This is the second of three posts focusing on the SKEA, a Kegel exercise product I backed last year on Kickstarter.. This post concerns the design of a Kegel exercise programme. The other posts in this series are: –
This past month I’ve been reviewing the available literature on Kegel exercises to see what makes for an effective programme for the SKEA. While I can certainly create an app to display pressure readings I’d like to be able to implement a Kegel exercise programme for people to use (and eventually present in a game format). I’m not quite there yet and I’m currently following NICE Clinical Guideline 171 (used by the NHS) which recommends at least 8 muscle contractions 3 times a day for the treatment of urinary incontinence.
During my research I did find an interesting curio regarding the exercises Kegel describes. It seems there is a significant level of confusion over what Kegel actually recommended. Now when people refer to a Kegel exercise they are referring to the pelvic floor muscle exercise described by Arnold Kegel in his 1948 publication on the subject (Kegel 1948). The work describes an exercise programme Kegel developed over the course of fifteen years to help restore pelvic floor muscle function, primarily in women after childbirth.
Kegel instructed his patients to practice pelvic floor muscle exercises for 20 minutes, 3 times a day. That’s it. He didn’t mention how many muscle contractions you’re expected to carry out, nor for how long each contraction should take, nor how many days to exercise for. All he required was that patients tracked their adherence to the exercise program, and using a device he developed (a perineometer), record the maximum force their muscles could exert.
I’ve read several papers on Kegel exercises including a couple of literature reviews, and a significant portion of them seem to describe the original exercise programme slightly differently. For example in a literature review by (Price et al. 2010) on pelvic floor muscle exercises up to 500 muscle contractions per day are attributed to Kegel’s programme which is not the case. Even the SKEA publicity material describes the exercise differently, 20 minutes a day for 3 months. What Kegel did say, is that patients should see improvement in muscle function after several weeks of exercising. This should appear as a gradual increase in the recorded pressure readings on the perineometer over the course of the exercise programme.
I particularly find the differences between Kegel’s work and it’s representations interesting because they make the exercise programme sound more strenuous and mind numbingly boring than it actually is. If anything the most difficult part of Kegel’s exercise programme, which Kegel talks about, is learning how to control your pelvic floor muscles in the first place. This is pretty much standard fare for any biofeedback training; you’re learning how to use a physiological function you don’t normally control, of course it’s going to be hard.
This post is continued in unSKEA – Android App for SKEA.
References
Kegel AH (1948) Progressive resistance exercise in the functional restoration of the perineal muscles. American Journal of Obstetrics and Gynecology 56:2.
Price N, Dawood R, Jackson SR (2010) Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas 67:309–315
NICE (2013) Urinary incontinence – The management of urinary incontinence in women. NICE clinical guideline 171.