Urinary incontinence (UI) can cause loss of autonomy and quality of life, feelings of distress, loss of self-esteem; and social isolation. It can be treated effectively with conservative interventions such as pelvic floor muscle training (PFMT), which is the first line treatment of this condition. A relationship between posture and UI might exist: several studies state that specific postures may predispose UI or other pelvic floor muscle (PFMs) disorders. As such, rehabilitation programs including postural exercises combined with PFMT are commonly used by clinicians for the management of PFMs dysfunction. Nevertheless, the evidence regarding the efficacy of adding postural exercises to PFMT remains scarce.
The aim of this randomized controlled trial with two parallel groups was to investigate whether the addition of postural instructions to a 12-week abdominopelvic exercise program is superior to an abdominopelvic exercise program alone, in terms of PFMs function and symptoms in climacteric women with stress UI (SUI).

Climacteric women aged between 40-75 years old who presented with SUI were included in this parallel study. All participants were randomly assigned in a 1:1 ratio to one of two groups: 1) a group performing an abdominopelvic exercise program (AEP); or 2) a group performing the same intervention with the addition of postural instructions (AEPPI). Both groups performed one 40-minutes session per week for 12-weeks. Electromyographical activity (EMG) and strength (through the Oxford Grading Scale) of PFMs were quantified during a maximal voluntary contraction. SUI symptoms were assessed using a 3-day bladder diary. Outcomes were collected at baseline, immediately after intervention, and 3-months after the intervention.
Sample size was calculated using G*Power software. Assuming an analysis of variance (ANOVA) of repeated measurements, a medium effect size (d = 0.5; ηp2 = 0.06), α = 0.05, power = 0.90, and a correlation among repeated measurements of 0.5, a total sample size of 36 subjects was needed to achieve an appropriate power level for this research.

A total of 47 women were included in the study (AEP [n = 23], AEPPI [n = 24]). Between-group analysis showed significant differences for post-intervention EMG and strength values, showing higher values for the AEPPI compared to the AEP group. At 3-months follow-up, statistically significant differences were only obtained in strength, with higher values in the AEPPI group. No significant differences were obtained in terms of UI symptoms.

A hypothesis that could explain the positive effect of the posture-based program combined with abdominopelvic training lies on the effect of body position on muscle recruitment.  PFMs and/or abdominal muscle contraction may be facilitated by the postural input. It is also possible that changes in spinal curvature and pelvic orientation could modify vector forces within the abdomen and influence intra-abdominal pressure management. 
A program including abdominopelvic exercises combined with postural instructions may be beneficial to improve moderate symptoms of SUI as well as PFMs activation and strength in women with SUI. Nevertheless, it is crucial to consider the importance of language and meaning when giving postural instructions, which should be implemented from an active rather than a protective point of view. Overly alarmist messages may generate hypervigilance, apprehension, and distortions in body image, with insights into behavioral and muscular responses.

A 12-session AEP supplemented with postural instructions is superior than an AEP alone in terms of voluntary PFMs activation and strength in women with SUI. When analyzing changes over time, PFMs activation and strength were improved in all subjects, regardless of receiving postural instructions or not. These findings should be considered with prudence due to the small size of our study.

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Continence 2S2 (2022) 100432
DOI: 10.1016/j.cont.2022.100432