Anatomy and Cell Biology Publications

Title

Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: a systematic review and meta-analysis

Authors

Margie H. Davenport, Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta
Taniya S. Nagpal, R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, The University of Western Ontario
Michelle F. Mottola, R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, The University of Western Ontario
Rachel J. Skow, Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta
Laurel Riske, Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta
Veronica J. Poitras, Independent researcher, Ottawa, Ontario, Canada
Alejandra Jaramillo Garcia, Independent researcher, Ottawa, Ontario, Canada
Casey E. Gray, Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute
Nick Barrowman, Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute
Victoria L. Meah, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University
Frances Sobierajski, Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta
Marina James, Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta
Megan Nuspl, Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta
Ashley Weeks, School of Interdisciplinary Health Sciences, University of Ottawa
Andree-Anne Marchand, Department of Anatomy, Universite du Quebec a Trois-Rivieres
Linda G. Slater, John W. Scott Health Sciences Library, University of Alberta
Kristi B. Adamo, School of Human Kinetics, University of Ottawa
Gregory A. Davies, Department of Obstetrics and Gynecology, Queen's University
Ruben Barakat, AFIPE Research Group, Technical University of Madrid
Stephanie-May Ruchat, Department of Human Kinetics, Universite du Quebec a Trois-Rivieres

Document Type

Review

Publication Date

11-2018

Issue

21

Journal

British Journal of Sports Medicine

Volume

52

First Page

1397

Last Page

1404

URL with Digital Object Identifier

https://doi.org/10.1136/bjsports-2018-099780

Abstract

Objective To examine the relationships between prenatal physical activity and prenatal and postnatal urinary incontinence (UI). Design Systematic review with random effects meta-analysis and meta-regression. Data sources Online databases were searched up to 6 January 2017. Study eligibility criteria Studies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [e.g., dietary; exercise + co-intervention]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcome (prenatal or postnatal UI). Results 24 studies (n=15982 women) were included. Low' to moderate' quality evidence revealed prenatal pelvic floor muscle training (PFMT) with or without aerobic exercise decreased the odds of UI in pregnancy (15 randomised controlled trials (RCTs), n=2764 women; OR 0.50, 95% CI 0.37 to 0.68, I-2=60%) and in the postpartum period (10 RCTs, n=1682 women; OR 0.63, 95%CI 0.51, 0.79, I-2=0%). When we analysed the data by whether women were continent or incontinent prior to the intervention, exercise was beneficial at preventing the development of UI in women with continence, but not effective in treating UI in women with incontinence. There was low' quality evidence that prenatal exercise had a moderate effect in the reduction of UI symptom severity during (five RCTs, standard mean difference (SMD) -0.54, 95%CI -0.88 to -0.20, I-2=64%) and following pregnancy (three RCTs, moderate' quality evidence; SMD -0.54, 95% CI -0.87 to -0.22, I-2=24%). Conclusion Prenatal exercise including PFMT reduced the odds and symptom severity of prenatal and postnatal UI. This was the case for women who were continent before the intervention. Among women who were incontinent during pregnancy, exercise training was not therapeutic.

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