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Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: a systematic review and meta-analysis
  1. Margie H Davenport1,
  2. Taniya S Nagpal2,
  3. Michelle F Mottola2,
  4. Rachel J Skow1,
  5. Laurel Riske1,
  6. Veronica J Poitras3,
  7. Alejandra Jaramillo Garcia3,
  8. Casey E Gray4,
  9. Nick Barrowman5,
  10. Victoria L Meah6,
  11. Frances Sobierajski1,
  12. Marina James1,
  13. Megan Nuspl7,
  14. Ashley Weeks8,
  15. Andree-Anne Marchand9,
  16. Linda G Slater10,
  17. Kristi B Adamo11,
  18. Gregory A Davies12,
  19. Ruben Barakat13,
  20. Stephanie-May Ruchat14
  1. 1 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, Edmonton, Alberta, Canada
  2. 2 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, London, Ontario, Canada
  3. 3 Independent researcher, Ottawa, Ontario, Canada
  4. 4 Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  5. 5 Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  6. 6 Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
  7. 7 Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  8. 8 School of Interdisciplinary Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
  9. 9 Department of Anatomy, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
  10. 10 John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
  11. 11 School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
  12. 12 Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
  13. 13 AFIPE Research Group, Technical University of Madrid, Madrid, Spain
  14. 14 Department of Human Kinetics, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
  1. Correspondence to Dr Margie H Davenport, Program for Pregnancy and Postpartum Health, University of Alberta, Edmonton T6G 2E1, Canada; mdavenpo{at}ualberta.ca

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=15 982 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, I2=60%) and in the postpartum period (10 RCTs, n=1682 women; OR 0.63, 95% CI 0.51, 0.79, I2=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, I2=64%) and following pregnancy (three RCTs, ‘moderate’ quality evidence; SMD −0.54, 95% CI −0.87 to –0.22, I2=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.

  • exercise
  • pregnancy
  • urinary incontinence

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

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    Footnotes

    • Contributors MHD, S-MR, MFM, GAD and KBA contributed to the conception of the study. MHD, S-MR, MFM, GAD, KBA, AJG, NB, VJP, CEG, LGS and RB contributed to the design of the study and development of the search strategy. LGS conducted the systematic search. TSN, RS, LR, VLM, FS, MJ, MN, AW and A-AM completed the acquisition of data. MHD, NB and MN performed the data analysis. All authors assisted with the interpretation. MHD and TSN were the principal writers of the manuscript. All authors contributed to the drafting and revision of the final article. All authors approved the final submitted version of the manuscript.

    • Funding Canadian Institute of Health Research Knowledge Synthesis Grant. MHD is funded by an Advancing Women’s Heart Health Initiative New Investigator Award supported by Health Canada and the Heart and Stroke Foundation of Canada. RS is funded by a Canadian Institutes for Health Research Doctoral Research Award. A-AM is funded by a Fonds de Recherche du Québec – Santé Doctoral Research Award.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.