Review Article

The Characteristics of the Pelvic Floor Muscle Training Programs Used in Experimental Studies with Surface Electromyography in Non-Pregnant Women: A Systematic Review


Background: We aimed to characterize the pelvic floor muscle training (PFMT) programs for non-pregnant women used in the experimental studies with surface electromyography, based on the four training components: the frequency, intensity, time and type of exercises. Then, to characterize the study groups in which the PFMT programs were applied and the effectiveness of these programs.

Methods: This is a review of 29 papers published in the years 1986-2019, available in PubMed, MEDLINE and SPORTDiscus with Full Text databases. We used keywords: "pelvic floor", "muscle training" and "EMG or electromyography".

Results: Only in six articles all training components were characterized. The frequency was given in 17 papers, and on average it was 4 ± 2 (M ± SD) times a week. The intensity was described in nine reports, most often the maximal contraction of the pelvic floor muscles was recommended. Researchers conducted their interventions on average for 10 ± 5 weeks. The exercise sessions lasted 25’ ± 10.49’. Type of exercises was specified in eleven papers and most often quick flicks were performed. In 90% of the studies the training programs were applied in women with pelvic floor muscle dysfunctions. In most works positive effects of PFMT were observed. No adverse outcomes of the use of electromyography were reported.

Conclusion: The full training description should be presented in any scientific work, providing information on applied intensity, frequency, volume and type of pelvic floor muscle exercises to enable their replication and comparability between various interventions. It is important to pay more attention to preventive approach and the implementation of PFMT programs in healthy women. It is justified to use surface electromyography to support PFMT, regardless of health condition.

1. Almeida MBA, Barra AA, Saltiel F et al (2016). Urinary incontinence and other pelvic floor dysfunctions in female athletes in Brazil: A cross-sectional study. Scand J Med Sci Sports, 26:1109-16.
2. Herbert J (2010). Total Body Fitness: The role of the pelvic floor muscles in core stability and bladder and bowel health. SportEX Medicine, 23-27.
3. Hoyte L, Damaser MS (2007). Magnetic resonance-based female pelvic anatomy as relevant for maternal childbirth injury simulations. Ann N Y Acad Sci, 1101:361-376.
4. De Paepe H, Renson C, Hoebeka P et al (2002). The role of pelvic-floor therapy in the treatment of lower urinary tract dysfunctions in children. Scand J Urol Nephrol, 36:260-267.
5. Di Benedetto P, Coidessa A, Floris S (2008). Rationale of pelvic floor muscles training in women with urinary incontinence. Minerva Ginecol, 60(6):529-541.
6. Opara J, Socha T, Poświata A (2013). Pelvic floor muscle exercise as the best stress urinary incontinence prevention method in women practising competitive sport. Physiotherapy, 21(2):57-63.
7. Pomian A, Lisik W, Kosieradzki M et al (2016). Obesity and Pelvic Floor Disor-ders: A Review of the Literature. Med Sci Monit, 22(1):1880-6.
8. Madill SJ, Harvey MA, McLean L (2010). Women with stress urinary incontinence demonstrate motor control differences during coughing. J Electromyogr Kinesiol, 20(5):804-12.
9. Opara J, Socha T, Prajsner A et al (2011). Physiotherapy in stress urinary inconti-nence in females Part I. Contemporary recommendations for Kegel exercises (PFME). Physiotherapy, 19:41-49.
10. Morkved S, Bo K (2014). Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a sys-tematic review. Brit J of Sport Med, 48(4):299-310.
11. Boyle R, Hay-Smith EJ, Cody JD et al (2014). Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women: a short version Cochrane review. Neurourol Urodyn, 33(3): 269-276.
12. Thompson RW (2010). ACSM's Resources for the Personal Trainer-third edition. Philadelphia: ACSM, 332-434.
13. Saltiel F, Miranda-Gazzola APG, Vitória RO et al (2018). Terminology of Pelvic Floor Muscle Function in Women With and Without Urinary Incontinence: A Systematic Review. Phys Ther, 98(10): 876-890.
14. Keshwani N, McLean L (2015). State of the art. review: Intravaginal probes for recording electromyography from the pelvic floor muscles. Neurourol Urodyn, 34(2):104-12.
15. Nazmi N, Abdul Rahman MA, Yamamoto SI et al (2016). Review of Classification Techniques of EMG Signals during Iso-tonic and Isometric Contractions. Sensors (Basel), 16(8): E1304.
16. Aukee P, Immonen P, Penttinen J et al (2002). Increase in pelvic floor muscle ac-tivity after 12 weeks' training: a random-ized prospective pilot study. Urology, 60(6):1020-3.
17. Huebner M, Riegel K, Hinninghofen H et al (2011). Pelvic floor muscle training for stress urinary incontinence: A randomized, controlled trial comparing different conservative therapies. Physiother Res Int, 16:133-140.
18. Luginbuehl H, Lehmann C, Baeyens JP et al (2015). Involuntary reflexive pelvic floor muscle training in addition to standard training versus standard training alone for women with stress urinary incontinence: study protocol for a randomized controlled trial. Trials, 16:524.
19. Chmielewska D, Stania M, Smykla A et al (2016). Bioelectrical activity of the pelvic floor muscles after 6-week biofeedback training in nulliparous continent women. Acta Bioeng Biomech, 18:105-113.
20. Botelho S, Martinho NM, Silva VR (2015). Virtual reality: a proposal for pelvic floor muscle training. Int Urogynecol J, 26(11): 1709-1712.
21. Pereira-Baldon VS, Avila MA, Dalmari CB (2019). Effects of different regimens for pelvic floor muscle training in young continent women: Randomized controlled clinical trial. J Electromyogr Kinesiol, 44: 31-35.
22. Ӧzengin N, Ün Yıldırım N, Duran B (2015). A comparison between stabilization exercises and pelvic floor muscle training in women with pelvic organ prolapse. Turk J Obstet Gynecol, 12(1): 11-17.
23. Lúcio AC, D'Ancona CAL, Lopes MHBM et al (2014). The effect of pelvic floor muscle training alone or in combination with electrostimulation in the treatment of sexual dysfunction in women with multi-ple sclerosis. Mult Scler, 20:1761-8.
24. Lúcio A, Dʼancona CAL, Perissinotto MC et al (2016). Pelvic Floor Muscle Training With and Without Electrical Stimulation in the Treatment of Lower Urinary Tract Symptoms in Women with Multiple Scle-rosis. J Wound Ostomy Continence Nurs, 43:414-9.
25. Hirsch A, Weirauch G, Steimer B et al (1999). Treatment of female urinary in-continence with EMG-controlled bio-feedback home training. Int Urogynecol J Pelvic Floor Dysfunct, 10:7-10.
26. Eyjólfsdóttir H, Ragnarsdóttir M, Geirsson G (2009). Pelvic floor muscle training with and without functional electrical stimulation as treatment for stress urinary incontinence. Laeknabladid, 95:575-580.
27. Lee-Bognar E (2009). Electrical stimulation is a useful adjunct in the management of urinary incontinence in people with multiple sclerosis. Aust J Physiother, 55:62.
28. Alves FK, Riccetto C, Adami DBV et al (2015). A pelvic floor muscle training program in postmenopausal women: A randomized controlled trial. Maturitas, 81:300-305.
29. Shin DC, Shin SH, Lee MM et al (2016). Pelvic floor muscle training for urinary incontinence in female stroke patients: a randomized, controlled and blinded trial. Clin Rehabil, 30:259-267.
30. Bertotto A, Schvartzman R, Uchǒa S et al (2017). Effect of electromyographic biofeedback as an add-on to pelvic floor muscle exercises on neuromuscular outcomes and quality of life in postmenopausal women with stress urinary incontinence: A randomized controlled trial. Neurourol Urodyn, 36:2142-2147.
31. Pereira VS, de Melo MV, Correia GN et al (2013). Long-term effects of pelvic floor muscle training with vaginal cone in post-menopausal women with urinary incontinence: A randomized controlled trial. Neurourol Urodyn, 32:48-52.
32. Elmelund M, Biering-Sørensen F, Due U et al (2018). The effect of pelvic floor muscle training and intravaginal electrical stimulation on urinary incontinence in women with incomplete spinal cord injury: an investigator-blinded parallel randomized clinical trial. Int Urogynecol J, 29:1597-1606.
33. Resende APM, Stüpp L, Bernardes BT et al (2012). Can hypopressive exercises pro-vide additional benefits to pelvic floor muscle training in women with pelvic or-gan prolapse? Neurourol Urodyn, 31:121-5.
34. Wang AC, Wang Y-Y, Chen M-C (2004). Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder. Urology, 63:61-6.
35. Di Gangi Herms AMR, Veit R, Reisenauer C et al (2006). Functional imaging of stress urinary incontinence. Neuroimage, 29:267-275.
36. Dannecker C, Wolf V, Raab R et al (2005). EMG-biofeedback assisted pelvic floor muscle training is an effective therapy of stress urinary or mixed incontinence: a 7-year experience with 390 patients. Arch Gynecol Obstet, 273:93-97.
37. Terra MP, Dobben AC, Berghmans B et al (2006). Electrical stimulation and pelvic floor muscle training with biofeedback in patients with fecal incontinence: a cohort study of 281 patients. Dis Colon Rectum, 49:1149-1159.
38. Piassarolli VP, Hardy E, Andrade NFd et al (2010). [Pelvic floor muscle training in female sexual dysfunctions]. Rev Bras Ginecol Obstet, 32:234-240.
39. Capelini MV, Riccetto CL, Dambros M et al (2006). Pelvic floor exercises with biofeedback for stress urinary incontinence. Int Braz J Urol, 32(4): 462-8.
40. Liu YJ, Wu WY, Hsiao SM et al (2018). Effi-cacy of pelvic floor training with surface electromyography feedback for female stress urinary incontinence. Int J Nurs Pract, 24(6):e12698.
41. Heidler H (1986). [Modification of urge in-continence by biofeedback mechanisms]. Der Urologe, 25:267-270.
42. McClurg D, Ashe RG, Marshall K et al (2006). Comparison of pelvic floor mus-cle training, electromyography biofeed-back, and neuromuscular electrical stimu-lation for bladder dysfunction in people with multiple sclerosis: a randomized pi-lot study. Neurourol Urodynam, 25:337-348.
43. McClurg D, Ashe RG, Lowe-Strong AS (2008). Neuromuscular electrical stimula-tion and the treatment of lower urinary tract dysfunction in multiple sclerosis--a double blind, placebo controlled, ran-domised clinical trial. Neurourol Urodyn, 27:231-7.
44. Stüpp L, Resende APM, Oliveira E et al (2011). Pelvic floor muscle training for treatment of pelvic organ prolapse: an as-sessor-blinded randomized controlled trial. Int Urogynecol J, 22:1233-9.
45. Slade SC, Dionne CE, Underwood M et al (2016). Consensus on Exercise Reporting Template (CERT): Explanation and Elaboration Statement. Brit J of Sport Med, 50:1428-1437.
46. Piernicka M, Szumilewicz A, Dornowski M et al (2015). Teaching the technique of pelvic-floor muscle exercises among sport university female students – a ran-domized controlled trail. JoHPaH, 25: 45-51.
47. Fritel X, de Tayrac R, Bader G et al (2015). Preventing Urinary Incontinence With Supervised Prenatal Pelvic Floor Exercises: A Randomized Controlled Trial. Obstet Gynecol, 126(2): 370-377.
48. Kegel AH (1948). Progressive resistance ex-ercise in the functional restoration of the perinela muscles. Am J Obstet Gynecol, 56:238-248.
49. Hay-Smith E, BØ K, Berghmans L, Hen-driks H (2001). Pelvic floor muscle train-ing for urinary incontinence in women. Cochrane Database Syst Rev, CD001407.
50. Marques A, Stothers L, Macnab A (2010). The status of pelvic floor muscle training for women. Can Urol Assoc J, 4(6):419-424.
51. Newman D (2014). Pelvic floor muscle re-habilitation using biofeedback. Urol Nurs, 34(4):193-202.
52. Frawley HC, Dean SG, Slade SC et al (2017). Is Pelvic-Floor Muscle Training a Physical Therapy or a Behavioral Therapy? A Call to Name and Report the Physical, Cognitive, and Behavioral Elements. Phys Ther, 97(4):425-437.
IssueVol 49 No 6 (2020) QRcode
SectionReview Article(s)
Pelvic floor; Muscle training; Electromyography; Exercise

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PIERNICKA M, DUDA-BIERNACKA B, BŁUDNICKA M, SZUMILEWICZ A. The Characteristics of the Pelvic Floor Muscle Training Programs Used in Experimental Studies with Surface Electromyography in Non-Pregnant Women: A Systematic Review. Iran J Public Health. 2020;49(6):1022-1032.