Table 3.
Research priorities to understand the associations between physical activity, the pelvic floor, and pelvic floor disorders and the impact of pelvic floor disorders on sports performance and participation
| Understudied populations |
|---|
| Elite athletes |
| Weight trainers |
| Pregnant athletes |
| Understudied outcomes |
| Anal incontinence |
| Pelvic organ prolapse |
| Labor and delivery: duration of first and second stages, instrumental delivery, cesarean delivery |
| Under-represented research designs |
| Prospective cohort studies |
| Randomized clinical trials |
| With untreated control groups |
| Large and generalizable samples |
| Important research questions |
| Pelvic floor muscle training |
| What is the effect of PFMT in recreational athletes on PFD symptoms? |
| What is the effect of PFMT in women exposed to high loads on the pelvic floor (such as high-impact athletes or weight lifters) on PFD symptoms? |
| Does the effect of PFMT in athletes on PFD symptoms differ according to type of sport (static versus dynamic)? |
| Other than PFMT, what treatment modalities may improve PFD symptoms in athletes? |
| Is PFMT cost effective in athletes? |
| What is the knowledge base of coaches and trainers about PFM and PFDs? |
| How can PFMT best be incorporated into athletes’ training regimens? |
| How does PFMT affect athletic performance? |
| Prospective assessment of effect of exercise on the pelvic floor |
| How does commencing heavy and strenuous exercise impact the PF? |
| What is the effect of general exercise training (excluding PFMT) on PFM strength and function? |
| What is the long-term impact of teen strenuous activity on PFM strength and function, and on PFDs? |
| What is the long-term impact of strenuous activity initiated after teenaged years on PFM strength and function and PFDs? |
| Effect of exercise on PFD symptoms |
| What effect does initiating a sports or exercise training program have on urinary incontinence incidence or resolution? |
| What are modifiable risk factors for PFDs in elite athletes and strenuous exercisers? |
| How does UI affect athletic performance? |
| What beliefs and social constructs do athletes place on UI? |
| What is the effect of strenuous exercise during pregnancy on subsequent PFD symptoms? |
| What are the prevalence rates of UI in teenaged athletes performing different types of sports? |
| Effect of exercise on intra-abdominal pressure |
| How does exercise training affect IAP during different types of activities? |
| How does IAP generated during single vs repetitive and static and vs dynamic activities affect PFM strength and function and PFD symptoms? |
| How does breathing pattern during exercise affect IAP? |
| Assessment |
| How can measuring PFM strength and function accurately during physical activity be improved upon? |
| How can kinematic aspects of PFM function best be assessed? |
| What other methods can be developed to measure the influence from physical activity on the pelvic floor? |
PFM pelvic floor muscle, PFMT pelvic floor muscle training, PFD pelvic floor disorder, PF pelvic floor, UI urinary incontinence, IAP intra-abdominal pressure