The effects of training by virtual reality or gym ball on pelvic floor muscle strength in postmenopausal women: a randomized controlled trial

ABSTRACT Objective To evaluate the effectiveness of abdominopelvic training by virtual reality compared to pelvic floor muscle training (PFMT) using a gym ball (a previously tested and efficient protocol) on postmenopausal women’s pelvic floor muscle (PFM) strength. Method A randomized controlled trial was conducted with 60 postmenopausal women, randomly allocated into two groups: Abdominopelvic training by virtual reality – APT_VR (n=30) and PFMT using a gym ball – PFMT_GB (n=30). Both types of training were supervised by the same physical therapist, during 10 sessions each, for 30 minutes. The participants’ PFM strength was evaluated by digital palpation and vaginal dynamometry, considering three different parameters: maximum strength, average strength and endurance. An intention-to-treat approach was used to analyze the participants according to original groups. Results No significant between-group differences were observed in most analyzed parameters. The outcome endurance was higher in the APT_VR group (p=0.003; effect size=0.89; mean difference=1.37; 95% CI=0.46 to 2.28). Conclusion Both protocols have improved the overall PFM strength, suggesting that both are equally beneficial and can be used in clinical practice. Muscle endurance was higher in patients who trained using virtual reality

Self-Care Associated with Home Exercises in Patients with Type 2 Diabetes Mellitus

<div><p></p><p>The objective of this study was to verify self-care guidelines together with lower limb home exercises alter ankle and foot plantar pressure and alignment in patient with Type 2 Diabetes Mellitus (DM) measuring health and sociodemographic factors. The health factors analyzed were sensitivity and circulation aspects, risk rating, and neuropathy symptom score, ankle and foot alignment (photogrammetry), plantar pressures, and postural stability (baropodometry) before and after administering these guidelines and home exercises in 97 patients type 2 DM during 10 months. The self-care guidelines and exercises changed the forefoot alignment (Right Foot – Initial vs Final, <i>p</i> = 0.04; Left Foot, <i>P</i><0.01), the center of the force displacement in the mediolateral (Right Foot - Initial versus Final, <i>p</i> = 0.02; Left Foot, <i>P</i><0.01), and the anterior-posterior (Right foot - Initial versus Final, <i>p</i> = 0.01) direction, and body balance (Initial versus Final, <i>p</i> = 0.02). There was no change in the remaining assessed parameters. Self-care associated with the guidelines for home exercises for the lower limbs in patients with type 2 DM are effective in maintaining and improving the alignment of the feet, mediolateral stability and prevention of complications.</p><p>Trial Registration</p><p>The Brazilian Clinical Trials Registry <a href="http://www.ensaiosclinicos.gov.br/rg/RBR-8854cd/" target="_blank">RBR-8854CD</a></p></div

Static (S) and dynamic (D) podometric analysis before and after 10 month follow-up (n = 45).

<p>Data are means ± SD indicated.</p><p>*Paired <i>t</i> test <i>P</i><0.05. Center of pressure displacement in mediolateral (ML), anterior-posterior (AP) and body (DB) direction.</p><p>Static (S) and dynamic (D) podometric analysis before and after 10 month follow-up (n = 45).</p

Comparison of the alignment of the feet before (initial) and after (final) 10 monitoring sessions.

<p>Data are means ± SD indicated.</p><p>*Wilcoxon test with <i>P</i><0.05.</p><p>Comparison of the alignment of the feet before (initial) and after (final) 10 monitoring sessions.</p

Frequency of adherence to the guidelines for the exercises and self-care of the feet (n: 97).

<p>Data are means ± SD indicated. The numbers in detail are the same as <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0114151#pone-0114151-t001" target="_blank">table 1</a>. <i>versus</i> mean attendance - variance ratio (<i>F</i>) ratio significance <i>P</i><0.05. Variance ratio test (<i>F- test)</i>.</p><p>Frequency of adherence to the guidelines for the exercises and self-care of the feet (n: 97).</p

Check list for the exercise and self-care guidance used in the follow-up to the individuals.

<p>Check list for the exercise and self-care guidance used in the follow-up to the individuals.</p

Patient characteristics.

<p>Data are means ± SD or % indicated.</p><p>Patient characteristics.</p

Consort flowchart.

<p>Consort flowchart.</p