Who’s the Biggest Loser? Pelvic Floor Safe Exercises for Women!

High drama in this season’s ‘Biggest Loser’ reality weight loss show recently when 41 year old Anita, was rushed to hospital with a mystery abdominal injury she sustained doing deep pelvic floor safe exercisedswide leg squats thrusting a 5kg weight from ground level up over her head.

My teenage son innocently asked “mum do you think she’s had a prolapse?” I couldn’t help thinking that in view of the exercise Anita had been doing and her pelvic floor risk factors, pelvic prolapse was definitely up there in the range of possibilities.

I had to wonder why, if my teenage son can see the potential for pelvic floor injury, does high risk exercise for pelvic floor injury continue to be inflicted on women during prime time TV? I have deliberated about writing about this issue after years of cringing every time I see unsafe exercises for women, and my son’s question has finally prompted me into action.

I will preface this article by saying one can only applaud the efforts of anyone seeking to lose weight, improve their health and fitness, and that personal trainers are well intentioned in seeking to help their clients achieve their goals, and there are now many personal trainers who are highly committed to providing pelvic floor safe exercises to their clients.

However, isn’t it time that mainstream exercise prescription for women is tailored to their individual needs rather than the one fits all model for men and women we often continue to see? The pelvic floor of a woman is vastly different from that of a male, far more vulnerable to injury with inappropriate exercise.

Who is at Increased Risk of Pelvic Organ Prolapse?

Many risk factors for pelvic prolapse and pelvic floor dysfunction apply to the mature women on this season’s ‘Biggest Loser’:

  • Overweight or obese women
  • Previous pregnancy and childbirth
  • Menopause and beyond
  • Regular heavy lifting.

These are all major risk factors for pelvic floor dysfunction including pelvic organ prolapse.

Overweight and Pelvic Floor Problems

This season’s ‘Biggest Loser’ female contestants would have been classified as obese at the outset (i.e. BMI or body mass is greater than 30). Obese women have increased load on their pelvic floor safe exercises pelvic floor whenever they are upright. The weight in and around an overweight woman’s abdominal organs combined with gravity weighs down  their pelvic floor. The mature female contestants admit to years of obesity – in other words years of walking around with increased load on their pelvic floor.

Scientific studies confirm that increased body weight is a risk factor for prolapse surgery in women1. Obesity has been identified by the International Continence Society as an independent risk factor for incontinence2. In other words the increased load on the pelvic floor with obesity (and overweight) potentially increases the risk of pelvic floor problems occurring. Obesity combined with exercises that potentially overload the pelvic floor make this issue more problematic for overweight women and can potentially have adverse long-term outcomes for a woman’s pelvic floor health.

Childbirth and Pelvic Floor Problems

Women who have been pregnant and given birth are at increased risk of pelvic floor dysfunction. This season the theme is for a parent and child to lose weight together – so we know the mothers involved have gone through pregnancy and childbirth at least once in their lives. Pregnancy and childbirth are known to impact upon the supportive function of the pelvic floor. Studies implicate vaginal delivery as a risk factor for pelvic organ prolapse3.

Menopause and Pelvic Floor Problems

Menopause and increasing age are associated with increased likelihood of pelvic floor weakness and decreased pelvic floor support. The adult women in this season’s show are mature, some with children in late teens or early twenties, so we can reasonably expect that some are close to or past menopause. With decreased oestrogen the pelvic floor tissues becomes thin, weak and less elastic making the mature woman’s pelvic floor at increased risk of pelvic floor dysfunction.

Exercise, Heavy Lifting and Pelvic Floor Injury

Exercises that increase stress on a woman’s pelvic floor muscle supports increase the risk of pelvic floor dysfunction including incontinence and pelvic organ prolapse. It is known that lifting heavy weights, high-impact exercises and long distance running increase the risk of pelvic organ prolapse3. Intense core abdominal exercises (abdominal curls or sit ups) are known to create pressure causing pelvic floor descent in women with previous vaginal delivery4 – if the pelvic floor is unable to withstand repeated loading of intense core exercise, then pelvic floor dysfunction may result.

So one would expect that in a group of obese and overweight menopausal women (mothers) who have numerous risk factors for pelvic floor injury we would see appropriate pelvic floor safe  exercises to promote weight loss and avoid pelvic floor dysfunction. However  here’s just a taste of some of the weight loss exercises we have witnessed these women perform to date alongside their male counterparts:

Heavy lifting

  • Pulling a semitrailer with an abdominal harness (team) pelvic floor safe exercises
  • Pushing/pulling/lifting a surf boat from end of the beach to the other (team)
  • Lifting heavy weights with squats from ground height (shown right)
  • Lifting and running to build a tower out of bales of hay (partner).

Intense core abdominal exercises

  • Sit up exercises
  • Plank extended holds
  • Men’s push ups

High Impact Exercise

  • Long distance running half marathon (team)
  • Sprinting
  • Burpees
  • Running with load (surf boat, hay bale, semi trailer and harness)

Any Pelvic Floor Safe Exercises?

Participants have also performed low impact exercises including elliptical machines, walking and stationary cycling. It is difficult to comment on whether these exercises were offered as alternative pelvic floor safe exercises to some high impact gym-based exercises.

Implications for Women’s Exercise?

National television coverage of the exercises we have seen keeps us in the dark ages when it comes to promoting appropriate pelvic floor safe exercises for mature overweight women.

There are a number of potential negative implications for women’s pelvic floor safe exercise:

  • This type of coverage legitimises these types of high impact heavy loading exercise interventions for overweight women and the notion that the same exercise interventions are appropriate for men, women and teenage children.
  • The exercises are prescribed by personal trainers adding to this sense that the exercises are safe and appropriate for obese and overweight women to perform.

The real risk is that large numbers of unsuspecting mature women who are at-risk of pelvic floor injury owing to obesity or being overweight could readily view the types of exercises prescribed as appropriate for them to include in their own exercise regime. If pelvic floor injury is sustained, or any musculoskeletal injury for that matter during exercise it makes it all the more difficult for these individuals to adhere to their weight loss and fitness endeavours and achieve success.

Isn’t it high time that exercise interventions for women cater for a woman’s weakest link ? In many mature women their weakest link is their pelvic floor. Why aren’t the exercises for these at-risk women modified to promote weight loss and pelvic floor protection? This is a simple matter of providing or low impact exercise alternatives, pelvic floor safe lifting practices and avoiding or modifying  intense core abdominal exercises.

We want women to be able to exercise safely and effectively, and help them to avoid foreseeable pelvic floor issues they may encounter with inappropriate exercises. If this one fits all model of exercise prescription continues there is only one biggest loser – pelvic floor safe exercise for women.

Will anything change as a result of this article? Probably not, it appears that even the Australian Government funded Pelvic Floor First Initiative that seeks to educate the fitness community and broader community on pelvic floor safe exercises isn’t being heard in some quarters.

At least tonight I can rest easy, and maybe, just maybe, some unsuspecting overweight woman undertaking a new exercise program may glance over this article, have a light bulb moment and save herself some considerable pelvic floor grief.

References

1. Mant, Jonathan, Painter, Rosemary, Vessey, Martin (1997) Epidemiology of genital prolapse: observations from the Oxford Family Planning Association study BJOG: An International Journal of Obstetrics & Gynaecology, 104, 579- 585.
2. Chiarelli P (2007) Lifestyle interventions for pelvic floor dysfunction. In evidence-based physical therapy for the pelvic floor Bridging Science and Clinical Practice Editors Bo K. Bary Berghmans, B. Morkved, S Van Kampen M Toronto         Elsevier p 148-149.
3. Balmforth J and Robinson D (2007) Pelvic organ prolapse. In evidence-based physical therapy for the pelvic floor Bridging Science and Clinical Practice Editors Bo K. Bary Berghmans, B. Morkved, S Van Kampen M Toronto Elsevier   p235-236.
4. Thompson JA, O’Sullivan PB, Briffa NK, Neumann P. (2007) Comparison of transperineal and transabdominal ultrasound in the assessment of voluntary pelvic floor muscle contractions and functional manoeuvres in continent and     incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2007 Jul;18(7):779-86. Epub 2006 Oct 17.

Inside Out Book & DVDABOUT THE AUTHOR, Michelle Kenway

Michelle Kenway is a Pelvic Floor Physiotherapist and author of Inside Out – the Essential Women’s Guide to Pelvic Support. The Inside Out exercise DVD and book show women how to exercise effectively with pelvic floor safe exercises.

Comments

  1. Hi Michelle
    I have just come across your site as I was searching for some safe exercises. I am 58 with 2 children born vaginally with no problems although had a slight tear sutured. I had previously worked at a airport checking in heavy luggage whick we had to lift and place on a conveyer belt behind us. I know this did not do my back any good but was not aware of the pelvic floor. My only exercise when younger was squash or tennis. I was told a few years afo by my doctor that I has a slight prolapse and do have some incontenince. A year ago I started going to pilates and did enjoy that, but with overuse of my right shoulder had a previous restriction of backwards
    Movement of the arm, then I joined the gym and started lessions which were available for women that had 20kg or more to use and run by a PT who had lost 55kg herself. She worked around the shoulder issue but we were still doing lunges squats, carrying tyres etc. She left end Jan14 and I continued attending gym classes doing Balance, Cardo Boxing and some weight work, however during blocking at cardio boxing I hurt my arm again and ultrasounds have confirmed a tear and bursa swelling. Been to physio massage acupunture scener therapy with no additional range of movement. I lost 15kgs to Mar14 and walk 50mins twice a week outside and have only being going to gym 1 a week do 30mins treadmill 1.5 incline legpress25kg 15repsx3 and floor exercises which included situps, tabletop bycicle on side single leg lifts, and heels together liftìng top knee. I have found that my prolapse seems to be worse as can feel soft bulge like a balloon . I have really been struggling with what exercises to do because of the shoulder, now I need to modify for the pelvic floor. I will be ordering your book and DVD. Is there any advice you can give me. Thank you.
    Rhonda

    • Michelle Kenway says

      Hi Rhonda
      Thank you for sharing your history – yes there are many factors that may have contributed to your prolapse as you are no doubt aware – heavy lifting for work, exercises that load the pelvic floor (carrying tyres, sit ups, tabletop) it’s almost a script for what to avoid.

      You obviously need to take care with the exercises you choose to protect your shoulder, have you seen a physio for treatment for your shoulder?

      It also sounds as though your prolapse may have worsened so it would be worth your while returning to your gynaecologist if you haven’t done so already.

      As far as exercise goes when you receive your book you will see that appropriate and inappropriate exercises are covered in detail as well as information to help you strengthen your pelvic floor. As you are aware this whole site is dedicated to appropriate exercises for women and you will find much more than I can write in a comment starting our library and click the link for prolapse if you are unsure where to start.

      I hope this helps you get started Rhonda

      All the best
      Michelle

  2. Hello Michelle,

    Along with your home exercise DVD I was thinking id like to do some cardio at the gym can you recommend what exercises I should do and are there any precautions or contraindications? I was thinking treadmill, bike, rower and cross trainer (not all in one go lol, just that these would be the safest machines to use). I did read in your book to remain seated when riding the bike and no running, to do exercises that keep both feet on the ground.

    Thank you Michelle

    • Michelle Kenway says

      Hi Lisa

      Yes you are spot on with the bike (low resistance go for speed), cross trainer and treadmill walking flat (not incline). I think rowing machine is unclear in terms of pelvic floor safe exercise and depends on technique and resistance and there are ways to modify it to make it kinder to the pelvic floor – did you see this month’s featured exercise in the newsletter on rowing machine? Just let me know if you need me to forward you the information on modifying it.

      Also mix up the exercises regularly for variety, not only is this the best approach for fitness (and weight management) but also kindest for your pelvic floor rather than treadmill walking day-in day-out.

      Hope this answers your question, let me know anything further

      All the best
      Michelle

  3. My pelvic floor muscles are tight as a results of heavy squatting with bad form for over a month straight.
    Can tight PFM cause a loss of libido in men?
    Can they also cause constricted genitals that seem to shrink them or cause a lack of blood flow and sensitivity?
    The squats also threw my posture out of whack… Will prolonged bad posture cause these issues too?
    Thanks!

    • Michelle Kenway says

      Hi Max
      Great questions, thank you!
      Yes tight pelvic floor muscles in males can contribute to loss of libido, decreased blood flow and reduced sensitivity. Yes poor posture can exacerbate these issues, there is a posture known as the pelvic pain posture which involves slumped forwards shoulders. Habitually overbracing the abdominal muscles will also increase pelvic floor muscle tension in men and women.

      Max there is an excellent new CD available to treat pelvic floor muscle tension or tightness in en that has just been released – I do have some in stock but haven’t had the chance to get them online just yet (too busy writing back to people:) just send me an email via our contact page if you would like further details.

      All the best
      Michelle

  4. Does horseback riding affect pelvic organ prolapse? I have moderate bladder and rectal prolapse.

    • Michelle Kenway says

      Hi Karen

      This will depend on the style of riding and how proficient the rider is. Jumping and high impact riding could forseeably impact upon the pelvic floor. Novice riders trotting will probably have greater impact on their pelvic floor compared with expert riders in a smooth canter. This also depends on individual pelvic floor strength and control as well as the prolapse severity.

      All the best
      Michelle

  5. Wanted to ask if you thought jumping up and down on a trampoline is a safe pelvic floor exercise?

    • Michelle Kenway says

      Hi Gloria
      Yes good question on trampoline, I need to write on it as it is a FAQ. This reply to a similar question on trampoline and pelvic floor should help, let me know if you would like to know anything further
      Cheers
      Michelle

  6. Michelle Fraser says

    Hi Michelle,
    Another great article – I have been a PT for 3 years now and loving it. I am 40 years old and fortunatly don’t have any PF problems. In my years training clients though I have come across PF issues and prolapse. So I decided to study up. I came across your website, purchased your books and read many others. You are an inspiration. Keep posting your knowledge. Always interesting to hear what you have to say.
    Cheers
    Michelle

  7. What a fantastic article – you highlighted my exact thoughts!
    Biggest Loser is inspiring for many reasons, but when it comes to how they do it – I often cringe. As a dietitian and PT (who works with post-natal mums!), many of the approaches they use are scary.
    Thanks Michelle.
    P.S. I’m going to share this story with all my clients!

    • Michelle Kenway says

      Hi Sally
      You are at the coal face doing exactly this type of work, it must make you really cringe. What a great combo dietician and PT! Thank you for your feedback and for sharing this with your clients, I hope it helps you promote their awareness of pelvic floor safe exercises and appropriate women’s training.
      Cheers
      Michelle

  8. Hi Michelle,
    Thank you so much for all info. how to keep pelvic floor “happy”. Could you let me know what do you think about rebounding exercises, my husband bought one and I just wonder if it is safe for me to use it as I have slight problem with incontinence. Thanks.
    Bianka

    • Michelle Kenway says

      Hi Bianka
      I think the key to rebounding with pelvic floor problems is to try to keep it low impact (if you choose to use the rebounder). This will mean keeping at least one foot in contact with the rebounder throughout, no high knees or both feet off simultaneously which will increase pelvic floor impact with landing. If the issue is with bladder urgency, the bouncing up and down may not be helpful at all. I think judge by the effect on your bladder symptoms when keeping things low impact and you will know. Otherwise, brisk walking will keep you in shape and keep things low impact too.
      Best of luck
      Michelle

  9. Thanks for a great article! I was just diagnosed with bladder prolapse and my physical therapist was aghast at the exercises I had been doing regularly with intensity per Jillian Michaels program. I love the workouts but never clicked that I was setting myself up for this and have now arrived with two surgical consults pending. Still love Jillian, her program along with the iDiet has helped me get in shape and lose 35 pounds but am clearing all future exercises with my pelvic floor specialist!

    • Michelle Kenway says

      Good for you Amy, yes just clear your exercises first to keep them safe for you
      Cheers
      Michelle

  10. Sorry if this is off topic, after 1 1/2 yrs post baby I decided to get into excercise, running, sprinting, squats etc to prepare for a charity 8mile up mountain walk. however 2wks into preparation i just noticed what appears to be the beginning of prolapses. I just wanted to know is there any type of walking, running or cardio excercise which is appropriate to prepare for this? I know you offer alt of advice on stationary excercises but in the means of running/jogging/uphill walking what are the simple do’s and dont’s?? Thank you so much for this helpful page also.

    • Michelle Kenway says

      Hi Gemmah
      Running with a prolapse is a good question, I think this article on prolapse and running should help you with the do’s and don’ts – just let me know if you need anything further.
      Best of luck
      Michelle

  11. Leslie Stager RN, LMT says

    Thanks for your article and focus on women’s pelvic health! Glad to hear of other emissaries around the world encouraging more awareness in that regard. I do internal pelvic floor bodywork for women to help address many of the risks mentioned above, including prolapse, incontinence, pain. I find that many women are not connected with their pelvic region at all–physically or energetically, until problems arise to draw their attention there. Holistic Pelvic Care is one way to help women get in touch with and re-inhabit their pelvic bowl with full vitality and also give women a proprioceptive feel for doing pelvic muscle conditioning properly. I have found that internally, if the pelvic muscles are not well-balanced,– for instance, if one area of the internal muscles is firing, and another area not firing– more imbalance and problems can be created. I noticed in other areas of your site you talk about the importance of ensuring women are doing the kegel strengthening properly– I can’t agree with you more about that! They need to be assessed or assess internally themselves to ensure all quadrants in the pelvis are firing, and that they are really squeezing internally, vs using legs/thighs/abdomen!
    Thanks again for your educational efforts! http://www.Holisticpelviccare.com

  12. Karen Matthews says

    Thanks Michelle for raising this topic and warning women about the pit falls of exercise that is harming their bodies instead of helping. The feedback from your readers on their experiences is sadly enlightening.
    Karen

    • Michelle Kenway says

      Thanks for your comment Karen, yes the comments are revealing aren’t they. If only we could reach more women …

  13. Hi Michelle. I read this article with great interest as I’m currently studying to specialize in prenatal strength training – however I can see a future specializing in many aspects of women’s health strength and conditioning, including women with pelvic floor issues. Like you and many others, when I watch the Biggest Loser I’m in pain for these people. All I can think is “injury, injury, injury!!!” (actually I don’t watch it anymore because its too frustrating). The reason I’ve decided to specialize in prenatal is from my own experience working out while pregnant (currently in my third pregnancy) and seeing there is a huge disconnect between the strength training and physical therapy world. Some of the stories here – I can totally relate to seeing women training or BEING trained in the gym inappropriately and having to bite my tongue!

    Concerning my own body, I’m continually finding “current” information that is conflicting. I’ve recently read a blog (biomechanist Katy Bowman of Aligned and Well) explaining why squats are THE exercise to be doing for a stronger pelvic floor. Not just any squat, but a deep squat (to target the glutes). Bowman actually has a course titled “No More Kegels” as she says too many kegels will damage your pelvic floor! But I’ve since come across many women’s health physiotherapists criticizing this. From this article I would ask you (for myself and future clients!) 1 – is it okay to be squatting deep and lifting heavy if the pregnant woman is a healthy weight with no pelvic floor dysfunction symptoms? And 2 – (as Lara Eadley commented) if I proceed with heavy lifts (which I get greatest satisfaction from), should I “kegel” when contracting (straining!)? Some really great comments here and more awesome resources for me – Lara Eadley and Brioney O’Conner – thank you as well.
    Thank you!
    Jennifer of http://www.mamalionstrong.com

    • Michelle Kenway says

      Hi Jen

      Yes I have had other ladies write to me about no more Kegels. I have not read Katy’s work so I cannot comment on that. Rather I will say that the notion of doing squats to strengthen the pelvic floor goes entirely against what is known to be true in terms of specificity of muscle training – that is that to strengthen a muscle you need to exercise that muscle. What we know from recent scientific research is that Kegel exercises or pelvic floor exercises (not squats) improve pelvic floor function in women pelvic floor disorders including stress urinary incontinence and prolapse. I have not read any research to suggest that squatting has this effect. There is no evidence to suggest that when women perform Kegels correctly that they are in any way dangerous. The risk would be when women don’t use the correct action, if they fail to relax their pelvic floor or if they do Kegels when they already have overactive pelvic floor muscles.

      Lifting a load from ground level increases intra abdominal pressure and subsequent pelvic floor loading when compared with lifting from standing height (Weir et al 2006). It seems that unloaded squat and lift from ground level generates more intra abdominal pressure that lifting a heavy load in standing.

      So women who have or at risk of pelvic floor injury (including pregnant women with or without current pelvic floor problems) would be well advised to avoid deep squats with heavy lifting. During pregnancy the pelvic floor is under increasing load, causing stretch, strain and weakness so during pregnancy a woman’s pelvic floor is far more vulnerable to injury.

      On squats – fantastic exercise for strengthening the quads and gluteals, because these are the muscles directly contracting. Do squats help women who have well functioning pelvic floor muscles to strengthen their pelvic floor? It may well be that because the pelvic floor muscles are required to contract to counteract associated downward load on the pelvic floor that they do strengthen in women without pelvic floor dysfunction. I don’t know but it’s possible however I would strongly suggest against at risk women performing deep wide heavily loaded squats (which also happen to compromise the knees but that’s another story).

      Thanks for your contribution Jen
      Michelle

  14. Thanks for all the great work you’re doing Michelle to educate people about pelvic floor issues and to help women get back in touch with their bodies.

    TBL would be such a great opportunity to educate women.
    And I wish gym instructors had more knowledge in this area too!

    I thought I was very aware of my body. I exercised regularly and had just completed my second 10km city to surf when I decided to join the Michelle Bridges weight loss program to shed a few kilos. I thought my pelvic floor was safe now that my daughter was 2. But about 6 weeks into the programme, with all the intense aerobic workouts I was doing, my pelvic floor gave way and I now have vaginal and rectal prolapse.
    I wish I had known then, what I know now!

    • Michelle Kenway says

      Hi Sophie
      Thanks so much for your comment, isn’t it such a shame that we often learn this information after the event. I’m not familiar with the Michelle Bridges weight loss program but I imagine there are plenty of at-risk women who are overweight doing her aerobic workouts. Did the prescreening for the program re your general health include any qns that might suggest your risk of pelvic floor injury e.g. recent childbirth, weak pelvic floor muscles etc? This really needs to be included to identify women at risk so that exercise can be appropriate and matched to the woman’s needs. I really appreciate your input Sophie, thank you.
      Michelle

      • Hi Michelle,
        I certainly don’t remember anything in the pre-screening that alerted me to being at risk to pelvic floor injury.
        They offer various programs including a ‘pregnancy’ program and some kind of ‘low impact’ options, which seemed to really be aimed towards injured people.
        I admit I didn’t get a clearance from my doctor, but as I said, I was fit, already running fairly regularly, no injuries – I’m sure my Doctor would have said ‘Go for it!’
        I’m a single mum most of the time, as partner works away, so I chose to get her DVD to completer the program so I could do it at home when daughter was asleep. Lots of skipping, jumping, crunches, weights. And I imagine many Mums choose this option as they are stuck at home with kids. Work outs are daily and intense.
        The Michelle Bridges Program has gained a lot of momentum lately, especially when TBL is on. And the exercise programs are based a great deal on the same style of training they do in TBL – heaps of cardio, heaps of crunches, skipping, running – all those thing I can’t do now!!
        I really miss my running :(

        They do offer some alternative exercises in the program once you have a good search, but as I said, it always felt like these were aimed at people with existing injuries. Not me!

        Sophie

        • Michelle Kenway says

          Hi Sophie
          Thanks so much for this information about Michelle Bridge’s 12 week challenge – helps me and other readers too I am sure. It’s a shame that the alternatives seem to be pitched at the injured individuals. If individuals don’t realise they are at risk, then we know what can happen when it comes to the pelvic floor. Yes I can see how this type of program would appeal to women at home looking after kids like you.

          I have receieved some interesting info from the US – see Diane’s comments from the US about the spin off PT program over there.

          What about a stationary bik for Xmas? Have you tried the high low intensity Lifesprints workouts – fantastic for time saving, fitness and fat burning. Just a thought …
          Best wishes
          Michelle

  15. Having had 2 prolapses I also cringe when watching Biggest Loser and wonder what damage is being done. This also applies to classes run at gyms which I blame for my second proplapse. It’s disappointing gym instructors and personal trainers aren’t more educated with pelvic floor problems.

    • Michelle Kenway says

      Hi Kathy
      Yes, gyms and fitness centres too. I really think that pelvic floor safe exercise should be a core component of instructor training. Yes there are attempts to train instructors who are interested in professional development in this area, and I do know of some absolutely fantastic PT’s and fitness leaders who have undertaken the additional training and are committed to pelvic floor safe exercise. However the enormity of this problem warrants mandatory training in pelvic floor safe exercise and including it as a core subject with theory and practical during instrucotor training, not some elective course that’s conducted on the side (which is at least a start).
      Thanks Kathy
      Michelle

  16. Thank you for this!

    Two years ago I subscribed to Jillian Michaels’ online exercise program. My weight was in a normal range, yet I wanted to improve strength. I was, at that time, 54 years old, post menopause and hysterectomy. I never had heard about pelvic floor issues at the time. The online program was full of what I later learned were inappropriate abdominal exercises, as well as similar exercises as you described above. One day, during the exercise program, I felt severe pain in my pelvic region, and later followed up with my gynecologist and a urologist who promotes pelvic floor safe exercises. I quit the Jillian Michaels program and have modified my own exercise program accordingly, looking to your website often for advice. I am fine, and have never experienced that pain since. For me, it was an excellent learning experience, yet I worry about other women who may not be so lucky.

    I followed up with the Jillian Michaels’ program, explaining why I quit the program, and asking them to consider safe pelvic floor exercises as part of their program. I never heard back from them.

    • Michelle Kenway says

      Hi Diane
      What a shame you had to go through this awful learning experience when you were well intentioned just trying to strengthen and stay well, it is so easy to see why some women just give up. Diane I’m not familiar with the Jillian Michaels exercise program, where is it based do you know? Is it marketed at women? Is there any pelvic floor screening before commencing?

      Thanks so much for sharing your story, it will undoubtedly help other women.
      Best wishes
      Michelle

      • Michelle,
        Thank you for your reply. Jillian Michaels is one of the trainers on the Biggest Loser. She has a big following in the US. What was most disappointing in my situation was the lack of response from her team when I explained why I quit the program. I realize there are probably thousands of subscribers to her online program, but if I remember correctly, there were lots of “we want to hear from you” type messages when I was paying for my subscription.
        Diane

        • Also, no pelvic screening before commencing the program which is why I specifically communicated with them asking them to consider pelvic floor safe exercises.

        • Michelle Kenway says

          Hi Diane

          So let me get this straight – you have The Biggest Loser TV show in the US too? You have the same type of high impact, heavy lifting, intense core strength exercises being given to overweight women that I mention in this article? And you have the Jillian Michaels program as a spin off?

          We too have the Michelle Bridges spin off (she’s one of the personal trainers on the show). I’d love to know what her ’12 week challenge’ involves that you can sign up for and whether there’s any pelvic floor safe exercise screening before participating.

          Thanks so much for filling us in on what’s happening there. Maybe you can tell us what we have to look forward to in terms of pelvic floor safe exercise next season! :)

          • From what I understand, the US Biggest Loser was the original, and it looks like Michelle Bridges is the Jillian Michaels counterpart. I’d bet Michelle Bridges’ online program is very much like Jillian Michaels’.

            Unfortunately, these are not the only TV programs in the US that promote unsafe exercises, for women and men. We have a couple of daytime shows, “Dr. OZ”, and “The Doctors”, which have physicians hosting the shows, and invariably will have a guest trainer demonstrating “kick your butt” type high impact and intense core exercises, etc to “encourage” viewers to get in shape, with no warning of pelvic floor safety. They seem more interested in the “Biggest Loser” sort of hype, than using their programs as an opportunity to really educate people on such issues.

            Thank you for your voice! You are reaching many women.

  17. Allison Bryant says

    Well done Michelle.
    It is always great to have excellent resources to refer these women to, especially since you give them great alternatives for advanced, challenging exercises in a safe way.
    Love your work!
    Allison

  18. Love this article. Having lifted weights for years along with high impact cardio routines – imagine my surprise when I found myself up for major pelvic floor surgery and 8 weeks off work! I couldn’t believe that I’d been so totally kept in the dark about the heinous damage these activities caused to my pelvic floor. I’ve been terrified to exercise since the operation and have piled on 8 kilos. I’m only now addressing the weight problem but am proceeding with extreme caution. I also watch TBL and fear for those mothers’ pelvic floors! They’re all in my age group and I can’t help but think what a lost opportunity to promote pelvic floor health via a program like TBL. They should get you on there Michelle – I think ratings would boom. Every woman in the land would be glued as it applies to all of us. One of the most powerful things I read (and it may have been on Michelle’s site) – was that the majority of women end up in nursing homes, not because of dementia – but because of incontinence. I also find it positively scary that incontinence is being ‘normalised’ as other women on this site have noticed. No doubt this will keep the profits rolling in for the manufacturers but at a high price for the average woman.

    • Michelle Kenway says

      Hi Barbara
      Yes isn’t it just a lost opportunity to promote safe approriate exercise for women! Yes incontinence is the biggest reason for admission to nursing homes in Australians, isn’t that a wake up call. Thanks so much for sharing your personal experience with this issue Barbara, makes your words and insights very meaningful to all of us.
      Best wishes
      Michelle

  19. Stephanie Taylor says

    Bravo Michelle great blog.

  20. Briony O'Connor says

    Hi Michelle,
    Well written. I have recently started back at some high intensity boxing fitness group sessions with a lovely PT. Have been longing for a high energy class for my own psychological wellbeing. At least 50% of the group are school Mums as it is held to suit school pick up. I am absolutely loving getting the chance to work hard but I cringe at a few of the exercise prescriptions. I had actually mentioned to the girl at my first class that although I don’t have any pelvic floor issues I have had 3 vaginal births so wanted to be respectful of that history. At my 3rd class a different instructor prescribed planks with legs extended 30cm above the ground holds and then performing double leg raising and lowering. I was the only one doing my own modifications and had to use all my strength not to say something as I saw all of the Mums in the group bulging their abdominals and arching their backs, holding their breath. It concerns me that the exercises weren’t modified when there was very obvious poor technique and that some of the exercises were prescribed at all with the class participants background. I didn’t really want to rock the boat when I had just started there and I was loving the majority of the class. I hope to gradually add in some suggestions as I get to know the team but for now allow myself to take off my physio hat for 45min just for me. I have posted a link on my fb page so hopefully will get a lot of my ladies reading your wise words. Thanks. Briony http://www.beinblossom.com.au

    • Michelle Kenway says

      Thanks Briony, I hear you on the group exercise and taking your physio hat off… During holidays I go to a gym with other female family members,and I always feel a little self conscious modifying the intense abs. and wide leg deep squat pump exercises. The classes are filled with mature women and while everyone does eye watering core abs, I feel as though I need to try to somehow remain inconspicuous in modifying these exercises. I think your comments highlight the expectations we often feel in group exercise to fit in regardless – as physios we know and see the consequences of inappropriate exercises prevention is at the forefront of our thinking so where does this leave women generally who perhaps notice pelvic floor symptoms – still compelled to perform regardless or just avoid altogether? I think that one solution is to offer women various exercise alternatives or levels of exercise intensity, and encourage everyone to exercise at their own level of comfort.
      Thanks again for your comments Briony and best of luck on your quest

  21. Cath Willis says

    Thanks Michelle for voicing what so many of us are thinking. It’s so hard to educate patients and keep them motivated with PF Safe exercises when they are being influenced by what they see on national tv, but I truly believe in the “ripple effect”: if we can consistently circulate and celebrate the results of appropriate exercise for women and girls of all ages, we will prevail! Anyone else feel a march coming on?
    Cath

    • Michelle Kenway says

      I’m there Cath!
      Yes agreed it makes it very difficult to educate patients and maintain motivation when they see extreme exercises on TV getting extreme results. Unfortunately we see too many women downstream when things have already gone wrong. Very difficult to get a preventative message out there that appeals to the media.

  22. Sue Croft says

    Wonderful blog Michelle. Your son doing early training to be a switched on Urogynaecologist!! Everyone else has said all the rest
    Sue x

    • Michelle Kenway says

      Sue if my son becomes a switched on Urogynae my life’s work is complete!

  23. Marietta Mehanni says

    Hi Michelle,
    This comment is short and sweet – YAHHHH. I was so happy when I read your article, well thought out, informative and accurate. So happy that you did speak out and not be intimidated by the reverence that the fitness industry seems to have in all things media. I was high fiving everyone in my vicinity at your courage and wisdom in writing this.
    With gratitude
    Marietta

    • Michelle Kenway says

      Hi Marietta
      In all honesty they should have a trainer like you on the show to advise them on PT and apropriate exercises for women. You are doing amazing work in training PT’s across Australia in pelvic floor safe exercise for women and we all thank you for your commitment, energy and devotion to helping women exercise safely, and to training instructors on behalf of the Continence Foundation of Australia in how to deliver pelvic floor safe exercise programs.
      Keep up your great work Marietta
      Michelle

  24. as a Pt I am against group training with various ages in a group of 4 or more.
    Everyone is different therefore different exercises need to be prescribed rather than a one exercise fits all training g. These shows are purely for ratings rather than than the long term care of the client.

    • Michelle Kenway says

      Hi Kerry
      Agreed, group exercise is so challenging, especially when dealing with really diverse groups (men, women & kids). Yes sadly you are right it’s a ratings game for sure, at what expense.
      Many thanks
      Michelle

  25. Anna Reid says

    Hi Michelle,
    What great awareness you are sharing with people. I am currently studying to be a Personal Trainer, and am wanting to provide a safe and effective environment for my future clients. Your article has definitely made me think about the effects of high impact exercises and heavy lifting for women. I look forward to sifting through your website! Thank you

    • Michelle Kenway says

      Hi Anna
      Thanks so much for your comment – maybe visit the Pelvic Floor First website too, they have online training for PT’s and this would be great information for you to know and a wonderful service for you to offer your clients who will love you for it in the future!
      Cheers
      Michelle

  26. Well written and yet another question that should be put to the TV trainers.
    Of course, not all trainers should be tainted by the unpressional actions of these pseudo celebrity trainers.
    Sadly, in TV world a charismatic personality and a chiselled body does not mean your a good trainer with ongoing education credits and an interest in physiological improvements in their clients training. Long sentence, sorry but I feel a major rant erupting. As a trainer myself since 1997 I continuously feel disheartened by what I see on TV. I do remind myself that it is of course no more than entertainment… Unless you’re a participant.
    Real world and successful trainers listen to their clients, training objectively towards goals and more than anything ‘do no harm’.
    It would be great to see a proper trainer on one of these shows who demonstrate good instruction. :-/

    • Michelle Kenway says

      Hi Jamie
      So great to hear from you and to put this message across – yes I too see real world trainers listening to their clients, and I am blown away by the support, interest and knowledge of those trainers I have met at the pelvic floor safe exercise courses and forums we have run with the CFA at various gyms and venues throughout QLD.

      Yes the show is about entertainment on one level. As a health professional I feel an ethical and moral obligation to speak out when there is a forseeable risk of injury. If no one ever says anything, where will the impetus for change come from?

      Keep up yur great work with your clients Jamie!

  27. Lara Eardley says

    Another great article Michelle.
    Although… I do think women can lift heavy objects, cart a boat up the beach and lift hay bales. IF… they have the right education…. IF… they lift and contract their pelvic floor muscles as they lift. I think this is getting stronger in two places, internally and externally.
    About main stream television, I’m constantly flabbergasted by the billion dollar pad making companies efforts to glamorize incontinence and encourage the population to accept it as a natural part of ageing aren’t you? What do we know? That a pad now is a diaper later and what an un-dignified way to age.
    It’s so nice to have an intelligent Ally out there, your such a graceful teacher.
    The problem is.. that we are pioneering a new revolution in internal fitness and it’s not that they “the biggest loser fitness instructors” are trying to do harm it’s just that they aren’t yet up to speed with the internal muscles. For so long it’s always been about the external body and it takes time for us to change the psyche of the population. Slowly but surely, faster if we can, we shall get their attention and educate them about how to be fit where it really counts.
    I just published my first DVD Pelvic Floor Strength Vol 1 outlining 4 internal moves and I have two more to produce which will expound the 20 internal moves I have developed that are performed in the privacy of the body, with no external movement. Let’s get them breaking out in a sweat without their external body moving an burning calories that way?
    Love you book, love your work, look forward to meeting you, I feel we are kindred. Respectfully Lara Eardley. http://www.pelvicfloorstrength.com.au

  28. Lori Forner says

    Excellent Michelle! So glad someone addressed this and as well as you have! Just so sad that the women are probably not aware of the pelvic health compromise and reality TV may put even more women at risk! One day more people will hear us!! Keep up the great work!!

    • Michelle Kenway says

      Yes I agree Lori, it’s such a shame for these women who are potentially being placed at risk for the sake of ratings and the advertising dollar, the more sensational the exercise (i.e. pulling a semitrailer, running with a tyre) the more people will watch and the more money made) so who’s the biggest loser and who’s the real winner?

  29. Thanks Michelle for having the courage to have a really good go at this subject.
    Please may I re- post this ,email it and print / laminate it for the waiting room in our practise ? Wouldn’t it be nice to get it through to MORE personal trainers!!

    • Michelle Kenway says

      Hi Vanea
      Yes of course, I will send you a pdf if you like and thanks for your comment! There are so many great Personal Trainers out there that are individualising exercise programs, it’s such a shame that they are profiled in this manner on TV!

  30. Dianne Edmonds says

    Well done Michelle for putting it in writing. I don’t watch the show, but have done plenty of cringing over the years. So glad you help to lead the way in the next generation of change and awareness! Dianne

    • Michelle Kenway says

      Well thankfully we have elite personal trainers like you out there helping women to love exercise and not feel afraid of injury, thank you Dianne!

  31. Love it slash pretty sad that your teenage son could recognise prolapse indicators over the trainers on TBL

    • Michelle Kenway says

      Hi Mish
      Yes it’s a worry although admittedly my teenage son probably has a little more awareness about prolapse issues in women than most boys his age – I hope that this is a good thing :)
      Michelle

  32. Marg Nugent says

    Thanks for a wonderful article Michelle, lets hope those who read this will realise the importance of safe exercise habits, so important for women but also for men, perhaps your readers could get the menfolk to take a peek at this too. I no longer watch TBL as, like you, I am afraid for the contestants. Keep sharing your expert advice and knowledge it is so appreciated. Cheers Marg.

    • Michelle Kenway says

      Thanks Marg, you are spot on this is an issue for men to be aware of as well, especially male trainers
      Cheers
      Michelle

  33. Britton Weber says

    All through my 20’s I did high impact aerobics. When I had childen in my 30’s my pelvic floor prolapsed and I had a hysterectomy at age 39. I was not told at the time about safe exercises and went back to the high impact aerobics and weights.
    Now I’m 56 and my vaginal wall has prolapsed and I suffer with incontinence. I thought pilates and yoga would help strengthen the pelvic floor. But I’ve been doing all the harmful exercises. I ran across your website today and was so surprised that there was so much information. I have ordered your book and DVD. I also plan to share this info with my daughter. Thank you!

    • Michelle Kenway says

      Hi Britton
      Thanks for your comment! It’s a shame that no one really knew about pelvic floor safe exercises in years gone by – I think that out ability to see what happens to the pelvic floor during exercises using real time ultrasound has been a big leap forward for us in terms of our understanding. It’s good that you are developing an understanding to help you exercise for many years to come.
      Hope all goes well for you
      Michelle

  34. Hi Michelle
    Tell you what this is a light bulb article. Every time I watch TBL I cringe and cross my legs thinking there is no way I could do that and now I know why.

    I wish you were on the show looking after the mothers in the group, I think you could give those puffed up trainers a run for their money.
    Thanks
    Pauline

    • Michelle Kenway says

      I cringe with you Pauline! Thank you

      • is jumping rope okay?

        • Michelle Kenway says

          Hi Nico
          Jumping rope is a high impact exercise and not considered pelvic floor afe because of the impact placed on the pelvic floor when landing – this is an exercise to leave out of a pelvic floor safe exercise program.
          Cheers
          Michelle

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