In “past, present, future”, we ask clinical or academic experts to reflect on selected Sports & Exercise Medicine topics. Today Kari Bø on Pelvic Floor Issues in Female Athletes.
Tell us more about yourself.
Kari Bø is a trained physical therapist and exercise scientist. She had her PhD (doctor of science) in 1990 and was appointed professor of exercise science in 1997. She was elected pro-rector (vice head) of NIH (a specialized university) 1998-2001 and rector (head) of the NIH 2013-2017. She was the first vice president of the International Organization of Physical Therapists in Women’s Health, WCPT 1999-2007, and has been the vice president of the Norwegian Council for Physical Activity for 8 years, giving direct advice to the Norwegian Minister of Health on physical activity, fitness and health. In addition, professor Bø has been the vice president of the Norwegian Physiotherapy Association subgroup for Sports Physiotherapy from 2003-2007. She holds a 20% position as project leader at Akershus University Hospital, Norway, Department of Obstetrics and Gynecology and is a board member of “The pelvic floor Center” at the same hospital.
Professor Bø has published/in press/submitted/in manuscript > 290 peer review scientific papers on pelvic floor dysfunction, treatment of incontinence and low back- and pelvic girdle pain, exercise during pregnancy and after childbirth, diastasis recti abdominis, measurement methodology, fitness and women’s health and has given > 300 invited international keynote presentations worldwide. Her H-factor on Research Gate in June 2020 was 61 and on Web of Science 48. She has supervised 20 completed PhD candidates and numerous master students and has 9 PhD students currently under supervision. In addition, she has published numerous articles, videos/DVDs and books about the pelvic floor, fitness, pregnancy and physical activity, and women’s health in general for the lay public. She has developed and been in charge of the post-graduate course for physiotherapy for pelvic floor dysfunction on behalf of the Norwegian Physiotherapist Federation since the early 1990ies. She has given numerous postgraduate courses for physiotherapists internationally. She was an appointed member of the Program Committee for Clinical Research at the Norwegian Research Council for 3 years and an appointed member from the Norwegian Research Council in Science Europe, EU. Professor Bø was appointed by the Swedish government as a board member of the Swedish School of Exercise and Health 2017-2020. She has been a visiting fellow to Stanford University, the USA, and a visiting professor at the University of Dunedin, New Zealand, University of Melbourne, Australia, The Ministry of Health, Singapore, The George Institute for Public Health, Sydney, Australia, Bristol Urology Institute, England, Monash University, Melbourne, Australia and Auckland University, New Zealand. Bø has been a guest professor at the University of Sao Paolo, Ribeirao Preto, Medical School, Brazil, for the last 10 years.
She is an honorary member of the Norwegian Physiotherapy Association’s Subgroup of Women’s health, the Brazilian Physiotherapy Association for Women’s Health and the Chilean Physiotherapy Association for Women’s Health. In 2014, one of her randomized controlled trials on pelvic floor muscle training was ranked and awarded one of 15 top trials in physiotherapy among >25.000 studies in the PEDro database. In 2015, she was awarded the Mildred Elson Award, the most prestige’s award from the World Confederation of Physiotherapy (WCPT), for her contribution to research and education in pelvic floor dysfunction and women’s health. In 2016 she was awarded the International Continence Society Lifelong Achievement Award for her research and education on the pelvic floor and incontinence. In 2019 she was awarded as an honorary member of the Norwegian Physiotherapy Association for her work for physiotherapy in Norway and worldwide.
Kari has a background as a dancer (jazz and contemporary), rhythmical gymnast (Nordic champion in a team) and sports model showing Norwegian sports clothes in a dance and gymnastic show in Las Vegas, Germany and France. In 1989 she developed the Norwegian Aerobic Fitness Model, an 80 hours course for aerobic instructors and a 60 min exercise class for health-enhancing training for women (containing aerobic dance, flexibility, strength training and relaxation). She still holds two exercise classes per week at her local sports club.
What was hip and happening 10 years ago?
In the pelvic floor area, we have had an increasing number of RCTs and systematic reviews, including meta-analyses showing that there is 1A evidence/recommendation for pelvic floor muscle training in the treatment of stress and mixed urinary incontinence. One RCT only is published on the effect on elite athletes. This study was on female volleyball players and showed a significant effect of the training for this group of women exposed to intensive high impact activities (jumping and abrupt movements). We also had an increasing number of epidemiological studies from different sports worldwide confirming that the prevalence of UI is high in young, nulliparous elite athletes.
What are we doing now?
There is increasing interest in the female athlete in general and how health issues specific for females can affect participation in sport and fitness activities (the effect of menstruation on sports performance, pregnancy and resumption of strenuous activities after childbirth). We have more data from ultrasound studies following recovery of the pelvic floor after childbirth. When it comes to the pelvic floor in athletes, the research has expanded to strength sports, and there are now a few studies on power and Olympic weight lifters and cross-fit. High prevalence has been found both for urinary and faecal incontinence and symptoms of pelvic organ prolapse.
We have an increasing scientific interest in the abdominal muscles during pregnancy and recovery after childbirth, with a special interest in diastasis recti abdominis. There are no studies on this phenomenon in elite athletes after childbirth, and we have no evidence on whether specific exercises are working to prevent or treat the condition.
Where do you think we will 10 years from now?
Hopefully, there will be increasing interest in female athletes and how to address female health challenges to improve sports performance and their ability to continue being physically active after cessation of their carrier. We need more studies on pelvic floor mechanisms during physical activity and especially recovery after childbirth, especially on the structural support and development of pelvic organ prolapse in nulliparous women. The same with abdominal recovery after childbirth, risk factors and whether it is causing low back or pelvic girdle pain the general female population and how it may affect athletic performance. Both the athletes and the coaches/ trainers need more knowledge about general female health problems and especially that pelvic floor dysfunction can be treated by strength training of the pelvic floor muscles.