Effects of Strength Training on the Gait and Pelvic Floor in Menopausal Women

A prospective experimental study will be conducted. A single-blind, randomised controlled clinical trial.

The study subjects will be selected voluntarily and will meet the inclusion criteria of the study. The sample will be recruited through social networks (Instagram, twitter, facebook), messaging applications (whatsapp, tiami, lex), public and private gynaecology consultations in different health centres and women's associations.

Women over 45 and under 77 years of age in the menopausal period (minimum 12 months of amenorrhoea) who have read the information sheet, completed the informed consent form and met the following inclusion criteria will participate in the study:

A prospective experimental study will be conducted. A single-blind, randomised controlled clinical trial.

The study subjects will be selected voluntarily and will meet the inclusion criteria of the study. The sample will be recruited through social networks (Instagram, twitter, facebook), messaging applications (whatsapp, tiami, lex), public and private gynaecology consultations in different health centres and women's associations.

Women over 45 and under 77 years of age in the menopausal period (minimum 12 months of amenorrhoea) who have read the information sheet, completed the informed consent form and met the following inclusion criteria will participate in the study:

Sedentary described as less than 30 minutes per day of regular exercise and less than 3 days per week as defined by the W.H.O. regular physical activity.

Availability to participate in the study and to attend all the scheduled sessions.

Be able to read and write and be fluent in spoken and written Spanish. Have a diagnosis of urinary incontinence and/or pelvic organ prolapse and/or sexual dysfunction.

Exclusion criteria:

Systemic disease Cardiovascular disease Vestibular and/or visual pathology including clinical symptoms of vertigo, tinnitus, hypoacusis and/or aural plentitude History of psychiatric illness Cognitive deficits for any reason Neurological injury Walking aids, orthoses or prostheses Ingestion of vestibular sedatives or other central nervous system depressants Musculoskeletal diseases with lower limb deformity Lower limb surgery within the last 10 years Urogenital surgery Latex allergy

Interested subjects who have received the contact request will contact the PI by email and fill in the online citation questionnaire, the purpose of this questionnaire will be to exclude subjects with any exclusion criteria. Provided they meet the inclusion criteria, the selected subjects will be sent the information form for the subjects and visits will be scheduled at the research laboratory of the European University, where the data of the variables will be recorded by a physiotherapist specialised in pelviperineology and with experience in the use of the required apparatus, in this case, the, PI who will be blinded to the assignment groups where he/she will measure: pelvic floor, gait analysis and the described questionnaires (IFSF, EPIQ, FRAX, ICIQ) that the patients will fill in themselves on a tablet device that we will have in the laboratory. The PI will verify that they meet the inclusion criteria, that they have read and understand the HIP and the informed consent. All measurements will be performed on the same day. At the end of the assessment by the PI, they will be contacted by researcher 1 who will randomly assign participants to the intervention or control group. This 1:1 randomisation is performed by investigator 1 using validated OxMaR software.

Participants in the intervention group will be scheduled two days a week for two guided sessions of live training and online exercises supervised and guided by a physiotherapist trained in therapeutic exercise. In the case of the intervention group, two 60-minute sessions will be carried out every week for three months. The control group will not carry out any training sessions, only the same assessments as the intervention group.

All participants will undergo a total of 3 assessments and the intervention group a total of 24 live training sessions.

The adherence of the participants will be recorded in an activity forum in which they will be instructed at the time they enter the study.

• Strength training (Other): Two 45-60 minute sessions per week for 12 weeks of live online training supervised by a qualified exercise specialist/physiotherapist.

Primary outcomes

• Pelvic Floor Muscle Activity During Gait [Baseline, Week 12 (post-intervention), Week 16 (1-month post-intervention), and Week 24 (3-months post-intervention)]: Mean root mean square (RMS) amplitude of the EMG signal of pelvic floor muscles recorded during 90 seconds of steady-state walking at self-selected speed using intracavitary electromyography (Mdurance®). Signals will be band-pass filtered (10-480 Hz), rectified, and processed using RMS.

Secondary outcomes

• Gait Kinematics [Baseline, Week 12 (post-intervention), Week 16 (1-month post-intervention), and Week 24 (3-months post-intervention)]: Kinematic parameters during steady-state walking at self-selected speed assessed using the OptiTrack® motion capture system. Mean values will be calculated from selected cycles with the lowest variability.
• Plantar Pressure Distribution [Baseline, Week 12 (post-intervention), Week 16 (1-month post-intervention), and Week 24 (3-months post-intervention)]: Plantar pressure distribution during steady-state walking at self-selected speed assessed using the Tekscan® system. Mean values will be calculated from selected cycles with the lowest variability.

Sex: Female, ages: 45 Years to 77 Years, accepts healthy volunteers

Inclusion Criteria:

* Women aged 45 to 76 years.
* Menopausal (minimum 12 months of amenorrhea).
* Sedentary lifestyle (less than 30 minutes per day of regular exercise and less than 3 days per week according to WHO definition).
* Availability to participate in the study and attend all scheduled sessions.
* Able to read, write, and command spoken and written Spanish language.
* Diagnosis of urinary incontinence, pelvic organ prolapse, and/or sexual dysfunction.

Exclusion Criteria:

* Systemic disease.
* Cardiovascular disease.
* Vestibular and/or visual pathology (including vertigo, tinnitus, hypoacusis, or aural tinnitus).
* History of psychiatric illness.
* Cognitive deficits for any reason.
* Neurological injury.
* Use of walking aids, orthoses, or prostheses.
* Ingestion of vestibular sedatives or central nervous system depressants.
* Musculoskeletal diseases with lower limb deformity.
* Lower limb surgery within the last 10 years.
* Urogenital surgery.
* Latex allergy.