fitness professionals, from the Pelvic Floor First website: The '10 step guide', 'PF and resistance exercises' and 'PF and core exercises' will provide you with guidelines for pelvic floor-safe exercise modification and programming.
- Take every opportunity to learn about modifying exercises to make them pelvic floor-safe, and the small progressions that will be necessary for ongoing safe exercise programming. Resources from authors such as Michelle Kenway6, Dianne Edmonds7, Lisa Westlake8 and Mary O'Dwyer9 are recommended.
Remember, pelvic floor-safe exercise is not a simple matter of randomly saying 'lift your pelvic floor' during an exercise session or fitness class. There is so much more to be learnt, and understood;
- Attend a Pelvic Floor First workshop to be inspired and enlightened
- Connect with Pelvic Floor First through the website, resources, e-newsletter and email. They will provide fantastic information, support and encouragement.
- Complete the new pelvic floor courses online5 to launch yourself into learning.
- Remain mindful that the certificates of completion do not make us 'experts' in pelvic floor-safe exercise. They do, however, indicate our position as committed students and advocates of safe exercise for women.
- Remember; when you are planning exercise for female clients and members, think 'pelvic floor first'.
Troy Morgan, BSc (Exercise Science)
The managing director of Queensland's Fitness Business of the Year 2010, Troy turned his vision for Willows Health & Lifestyle Centre into a successful facility that incorporates traditional fitness services and an allied health centre. With over 15 years experience in health and fitness, Troy is a highly sought after professional speaker, and he is currently completing a masters of applied science (sports coaching) at the University of Queensland. For more information visit www.willowshealth.com.au
In her role as Women's Health Fitness Coach at Willows Health and Lifestyle Centre, Carol specialises in promoting the importance of safe exercise for women. She coordinates Willows' Safe Exercise Project, focusing on pelvic floor safe exercise programs, and developing safe exercise pathways to help women achieve their health, fitness and wellbeing goals. Carol holds qualifications in fitness, Pilates and training older adults, and is an advocate for a training certificate in women's exercise.