Atividade física e função da musculatura do assoalho pélvico em mulheres climatéricas: um estudo transversal / Physical activity and pelvic floor muscles function in climacteric women: a transversal study

Introdução: A mulher climatérica apresenta fraqueza muscular que pode gerar disfunções pélvicas. Aparentemente a prática regular de atividade física nesse período promove uma melhora da função muscular global. Objetivo: avaliar a função da musculatura do assoalho pélvico (MAP) de acordo com nível de atividade física em mulheres climatéricas. Métodos: estudo observacional, analítico e transversal. A amostra foi composta por 457 mulheres divididas de acordo com o nível de atividade física. A coleta de dados ocorreu através da aplicação da ficha de avaliação, aplicação do Questionário Internacional de Atividade Física (IPAQ), e avaliação por meio da palpação vaginal e manometria da MAP. Para análise estatística foram usados os testes de Kolmogorov-Smirnov, ANOVA, qui-quadrado e correlação de Pearson. Resultados: As mulheres classificadas como muito ativas obtiveram uma pressão média de 45,24cmH2O, as ativas apresentaram 29,03cmH2O e as sedentárias 27,20cmH2O, com diferença estatística entre os grupos (p=0,003). Conclusão: Quanto mais ativa for a mulher climatérica, melhor será a função da MAP.

Introduction: climacteric woman has muscle weakness that can lead to pelvic floor dysfunctions. Apparently the regular practice of physical activity in this period promotes an improvement of the global muscular function. Objective: to evaluate the pelvic floor muscles (PFM) function according to the level of physical activity in climacteric women. Methods: observational, analytical and transversal study. The sample consisted of 457 women divided according to the level of physical activity. Data collection was made through the application of evaluation form and International Physical Activity Questionnaire (IPAQ), and vaginal palpation and manometry from PFM. For statistical analysis were used the Kolmogorov-Smirnov, ANOVA, chi-square and Pearson correlation tests. Results: The very active women obtained an average pressure of 45, 24cmH2O, the actives presented 29, 03cmH2O and the sedentary 27, 20cmH2O, with statistcal difference between the groups (p = 0,003). Conclusion: The more active the climacteric woman is, the better her PFM function will be.

Efeito do treinamento resistido na redução da dor no tratamento de mulheres com fibromialgia: revisão sistemática / Eff ect of resistance training in pain reduction on the treatment of women with fi bromyalgia: a systematic review

A fi bromialgia (FM) é uma doença reumática, de etiologia desconhecida que apresenta como principal característica a dor musculoesquelética, desencadeando um ciclo de descondicionamento. A fisioterapia exerce um papel muito importante com os programas de exercícios físicos, compostos por alongamento, exercício aeróbio e exercício resistido para reverter os sintomas apresentados. Recentemente, estudos têm apontado para o fato de que os exercícios resistidos poderiam ocasionar uma redução da dor em pacientes com FM, gerando um novo questionamento sobre os efeitos do exercício resistido nestes pacientes. Com isso, este estudo teve o objetivo de investigar o efeito do treinamento resistido na redução da dor em mulheres com FM, bem como estabelecer parâmetros, como volume e duração, para o tratamento da dor nesses pacientes. Para tanto, foi realizado uma revisão sistematizada dos estudos publicados até junho de 2016 nas bases de dados eletrônicas PubMed, PEDro, Scielo e Lilacs. O levantamento dos estudos encontrados foi realizado no período de maio a junho de 2016, usando os seguintes descritores na língua inglesa: Physical Therapy Modalities, strength training, Pain, Fibromyalgia e seus equivalentes na língua portuguesa e espanhola. Após a busca, foram encontrados 85 artigos. Após a análise dos resumos, 80 artigos foram excluídos de acordo com os critérios pré-estabelecidos, restando apenas 5 estudos randomizados controlados, sendo selecionados para análise dos seus dados. Após a análise, conclui-se que o treinamento resistido reduz a dor em mulheres com fi bromialgia, a partir da 8ª semana de treinamento, desde que esse seja realizado de forma continuada e orientada, com duração de no mínimo 30 minutos, com frequência de 2 a 3 vezes por semana....(AU)

The fi bromyalgia (FM) is a rheumatic disease of unknown etiology that has as main characteristic the musculoskeletal pain, triggering a deconditioning cycle. The physical therapy has a very important role with the physical exercise programs, compounds for stretching, aerobic exercise and resistance exercise to reverse the symptoms. Recently, studies have pointed to the fact that resistance exercise could cause a reduction of pain in patients with FM, generating a new questioning of the eff ects of resistance exercise in these patients. Therefore, this study aimed to investigate the effi cacy of resistance training in reducing pain in women with FM, as well as establishing, as volume and duration, for the treatment of the pain in these patients. For this, was performed a review of published studies ystematically until June 2016 in electronic databases PubMed, PEDro, Scielo and Lilacs. The survey found the studies was carried out from May to June 2016, using the following key words in English: Physical Therapy Modalities, strength training, Pain, Fibromyalgia and its equivalent in Portuguese and Spanish. After the search, found 85 articles. After analyzing the abstracts, 80 articles were excluded according to pre-established criteria, with only 5 randomized controlled trials, were selected for analysis of their data. After the analysis, it is concluded that resistance training interferes positively in reducing pain in women with fi bromyalgia, from the 8th week of training. This being done continuously and targeted manner, with duration of minimum 30 minutes, often 2 to 3 times per week....(AU)

A manometry classification to assess pelvic floor muscle function in women.

OBJECTIVE: To develop a classification scale for manometry of pelvic floor muscles (PFM) in Brazilian women, according to the modified Oxford scale. METHODS: A cross sectional study, with 288 women enrolled in the Maternity, Natal, Brazil. Manometry and PFM strength data were collected and classified according to the modified Oxford scale. A simple linear regression was performed to determine the classification scale of manometry using the modified Oxford scale as the explanatory variable and the arithmetic mean of the manometry measurements as the response variable. RESULTS: The average age was 52.80 (±8.78; CI: 51.67-53.93) years. Manometry showed an average of 35.1 (±22.7; CI: 32.1-38.0) cmH2O and most women (29.7%) scored grade 3 on the modified Oxford scale. According to the proposed scale, values between 7.5 to 14.5 cmH2O correspond to very weak pressure; 14.6 to 26.5 cmH2O represent weak pressure; 26.6 to 41.5 cmH2O represent moderate pressure; 41.6 to 60.5 cmH2O represent good pressure, and values above 60.6 cmH2O correspond to strong pressure. CONCLUSION: Manometry values were rated on a five-point scale. It is possible to rank the pressure levels performed by voluntary contraction of PFM with this new scale.

Assessment of lower urinary tract symptoms in different stages of menopause.

[Purpose] To assess lower urinary tract symptoms in different stages of menopause and the quality of life of females with incontinence. [Subjects and Methods] The sample consisted of 302 females, aged between 40 and 56 years, divided into three groups: PRE (n= 81), PERI (n= 108) and POST (n= 113). This was a cross-sectional, analytical, observational study. Data were collected by assessment chart and conducting the International Consultation on Incontinence Questionnaire-Short Form. [Results] Most of the women had less than 10 years of schooling and were married. In PERI and POST menopause, the most frequent lower urinary tract symptoms were urinary urgency and stress incontinence. The PRE group did not exhibit nocturia, urge incontinence or urinary urgency, and had the lowest symptoms frequency. In the three stages, stress incontinence was the most prevalent symptom. Of the three menopause stages, PERI had a greater impact on urinary incontinence according to the International Consultation on Incontinence Questionnaire. [Conclusion] The presence of lower urinary tract symptoms can vary across the different stages of menopause and the urinary incontinence was the most frequent complaint. Moreover, it was observed that quality of life was more affected in the perimenopause stage.

The relationship between the presence of lower urinary tract symptoms and waist circumference.

PURPOSE: The aim of the study is to evaluate the pressure of the pelvic floor muscles (PFM) according to waist circumference (WC) and correlate the presence of urinary tract symptoms (UTS) with WC. PATIENTS AND METHODS: The study was observational and cross-sectional. One-hundred and sixty-four females between 45 and 65 years of age were evaluated. The sample was divided into two groups, according to WC: Group ≤80 (G≤80) was composed of females in whom WC was up to 80 cm; and Group >80 (G>80) was composed of females with WC above 80 cm. The subjects were assessed in terms of sociodemographic data, pre-existing conditions, urogynecological and obstetric history, and the presence of lower UTS (LUTS), as well as physical examination, measurement of WC, height, and weight. The PFM assessment was made by perineometry. To compare the mean between groups, the independent samples t-test was applied, and to correlate the WC with perineometry and LUTS, the Pearson's correlation test was used. RESULTS: The final sample was composed of 156 patients. The average age of participants was 55.21 (±24.5) years in G≤80 and 57.23 (±6.12) years in G>80. There were significant differences regarding the presence of LUTS between the groups (P<0.05); as to the perineometry, there was a significant difference (P=0.03) between the groups: 38.68±13.63 cmH2O for G≤80 and 30.11±11.20 cmH2O for G>80. There was a correlation between the presence of urinary urgency (r=0.7; P=0.00), nocturia (r=0.7; P=0.00), and urinary incontinence (r=0.9; P=0.00) with WC. CONCLUSION: Females with larger abdominal diameter have a higher prevalence of LUTS such as urinary incontinence, nocturia, and urinary urgency, as well as a lower PFM pressure. Furthermore, a relationship between LUTS with WC was also observed.

Influence of parity, type of delivery, and physical activity level on pelvic floor muscles in postmenopausal women.

[Purpose] The aim of the present study was to assess the influence of parity, type of delivery, and physical activity level on pelvic floor muscles in postmenopausal women. [Subjects and Methods] This was an observational analytic cross-sectional study with a sample of 100 postmenopausal women, aged between 45 and 65 years, divided into three groups according to menopausal stage: hysterectomized and early and late postmenopause. Patients were assessed for sociodemographic and gyneco-obstetric factors and subjected to a muscle strength test and perineometry. Descriptive statistics, ANOVA, Kruskal-Wallis and multiple regression were applied. [Results] The results showed homogeneity in sociodemographic and anthropometric characteristics. There was no difference in pelvic floor muscle function among the three groups. Type of delivery, parity and physical activity level showed no influence on muscle function. [Conclusion] The findings demonstrate that parity, type of delivery, and physical activity level had no influence on pelvic floor muscle pressure in postmenopausal women. One hypothesis to explain these results is the fact that the decline in muscle function in postmenopausal women is related to the female aging process.