Pelvic floor friendly exercise. No one size fits all
By Lisa Westlake, Pelvic Floor First ambassador
As a physiotherapist working in the fitness industry, I would have to say that the enhanced awareness regarding the relationship between pelvic floor function and exercise is one of the most valuable progressions of the last decade, especially in regards to women’s health and wellbeing.
I am very proud to have been involved with the Pelvic Floor First project and thrilled to see improved discussion, understanding and exercise programing, allowing women to reap the benefits of exercise while simultaneously managing or preventing incontinence.
We know that certain exercises can contribute to or exacerbate the symptoms of stress incontinence, leading women to either push on regardless, increasing their symptoms and risk of prolapse, or discontinue exercise and miss out on all the physical and emotional benefits.
More and more instructors are offering pelvic floor safe options to their clients and classes, but often these can be quite general: “No high impact” or “avoid ab curls”, for example.
The tricky thing is, like all fitness programming, it is so individual. What is safe for one woman’s pelvic floor differs not only woman to woman, but also day to day and week to week. A range of elements can affect a woman’s pelvic floor integrity when they are training, including their hormones, fatigue level, anxiety, back pain or what they did the day before.
It is true that for many women suffering incontinence, running or ab curls are not appropriate, but like all rehabilitation exercise programs, there is a continuum of measured exercise progression. Pelvic floor function and fitness is very individual and hard to monitor as we are unable to see the muscle working. The challenge is knowing what is right for who.
Exercise for the weakest link
First and foremost, if your pelvic floor function is compromised, then this is your deciding factor on how hard an individual can work, irrelevant of how fit or strong they are elsewhere.
For all areas of fitness – cardio, endurance, strength training – reps, sets and timeframes should all be determined by pelvic floor response. If the pelvic floor is struggling, cut back intensity, impact, load, reps or time, and then gradually increase the fitness program as pelvic floor strength improves.
Self awareness to determine how much, how hard
We cannot see the pelvic floor so women are encouraged to become aware of their pelvic floor function and how it should feel during training. This will be greatly assisted by some time spent with a women’s health and continence physio, but two general guidelines are:
- If you, during any exercise, feel leakage or heaviness, it is too much for your pelvic floor
- Can you engage your pelvic floor while performing the exercise?
It is not realistic to consciously work your pelvic floor for a 60-minute workout, but it is good to check in often. Can you lift and squeeze your pelvic floor while doing that squat, cycling hill climb or bicep curl? If not, your pelvic floor is telling you to cut back for now and you will progress with time. If, for example, your first try at running tells you your pelvic floor is not yet ready, try hill walking instead.
Or maybe your pelvic floor can be engaged and in control during three ab curls or walking 100m, jogging 10m regime, but five curls or 20m running is too much. Stick with the lesser option while practicing pelvic floor lifts. Slowly, you can increase the number of ab curls or the time you run AS your pelvic floor strengthens.
Progress comes with patience
Women with incontinence should start with exercises that are pelvic floor friendly (low load, stress free) but the training of your pelvic floor will progress well if you allow your pelvic floor integrity to determine your training progressions.
Three vital tips
Three important factors for women wanting to commence or continue a fitness regime while aiming to decrease risks and symptoms of incontinence and improve their pelvic floor strength and function.
Quality not quantity
Include pelvic floor muscle training as a part of your daily routine.
Three times a day, perform only as many pelvic floor lifts (long holds or quick lifts) as you can do with excellent form. Gradually, you will be able to hold for longer and increase your reps, but always remember … quality not quantity.
Put your pelvic floor first
Listen to your pelvic floor. Modify any exercise to a lighter (pelvic floor) option if it causes any sensation of strain, heaviness or vulnerability in your pelvic floor.
Check in often
Engage your pelvic floor and deep abdominals before heavy lifting or intense exercises and frequently check that your pelvic floor can engage during your workouts.