AUGS SPECIAL ISSUE SUBMISSION
Prevalence of Female Urinary Incontinence in Crossfit
Practitioners and Associated Factors: An Internet
Population-Based Survey
Maita Poli de Araújo, MD, PhD,* Luiz Gustavo Oliveira Brito, MD, PhD,† Fabiana Rossi, BSc,*
Maria Luiza Garbiere, BSc,* Maria Eduarda Vilela, BSc,*
Vitor Ferraz Bittencourt, BSc,* for the Cross Continence Brazil Collaboration Group
Objectives: CrossFit comprises a set of high-intensity, high-impact exercises
that includes movements that may increase intra-abdominal pressure and cause
involuntary loss of urine. There is scant literature about the prevalence of uri-
nary incontinence (UI) in female crossfitters, as well as its associated factors.
Downloaded from http://journals.lww.com/jpelvicsurgery by BhDMf5ePHKbH4TTImqenVIU9NkCnp6A3ElbgDYOidZ3hoF/M8Y5XsKxvMOhii8sZ on 02/28/2020
Methods: A population-based Internet survey stored in a website created with
information on the benefits and risks of CrossFit for women’s health (https://
crosscontinencebr.wixsite.com/crosscontinencebr) invited female crossfitters.
In total, 551 women answered an online questionnaire, and the demographic
variables (age, marital status, and parity), anthropometric data (weight, height,
and body mass index), and the presence of UI during exercises were also inves-
tigated. The prevalence of UI and its associated factors were calculated using a
logistic regression model. The significance level was set at 5%.
Results: The overall prevalence of UI during CrossFit exercises was
29.95%, and most women with UI reported loss of urine during at least
one exercise (16.70%). Women with UI were older (33.77 ± 8.03 years)
than those without UI (30.63 ± 6.93 years; P < 0.001). Double under
(20.15%) and single under (7.99%) were the exercises that were most fre-
quently associated with UI and also the only variables that remained in the
final model that caused UI. The duration of CrossFit practice, number of
days per week practicing CrossFit, daily time practice, previous vaginal de-
livery, and mean birth weight were not statistically associated with UI.
Conclusions: One-third of female crossfitters presented with UI during
exercise. Double under was the exercise that was the most associated with UI.
Key Words: urinary incontinence, athletic incontinence,
cross-sectional study, survey, CrossFit
(Female Pelvic Med Reconstr Surg 2020;26: 97–100)
U rinary incontinence (UI) is a prevalent disorder in the female
population. Common risk factors for UI are postmenopausal
status, obesity, and multiparity.1 However, UI can also affect
From the *Universidade Anhembi Morumbi – Laureate International Universi-
ties, Medical Course, Mooca; and †Department of Obstetrics and Gynecology,
School of Medical Sciences, University of Campinas, Campinas, Brazil.
Correspondence: Maita Poli de Araújo, MD, PhD, Universidade Anhembi-
Morumbi, Medical Course, Rua Dr. Almeida Lima, 1134, Mooca, SP
03164-000, Brazil. E-mail: dramaita@gmail.com.
The group included the following colleagues who helped to bridge a research
network in Sport Urogynecology for this study: Jorge M. Haddad, Marair G.F.
Sartori, Marilene V. Monteiro, Marcia S. Geo, Rachel Silviano, Claudia S
Laranjeira, Leonardo R. Bezerra, Jussara M. Nunes, Emerson Oliveira,
Valeria B. Pontes, Cassia R. Juliato, Virginia C. Roncatti, Alexandre B. Sé,
Monique Azevedo, Ana Paula M. Resende, Rogerio de Fraga, Aljerry Rego,
Aparecida M. Pacetta, Daniela S. Prado, Lucas Schreiner, Marcelo Tissiani,
Silvia Carramao, Thuane da Rosa, Thais G. Santos, Lisandra Machado,
Alexandre Fornari, Paulo Szeles, José A. Vasconcelos-Neto, Sandra
Galhardo, Jan WC Sprey, and Camila G Carvalho.
This study was accepted for presentation at the American
Urogynecologic Society/International Urogynecology Association Joint
Meeting held in Nashville, TN; September 24–28, 2019.
The authors have declared they have no conflicts of interests and no sources of funding.
Supplemental digital contents are available for this article. Direct URL citations
appear in the printed text and are provided in the HTML and PDF versions
of this article on the journal’s Web site (www.fpmrs.net).
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/SPV.0000000000000823
Female Pelvic Medicine & Reconstructive Surgery • Volume 26, Number 2, February 2020
Copyright © 2020 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
young athletes, and practitioners of high-impact and high-
performance exercises; when involuntary urine loss occurs only
during this practice, it may be called athletic incontinence (AI).
Athletic incontinence affects long distance runners, basketball
and volleyball players, and aerobatic trampoline practitioners.2
The conditions that contribute to UI have not yet been fully
elucidated. Direct impact to the pelvic floor (especially the levator
ani muscle) and/or hormonal changes are some of the most stud-
ied hypotheses. The direct impact occurs through increased
intra-abdominal pressure during exercises such as weightlifting
and trampolining. However, indirect impact is related to compro-
mise of the blood supply of the muscular fiber (fatigue), mainly in
resistance (running) modalities. In addition, disorders that lead to
hypoestrogenism (menstrual irregularity and eating disorders)
weaken the suspension (fascia and ligaments) and support the
muscle system.3
CrossFit is a program of functional exercises, performed at
high intensity and in the shortest time possible. CrossFit gyms
are present in more than 100 countries across 7 continents with
thousands of members, and they intend to provide a comprehen-
sive and inclusive physical fitness based on measurable, observ-
able, and repeatable results. Exercises are based on gymnastics
movements, weightlifting, running, rowing, and many others.
The intensity is essential for the result, that is, that more work
should be done in a shorter time interval.4 Currently, there are at
least 12 different types of movements registered in CrossFit (air
squat, front squat, overhead squat, shoulder press, push press,
push jerk, deadlift, medicine-ball clean, sumo deadlift high pull,
thruster, wall ball, and pull-up). A recent systematic review has as-
sociated CrossFit practice with higher levels of sense of commu-
nity, satisfaction, and motivation.5 However, high-intensity
sports such as CrossFit can cause some health damage such as ten-
don and ligament injuries, stress fractures, and impact to the pelvic
floor.6,7 A pilot study has shown that intra-abdominal pressure is
highly increased during CrossFit exercises.8 Two systematic re-
views were recently published; however, these did not gather in-
formation on crossfitters,9,10 and only one study on this sport
modality has interviewed 105 US American crossfitters.11 Given
that CrossFit is increasingly being practiced, it is important to have
adequate information to present to women for the prevention and
treatment of UI. With this purpose, we sought to investigate the
prevalence of UI and its associated factors during CrossFit exer-
cises using an Internet-based population survey.
METHODS
Study Design
This was a cross-sectional study performed across all Brazil-
ian regions with female CrossFit practitioners. The institutional re-
view board approved this study (CAAE 74491417.7.1001.5492)
before commencement, and this study followed all steps from
www.fpmrs.net 97
Poli de Araújo et al Female Pelvic Medicine & Reconstructive Surgery • Volume 26, Number 2, February 2020

the STROBE protocol. Women were invited to participate through precision and a 5% α level, a minimal sample size of 323 CrossFit
social media platforms, and they were forwarded to a specific athletes was determined necessary to complete this study.
website that contained information on UI and prevention methods Continuous variables were expressed by mean and SD or
as well as the online questionnaire with multiple-choice questions median/range, whereas categorical variables were described as
(https://crosscontinencebr.wixsite.com/crosscontinencebr). The percentages. The unpaired Student t test was performed for con-
questionnaires were available from November 2017 to August tinuous variables and the χ2 test for binomial variables. Bivariate
2018. The concept for this study came from the Cross Continence analysis was expressed as odds ratio with lower and upper limits
Brazil Collaboration Group, which was created to provide assis- within a 95% confidence interval. CrossFit modalities were trans-
tance and treatment to female athletes with UI. formed into dummy variables to seek an association with UI. Mul-
tivariate analysis was calculated by logistic regression with all
Inclusion/Exclusion Criteria independent variables whose P values were less 0.10 in the final
Women older than 16 years who practiced CrossFit in the of- model, and the significance level was set at 5%. A statistical
ficial academies accredited on the website: www.crossfit.com package was used for further analysis (Intercooled Stata 13.0;
were eligible to take part in the study. After reading the informed StataCorp, College Station, Texas). Missing data were not
consent, if they agreed to participate, they were transferred to a treated with imputation methods.
link containing the main questionnaire where they could select
their CrossFit center and fill out a sociodemographic questionnaire.
Women between 16 and 18 years of age presented an informed con-
RESULTS
sent form to their parent or guardian to obtain consent before their A total of 551 women answered the questionnaire, and all
participation. The reason for including a percentage of adolescents Brazilian regions participated, with the majority coming from
in this survey is that CrossFit also has adolescents as practitioners, the Southeast (44.83%), followed by the Midwest (23.05%). The
and we do not have information whether this age zone may present mean age of participants was 31.75 ± 7.41 years, and the range
a different behavior. If the center was not registered in the system, was from 16 to 64 years. The mean BMI was 23.80 ± 3.15 kg/m2,
participants could fill out the address and the record was validated and the range was from 16 to 38 kg/m2. Table 1 shows some
later so that the number of losses could be reduced. The exclusion
criteria were women who attended gym clubs or places that offered
TABLE 1. Prevalence of UI and Characteristics of Crossfit
CrossFit exercises but were not accredited to the CrossFit network. Exercises
Furthermore, women who presented UI in situations other than
performing physical activity were not included. The questionnaire Variables n %
was only available in Portuguese language (Supplemental Digital
Content in English, http://links.lww.com/FPMRS/A131). Attempts UI
to reduce selection bias were carried out by sending an e-mail to No 386 70.05
CrossFit gyms and social media, and questionnaires were deidentified. Yes 165 29.95
No. exercises that women referred that UI
OUTCOMES occurred during execution
The primary outcome was UI, defined as an involuntary loss of 1 92 54.12
urine,12 according to the International Urogynecology Association/ 2 47 27.64
International Continence Society consensus; for this study, stress 3 15 8.8
UI (SUI) was considered as the loss of urine during CrossFit exer- 4 12 7.1
cise. Two questions were present at the questionnaire, one for UI 5 2 1.1
and the other for SUI. No specific questionnaire for UI was added 6 2 1.1
because we believed that it would increase the duration of filling Most common Crossfit exercises where UI occurred*
out the questionnaire, and, thus it would increase the odds for
Box jump 24 14.54
not finishing the survey. We believe that most of the UIs during
exercise are stress related; however, because we did not perform Deadlift 8 4.84
any objective measurements, we decided to define this as UI Medicine ball clean 10 6.06
and not as SUI. The independent variables were as follows: Wall ball 18 10.90
age (in years), self-reported weight and height, body mass index Overhead squat 12 7.27
(BMI; calculated from the previous variables), city (Brazilian re- Front squat 18 10.90
gion), CrossFit gym attended, previous vaginal surgery, birth Double under 111 67.27
weight, number of exercises that presented UI, and the type of Single under 44 26.66
CrossFit exercise that was associated with UI (there were drawings Thruster 20 12.12
with the associated exercise with a checkbox for clarity). The ques- Others 32 19.39
tionnaire consisted of data such as name, age, e-mail, city, CrossFit
Brazilian region
gym attended, daily time training, number of times practicing
CrossFit per week, and duration period practicing CrossFit. The F. North 1 0.18
I.T.T. formula was calculated using all parameters (frequency, type, Northeast 45 8.17
and time), with the exception of the intensity target heart rate.13 Midwest 127 23.05
Southeast 247 44.83
Statistical Analysis South 47 8.53
Sample size calculation was based on the study by Sprey Not informed 84 15.25
et al6 that showed 40,000 CrossFit practitioners in Brazil, 43% *Percentage was calculated, with the denominator being the total of
of which were women. We expected to find a minimal UI prevalence women with UI. Thus, total may be more than 100%.
of 30% within this population, and considering a 5% absolute

98 www.fpmrs.net © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Copyright © 2020 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Female Pelvic Medicine & Reconstructive Surgery • Volume 26, Number 2, February 2020 Female UI in Crossfit Practitioners

TABLE 2. Univariate and Multivariate Analyses of Sociodemographic and CrossFit Exercises Data With UI Prevalence

UI
Variables Yes No Crude OR (LL–UL) P Adjusted OR (LL–UL) P
Age, y 33.77 ± 8.03 30.63 ± 6.93 1.05 (1.03–1.08) <0.001 1.06 (0.99–1.13) 0.06
Age, y
<20 4 (2.42%) 17 (4.40%) Ref
20–34 94 (56.97%) 278 (72.02%) 1.44 (0.47–4.37) 0.52 0.44 (0.10–1.96) 0.28
35+ 67 (40.61%) 91 (23.58%) 3.12 (1.01–9.73) 0.049 1.01 (0.22–4.63) 0.99
Weight, kg 63.29 ± 8.57 64.17 ± 10.91 0.99 (0.97–1.01) 0.36
BMI, kg/m2 23.69 ± 2.85 23.85 ± 3.30 0.98 (0.93–1.04) 0.59
BMI, kg/m2 0.90 (0.71–1.13) 0.38
<17.99 7 (4.24%) 22 (5.70%) 0.80 (0.61–1.24) 0.42
18–24.99 256 (66.32%) 119 (72.12%)
25–29.99 72 (18.65%) 27 (16.36%) 1.46 (0.60–3.51) 0.40
30–34.99 23 (5.96%) 10 (6.06%) 1.17 (0.45–3.07) 0.73
35–39.99 10 (2.59%) 0 (0%) 1.36 (0.44–4.22) 0.59
40+ 3 (0.78%) 2 (1.21%) 2.09 (0.29–15.19) 0.46
CrossFit time of practice, mo 36.18 ± 18.42 29.79 ± 20.91 1.02 (1.01–1.03) 0.001 0.99 (0.97–1.02) 0.58
Daily training time, min 65.96 ± 22.64 66.85 ± 26.89 0.99 (0.99–1.01) 0.71
Previous vaginal delivery (median) 0 (0–1) 0 (0–0) 2.20 (1.48–3.26) <0.01 1.63 (0.91–2.93) 0.10
Birth weight 1.68 (0.61–4.68) 0.50
<2.5 3 (4%) 5 (5%) Ref
2.5–4 67 (89.33%) 92 (92%) 1.21 (0.28–5.25) 0.79
4+ 5 (6.67%) 3 (3%) 2.78 (0.36–21.02) 0.32
No. days/week 4.26 ± 1.07 4.33 ± 1.16 0.94 (0.80–1.11) 0.48
CrossFit time of practice, mo 1.60 (1.25–2.04) <0.01
<6 10 (13.33%) 28 (28%) Ref
7–23 9 (12%) 11 (11%) 2.32 (1.20–4.49) 0.01 1.50 (0.54–4.23) 0.44
24+ 56 (74.67%) 61 (61%) 2.82 (1.66–4.77) <0.01 0.93 (0.41–2.11) 0.87
F.I.T.T 290.24 ± 159.07 297.63 ± 172.31 0.99 (0.99–1.00) 0.64
Type of exercise
Double under 106 (95.5%) 5 (4.5%) 136.90 (53.59–349.74) <0.01 229.1 (83.4–629.32) <0.001
Single under 40 (90.91%) 4 (9.09%) 30.56 (10.72–87.11) <0.01 78.44 (25.18–244.28) <0.001
LL, lower limit; OR, odds ratio; UL, upper limit.

characteristics of women with UI. The UI prevalence was 29.95%, DISCUSSION

and most women presented with a loss of urine with a single exer-
cise (52.12%). In total, 21 exercises were cited as related to UI;
however, the most cited were the double under (20.15%), single
under (7.99%), box jump (4.36%), thruster (3.63%), and front
squat (3.27%). Women with UI reported symptoms with at least
a 13-month duration (range, 1–60 months).
Table 2 presents univariate and multivariate analyses from
the study. Although women with UI presented with a higher mean
age (33.77 ± 8.03 vs 30.63 ± 6.93 years, P < 0.01) and duration of
CrossFit practice (36.18 ± 18.42 vs 29.79 ± 20.91 months,
P = 0.001) compared with continent women, these variables were
not statistically associated with UI after multivariate analysis. Fur-
thermore, BMI was not higher in women with UI (P = 0.59), and
all continent women were nulliparous (P < 0.01); however, parity
did not remain in the final model associated with UI (P = 0.10).
The daily training time (P = 0.58), number of days per week
(P = 0.48), and F.I.T.T. (P = 0.64) did not differ between incon-
tinent and continent women. Multivariable analysis has shown
that double under (adjusted odds ratio, = 229.1 [83.4–629.32];
P < 0.001) and single under (adjusted odds ratio, 78.44
[25.18–244.28]; P < 0.001) were the only variables to be associ-
ated with UI in the final model.
The prevalence of UI in female crossfitters was almost
30%, a percentage similar to that obtained in previous studies
on athletes,14–16 or lower than that obtained in athletes who pre-
sented with UI irrespective of exercise status.17,18 Another study
in women who practiced high-impact exercises found a lower
prevalence (14.3%); however, this study excluded obese and
nonnulliparous women.19 It remains unknown whether pelvic
muscle function plays a role in the presence of UI. A cross-
sectional study in Brazil has shown that incontinent athletes pres-
ent with greater pelvic floor muscle (PFM) strength compared
with continent athletes20; however, this was not seen in a case-
control study in Iceland.17 Anatomically, previous data have sug-
gested that nulliparous athletes present with a higher mean diam-
eter of pubovisceral muscle, greater bladder neck descent, and a
larger hiatal area on the Valsalva maneuver compared with the
control groups.21 This paradox between PFM function and anat-
omy needs to be further investigated.
In our data, double and single under were the independent
risk factors associated with AI in crossfitters. If we divide the
CrossFit Workout of the Day into 3 modalities (gymnastics, met-
abolic conditioning, and weightlifting), a previous study has

© 2020 Wolters Kluwer Health, Inc. All rights reserved. www.fpmrs.net 99

Copyright © 2020 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Poli de Araújo et al Female Pelvic Medicine & Reconstructive Surgery • Volume 26, Number 2, February 2020
shown that muscular fatigue is produced after gymnastic and
weightlifting sessions, and recovery of this fatigue was observed
during metabolic conditioning.22 Double and single under are ex-
ercises performed in the gymnastic sessions that are related to
jumping rope movements, drop landings, and mini-trampolining
exercise. Trampolinists present one of the highest prevalence of
UI among female athletes (80%).23 Furthermore, a computational
modeling study has shown that pelvic floor deformations gener-
ated during a jump-landing process differed from those seen in a
Valsalva maneuver.24 This probably has different effects on the
PFM, as a recent study using surface electromyography has shown
an increased PFM activity in health volunteers during jumping
and mini-trampolining.25 However, how PFM activity behaves
during AI is currently unknown.
To the best of our knowledge, this is the second study to in-
vestigate the prevalence of UI within a population of female
crossfitters. Recently, 2 systematic reviews9,10 were published re-
garding UI in female athletes, neither of which included data from
crossfitters. The only study that has addressed this type of exercise
analyzed 105 women; 50 of whom reported SUI during exercise,
and similar to our study, the most prevalent exercise was the dou-
ble under (47.3%). However, this current survey excluded women
who presented with UI in situations other than exercising, and this
probably reflects the true UI, an involuntary loss of urine during
exercise. Moreover, in the present study, we included participants
from all Brazilian regions. Furthermore, only athletes practicing in
CrossFit accredited gyms could answer this questionnaire; thus,
we excluded gym clubs that presented other functional exercises
that are similar to CrossFit but do not follow the Workout of the
Day routine.
There are several limitations of the current study. First, the
use of a cross-sectional survey may impart a selection bias, and
we cannot establish a causality between dependent and indepen-
dent variables after multivariate analysis. Second, we did not use
a standardized questionnaire because all validated questionnaires
for UI are not specific for sports. Indeed, most validated question-
naires for UI focus on the most recent occurrences of UI, and as
we were excluding women with UI during activities other than
sport, it would be difficult to apply them. Because the survey
was online, no objective confirmation could be performed. How-
ever, we did offer women to seek treatment in participating
urogynecological centers. Finally, there was also an unknown re-
sponse rate and we did not perform this survey globally, which
may impair generalization of the results because we are aware that
the pelvic floor can behave differently in different populations.
By providing information to women with UI that practice
CrossFit, we hope to help these patients with treatment so that they
can maintain their performance during physical activity. We also
hope that this information will assist with training in medical insti-
tutions for the diagnosis, treatment, and prevention of AI.
REFERENCES
1. Castro RA, Arruda RM, Bortolini MA. Female urinary incontinence:
effective treatment strategies. Climacteric 2015;18(2):135–141.
2. Araújo MP, Sartori MG, Girão MJ. Athletic incontinence: proposal of a new
term for a new woman. Rev Bras Ginecol Obstet 2017;39(9):441–442.
3. Shaw JM, Nygaard IE. Role of chronic exercise on pelvic floor support and
function. Curr Opin Urol 2017;27(3):257–261.
4. Smith MM, Sommer AJ, Starkoff BE, et al. Crossfit-based high-intensity
power training improves maximal aerobic fitness and body composition.
J Strength Cond Res 2013;27(11):3159–3172.
5. Claudino JG, Gabbett TJ, Bourgeois F, et al. CrossFit overview: systematic
review and meta-analysis. Sports Med Open 2018;4:11.
100 www.fpmrs.net
Copyright © 2020 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
6. Sprey JW, Ferreira T, de Lima MV, et al. An epidemiological profile of
CrossFit athletes in Brazil. Orthop J Sports Med 2016;
4:2325967116663706.
7. Fisker FY, Kildegaard S, Thygesen M, et al. Acute tendon changes in
intense CrossFit workout: an observational cohort study. Scand J Med Sci
Sports 2017;27(11):1258–1262.
8. Gephart LF, Doersch KM, Reyes M, et al. Intraabdominal pressure in
women during CrossFit exercises and the effect of age and parity. Proc
(Bayl Univ Med Cent) 2018;31(3):289–293.
9. de Mattos Lourenco TR, Matsuoka PK, Baracat EC, et al. Urinary
incontinence in female athletes: a systematic review. Int Urogynecol J
2018;29(12):1757–1763.
10. Teixeira RV, Colla C, Sbruzzi G, et al. Prevalence of urinary incontinence in
female athletes: a systematic review with meta-analysis. Int Urogynecol J
2018;29(12):1717–1725.
11. Yang J, Cheng JW, Wagner H, et al. The effect of high impact crossfit
exercises on stress urinary incontinence in physically active women.
NeurourolUrodyn 2019;38(2):749–756.
12. Haylen BT, de Ridder D, Freeman RM, et al. An international
Urogynecological Association (IUGA)/International Continence Society
(ICS) joint report on the terminology for female pelvic floor dysfunction.
Int Urogynecol J 2010;21:5–26.
13. Pescatello LS, Arena R, Riebe D, et al. ACSN’s Guidelines for Exercise
Training and Prescription. 9ed ed. Wolters Kluver/Lippincott Williams &
Wilkins; 2014.
14. Carvalhais A, Araújo J, Natal Jorge R, et al. Urinary incontinence and
disordered eating in female elite athletes. J Sci Med Sport 2019;22:
140–144.
15. Nygaard IE, Thompson FL, Svengalis SL, et al. Urinary incontinence in
elite nulliparous athletes. Obstet Gynecol 1994;84:183–187.
16. Thyssen HH, Clevin L, Olesen S, et al. Urinary incontinence in elite female
athletes and dancers. Int Urogynecol J Pelvic Floor Dysfunct 2002;13:
15–17.
17. Ludviksdottir I, Hardardottir H, Sigurdardottir T, et al. Comparison of
pelvic floor muscle strength in competition-level athletes and untrained
women. Laeknabladid 2018;104(3):133–138.
18. Cardoso AMB, Lima CROP, Ferreira CWS. Prevalence of urinary
incontinence in high-impact sports athletes and their association with
knowledge, attitude and practice about this dysfunction. Eur J Sport Sci
2018;18(10):1405–1412.
19. Hagovska M, Švihra J, Buková A, et al. Prevalence of urinary incontinence
in females performing high-impact exercises. Int J Sports Med 2017;38(3):
210–216.
20. Dos Santos KM, da Roza T, Mochizuki L, et al. Assessment of abdominal
and pelvic floor muscle function among continent and incontinent athletes.
Int Urogynecol J 2019;30(5):693–699.
21. Kruger JA, Dietz HP, Murphy BA. Pelvic floor function in elite nulliparous
athletes. Ultrasound Obstet Gynecol 2007;30:81–85.
22. Mate-Munoz JL, Lougedo JH, Barba M, et al. Muscular fatigue in response
to different modalities of CrossFit sessions. PLos One 2017;12(7):
e0181855. doi: 10.1371/journal.pone.0181855.
23. Eliasson K, Larsson T, Mattsson E. Prevalence of stress incontinence in
nullparous lite trampolinists. Scand J Med Sci Sports 2002;12(2):106–110.
24. Dias N, Peng Y, Khavari R, et al. Pelvic floor dynamics during high-impact
athletic activities: a computational modeling study. Clin Biomech 2017;41:
20–27.
25. Saeuberli PW, Schraknepper A, Eichelberger P, et al. Reflex activity of
pelvic floor muscles during drop landings and
mini-trampolining-exploratory study. Int Urogynecol J 2018;29(112):
1833–1840.
© 2020 Wolters Kluwer Health, Inc. All rights reserved.