Training for  pelvic floor muscles (TPFM) presents level 1 and degree of evidence A for the treatment of urinary incontinence (UI) [1]. Currently, a new therapeutic approach has been used, gametherapy. However, there are still few publications about this new modality for UI treatments [2]. It is important to emphasize that the presence of urinary symptoms can strongly affect patients' quality of life (QoL), causing physical, social, occupational and sexual limitations [3]. Therefore, the objective of this study was to compare the impact of UI on QoL and urinary loss before and after a TPFM by gametherapy in women with mixed urinary incontinence (MUI) .

A single blind clinical trial. Participated in the study 16 women aged 45 to 70 years with diagnosis of MUI. Socio-demographic data, urogynecological, obstetrical and sexual history, as well as physical examination (height and weight) were collected through an evaluation form. Patients were evaluated before and eight weeks later on the impact of UI on QoL the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), on urinary losses through one-hour pad test and the evaluation of the intervention (PGI-I). During the eight weeks the volunteers underwent gametherapy training of the pelvic floor musculature. The training protocol was carried out through the the Nintendo® brand video game called Wii® using the Wii Fit Plus® game, being composed of a warm-up and exercises that involved general pelvic movements, such as retroversion movements, anteversion, lateral-lateral inclination and circumference.The games used were: Lotus Focus, Peguin Slide, Step Basic and HulaHoop. During the training there were progressions, in the first two weeks 2 sets of 8 repetitions were performed for each game and in the third and fourth week were performed 3 sets of 8 repetitions, the rest time between games was 1 minute. The training was conducted on an individual basis and the participants received an educational content throughout the sessions, with information about the location and function of the AP, types of UI, bladder and bowel functioning, as well as guidelines on risk factors. The training lasted 40 minutes.  The descriptive statistics and the paired Student T test were used in the analysis of the data. The analysis of PGI-I was given by percentage.

The mean age of the sample was 54.43 (± 9.96), the majority had more than eight years of schooling (68,8%), had children (100%), had unregulated menstrual cycles (68,7%) and were sexually active (56,3%). There was a statistically significant difference at the end of the intervention in the two analyzed variables: ICIQ-SF (p = 0.000) and one-hour pad test (p = 0.000). Regarding PGI-I, 81.3% of the volunteers reported being "much better or better" at the end of the training.

In the assessment of the impact of UI on QoL, it was observed that after the intervention there was a reduction of 92.36% in ICIQ-SF. The result showed that training with game therapy was able to reduce the ICIQ-SF final score by 7 points. A study [4] evaluated 214 women with SUI, before and after training to strengthen the PFM, and found 2.5 as the minimum clinically relevant difference in the total ICIQ-SF score. After the intervention we noticed that there was a 78.01% decrease in urinary losses. It is important to notice that all the volunteers at the end of the training obtained a final mean of urinary losses of less than 1 g, which according to ICS, is considered as continent. The use of the 1-h pad test proves to be a simple, practical and quick way of measuring urinary loss, and can effectively evaluate the outcome of an intervention [5]. Women treated with any type of training for PFM are more likely to report cure or improvement of symptoms, to report better QoL, to present fewer episodes of urinary loss per day, and less urine loss based on one-hour pad test [6].  This information corroborates the findings of our research.

Statistically significant differences were found in the results of the analyzed variables. Thus, the intervention with gametherapy was effective in improving /curing MUI, as well as improving QoL and urinary losses. Besides the scientific aspect, the result of this study also presents a positive social impact, since the patients with MUI can benefit from the proposed intervention.

Nystrom E, Sjostrom M, Stenlund H SE. ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence. Neurourol Urodyn. 2015;34:747–51.
Dumoulin C, Hay-Smith EJC MH-SG. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women (Review). Cochrane Database Syst Rev. 2014;(5):Art. No.: CD005654.
Goode PS, Burgio KL, Richter HE MA. Incontinence in older woman. JAMA. 2010;303(21):2172–81.