Modifying exercise programs

Did you know that almost every exercise your client does affects their pelvic floor?

As a fitness professional, you are ideally placed to identify people with, or at risk of, pelvic floor problems, refer them to a continence professional and support them with an appropriate pelvic floor exercise program.

As you know, one size doesn’t fit all when it comes to exercise. If your client has, or is at risk of, pelvic floor problems, it’s important to tailor their exercise program to suit their needs.

As a fitness professional your challenge is to consider:

• which clients are at risk of pelvic floor problems
• are you prescribing exercises that are appropriate for their pelvic floor, and
• how can you help your client achieve their health and fitness goals whilst protecting their pelvic floor?

Why modify an exercise program?

Modifying an exercise program for a high risk client minimises the risk of further damage to their pelvic floor. This is no different to managing an injury to any other muscle group.

For example, if your client injures their ankle, they should give that ankle time to heal before full participation in exercise or sport. You would help them by modifying their exercise program to rebuild the joint’s strength, flexibility and stability until it is fully healed. The same is the case for the pelvic floor, which should be protected from further damage, whilst allowing the client a suitable timeframe to get back in control.

Identifying high risk clients

The Continence Foundation has a simple screening tool to help you identify clients with, or at risk of, pelvic floor problems.  These can be used at your initial consultation, to help identify what kind of exercise program would suit their pelvic floor fitness needs.

• Pelvic floor screening tool for women
• Pelvic floor screening tool for men

You can also consider these ‘red flag’ indicators of a potential pelvic floor problem:

• If a client regularly visits the toilet before a workout, this is a red flag
• If a client needs to go to the toilet during a workout, this is a red flag
• If a client limits their fluid intake during a workout, this is a red flag

Things to consider when modifying an exercise program

Exercises that increase intra-abdominal pressure can place more stress on the pelvic floor. These exercises should be avoided or modified for clients with, or at risk of, pelvic floor problems.

Examples of these exercises include:

Core

• Abdominal exercises (e.g. sit ups, curl ups, crunches, double leg lifts, exercises on machines)
• Any weighted rotation exercises (e.g. Seated medicine ball twists, suspended torso rotations, rotating planks)
• Planks on toes and variations of this (e.g. planks with feet on ball or in suspension straps, planks on hands and toes and moving to elbows)

Resistance

• Weight training for both upper and lower body where the load is heavier than 50% 1RM
• Long stride and/or deep lunges in any direction
• Wide leg and deep squats
• Exercises with both feet off the floor unassisted (e.g. tricep dips and chin ups)
• Body weight training when using the full body weight (e.g. push-ups on toes)

Exercises that place downward force or pressure on the pelvic floor can also stress the pelvic floor.  Examples of these exercises include:

• Running, including running down stairs
• Jumping, including box jumps
• Skipping rope
• Boxing (with bag contact)
• High impact exercise classes
• HIIT workouts
• Sporting drills

Regardless of any exercise that is performed, cueing pelvic floor activation while maintaining good posture is paramount. Even performing a lower risk exercise can compromise a dysfunctional pelvic floor if it is not cued or performed correctly.

There are some exercises that are recommended for people with, or at-risk of, pelvic floor problems:

Cardio exercises

Resistance exercises

Core exercises

How do I know if an exercise is appropriate for my client?

To help to determine if an exercise is appropriate for your client’s pelvic floor, ask them to consider these four questions during and after the exercise:

1. Do you experience urinary leakage?
2. Do you feel heaviness, bulging or a dragging sensation in your vagina? (for females)
3. Do you feel pain in your pelvis?
4. Are you unable to contract your pelvic floor during the exercise?

If they answer ‘yes’ to any of these questions, encourage them to reduce the intensity or modify the exercise and seek help from a pelvic floor physiotherapist to improve their pelvic floor function.

As a general rule:

1. Screen your clients for pelvic floor problems
2. Provide them with an exercise program appropriate for their pelvic floor, including options for modifications
3. Refer them to a pelvic floor physiotherapist for assessment and treatment. Provide them with Pelvic Floor First resources and encourage them to visit pelvicfloorfirst.org.au to find out more.

Help is available

If your client has a pelvic floor problem, advise them to see a continence professional, as in many cases their issues can be improved and often cured. Exercise modifications may not be forever – with the right advice from a continence professional and an appropriate exercise program, your client can enjoy the benefits of exercise while allowing time for their pelvic floor to recover.

Want to know more?

Increase your knowledge and confidence in working with clients with pelvic floor dysfunction by enrolling in the 2-part online course with Australian Fitness Network.