Semi-supervised Telerehabilitation Exercise Program for Pelvic Floor Function in Pregnant Women with Gestational Diabetes Mellitus: A Randomized Controlled Clinical Trial

Authors

  • Joyce Maria Pereira de Oliveira Postgraduate Program in Applied Sciences to Women's Health, Federal University of Rio Grande do Norte, Natal, Brazil
  • Letícia Amaro Vieira Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil
  • Edson Silva-Filho Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil
  • Adriana Gomes Magalhães Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil
  • Leony Morgana Galliano Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
  • Eduardo Caldas Costa Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
  • Sávio Ferreira Camargo Postgraduate Program in Applied Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
  • Maria Thereza Albuquerque Barbosa Cabral Micussi Postgraduate Program in Applied Sciences to Women's Health, Federal University of Rio Grande do Norte, Natal, Brazil; Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil

DOI:

https://doi.org/10.63144/ijt.2026.6738

Keywords:

Exercise, Gestational diabetes mellitus, Pelvic floor, Telerehabilitation, Urinary incontinence

Abstract

Introduction: Pelvic floor dysfunctions (PFD) are common during pregnancy, and the metabolic stress of Gestational Diabetes Mellitus (GDM) may exacerbate this condition. Supervised muscle training is an option that might be effective for treating PFD. This study aimed to evaluate the effects of a semi-supervised exercise program, delivered via telerehabilitation, on pelvic floor function in pregnant women with GDM. Methods: A randomized, controlled, blinded clinical trial was conducted with participants allocated into an Exercise Group (EG; n=20) and a Control Group (CG; n=20). The EG performed an exercise protocol (aerobic, global strength, and pelvic floor muscle–specific training) for 10–20 weeks, with telemonitoring via smartphone. The CG received educational booklets. Pelvic floor muscle function, PFD symptoms and impacts, and sexual function were assessed before and after the intervention. Perceived global improvement was measured at the end of the study. Results: Although no between-group differences were observed post-intervention for the overall sample, the stratified analysis of participants with urinary incontinence (UI) revealed a significant time-by-group interaction for the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF) (p = 0.007). Among women with UI, post-intervention between groups comparisons indicated mean differences of 4.07 (IC95%: 1.03;7.11) for the ICIQ-SF, 14.51 (IC95%: 1.26;27.76) for the UDI, and 2.68 (IC95%: -19.21;24.57) for the UIQ. In this subgroup, the EG demonstrated a numeric significant reduction in urinary discomfort and a protective effect against worsening UI severity compared with the CG. Conclusion: A semi-supervised telerehabilitation program appears to be effective in reducing and preventing the progression of urinary symptoms in pregnant women with GDM and pre-existing urinary incontinence.

  

References

American College of Obstetricians and Gynecologists. (2020). Physical activity and exercise during pregnancy and the postpartum period (ACOG Committee Opinion No. 804). Obstetrics & Gynecology, 135(4), e178–e188. https://doi.org/10.1097/AOG.0000000000003772

Apostolakis-Kyrus, K., van Raalte, H. G., van Raalte, T. J., & van Raalte, J. (2021). Feasibility and safety of antepartum tactile imaging. International Urogynecology Journal, 32(10), 2645–2653. https://doi.org/10.1007/s00192-020-04552-6

Arouca, M. A. F. (2015). Validação e tradução dos questionários PFIQ-7 e PFDI-20 para a língua portuguesa. Universidade de São Paulo.

Barbosa, P. H. S., Antônio, F. I., Resende, A. P. M., & Da Luz, S. T. (2024). Diagnostic accuracy and cut-off points for vaginal manometry to differentiate between weak and strong pelvic floor muscle contraction in pregnant women. International Urogynecology Journal. https://doi.org/10.1007/s00192-024-05860-x

Carter, D. D., Robinson, K., Forbes, J., & Hayes, S. (2018). Experiences of mobile health in promoting physical activity: A qualitative systematic review and meta-ethnography. PLoS ONE, 13(12), e0208759. https://doi.org/10.1371/journal.pone.0208759

Cattani, L., Van Schoubroeck, D., Samešova, A., Packet, B., Housmans, S., & Deprest, J. (2024). Pelvic floor ultrasound findings and symptoms of pelvic floor dysfunction during pregnancy. International Urogynecology Journal, 35(12), 2423–2430. https://doi.org/10.1007/s00192-024-05931-z

Dall, T. M., Yang, W., Gillespie, K., Mocarski, M., Byrne, E., Cintina, I., et al. (2021). The economic burden of elevated blood glucose levels in 2021: global estimates and projections. Diabetes Research and Clinical Practice, 177, 108862. https://doi.org/10.1016/j.diabres.2021.108862

Dietz, H. P. (2019). The pelvic floor in pregnancy and childbirth. In S. Elneil & A. Rane (Eds.), Pelvic floor dysfunction: A multidisciplinary approach (pp. 119–128). Springer. https://doi.org/10.1007/978-3-030-05384-2_10

Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. J. C. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, CD005654. https://doi.org/10.1002/14651858.CD005654.pub4

Ferreira, C. H. J., Barbosa, P. B., Souza, F. D., Antônio, F. I., Franco, M. M., & Bø, K. (2011). Inter-rater reliability of the modified Oxford grading scale and the Peritron manometer. Physiotherapy, 97(2), 132–138. https://doi.org/10.1016/j.physio.2010.06.011

Fitz, F. F., Stüpp, L., da Costa, T. F., Bortolini, M. A. T., Girão, M. J. B. C., & Castro, R. A. (2017). Outpatient biofeedback in addition to home pelvic floor muscle training for stress urinary incontinence: A randomized controlled trial. Neurourology and Urodynamics, 36(8), 2034–2043. https://doi.org/10.1002/nau.23226

Haley, S. M., Andres, P. L., Coster, W. J., Kosinski, M., Ni, P., & Paul, J. J. (2008). Item response theory and the measurement of change. Journal of Outcome Measurement, 2(4), 384–401.

Hao, J., Yao, Z., Remis, A., Huang, B., Li, Y., & Yu, X. (2024). Pelvic floor muscle training in telerehabilitation: A systematic review and meta-analysis. Archives of Gynecology and Obstetrics, 309(5), 1753–1764. https://doi.org/10.1007/s00404-024-07380-x

Haylen, B. T., de Ridder, D., Freeman, R. M., Swift, S. E., Berghmans, B., Lee, J., Monga, A., Petri, E., Rizk, D. E., Sand, P. K., & Schaer, G. N. (2010). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. International Urogynecology Journal, 21(1), 5–26. https://doi.org/10.1007/s00192-009-0976-9

Hopewell, S., Chan, A. W., Collins, G. S., Hróbjartsson, A., Moher, D., Schulz, K. F., et al. (2025). CONSORT 2025 statement: Updated guideline for reporting randomised trials. The Lancet. https://doi.org/10.1016/S0140-6736(25)00672-5

Kegel, A. H. (1948). Progressive resistance exercise in the functional restoration of the perineal muscles. American Journal of Obstetrics and Gynecology, 56(2), 238–248. https://doi.org/10.1016/0002-9378(48)90266-X

Kocaöz, S., Talas, M. S., & Atabekoğlu, C. (2020). The effect of gestational diabetes mellitus on pelvic floor muscle strength and urinary incontinence. Neurourology and Urodynamics, 39(7), 2051–2058. https://doi.org/10.1002/nau.24470

Mielke, G. I., Tomicki, C., Botton, C. E., Cavalcante, F. V. S. A., Borges, G. F., Galliano, L. M., Rocha, P. B., Del Duca, G. F., Oliveira, A. J. P., Domingues, M. R., & Hallal, P. C. (2021). Physical activity for pregnant and postpartum women: Brazilian physical activity guidelines. Revista Brasileira de Atividade Física & Saúde, 26, e0217. https://doi.org/10.12820/rbafs.26e0217

Mottola, M. F., Davenport, M. H., Ruchat, S. M., Davies, G. A., Poitras, V. J., Gray, C. E., Garcia, A. J., Skow, R. J., Meah, V. L., Adamo, K. B., Barrowman, N. J., Brooks, G. A., Day, G. A., Giglio, R., Hydock, D. S., Lane-Cordova, A. D., Miller, S., Okun, M. L., Orlowski, A. S., ... & Zehr, E. P. (2018). 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 52(21), 1339–1346. https://doi.org/10.1136/bjsports-2018-100056

Oliveira Bezerra, L., de Carvalho, M. L. A. S., Silva-Filho, E., Oliveira, M. C. E., de Andrade, P. R., & Micussi, M. T. A. B. C. (2024). Pelvic floor muscle training associated with photobiomodulation therapy for women affected by genitourinary syndrome of menopause: A study protocol. PeerJ, 12, e17848. https://doi.org/10.7717/peerj.17848

Pires, T., Duarte, T. B., Latorre, G. F., & Fonseca, A. M. (2020). Evaluation of perineal muscle strength in the first trimester of pregnancy. Revista Latino-Americana de Enfermagem, 28, e3345. https://doi.org/10.1590/1518-8345.3477.3345

Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., et al. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26(2), 191–208.

Samsa, G., Edelman, D., Rothman, M. L., Williams, G. R., Lipscomb, J., & Matchar, D. (1999). Determining clinically important differences in health status measures: A general approach with illustration to the Health Utilities Index Mark II. Pharmacoeconomics, 15(2), 141–155.

Tamanini, J. T. N., Dambros, M., D’Ancona, C. A. L., Palma, P. C. R., & Netto, N. R. Jr. (2004). Validation of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for Portuguese. Revista de Saúde Pública, 38(3), 438–444.

Van Veelen, G. A., Schweitzer, K. J., & Van der Vaart, C. H. (2014). Ultrasound imaging of the pelvic floor. Ultrasound in Obstetrics & Gynecology, 44(4), 476–480. https://doi.org/10.1002/uog.13301

Vasconcelos, H. C. A., Sousa, G. T., Silva-Júnior, L. G., Rocha, H. A., Mendonça, L. B. A., Feitosa, A. N. A., & Albuquerque, G. A. (2024). Prevalence of gestational diabetes mellitus in Brazil: A systematic review and meta-analysis. Research, Society and Development, 13(1), e0113144545. https://doi.org/10.33448/rsd-v13i1.44545

Wang, Q., Wu, X., Jia, Y., Zhang, D., Sun, X., & Wang, J. (2023). Gestational diabetes mellitus and pelvic floor function 6 weeks postpartum in Chinese women. International Urogynecology Journal, 34(7), 1619–1626. https://doi.org/10.1007/s00192-022-05438-5

Wang, X., Qiu, J., Li, D., et al. (2024). Pressure-mediated biofeedback with pelvic floor muscle training for urinary incontinence: A randomized clinical trial. JAMA Network Open, 7(11), e2442925. https://doi.org/10.1001/jamanetworkopen.2024.42925

Weinstein, M. M., Dunivan, G. C., Guaderrama, N. M., & Richter, H. E. (2025). Impact of a digital therapeutic device on pelvic floor symptoms. Urogynecology. https://doi.org/10.1097/SPV.0000000000001674

World Health Organization. (2013). Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. World Health Organization.

Yalcin, I., & Bump, R. C. (2003). Validation of two global impression questionnaires for incontinence. American Journal of Obstetrics and Gynecology, 189(1), 98–101. https://doi.org/10.1067/mob.2003.379

Zajdenverg, L., Façanha, C. F. S., Dualib, P. M., Golbert, A., Moisés, E. C. D., Calderon, I. M. P., Mattar, R., Francisco, R. P. V., Negrato, C. A., & Bertoluci, M. C. (2023). Rastreamento e diagnóstico da hiperglicemia na gestação: Diretriz oficial da Sociedade Brasileira de Diabetes. Sociedade Brasileira de Diabetes. https://doi.org/10.29327/557753.2022-11

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Published

2026-06-24

How to Cite

Pereira de Oliveira, J. M., Amaro Vieira, L., Silva-Filho, E., Gomes Magalhães, A., Morgana Galliano, L., Caldas Costa, E., … Albuquerque Barbosa Cabral Micussi, M. T. (2026). Semi-supervised Telerehabilitation Exercise Program for Pelvic Floor Function in Pregnant Women with Gestational Diabetes Mellitus: A Randomized Controlled Clinical Trial. International Journal of Telerehabilitation, 18(1). https://doi.org/10.63144/ijt.2026.6738

Issue

Vol. 18 No. 1 (2026)

Section

Clinical Research

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Copyright (c) 2026 Joyce Maria Pereira de Oliveira, Letícia Amaro Vieira, Edson Silva-Filho, Adriana Gomes Magalhães, Leony Morgana Galliano, Eduardo Caldas Costa, Sávio Ferreira Camargo, Maria Thereza Albuquerque Barbosa Cabral Micussi

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