Kegel Exercícios

[Vinay Pettyjohn]

Toinvestigate the influence of a protocol of Pilates exercises on the functionality and contractility of the pelvic floor muscles (PFM) of older women living in the city of Campo Grande, Mato Grosso, Brazil.

Ten women (median age of 63.44.5 years) with little or no pelvic floor dysfunction were subjected to 24 sessions of Pilates exercises lasting one hour each, for 12 weeks. The pressure of the pelvic floor muscles (PFM) was assessed using a perineometer (cmH20) and contractility was assessed with the PERFECT scheme. Data were described as median interquartile range and inferential analysis was performed using the Wilcoxon paired test, with a significance level of 5%.

The results indicate that the Pilates method increased the contractility and pressure of the PFM of elderly women with little or no PFM impairment. Further studies are required to determine whether the Pilates method is an effective method for the treatment of women with severe pelvic floor dysfunction.

Dez mulheres (idade mediana de 63,44,5 anos) com pouca ou nenhuma disfuno do assoalho plvico foram submetidas a 24 sesses de exerccios do mtodo Pilates com durao de 1 hora, por 12 semanas. A presso da musculatura do assoalho plvico (MAP) foi avaliada por um perinemetro (cmH20) e a contratilidade pelo esquema PERFECT. Os dados foram descritos em mediana intervalo interquartil, e anlise inferencial foi realizada pelo teste pareado de Wilcoxon, sob um nvel de significncia de 5%.

Os resultados apontam que o mtodo Pilates incrementou a contratilidade e a presso da MAP em mulheres idosas com pouca ou nenhuma disfuno da MAP. Faz-se necessrio estudos posteriores para determinar se o Pilates pode tratar mulheres com disfunes graves do assoalho plvico.

Pilates emerged as a method of rehabilitation during World War I, when Joseph Hubertus Pilates applied his knowledge to rehabilitate injured men. The popularity of the method grew most in the 1980s11 Rahimimoghadam Z, Rahemi Z, Mirbagher Ajorpaz N, Sadat Z. Effects of Pilates exercise on general health of hemodialysis patients. J Bodyw Mov Ther. 2017;21(1):86-92.,22 Dos Santos NT, Raimundo KC, da Silva SA, Souza LA, Ferreira KC, Borges Santo Urbano ZF, Gasparini AL, Bertoncello D. Increased strength of the scapular stabilizer and lumbar muscles after twelve weeks of Pilates training using the Reformer machine: A pilot study. J Bodyw Mov Ther. 2017 Jan;21(1):74-80.. More recently, Pilates has been used by health care professionals to integrate the mind and body of subjects, resulting in improved fitness (flexibility, strength and balance) and body consciousness. The method features ground and apparatus-based exercises created by Joseph Pilates11 Rahimimoghadam Z, Rahemi Z, Mirbagher Ajorpaz N, Sadat Z. Effects of Pilates exercise on general health of hemodialysis patients. J Bodyw Mov Ther. 2017;21(1):86-92.

2 Dos Santos NT, Raimundo KC, da Silva SA, Souza LA, Ferreira KC, Borges Santo Urbano ZF, Gasparini AL, Bertoncello D. Increased strength of the scapular stabilizer and lumbar muscles after twelve weeks of Pilates training using the Reformer machine: A pilot study. J Bodyw Mov Ther. 2017 Jan;21(1):74-80.

3 Oliveira LC, Pires-Oliveira DA, Abucarub AC, Oliveira LS, Oliveira RG.Pilates increases isokinetic muscular strength of the elbow flexor and extensor muscles of older women: A randomized controlled clinical trial.J Bodyw Mov Ther. 2017;21(1):2-10.-44 Vasconcelos AP, Cardozo DC, Lucchetti AL, Lucchetti G.Comparison of the effect of different modalities of physical exercise on functionality and anthropometric measurements in community-dwelling older women. J Bodyw Mov Ther. 2016;20(4):851-6..

The pelvic floor (PF) consists of muscles, fascia and ligaments that occupy the region of the lower pelvis. These muscles are classified as skeletal striated or voluntary contraction muscles, and thus respond to training techniques just like the other skeletal muscles of the human body. There are two hypotheses about the mechanisms by which the strengthening of this muscle group can prevent or treat urinary incontinence and pelvic organ prolapse. These are: (1) women develop the ability to consciously contract the pelvic floor muscles before and during the increase of intraabdominal pressure; and 2) the strengthening of this muscle group can build support for the bladder and uretra66 Bo K Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction.World J Urol. 2012;30(4):437-43..

Due to the fact that most Pilates exercises are performed in conjunction with the recruitment of PF muscle fibers, many Pilates instructors believe that the method can produce a significant increase in the force or contractility of the muscles. Furthermore, if Pilates promotes an improvement in the functioning of the pelvic floor muscles (PFM), it may be an alternative for the treatment and prevention of pelvic floor dysfunction.

Urinary incontinence, pelvic organ prolapse and other manifestations of pelvic floor dysfunction are highly prevalent in women, especially in old age77 Bazi T, Takahashi S, Ismail S, B K, Ruiz-Zapata AM, Duckett J, Kammerer-Doak D. Prevention of pelvic floor disorders: international urogynecological association research and development committee opinion. Int Urogynecol J. 2016;27(12):1785-95.. These symptoms are associated with a number of factors that lead to damage to the integrity of the pudendal nerve or skeletal muscle fibers of the levator ani or coccygeus muscles88 Souza CEC et al. Estudo comparativo da funo do assoalho plvico em mulheres continentes e incontinentes na ps menopausa. Rev Bras Fisioter. 2009; 13(6):535-41..

Due to the high prevalence of pelvic floor dysfunction among the elderly, the present study aimed to verify the influence of a protocol of Pilates exercises on the functionality and contractility of the PFM of elderly women.

The study consisted of an initial sample of 30 volunteers who were enrolled at the Universidade Aberta para a Terceira Idade (the Open University for the Third Age) at the Federal University of Mato Grosso do Sul (UnAPI / UFMS), in the city of Campo Grande, Mato Grosso, Brazil. The subjects were invited to participate in the survey via telephone. However, eleven did not meet the inclusion criteria, six declined the invitation and three alleged personal reasons that prevented them from attending the exercise therapy sessions. The present study therefore adopted a longitudinal design, in which ten elderly women were accompanied during the execution of the procedure. The sample size calculation was based on the delimitation of type 1 error at 5% (α=0.05), a power of 80% (1-β=0.20), under a bicaudal curve, and an effect size of 0.50. Due to the lack of studies addressing the impact of Pilates on the PFM, it was not possible to use data published in literature to calculate the effect size. Thus, the delimitation of this topic was carried out using the hypothesis of improvement initially stipulated by the authors. From the calculations, the ideal sample size should be at least 28 subjects. This fact led us to an initial screening of 30 subjects, as shown in Figure 1.

The inclusion criteria involved healthy, sedentary women (normal weight, without psychiatric and/or neurological diseases), the Metabolic Equivalent of Task (MET) of whose self-reported daily activities did not exceed three times the baseline value. The women were aged over 60 years, sexually active, non-smokers, non-alcoholics, with no clinical diagnosis of pelvic floor dysfunction, no history of urinary tract infection, and no previous history of gynecological surgery (in previous five years) or neurological or endocrine-metabolic disorders. Women who were allergic to latex gloves or condoms or who did not complete three Pilates sessions were excluded from the study. Based on these criteria, the initial sample suffered considerable losses and included ten participants, as detailed in figure 1.

The participants were previously informed about the data collection procedures, and all signed a free and informed consent form. Assessments and reassessments were performed by the same researcher. Anamnesis was performed initially, and soon after the pressure and contractility of the PFM were assessed, performed with the patient in the dorsal lithotomy position88 Souza CEC et al. Estudo comparativo da funo do assoalho plvico em mulheres continentes e incontinentes na ps menopausa. Rev Bras Fisioter. 2009; 13(6):535-41..

The measurement of intracavitary perineal pressure was performed using a perineometer (Perina, QUARK, Piracicaba, So Paulo, Brazil), graduated from 0-48 cm H2O. Perineometry is a pressure gauge which captures the pressure generated during the activation of the PFM, providing a reading on the display of the device on a scale in cmH2O. The equipment has an attached latex vaginal probe (25X90 cm) inflated by a pear type control99 Hundley AF, Wu JM, Visco AG. A comparison of perineometer to brink score for assessment of pelvic floor muscle strength. Am J Obstet Gynecol. 2005; 192:1583-91..

The PERFECT scheme consists of seven items and was developed and validated to assess the functionality of the PFM1010 Laycock J, Jerwood D. Pelvic floor assessment; the PERFECT scheme. Physiotherapy. 2001; 87(12):631-42.. The "P" (power/force) indicator evaluates the intensity of the contraction of the PFM, graded using the modified Oxford scale. The "E" (endurance/resistance) result evaluates how long the contraction is maintained and sustained in seconds, until a loss of 35% or more. The "R" (repetitions) result assesses the number of repetitions of the sustained contraction (up to 10) that the participant is able to perform with satisfactory duration (5 seconds), with 4 seconds between each contraction. The "F" (fast/rapid contractions) result is evaluated after a short rest break (1 minute), and measures the number of contractions lasting one second each (up to ten contractions).

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