Effects of an 8-Week Abdominal Hypopressive Technique Program on Pelvic Floor Muscle Contractility: An Assessor-Blinded Randomized Controlled Trial

Abstract

Background: Pelvic floor muscle (PFM) dysfunctions, such as urinary incontinence (UI), significantly impact women’s quality of life. The abdominal hypopressive technique (AHT), a breathing and posture-based intervention, has emerged as a promising approach to improve PFM function. Despite growing evidence on its efficacy, limited research explores its effect on PFM contractility. Objective: This study aimed to evaluate the effects of an 8-week AHT program on pelvic floor muscle (PFM) strength in adult women with no prior experience with AHT. Methods: A randomized controlled trial was conducted with 42 females (mean age 43 ± 9 years) assigned to an experimental group (EG, n = 21) or a control group (CG, n = 21). The EG completed 24 AHT sessions (30 min/session, 3 sessions/week) over 8 weeks. PFM strength, measured via maximum voluntary contraction (MVC), was assessed pre- and post-intervention using the Phenix Biofeedback Kit. Secondary outcomes included load absorption and muscle efficiency. Muscle efficiency and load absorption were also registered. Results: After the 8-week intervention, significant improvements were observed in the EG for maximal voluntary contraction (MVC1 (from 672.2 ± 344.1 g/cm² to 890.3 ± 435.8 g/cm², p = 0.002) and load absorption (from 83.9 ± 36.8 to 103.1 ± 37.3, p = 0.001), with no significant changes in the CG. Between-group differences for MVC1 (p = 0.001), MVC2 (p = 0.016), and load absorption (p = 0.008) were statistically significant. High adherence (96%) and no adverse events were recorded. Conclusions: An 8-week AHT program significantly improved PFM strength, load absorption, and muscle efficiency in women from the present study comparing with the CG. AHT could be considered a safe, non-invasive, and effective intervention for pelvic floor rehabilitation, with potential benefits for addressing UI and enhancing pelvic floor functionality. Future research should focus on long-term outcomes and comparisons with alternative therapies.

1. Introduction

Pelvic floor muscle (PFM) dysfunctions, such as urinary incontinence (UI), significantly impact women’s quality of life, affecting physical, emotional, and social well-being [1,2]. The conservative approach consisted of PFM training through voluntary contractions. Nevertheless, breathing and abdominal-based programs have gained popularity among pelvic floor therapists for the treatment and prevention of PFM dysfunctions. Among these programs, abdominal hypopressive technique (AHT) has emerged as a promising technique [3]. Initially, AHT was conceptualized to reduce intra-abdominal pressure through specific breathing maneuvers and well-defined postures to improve PFM basal tone [4]. AHT applications have expanded to address a broader spectrum of pelvic floor disorders such as pelvic organ prolapse [5] and urinary incontinence [3].

However, the current literature on clinical and non-clinical trials using similar training or rehabilitation techniques remains scattered and lacks a systematic review of their effectiveness. Previous studies have examined alternative methods, such as Kegel exercises, biofeedback training, and functional electrical stimulation in order to improve PFM functionality [6,7]. These approaches have been compared to AHT, but there is still no consensus regarding their relative effectiveness, particularly in terms of muscle contractility and endurance. Moreover, fewer studies have examined its direct impact on muscle contractility, load absorption, and muscle efficiency [7]. Additionally, the neurophysiological mechanisms underlying AHT’s effects on neuromuscular coordination and muscle endurance remain poorly understood.

AHT influences PFM activation through a combination of specific postures and diaphragmatic breathing. During AHT, a full exhalation is followed by apnea with ribcage expansion, triggering a reflex contraction of the deep core muscles, including the transversus abdominis and PFMs [8]. This maneuver creates negative intra-abdominal pressure, inducing involuntary diaphragm elevation and co-activation of the PFMs [4]. Additionally, the synchronization between diaphragmatic breathing and PFM activation enhances neuromuscular coordination and muscle efficiency [9]. The integration of postural techniques in AHT also contributes to the activation of tonic muscle fibers (type I), improving endurance, and postural control of the PFMs [10]. Therefore, AHT may enhance PFM function through neurological mechanisms involving reflex activation and synergistic coordination with the diaphragm and other core stabilizing muscles.

Prior research has substantiated the effects of AHT on PFM, demonstrating improvements following structured interventions [6,7]. Several studies found activation of transversus abdominis, internal oblique, and PFM in healthy female participants, as well as those with PFM disorders [11,12]. It has been postulated that the specific hypopressive breathing maneuver, also known as abdominal vacuum, in combination with postural adjustments, might contribute to muscle activation of abdominopelvic musculature and fascial mobilization [13,14]. However, literature exploring the impact of AHT on PFM contractility remains scarce.

To provide a more comprehensive understanding of the field, it is important to discuss different maneuvers used in related studies and how they compare them to those implemented in our research. For instance, studies such as Resende et al. [5] have examined the combination of AHT with other interventions, whereas Vieira et al. [15] have assessed the differences between training modalities, including active and passive muscle stimulation. These studies highlight the need to consider multiple training parameters, such as duration, frequency, and intensity, to optimize results. Our study aims to contribute to this growing body of evidence by focusing specifically on PFM strength improvements resulting from a systematic AHT program.

The functionality of the pelvic floor is critically dependent on both muscle tone and strength, each contributing uniquely to overall urogenital health [15]. Muscle tone refers to the continuous and involuntary contraction of the muscles, which is essential for maintaining posture and ensuring the stability of pelvic organs. Conversely, muscle strength pertains to the active capacity of the muscles to overcome a resistance during voluntary contractions, playing a pivotal role in activities requiring increased intra-abdominal pressure, such as coughing, lifting, jumping, and athletic endeavors [16]. Enhancing PFM strength has been shown to effectively improve pelvic floor dysfunctions, particularly UI. A systematic review by Alouini et al. [17] demonstrated that PFM training, both with and without adjuncts like biofeedback or electrostimulation, significantly reduced UI symptoms and enhanced PFM contraction in non-pregnant women. Specifically, 62% of participants experienced a notable reduction or complete resolution of UI, accompanied by improved PFM strength. These findings underscore the critical role of targeted muscle strengthening in restoring pelvic floor functionality and alleviating associated dysfunctions.

At the same time, load absorption and muscle efficiency are key parameters in assessing pelvic floor muscle (PFM) functionality. Load absorption refers to the pelvic floor’s ability to withstand and distribute intra-abdominal pressure changes effectively, preventing excessive strain on the musculature and surrounding structures. This is particularly relevant during activities that increase intra-abdominal pressure, as mentioned above (coughing, lifting, or physical exertion) [3]. Muscle efficiency, on the other hand, represents the ability of the PFMs to generate force with minimal energy expenditure, ensuring sustained contraction without early fatigue [3]. AHT is proposed to enhance these parameters through a combination of diaphragmatic aspiration, postural adjustments, and deep core muscle activation. The vacuum effect created by AHT induces reflexive co-activation of the transverse abdominis and PFMs, which may improve load absorption by optimizing the pressure distribution within the abdominopelvic cavity [4]. Additionally, repeated exposure to AHT postures and breathing patterns may enhance neuromuscular coordination and proprioception, leading to greater muscle efficiency over time. Studies have suggested that integrating hypopressive exercises (HE) into rehabilitation protocols can improve endurance and responsiveness of the PFMs, reducing functional impairments such as stress urinary incontinence and pelvic organ prolapse [5,7].

For all women, it is essential to have the pelvic floor and abdominal muscles in good condition to have maximum functionality. This situation is particularly interesting for female athletes. In the context of athletic performance, optimal pelvic floor muscle function is indispensable [18]. Adequate muscle tone provides the necessary support to pelvic organs, preventing conditions like urinary incontinence during high-impact activities [19]. Simultaneously, robust muscle strength enhances core stability and facilitates efficient force transmission between the upper and lower body, thereby improving coordination and power output [20]. Strength, complementary to tone, offers a dynamic perspective of muscular capacity, measured during maximum voluntary isometric contraction (MVIC) held over a defined duration. This approach facilitates a comprehensive understanding of the intervention’s impact on both peak and sustained force generation [21].

Distinguishing between tone and strength is crucial, as imbalances can lead to dysfunction. Hypertonicity, or excessive muscle tone, may result in pelvic pain and impede muscle relaxation [22], while hypotonicity can compromise support and continence mechanisms [23]. Therefore, interventions like AHT that aim to modulate both tone and strength are of significant interest for enhancing pelvic floor functionality and, by extension, athletic performance.

Understanding the interplay of alternative exercise programs as a resource to improve PFM strength is essential for developing effective training and rehabilitation programs tailored to the overall improvement of pelvic floor functionality.

Therefore, this study’s primary aim is to assess the potential efficacy of AHT to improve PFM strength over a training period of 8 weeks in a group of female naïve practitioners. We hypothesize that a structured training program based in AHT will improve PFM strength.

2. Materials and Methods

2.1. Study Design

A randomized parallel 1:1 controlled trial was conducted following the CONSORT guidelines to evaluate the impact of a structured eight-week AHT program on PFM strength in adult females with no previous experience with AHT. Women with no prior experience in HE were selected to ensure that their pelvic floor muscles had not been previously strengthened by this type of training, which could have diluted the effects of the intervention. Additionally, it was required that participants were not engaged in regular physical exercise to avoid potential confounding factors related to overall fitness levels. Participants were recruited from two cultural centers in the metropolitan area of Madrid, Spain. Participants were randomly assigned to one of the groups: The experimental group (EG), which performed the AHT intervention, while the control group 2 (CG) did not perform any additional program. Assessments were conducted at baseline and post-intervention. The study design allowed for comparing PFM contractility changes within and between groups.

2.2. Participants and Recruitment

The trial’s minimum sample size was determined using Stata (version 10.0, StataCorp, College Station, TX, USA). The calculation was based on a 20% increase in the normal pelvic tone (225 g/cm²), which was the trial’s primary endpoint. Power was set at 80% (β = 0.20), and the alpha level at 0.05. The estimated required sample size was n = 16 participants per group; this was then increased by 30% to account for non-response and lost to follow-up (21 per group). A non-probabilistic convenience sampling method was used. Participants were recruited on a voluntary basis from the local community through announcements, informational sessions and direct invitation. Inclusion criteria were females between 20 and 65 years of age; not engaging in regular exercise or sports (≤3 sessions per week); and not having any medical contraindications for hypopressive exercises (i.e., hypertension or pregnancy). Exclusion criteria included acute or recent pathological conditions, virginity, pregnancy, planning to get pregnant during the study period, or being in the postpartum period within the previous two months. Participants who met inclusion criteria were randomized using the Excel function ‘RAND()’, stratified by ‘age ≤ 40 years’ of age and ‘age > 40 years’.

2.3. Intervention

The intervention program consisted of AHT sessions performed three times a week on alternative days, over 8 weeks (a total of 24 group sessions), each lasting 30 min. The program involved progressive AHT postures incorporating different arm positions, diaphragmatic breathing and postural adjustments (axial elongation, ribcage expansion). Each session began with postures in standing position, followed by kneeling positions, quadruped, sitting, and lying positions. Once completed, the exercises were repeated in reverse order starting in supine position and finishing in standing position. For the study, all postures were repeated three times and apnea was maintained an average of 30 s. The first week was lighter, just learning the exercises. The intervention focused on optimizing body alignment and diaphragmatic aspiration through vacuum techniques. During the intervention weeks, the complexity and intensity of the exercises increased progressively, starting with static postures lying on the back, followed by static postures in a seated and standing position, and concluding with dynamic postures that required coordinating breathing with movement. The time in apnea started at 15 s and was increasing progressively till 30 s.

Table 1. Details of the exercise intervention.

Key Points	Technique	Positions
Posture	Feet parallel Self-elongation Variations of gravity center Shoulder de-coaptation and internal rotation	1—On feet 2—“Sumo” 3—Genuflection 4—Quadruped 5—Mahometan 6—Seated 7—Supine
Ventilation	Inspiration Expiration Apnea Costal opening

shows the details of the training protocol. A complete explanation of the exercises performed can be found as Supplementary File.

2.4. Procedure

All pelvic assessments were performed in a standardized supine position with 90° flexion at hips and knees and slight abduction of the hips with the Phenix device properly positioned to ensure reliable measurements and reproducibility. The dynamometer was introduced closed and subsequently opened to a predefined angle to facilitate accurate data collection. A single experienced physiotherapist performed all assessments to minimize inter-rater variability. The physiotherapist was blinded to the group assigned to reduce risk of bias. Baseline and post-intervention evaluations were completed for both periods, and measurements were blinded to group allocation.

2.5. Outcome Measures

The primary outcome was PFM strength, measured by the maximum voluntary contraction (MVC) in two different attempts (MVC1-MVC2), assessed using the Phenix Biofeedback Kit (Vivaltis, Montpellier, France), a reliable tool for quantifying PFM metrics, providing high precision and reliability for quantifying voluntary muscle contraction, with a precision of 1 g. This device measures force output during isometric contractions via a vaginal dynamometer and has been used in other studies [24]. Participants performed two MVCs, each sustained for 10 s against the dynamometer’s probes with a 20 s rest between attempts. Measured parameters included load absorption, maximum force (MVC1-MVC2), muscle efficiency (ME), and closure capacity (CC). A pelvic floor therapist with more than 20 years of experience evaluated all participants before and after the intervention.

2.6. Data Analysis

An “a priori” sample size was calculated with an 80% power and an alpha error of 0.05 to detect a 20% minimum difference in PFM tone and strength between groups. The estimated required sample size was n = 16 participants per group; this was then increased by 30% to account for non-response and lost to follow-up (total, n = 42). Data normality was verified using the Shapiro–Wilk test before using parametric tests. Between-group differences in the change pre-post in load absorption, ME 1 and 2, MVC1, and MVC2 were analyzed using independent t-tests, while paired t-tests assessed within-group changes were performed (Bonferroni correction was applied). Results are expressed as means, standard deviations, and ranges. Statistical significance was initially set at p < 0.05, and then to 0.015 to correct for multiple hypotheses. Analyses were performed using Stata v.18.0 (StataCorp LLC, College Station, TX, USA).

2.7. Ethical Considerations

The study adhered to the ethical principles outlined in the Declaration of Helsinki (2008), and written informed consent was obtained from all participants after being informed of the study’s objectives and procedures. Approval was granted by the Ethics Committee of the Universidad Camilo José Cela, Madrid, Spain, and the study was registered under ClinicalTrials.gov (ID: NCT0221241).

3. Results

Fifty-seven females were initially recruited. After screening, 15 were excluded due to not meeting the inclusion criteria. The remaining 42 were randomized to the study groups (EG = 21; CG = 21) with an average age of 43 years (SD = 9). Although the initial estimated sample size was 32 women, we recruited 42 to counteract dropouts and missing data. Nevertheless, there were no dropouts in any group. No significant differences in baseline PFM strength (p = 0.273) or any other analyzed variables were observed between groups (see

Table 2. Outcome measures at baseline.

Outcome Measure	Experimental Group (n = 21)			Control Group (n = 21)
	m (SD)	Range Min–Max	Med (P25–75)	m (SD)	Range Min–Max	Med (P25–75)
Load Absorption	83.9 (36.8)	43–16	80 (48.5–110.5)	102.6 (56.8)	30–223	81 (50–144)
MVC1 (g/cm2)	672.2 (344.1)	158–1354	689.5 (381–941)	658.1 (340.2)	209–1460	606 (325–894)
MVC2 (g/cm2)	557.0 (327.0)	53–1273	526 (325–807)	523.5 (291.3)	176–1220	454 (281–708)

Abbreviations: m = mean; SD = standard deviation; MVC1 = maximum voluntary contraction first time; MVC2 = maximum voluntary contraction second time. Med: median. P_25–75: 25–75 percentile.

). High adherence to the intervention program was found (96%), and no adverse events or effects were recorded during the intervention.

After two months of the AHT program, PFM strength significantly increased in the EG (from 672.15 ± 344.12 g at baseline to 890.25 ± 435.80 g post-intervention; p = 0.0023) while no differences were found in CG (from 658.16 ± 340.21 g at baseline to 587.15 ± 356.48 g post-intervention; p = 0.1500).

Table 3. Outcome measure results after the intervention.

Outcome Measure	EG (n = 21)			CG (n = 21)
	Pre m (SD)	Post m (SD)	p	Pre m (SD)	Post m (SD)	P
Load Absorption	83.9 (36.8)	103.1 (37.3)	0.001	102.6 (57.8)	99.1 (47.0)	0.595
MVC1 (g/cm2)	672.2 (344.1)	890.3 (435.8)	0.002	658.2 (340.2)	587.2 (356.5)	0.150
MVC2 (g/cm2)	557 (326.9)	739.6 (442.3)	0.086	523.5 (291.2)	516.7 (316.9)	0.860

Abbreviations: m = mean; SD = standard deviation; MVC1 = maximum voluntary contraction first time; MVC2 = maximum voluntary contraction second time; EG = experimental group; CG = control group.

shows the outcome measure results after the intervention.

Table 4. Between-group differences.

Outcome Measure	EG (n = 21) Mean (95% CI)	CG (n = 21) Mean (95% CI)	Group Differences Mean (95% CI)	p	Cohen’s d
Load Absorption	19.2 (8.7, 29.6)	−3.5 (−17.1, 10.1)	−22.7 (−39.1, −6.3)	0.008	−0.93
MVC1 (g/cm2)	218.1 (88.1, 348.1)	−71 (−170.20, 28.2)	−289.1 (−448.4, 129.8)	0.001	−1.2
MVC2 (g/cm2)	182.5 (52.2, 312.8)	−6.8 (−91.6, 77.9)	−89.3 (−341.4, −37.3)	0.016	−0.83
ME 1	134.6 (102.3, 166.8)	131.6 (98.8, 164.4)	−2.9 (−47.4, 41.49)	0.890
ME 2	112.2 (82.2, 142.2)	104.6(76.5, 132.8)	−7.5 (−47.4, 32.3)	0.700

Abbreviations: CI = confidence interval; EG = experimental group; CG = control group; MVC1 = maximum voluntary contraction first time; ME = Muscle efficiency; MVC2 = maximum voluntary contraction second time.

shows statistically significant differences within groups for load absorption and strength measures.

ME and CC also improved significantly in EG (from 2.94 ± 0.39 at baseline to 2.7 ± 0.25 post-intervention; p = 0.0006 for CC and from 83.85 ± 36.77 at baseline to 103.85 ± 37.28 post-intervention: p = 0.0011 for ME).

4. Discussion

The results of this study demonstrate that a structured two-month AHT program significantly improves PFM strength in EG, with robust increases in MVC and related metrics such as ME. These findings align with previous research emphasizing the benefits of AHT in addressing pelvic floor dysfunctions, including urinary incontinence (UI) and diminished PFM tone and/or strength [3,7].

The observed improvements in PFM strength are consistent with the physiological mechanisms proposed for AHT, which combine postural realignment and diaphragmatic breathing to stimulate deep muscle fibers [4]. The perineum should be understood as a muscular group with respiratory function, with its spinal control in the respiratory center. Proprioceptive control allows for a correct perineal block and facilitates a greater understanding of the impact of one’s own forces. At the same time, myotatic reflex plays a key role in the damping capacity, which might be potentiated by a specific breathing.

The mean increases in MVC recorded in this study echo findings from Soriano et al. [7], who reported significant gains in muscle tone following the same AHT intervention. Furthermore, the improvements in ME suggest that AHT not only enhances peak performance but also facilitates sustained functional capacity, which is critical for everyday activities requiring core stability as well as reducing UI. UI remains a significant concern for women’s quality of life, affecting their physical, emotional, and social well-being [1]. The gains in PFM strength found in the present study have direct implications for UI management. Increased muscle strength contributes to better urethral closure during activities that elevate intra-abdominal pressure, such as coughing, sneezing, or exercising. Moreover, higher strength levels and increased thickness of the levator ani muscle can contribute to reducing prolapses and improving the positioning and support of various pelvic organs [25,26]. This study corroborates AHT as a viable alternative or complement to traditional PFMT methods.

The effectiveness of AHT for PFM training has been explored in recent literature, but its relative efficacy compared to conventional PFM training methods, such as Kegel exercises, remains a subject of debate.

A study by Resende et al. [5] compared HE combined with traditional PFM training against PFM training alone in women with pelvic organ prolapse. The results indicated that both groups showed significant improvements in PFM function, as measured by MVC and muscle activation, with no additional benefit observed when HE were added to PFM training. Similarly, Parle et al. [27] found that a six-week hypopressive training program significantly improved PFM strength and reduced pelvic organ prolapse symptoms.

On the other hand, systematic reviews on PFM training, such as Mateus-Vasconcelos et al. [28], indicate that various physiotherapy methods, including biofeedback, vaginal cones, and coactivation of abdominal muscles, show improvements in PFM contraction, but none have been definitively superior to the others. This suggests that HE may offer an alternative, rather than a replacement, to traditional PFM training, particularly for individuals seeking a postural and breathing-based approach.

While our study focused on evaluating the effects of AHT on PFM strength, further research is warranted to directly compare its efficacy to Kegel exercises in terms of long-term functional benefits, such as urinary incontinence prevention and pelvic organ support.

Moreover, several advantages of AHT protocols can be pointed out compared to conventional PFMT. AHT emphasis on reducing intra-abdominal pressure, which may mitigate the risk of hypertonicity, which is a common side effect of repetitive strength training and can impede relaxation and a normal function of the PFM, causing pain and sexual dysfunction, among others [29]. This attribute makes AHT a complementary training option for women with organ prolapse [30] or those seeking a non-invasive rehabilitation option for UI or other pelvic floor dysfunctions [31]. Moreover, the absence of adverse events in this study reinforces the safety profile of AHT, even in community settings.

Previous literature highlighted the efficacy of AHT in improving muscle tone [7], but evidence of its impact on muscle strength has been limited. This study contributes to bridging this gap, confirming that AHT effectively enhances muscle functionality. However, as noted by Ruiz de Viñaspre Hernández [3], long-term studies are needed to evaluate the sustainability of these benefits and to establish standardized maintenance protocols. While our study demonstrates significant improvements in the intervention group, it is important to interpret these findings with caution. Previous research has suggested that expectations and motivation can influence neuromuscular performance [32], particularly in interventions involving voluntary muscle activation and biofeedback. Additionally, the interaction with therapists and the structured nature of the intervention could have reinforced adherence and engagement, further contributing to the observed effects [33]. Future studies should incorporate control conditions that account for placebo responses, such as a sham intervention or a non-exercise placebo group, to better isolate the specific effects of AHT.

Although no formal safety or usability assessment was conducted, it is worth noting that none of the participants reported any adverse effects, discomfort, or difficulties in following the AHT sessions throughout the intervention period. Moreover, the technique requires no equipment and is based on low-intensity breathing and postural exercises, which are generally well-tolerated. These observations suggest that AHT could be considered a potentially safe and accessible option for future implementation in pelvic floor rehabilitation programs.

This study shows that an eight-week AHT program significantly improves PFM strength in healthy, inactive women. While these findings support AHT as a promising training method for pelvic floor muscle enhancement, future research is warranted to confirm its clinical relevance and to formally evaluate its safety and applicability in broader populations.

In conclusion, AHT could be considered an alternative and effective training tool option for improving PFM strength in adult women without contraindications to perform this technique.

Limitations and Future Directions

This study has several limitations. First, the sampling method was non-probabilistic and based on convenience and voluntary participation, which limits the generalizability of the findings to broader populations. The results may not apply to women from different age groups, ethnic backgrounds, or with health conditions not represented in our sample. Furthermore, potential confounding variables—such as hormonal status, baseline physical activity, or individual neuromuscular characteristics—were not controlled and could have influenced the outcomes. Future research should aim to include more diverse and randomly selected samples to enhance external validity and better understand the applicability of AHT in various populations. On the other hand, while the randomized design of this study as well as the assessor and data scientist blinding were a strength, the absence of an active comparator group (e.g., PFMT) limits the generalizability of the findings. Also, we based our sample size estimations on detecting a 20% difference, which may not be considered clinically relevant; however, when we started our study, evidence was not sufficient to base sample size on an even larger effect. Additionally, the absence of follow-up period precludes conclusions about the long-term efficacy of AHT. Long-term studies are needed to evaluate the sustainability of these benefits and to establish standardized maintenance protocols. Another important limitation of this study is the absence of formal data on test-retest reliability or measurement error for the specific model of the Phenix Biofeedback Kit used. While this device is commonly employed in clinical and research settings to assess PFM strength, its psychometric properties have not been systematically established in scientific literature. Consequently, the potential impact of measurement variability cannot be fully ruled out, and future studies are encouraged to evaluate the reliability and validity of this instrument in controlled conditions. Furthermore, the feedback provided by the Phenix device during measurements may facilitate learning how to contract and localize the PFM, which, in itself, could improve MVC independently of the intervention. Future research, both cross sectional and longitudinal, should explore the integration of AHT with other therapeutic modalities, as well as its applicability across diverse populations, including postpartum women and those with specific pelvic floor disorders. Finally, another limitation of this study is the absence of specific data on the measurement error or test-retest reliability of the Phenix Biofeedback Kit model used. Although the device is commonly used in clinical practice and has been applied in previous studies to assess PFM strength, further validation studies are needed to determine its accuracy, reliability, and sensitivity to change.

5. Conclusions

This study provides compelling evidence that a two-month AHT program significantly enhances PFM strength. The observed improvements in pelvic floor muscle strength are consistent with previous research suggesting that enhanced PFM function may contribute to better continence outcomes. Therefore, our findings indirectly may have potential implications for preventing and managing pelvic floor disfunctions through strength-oriented pelvic floor interventions. AHT is a safe, non-invasive intervention that can serve as a valuable tool in pelvic floor rehabilitation. Continued research is essential to optimize its implementation and to compare its outcomes with alternative interventions.

6. Practical Application

Based on current evidence, AHT could be beneficial for women with mild to moderate pelvic floor dysfunctions, including stress urinary incontinence and pelvic organ prolapse, where muscle activation and postural adjustments play a crucial role in symptom management. Additionally, AHT might be useful for postpartum women seeking to restore pelvic floor function while addressing core stability deficits. Furthermore, this technique may be a suitable complement for individuals who experience difficulty performing conventional pelvic floor muscle training (e.g., Kegel exercises) due to poor proprioception or lack of adherence. A familiarization in the right technique as well as contraindications must always be taken into consideration. However, further research is needed to define precise clinical indications and compare AHT’s efficacy with other rehabilitation approaches.