title: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Curso de Fisioterapia, Escola de Enfermagem, Universidade Federal de Alfenas (UNIFAL-MG), Alfenas, MG, Brazil.
authors.forename: Natalia M
authors.initials: NM
authors.lastname: Martinho
authors.affiliation: Curso de Fisioterapia, Escola de Enfermagem, Universidade Federal de Alfenas (UNIFAL-MG), Alfenas, MG, Brazil.|Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Valéria R
authors.initials: VR
authors.lastname: Silva
authors.affiliation: Curso de Fisioterapia, Escola de Enfermagem, Universidade Federal de Alfenas (UNIFAL-MG), Alfenas, MG, Brazil.|Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Joseane
authors.initials: J
authors.lastname: Marques
authors.affiliation: Curso de Fisioterapia, Escola de Enfermagem, Universidade Federal de Alfenas (UNIFAL-MG), Alfenas, MG, Brazil.
authors.forename: Leonardo C
authors.initials: LC
authors.lastname: Carvalho
authors.affiliation: Curso de Fisioterapia, Escola de Enfermagem, Universidade Federal de Alfenas (UNIFAL-MG), Alfenas, MG, Brazil.
authors.forename: Denise H
authors.initials: DH
authors.lastname: Iunes
authors.affiliation: Curso de Fisioterapia, Escola de Enfermagem, Universidade Federal de Alfenas (UNIFAL-MG), Alfenas, MG, Brazil.|Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Simone
authors.initials: S
authors.lastname: Botelho
mesh_terms: D005081:Exercise Therapy; D005260:Female; D006801:Humans; D053580:Muscle Strength / Q000502:physiology*; D017773:Pelvic Floor / Q000502:physiology*; D017698:Postmenopause / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic; D063367:Virtual Reality Exposure Therapy / Q000379:methods*