#NACFC2016 – Exercises Targeting Trunk Muscles May Improve CF Urinary Incontinence

In a recent symposium, scientists discussed the increased importance of physical therapy in addressing cystic fibrosis-associated muscle impairments and urinary incontinence.

The presentation, titled “Posture, Pelvic Floor & Pistons: A Look Beyond ‘Kegels’ to Treat Urinary Incontinence,” was given today at the Symposium “Growing Older With CF” at the 30^th Annual North American Cystic Fibrosis Conference (NACFC) Oct. 27-29 in Orlando, Florida.

The role of the physical therapist in managing patients with cystic fibrosis (CF) is evolving. At first the physical therapist was restricted to helping patients clear secretions from the lungs. But as patients’ life expectancy significantly increases, other body systems also become affected by the disease, such as the the neuromuscular and musculoskeletal systems.

These secondary impairments caused by cystic fibrosis also need to be addressed so that CF patients have positive quality-of-life experiences.

The role of the physical therapist is essential in addressing these problems. Besides clearing secretions and addressing aerobic exercise capacity, physical therapy is needed to help CF patients increase their strength, flexibility, and bone density; decrease pain, improve breathing and posture, and help maintain urinary continence.

Alterations to the musculoskeletal system are seen in young children with CF even before they enter puberty. These changes are characterized by increased thoracic kyphosis (an exaggerated rounding of the back); scoliosis (any abnormal, sideways curvature of the spine); decreased lumbar lordosis (an exaggerated lumbar curve in the spine); peripheral muscle weakness; and arthritis.

Pain, decreased endurance and exercise capacity, urinary incontinence, diminished quality of life, and more frequent lung exacerbations are also associated with musculoskeletal alterations.

In fact, children with cystic fibrosis are particularly prone to develop urinary incontinence. CF adolescent and adult females with urinary incontinence range from 30-74 percent, while in age-matched healthy females this number is only 13 percent.

On top of musculoskeletal structural or postural changes, pelvic floor muscle (PFM) weakness, increased intra-abdominal pressure (IAP), and loading of the PFM during cough and exercise are also named as causes for stress urinary incontinence in CF patients. Notably, males with CF also report urinary incontinence, but at a much lower rate (2.4 percent to 16 percent).

Urinary incontinence has a negative impact on a person’s quality of life, leading to avoidance of physical exercise and decreased frequency and effort with airway clearance.

There is a lack of evidence on the most effective treatments for urinary incontinence in CF patients. Reported approaches include a physiotherapy technique called “the Knack” as well as Kegel exercises, but these may not be effective in all patients with stress urinary incontinence.

The Knack is a strong and well-timed contraction of pelvic floor muscles, actually a Kegel exercise. Specifically, the muscles contract immediately before and during any increase in downward pressure on the pelvic floor. Kegel exercises are simply clench-and-release motions to strengthen the muscles of your pelvic floor.

Researchers said the care team of CF patients should include an active screening strategy for musculoskeletal changes to reduce the impact and prevent, whenever possible, secondary impairments.

They emphasized how exercises that aim to mobilize, realign, and strengthen the muscles and joints of the trunk (those that move the vertebral column, the muscles that form the thoracic and abdominal walls, and those that cover the pelvic outlet) can improve patients’ core stability and function.

As a result, these exercises may benefit patients by also improving their posture, pain, peripheral muscle weakness, endurance, and urinary incontinence. This will ultimately result in better lung function and improved quality of life.