**5. Conclusions**

After reviewing the data about the main relationships between urinary incontinence and physical activity and sports practice referred to in this chapter, we identified a high prevalence of urinary incontinence symptoms in women who exercise, significantly higher in young athletes; we also noticed that strong-effort and high-impact exercises are a major cause of incontinence complaints. Though literature is still inconclusive on this matter, these exercises seem to represent a risk factor for the development of urinary incontinence or are likely to aggravate pre-existing symptoms. Just the same, little is known about the pelvic

Incontinence: Physical Activity as a Supporting Preventive Approach 83

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floor reactions during several physical activities and also during long term physical practice. Researches aiming to identify pelvic floor reactions to different mid and long term physical exercises should be carried out in the future.

Through our project and a proposal of physical activities (Aletha et al., 2009b) which included PFM training and strengthening exercises, we were able to point out that, besides the results showing a reduction of incontinence complaints and an improvement in the participants' body image, it is also possible to create strategies to be used by Physical Education professionals who train incontinent women. A systematic and integrated physical activity program as described in the previous item allow incontinent women to get a better health and quality of life perception, specially towards their own body image and towards a decrease in incontinence complaints, with a reduction of the amount and frequency of urinary leaking.

Unfamiliarity with the connection between urinary incontinence and physical activity creates a gap in the education of Physical Education professionals and, hence, in their teaching practice. Leaving PFM exercises out of global exercising programs does not seem reasonable, as those muscles are part of every woman's functional activity and deserve attention. Coaches and physical trainers should encourage female athletes and non-athletes to contract the pelvic muscles while exercising because women are quite unlikely to think about it without guidance. Every woman, athlete or not, must stimulate these muscles so as to identify and contract them during gym classes and aerobic exercises, in order to prevent or reduce urinary incontinence and improve bladder control. The coach should always ask his/her athletes about incontinence symptoms resulting from strong-effort and high-impact exercises so as to contribute with strategies which help solve or minimize the problem. Moreover, the coach should help his/her student or athlete become aware of urinary incontinence and of its connection with high impact exercises and sports and make them realize how important it is to strengthen the muscles responsible for female urinary continence. Hence, once they have a coach or instructor who is prepared to discuss these issues, students and athletes will find it safe to share their incontinence first symptoms or existing problems with them. These actions can change physical activity and sports practice into a supporting and even preventing intervention in the treatment of urinary incontinence, helping to reduce prevalence rates and to prevent incontinent women to quit physical activities, making sure they enjoy the benefits of such practice. Controlled studies carried out on future researches are needed, in order to investigate how physical activities, specific PFM exercises included, can bring benefits people with urinary incontinence in the mid and long run.
