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Odd-Einar Svinøy,1 Gunvor Hilde,1 Astrid Bergland,1 Bjørn Heine Strand2 1Faculty of Health Sciences, Department of Physiotherapy, OsloMet – Oslo Metropolitan University, Oslo, Norway; 2Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, NorwayCorrespondence: Odd-Einar SvinøyFaculty of Health Sciences, Department of Physiotherapy, OsloMet – Oslo Metropolitan University, PO Box 4, St. Olavs Plass, Oslo, 0130, NorwayTel +4798443171Email oddeina@oslomet.noPurpose: The Timed Up and Go (TUG) test is used to assess a person’s mobility and balance. We aimed to provide updated reference values for TUG performance for the community-dwelling older population according to age and sex, and according to the presence of arthritis and non-communicable diseases (NCDs).Participants and Methods: Cross-sectional data from the seventh wave (2015– 2016) of the population-based Norwegian Tromsø Study counting 5400 community-dwelling people (53% women), aged 60– 84 years were used. Reference values were presented as percentiles and means for men and women by age at five-year intervals.Results: Median TUG score was stable during age 60– 65 years, and after age 65 years median TUG score increased significantly with age (increase by 0.14 sec per 1 year higher age in both men and women, p< 0.001). At the youngest ages (< 65 years), in both men and women, there were no differences in TUG performance for those with NCD or arthritis compared to those without these diseases. After age 65 however, those without these diseases performed significantly better (p< 0.05) in both men and women.Conclusion: The present study provided percentile reference values for TUG performance in community-dwelling older adults in Norway by age and sex, and in subgroups of those having arthritis and NCDs. TUG scores increased with age, and performance was significantly poorer among participants with arthritis or NCDs after age 65 years. The findings may guide clinical interventions for individuals with mobility and balance disabilities.Keywords: arthritis, geriatric assessment, non-communicable diseases, physical function, reference values, Timed Up and Go

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Introduction: The present study aimed first to investigate the change in prevalence of major levator ani muscle (LAM) defects, also called avulsions, from 6 weeks to 1 year postpartum, and second to assess maternal and obstetric risk factors for having persistent major LAM defects/avulsions at 1 year postpartum. Material and methods: This is a secondary analysis of data from a prospective cohort study including 300 nulliparous women at 17-19 weeks of gestation. Major LAM defects were diagnosed at 6 weeks and 1 year postpartum using transperineal ultrasonography. We defined persistent major LAM defects as a defect diagnosed both at 6 weeks and 1 year postpartum. Maternal and obstetric data were obtained from the hospital's electronic birth records. Pelvic floor muscle function was measured vaginally by manometer at 21 weeks of gestation. The main outcome measurement was change in prevalence of major LAM defects. Maternal and obstetric risk factors for having persistent major LAM defect were also assessed. Results: Prevalence of major LAM defects was 19.4% at 6 weeks and 10.4% at 1 year postpartum. No new major LAM defects were diagnosed at 1 year postpartum. Persisting major LAM defects were associated with longer second stage of labor (median 74.5 minutes vs median 48.0 minutes, P = .012) and higher neonatal birthweight (mean difference of 232.3 g, 95% confidence interval [CI] 21.5-443.1). Vacuum delivery was independently associated with persistent major LAM defects, adjusted OR 3.0 (95% CI 1.0-9.0). Conclusions: There was a 50% reduction of sonographically diagnosed major LAM defects from 6 weeks to 1 year postpartum. This finding suggests that assessment of the major LAM 6 weeks postpartum may be too early to diagnose defects/avulsions. Long second stage of labor, high neonatal birthweight and vacuum delivery were associated with persistent major LAM defects/avulsions. Funding provided by the South-Eastern Norway Regional Health Authority.

Background: Women with high levels of physical exercise have increased demand for oxygen and nutrients. Thus, in pregnancies of women with high levels of exercise it is conceivable that the supply of oxygen and nutrients to the placenta is sub-optimal, and growth could be impaired. Objective: To study the association of frequency of exercise during pregnancy with placental weight and placental to birthweight ratio. Study design: A prospective study of 80,515 singleton pregnancies in the Norwegian Mother and Child Cohort Study. Frequency of exercise was self-reported by a questionnaire at pregnancy weeks 17 and 30. Information on placental weight and birthweight was obtained by linkage to the Medical Birth Registry of Norway. Results: Placental weight decreased with increasing frequency of exercise (tests for trend, P

Pregnancy and especially vaginal childbirth are risk factors for pelvic floor dysfunctions such as urinary incontinence (UI). The aim of this literature review was to give an overview of how the pelvic floor may be affected by pregnancy and childbirth, and further state the current evidence on pelvic floor muscle training (PFMT) on UI. Connective tissue, peripheral nerves and muscular structures are already during pregnancy subjected to hormonal, anatomical and morphological changes. During vaginal delivery, the above mentioned structures are forcibly stretched and compressed. This may initiate changed tissue properties, which may contribute to altered pelvic floor function and increased risk of UI. Trained pelvic floor muscles (PFM) may counteract the hormonally mediated increased laxity of the pelvic floor and the increased intra-abdominal pressure during pregnancy. Further, a trained PFM may encompass a greater functional reserve so that childbirth does not cause the sufficient loss of muscle function to develop urinary leakage. Additionally, a trained PFM may recover better after childbirth as the appropriate neuromuscular motor patterns have already been learned. Evidence based guidelines recommend that pregnant women having their first child should be offered supervised PFMT, and likewise for women with persistent UI symptoms after delivery (Grade A recommendations). Conclusion: Several observational studies have demonstrated significantly higher PFM strength in continent women than in women having UI, and further that vaginal delivery weakens the PFM. Current evidence based guidelines state that PFMT can prevent and treat UI, and recommend strength training of the PFM during pregnancy and postpartum.

Background: Urinary incontinence (UI) is highly prevalent in the female population and strongly associated with pregnancy and childbirth. The pelvic floor muscles (PFM) play an important role in pelvic organ support and for staying continent. Vaginal delivery is considered the most established risk factor for weakening of the PFM. Women having their first child should be offered supervised PFM training (PFMT) during pregnancy, and PFMT is first-line treatment of UI (Grade A recommendations). However, in populations of postpartum women with and without UI (mixed population), the current evidence on efficacy of PFMT on UI prevalence is not clear. Further, the effect of PFMT in women with major levator ani (LA) muscle defects is unknown. Conclusions: Most nulliparous pregnant women knew about PFMT, but few performed PFMT. Pronounced reductions in vaginal resting pressure, PFM strength and endurance were found after vaginal delivery, whereas only vaginal resting pressure changed after caesarean section. Women with major LA muscle defects had weaker PFM than women without such defects, however most women were able to contract their PFM. The postpartum PFMT intervention did not decrease UI prevalence six months after delivery in primiparous women, and the stratified analysis on women with and without major LA muscle defects showed similar non-significant results.

Introduction and hypothesis: There is limited knowledge on dyspareunia during pregnancy and postpartum and the role of the pelvic floor muscles (PFM) in women with dyspareunia. Aims of the study were to investigate the presence of dyspareunia before and during pregnancy and postpartum, and to compare vaginal resting pressure (VRP), PFM strength, and endurance between women with and those without dyspareunia. It was hypothesized that there is no difference in PFM variables between women with and those without dyspareunia. Methods: Three hundred nulliparous women participated in this prospective cohort and answered questions about dyspareunia and the level of bother at gestational weeks 22 and 37, 6 and 12 months postpartum, and retrospectively prior to their pregnancies using ICIQ-FLUTSsex. PFM variables were assessed by manometer at gestational week 22, and 6 and 12 months postpartum. Comparisons between groups were analyzed using independent samples t test. Results: Twenty-eight and 30 % of the women reported dyspareunia at pre-pregnancy and at gestational week 22 respectively. At gestational week 37, and 6 and 12 months postpartum, the percentages were 40, 45, and 33 respectively. No difference in PFM variables was found between women with and those without dyspareunia. Level of bother was higher postpartum than before and during pregnancy. Conclusions: Symptoms of dyspareunia were common at all time points. No link could be made between PFM function and dyspareunia. Women suffering from dyspareunia postpartum reported it as being bothersome. Our findings suggest that women should be asked about symptoms of dyspareunia related to pregnancy, and that future research should aim for preventative and therapeutic strategies.