Does a Kegel Exercise Program Prior to Resistance Training Reduce the Risk of Stress Urinary Incontinence?

This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance training (RT), to reduce the risk of stress urinary incontinence (SUI) compared to a group of women without prior Kegel exercises (KE). Incontinence severity index (ISI) score, pelvic floor muscle strength (PFMS), and body composition (such as body mass index (BMI), fat, and muscle mass), were obtained pre and post intervention. Results demonstrated that RT reduced SUI to a significantly greater extent only if preceded by KE as was observed in the Kegel exercise plus RT group (KE + RT) over time. The improvements in total ISI in both the KE + RT and RT groups were large (d = 1.50 and d = 1.17 respectively). A two-way ANOVA indicated a statistically significant improvement in average PFMS within the KE + RT group over time and between the two groups. A positive correlation was found between the average strength of pelvic floor muscles and SUI. Participants in KE + RT group demonstrated a significant increase in muscle mass (p ≤ 0.001) and concomitant reduction in fat mass (p = 0.018). This study determined a dedicated program of KE preceding a RT program improved average pelvic floor muscle strength and was effective in reducing SUI among incontinent women.

Association Between Obstetric History and Urinary Incontinence in a Cohort of Resistance-Trained Women.

Purpose: Urinary incontinence has the potential to reduce participation in sport and exercise and diminish athletic performance. The purpose of this study was to explore the association between obstetric history and urinary incontinence in a cohort of resistance-trained women. Patients and Methods: This international, cross-sectional survey was completed by 1252 women competing in either powerlifting, weightlifting or CrossFit. The Incontinence Severity Index determined the severity of urinary incontinence. Results: Almost 43% of the participants experienced urinary incontinence in the threemonths prior to the study. The prevalence of urinary incontinence in this cohort according to mode of birth were: caesarean 42.6%, unassisted vaginal 59.3%, vacuum extraction 58.8%, forceps 60.3%, vaginal and caesarean births 66.2%, forceps and vacuum extraction 73.1%. The prevalence of urinary incontinence in the subgroup of women who had undergone urogenital surgery was 63.6%. Kendall's tau-b indicated that the correlation between ISI score and the number of births was strong and positive (τ = 0.25, p < 0.001). Conclusion: Our results suggest that both the number of births and mode of birth influenced the likelihood of urinary incontinence in resistance-trained women. Women who had experienced only caesarean births had the lowest likelihood of urinary incontinence, while women who had experienced both vaginal and caesarean births had the most severe and second highest likelihood of urinary incontinence. Women who had undergone urogenital surgery continued to experience a high likelihood of urinary incontinence.

"You feel different in your body": Experiences of fatigue among children undergoing radiotherapy for cancer treatment.

PURPOSE: The aim of this research is to examine the experience and impact of radiotherapy related fatigue in children diagnosed with solid tumours. DESIGN AND METHODS: Children (n = 25) and parents (n = 19) participated in a semi-structured interview on the last week of radiotherapy treatment. The study sample included children who were 6 to 14 years of age, diagnosed with brain or solid tumour, and received radiotherapy as part of their treatment protocol over the period of 6 weeks. Interpretation of data was undertaken through the adoption of thematic analysis approach. RESULTS: Data revealed children's experience and response to fatigue while undergoing radiotherapy. Several recurring themes arose about their experience of fatigue/tiredness while undergoing radiotherapy. Two themes and eight sub themes, namely 'Experience of Fatigue' ("You feel Different in your body", Mood and Feeling, Activity and Occurrence) and 'Response to Fatigue' (Rest and Sleep, Activity, Mood and Concentration and Eating Habit) were identified. CONCLUSIONS: The findings illustrated significant fatigue on activity sleep, rest and mood of children undergoing radiotherapy. PRACTICE IMPLICATIONS: Monitoring and addressing fatigue and its consequences during radiotherapy treatment are essential to improve well-being of children with cancer.

Urinary Incontinence in Competitive Women Weightlifters.

ABSTRACT: Wikander, L, Kirshbaum, MN, Waheed, N, and Gahreman, DE. Urinary incontinence in competitive women weightlifters. J Strength Cond Res 36(11): 3130-3135, 2022-Urinary incontinence has the potential to diminish athletic performance and discourage women from participating in sport and exercise. This study determined the prevalence and possible risk factors for urinary incontinence in competitive women weightlifters. This research was a cross-sectional, survey-based study completed by 191 competitive women weightlifters. The frequency and severity of urinary incontinence was determined using the Incontinence Severity Index. Urinary incontinence was defined as an Incontinence Severity Index score >0. The survey questions focused on risk factors, the context and triggers for urinary incontinence, and self-care strategies. Approximately, 31.9% of subjects experienced urinary incontinence within 3 months of completing the survey. Incontinence Severity Index scores were significantly correlated with parity ( r = 0.283, p = 0.01) and age ( r = 0.216, p = 0.01). There was no significant correlation between the Incontinence Severity Index score and the number of years participating in any form of resistance training ( r = -0.010, p = 0.886) or weightlifting ( r = -0.045, p = 0.534), body mass index ( r = 0.058, p = 0.422), or competition total ( r = -0.114, p = 0.115). The squat was the most likely exercise to provoke urinary incontinence. Although the number of repetitions, weight lifted, body position, and ground impact may increase the likelihood of urinary incontinence occurring during a lift, it is difficult to determine which factor has the greatest influence. Some self-care strategies used by competitive women weightlifters who experience urinary incontinence, such as training while dehydrated, have the potential to diminish athletic performance.

Urinary Incontinence in Competitive Women Powerlifters: A Cross-Sectional Survey.

BACKGROUND: Urinary incontinence (UI) can negatively affect a woman's quality of life, participation in sport and athletic performance. The objectives of this study were to determine the prevalence of UI in competitive women powerlifters; identify possible risk factors and activities likely to provoke UI; and establish self-care practices. METHODS: This international cross-sectional study was conducted using an online survey completed by 480 competitive women powerlifters aged between 20 and 71 years. The Incontinence Severity Index (ISI) was used to determine the severity of UI. RESULTS: We found that 43.9% of women had experienced UI within the three months prior to this study. The deadlift was the most likely, and the bench-press the least likely exercise to provoke UI. ISI scores were positively correlated with parity (τ = 0.227, p < 0.001), age (τ = 0.179, p < 0.001), competition total (τ = 0.105, p = 0.002) and body mass index score (τ = 0.089, p = 0.009). There was no significant correlation between ISI and years strength training (τ = - 0.052, p = 0.147) or years powerlifting (τ = 0.041, p = 0.275). There was a negative correlation between ISI score with having a pelvic floor assessment (η = 0.197), and the ability to correctly perform pelvic floor exercises (η = 0.172). CONCLUSION: The prevalence of UI in this cohort was at the upper limit experienced by women in the general population. Women who had undergone a pelvic floor examination or were confident in correctly performing pelvic floor exercises experienced less severe UI.

Acupoint stimulation for cancer-related fatigue: A quantitative synthesis of randomised controlled trials.

BACKGROUND AND PURPOSE: This study aimed to identify the research evidence on acupoint stimulation (AS) for cancer-related fatigue (CRF) management. METHODS: Randomised controlled trials that utilised AS for CRF management were retrieved. The Cochrane Back Review Group Risk of Bias Tool was used for quality appraisal. RevMan 5.3 was used for meta-analysis. RESULTS: Fifteen studies were included. Both the overall (SMD = -0.95, p = 0.008) and sub-group (acupuncture: SMD = -1.25, p = 0.002; short-term AS: SMD = -0.95, p = 0.02; medium-term AS: SMD = -0.96, p = 0.003) analyses indicated that AS was more effective in alleviating CRF than standard treatment/care. A comparison between the true and sham AS interventions favoured the true AS for CRF management, although the difference did not reach statistical significance. CONCLUSION: This study identified a promising role of AS in improving CRF. However, the study findings should be interpreted prudently due to the limited quality and sample sizes of some of the included studies.

Urinary Incontinence and Women CrossFit Competitors.

PURPOSE: Urinary incontinence is a common condition that potentially discourages women from participating in physical activity. This study aimed to determine the prevalence of urinary and athletic incontinence and establish which activities and contexts were most likely to provoke urine leakage in women CrossFit competitors. PATIENTS AND METHODS: This research was an international, cross-sectional, survey-based study. The online survey was completed by 452 women CrossFit competitors. The Incontinence Severity Index was used to determine the frequency and severity of urinary incontinence. RESULTS: Urinary incontinence was experienced by 41.8% of participants in the three months prior to the study and 17.7% experienced athletic incontinence. Women came to experience athletic incontinence through two different pathways. Some women were continent before commencing CrossFit (9.7%), remain continent during everyday activities but now experience urinary incontinence during exercise. Alternatively, 8% of women were incontinent before commencing CrossFit, are now continent during everyday activities but remain incontinent during exercise. High impact CrossFit activities were most likely to provoke urinary incontinence. CONCLUSION: This study highlighted the importance of distinguishing between urinary incontinence that develops after commencing an exercise program in otherwise continent women and urinary incontinence that persists only during exercise in previously incontinent women.

In search of care strategies for distressed people with communication difficulties and a learning disability in palliative care settings: the lived experiences of registered learning disability nurses and palliative care professionals.

AIMS: The aim of this study was to gain an in-depth phenomenological understanding of the care strategies used by registered learning disability nurses (RNLDs) and palliative care professionals (PCPs) to identify and respond to the distress of people with communication difficulties and a learning disability (PCDLD) in palliative care settings. The objective was to critically explore the lived experiences of RNLDs and PCPs who care for distressed PCDLD in palliative care settings. METHODS: A single-phase hermeneutic phenomenological study following Van Manen provided the framework for the synthesis and structuring of the hermeneutic phenomenological text. Participants were drawn from learning disability nursing homes, community learning disabilities teams and hospices. Purposive sampling was used, and 13 participants comprising eight RNLDs and five PCPs were interviewed. Data were collected by semi-structured, audio-recorded interviews, field notes and a demographic questionnaire. Hermeneutic data analysis was used. Ethical approval was gained from the University Research Ethics Panel and from individual research locations. RESULTS: The primary strategies used by the participants to identify and respond to the distress of PCDLD were encapsulated by seven main themes: knowing by building relationships; positivity in successful caring outcomes; humane care; moral duty of care; time to care; comfortable care environment; and future perspectives. CONCLUSIONS: Effective care strategies based on the above-mentioned findings can reduce the dilemma professionals encounter in addressing the distress of PCDLD and enhance their confidence to care.

Tokenism or true partnership: Parental involvement in a child's acute pain care.

AIMS AND OBJECTIVES: To explore parental involvement in the child's acute pain care and establish ways in which parental preferences for involvement in their child's care can be identified, facilitated and enhanced by nurses. BACKGROUND: Despite growing evidence supporting effective acute pain management in children and the availability of national and international practice guidelines, children still experience acute pain. Involving parents in their child's pain care has been identified as being a central tenet of pain management in children. DESIGN AND METHODS: A qualitative study using an ethnographical approach with nonparticipant observation and follow-up semi-structured interviews was undertaken. Nurses (n = 14), parents (n = 41), grandparents (n = 2), other relative (n = 1) and children (n = 30) participated. The framework approach underpinned data analysis. Consolidated criteria for reporting qualitative research (COREQ) enabled comprehensive reporting of the study. RESULTS: Three concepts emerged from the data: "parents as advocates for their child," "nurses promoting involvement and partnership" and "nurses unintentionally preventing involvement and partnership." Variations in the way parents were involved in their child's pain care were identified. Despite family-centred care being the dominant model of involving families in their child's care, evidence of this being implemented was limited. Parents attempted to advocate effective pain care for their child, whether or not they were supported by nurses. CONCLUSIONS: Parental involvement in their child's acute pain care can improve the child's pain experience, reduce parental anxiety and increase parents' satisfaction in care. Nurses aspired to involve parents in pain care, but did not always enact this in practice. RELEVANCE FOR PRACTICE: Children deserve optimum pain care, which includes parental involvement. Parental involvement underpinned by the principles of family-centred care was poorly implemented. Parents attempted to be involved and advocate for their child's pain care whether or not they were supported by nurses. An alternative approach for supporting parents to advocate in their child's acute pain care is offered, the "Partnership in Pain Care Model."

Assessing stress, protective factors and psychological well-being among undergraduate nursing students.

OBJECTIVES: This study sought to examine predictors of psychological well-being (PWB) among nursing students at an Australian regional university. The study postulated that: stress would have a negative effect on PWB; internal factors such as self-efficacy, resilience and mindfulness would have a positive effect on PWB and, external factors like social support would have a positive effect on PWB. DESIGN: A cross sectional descriptive predictive model was used to test the study hypotheses. SETTING AND PARTICIPANTS: Convenience sampling was used to recruit participants at an Australian regional university with non-traditional nursing cohorts and where the curriculum is predominantly taught on-line. METHODS: Six validated scales (The Perceived Stress Scale; General Self-Efficacy Scale; Connor Davidson Resilience Scale; Multi-Dimensional Scale of Perceived Social Support; Psychological Wellbeing Scale, Mindfulness Awareness Scale) and a demographic inventory were administered as an online survey. A multiple linear regression analysis was performed to assess the internal and external factors to predict the participants' PWB. RESULTS: Of the 1760 invitations distributed, 657 responses were returned; however, because some were found to be significantly incomplete, 538 responses only were used for the data analysis. Demographics illustrated the characteristics of a non-traditional cohort that was female dominated. All three hypotheses were supported. An unexpected finding was that while it might be anticipated that non-traditional cohorts will have stronger coping skills due to life experiences, this should not be assumed. We found that our participants had higher stress scores and lower psychological wellbeing, compared to the younger groups (nursing or health allied) reported in previous studies. It was perhaps due to their difficulties in juggling responsibilities between study, work and family and the nature of studying externally online. CONCLUSIONS: This study represents only a snapshot in time but emphasises the need for specific curriculum preparation to promote positive coping strategies. In this way, new graduates may be better prepared to engage with complex, demanding and ever-changing work environments across the globe.

Physical functioning and psychological morbidity among regional and rural cancer survivors: A report from a regional cancer centre.

OBJECTIVE: To identify factors associated with psychosocial, physical and practical difficulties of daily living and distress among cancer survivors from a regional area in Australia. DESIGN: Cross-sectional study. SETTING: Riverina region of southern New South Wales. PARTICIPANTS: The sample included 134 patients who completed treatment for breast, colorectal, lung or cancer at the Riverina Cancer Care Centre. MAIN OUTCOME MEASURES: Distress was assessed by the Distress Thermometer. Psychosocial, physical and practical difficulties of daily living were assessed by the Patient-Reported Outcomes Measurement Information System questionnaires. RESULTS: A high proportion of cancer survivors had abnormal scores for physical function, sleep disturbance, satisfaction with role, fatigue and pain interference, with many also displaying abnormal scores for anxiety, depression and distress. Survivors living in rural areas and those who had undergone surgery had higher odds of having abnormal scores for sleep disturbance than their counterparts. Living without a partner increased the odds of anxiety and depression. Having advanced disease increased the odds of anxiety and pain. Colorectal cancer and higher education were associated with depression. CONCLUSION: Monitoring for abnormal physical and psychosocial issues after cancer treatment is essential to maintain or improve psychosocial well-being during survivorship. When developing survivorship care plans for patients residing in regional centres, health professionals should consider availability of high-quality and accessible support services in regional areas of Australia.

Coping Strategies Used by Breast, Prostate, and Colorectal Cancer Survivors: A Literature Review.

BACKGROUND: Individual coping strategies are a fundamental element underpinning psychosocial distress. OBJECTIVE: The aim of this study was to describe coping strategies and their measurement used by survivors of breast, prostate, and/or colorectal cancer after treatment. METHODS: A search of electronic databases (PubMed, CINAHL, and PsycINFO) was conducted from January 1980 to March 2015. Data were extracted using standardized forms and included studies that explored the coping mechanisms of survivorship of breast, prostate, or colorectal cancer. RESULTS: Two thousand one hundred forty-seven studies were retrieved for potential inclusion; 19 publications met the inclusion criteria and were included in the review. CONCLUSIONS: Breast, prostate, and colorectal cancer survivors seem to use different coping strategies that varied throughout the survivorship trajectory. Breast cancer survivors highlighted the importance of accepting their diagnosis and engaging in physical activities that provided social and emotional support. Personality seemed to have a significant effect on coping for prostate cancer survivors. Colorectal cancer survivors emphasized the importance of seeking information to master self-management and return to social activities. IMPLICATIONS FOR PRACTICE: Understanding coping strategies, during the survivorship trajectories, is essential to planning contemporary care after cancer treatment. Nurses and other healthcare professionals may use this knowledge to improve quality of life and decrease distress after diagnosis.

Art in cancer care: Exploring the role of visual art-making programs within an Energy Restoration Framework.

PURPOSE: In contrast to art-therapy, little is known about the role of art-making for people who have been diagnosed with cancer, and even less is known about program-based art-making. This study explored the experience of participation in a visual art-making program for people during and after cancer treatment in the Northern Territory of Australia. METHOD: A longitudinal, qualitative, single cohort study was undertaken. Eight women diagnosed with breast and/or ovarian cancer participated in weekly art-making sessions over eight weeks, facilitated by two professional artists. Data were collected before, during and after the sessions by interviews and group discussions. The Energy Restoration Framework was used to document and analyse the benefits of participation in terms of the a priori themes of: Expansive, Belonging, Nurturing and Purposeful. RESULTS: The four a priori themes were retained and an additional attribute of an energy restoration activity called Stimulating was added, along with sub-themes, which broadened and deepened understanding of the art-making experience within cancer care. CONCLUSIONS: Involvement in an activity that was expansive, new, beautiful and fascinating was highly valued in addition to the appreciation for being with and belonging to a supportive and accepting group facilitated by dynamic artists. There is much scope for continued research and promotion of art-making programs as an adjunct to cancer treatment.

An exploratory study of reiki experiences in women who have cancer.

AIMS: To explore the perceptions and experiences of reiki for women who have cancer and identify outcome measures for an intervention study. METHODS: A cross-sectional qualitative study of 10 women who had received reiki after cancer treatment was conducted. Interviews were audiotaped, transcribed and coded using framework analysis. RESULTS: Key themes identified were: limited understanding of reiki prior to receiving any reiki; release of emotional strain during reiki-feelings of a release of energy, a clearing of the mind from cancer, inner peace/relaxation, hope, a sense of being cared for; experience of physical sensations during reiki, such as pain relief and tingling; physical, emotional and cognitive improvements after reiki, such as improved sleep, a sense of calm and peace, reduced depression and improved self-confidence. CONCLUSION: Findings suggest that reiki could be a beneficial tool in the self-management of quality of life issues for women who have cancer.

Making the most out of life: Exploring the contribution of attention restorative theory in developing a non-pharmacological intervention for fatigue.

OBJECTIVES: This study investigates an approach based on Kaplan's Attention Restorative Theory (ART) to develop a non-pharmacological intervention to help individuals manage the distressing effects of illness related fatigue. The study aims to: identify activities perceived as being enjoyable by individuals who have moderate to severe fatigue related to advanced illness; determine the core attributes of potentially beneficially interventions; analyse reported 'enjoyable' experiences within the ART framework by mapping emergent themes to attributes of attention restoration; and develop the prototype for a self-management intervention tool. METHODS: A purposive sample of 25 individuals who experienced moderate to severe fatigue was selected from the local hospice and community. Focused semi-structured interviews probed the questions: What do you enjoying doing? What is it about the activity that you particularly enjoy? Framework analysis was used to manage responses. RESULTS: Seventy-five 'enjoyable experiences' were identified, including artistic pursuits, voluntary work, socialising and learning. These activities were organised into four conceptual themes: Belonging, Expansive, Nurturing and Purposeful. When mapped against attributes of restorative activities specified in ART, there was some congruence and variation. It was clear that the participants expressed a great need to be safe and in a nurturing environment. Some participants placed a high value in and received great joy from contributing to the community; this was not noted in previous ART literature. SIGNIFICANCE OF RESULTS: This study has extended Kaplan's insightful work on restorative behaviours by revealing the value that purposeful, engaging and safe activities hold for people who live with fatigue. ART has inspired the research team to develop a self-management intervention tool to guide health care practitioners in promoting a non-pharmacological approach to manage fatigue through exploring, discovering and promoting experiences which engage, excite, nurture and challenge the person. Further research is needed to integrate this approach into clinical practice.

Understanding the meaning of fatigue at the end of life: an ethnoscience approach.

PURPOSE: Fatigue is a devastating state of body and mind associated with distress at the end of life. We report the results of the third in a series of papers outlining a novel approach we have developed for understanding the meaning of fatigue by exploring how this meaning is shaped by beliefs and values. The aims of the study were to examine the perception and experiences of fatigue held by patients attending a hospice in England; identify the behavioural patterns that distinguish fatigue from tiredness and exhaustion; provide conceptual definitions of tiredness, fatigue and exhaustion. METHOD: An Ethnoscience design was selected. The sample comprised nine people who attended a hospice between May and December 2009. Inclusion criteria included: at least 18 years of age, experiencing fatigue, able to provide informed consent and resident in the selected city in northern England for 10 years. Data were collected from two consecutive semi-structured interviews for each participant. RESULTS: We found that tiredness, fatigue and exhaustion are markers of progressive functional decline. Fatigue had two dimensions: 1) Mental Challenge, which included: emotional effects, cognitive realisation of decline and mental tenacity and 2) Physical Challenge, which included: limitations in leisure activities, limitations in functional roles and re-patterning routines. CONCLUSIONS: This study provides evidence that symptom experience is socially constructed, which has potential implications for the development of effective interventions.