Sacrocolpopexy favorably affected physical activity one year after surgery. One-third of the women in this study reported a higher level of exercise one year after surgical treatment of pelvic organ prolapse. Presumably, these women increased their exercise level in response to a reduced prolapse-related symptoms and activity interference. Given the physical, mental, and psychological health burden of a sedentary lifestyle8, 9
, we believe this to be an important outcome of surgery for severe prolapse.
Although we observed a shift from women reporting no exercise/mild exercise to moderate/strenuous exercise following surgery, in this study, we were unable to determine if women were exercising sufficiently for maximum health benefits. The Healthy People 2010 objectives for physical activity in adults indicate that moderate or vigorous (at 70% of maximum heart rate) physical activity for at least 30 minutes should be encouraged as part of a daily routine.10
Recreational activities, yardwork/housework, and employment are of course important and have great potential to impact quality of life, but resuming these activities may not have the same health impact as exercise. For example, in a large study of men and women 70–79 years old, those who participated in 20–30 minutes of moderately intense exercise on most days of the week had better physical function than those who were active throughout the day or who were inactive.11
To discern the full health benefits of exercise, physicians should query the patient regarding exercise frequency. Likewise, patients should be advised by their physician or another health care professional with expertise in exercise prescription (physical therapist or athletic trainer) on how to gradually and safely implement their exercise program and on how to monitor their physiological responses to exercise.
While most women in this study reported less interference from prolapse after surgery, some had ongoing or new interference from prolapse or its treatment one year after surgery. Of these, about half did not report interference at baseline. At one year follow-up, women who reported “substantial” interference were not more likely to have symptoms of stress incontinence or recurrent prolapse at one year, or to have required interval treatment of stress incontinence, than women that did not report substantial interference at follow-up. Thus, it does not appear that interference reported by these participants after surgery is related to prolapse or incontinence symptoms.
One year after surgery, a common reason cited for interference with physical activity was physician advice (“my doctor advised me not to do these activities”). We believe that such advice is based on expert opinion rather than scientific evidence, as there is currently insufficient scientific evidence to suggest an adverse effect of physical activity one year after surgery for prolapse. Indeed, in one study, many activities commonly restricted following surgery for pelvic floor disorders did not increase intra-abdominal pressure more than simply rising from a chair.12
Women also cited a fear of prolapse recurrence as a reason for interference with activities at one year (“I’m afraid my condition will recur if I do them”). Given the known health benefits of regular physical exercise, it is not clear whether the potential risks of recurrence outweigh the benefits of physical activity in this setting. This is an important area for future research. In the meantime, patients who desire to gain an increase in physical activity or exercise level but are fearful to do so might benefit from referral to a physical therapist for exercise instruction.
A limitation of this research is that treatment protocols and patient instructions were not standardized across surgeons. Thus, variations in physician advice regarding physical activities could affect our results. Also, activities were self-reported by the participants and some under- or overestimation of physical activities might have occurred. The instrument we used to measure recreational activity was validated in a group of educated white collar workers and may be less reliable in our population. In addition, we did not have a non-intervention (control) group and it is conceivable that without intervention, physical activity would have declined further in this population. Therefore our findings may underestimate the impact of surgery on physical activity in women with symptomatic prolapse. An additional limitation of this work is that some subgroups were small (for example, the number of women with new onset of substantial interference with activities), and statistical inferences drawn may be incorrect. Finally, our results may be specific to the surgical intervention studied in this research (sacrocolpopexy with or without Burch urethropexy) and may not be generalizable to other surgeries or to nonsurgical treatment of prolapse.
In conclusion, one year after abdominal sacrocolpopexy, women are more likely to increase exercise intensity and far less likely to report perceived interference with physical activity due to prolapse or its treatment. Most women do not restrict activities one year later but of the minority that do, many report that they are following physicians’ advice.