E-Lean Personal Training

The pelvic floor conversation we’re not having

Eline Vring — Mon, 06 Jul 2026 14:18:02 +0000

The pelvic floor conversation we’re not having

Whether it’s my algorithm or a genuine shift in the conversation, core and pelvic floor content seems to be everywhere lately. And honestly? I’m here for it. We’re getting better at talking about and researching female health and more importantly, the recognition that there has been a lack of research into female diseases and the female body. Alongside endometriosis, PCOS and breast cancer finally getting the recognition they deserve, the taboos around pelvic floor disorders (including: urinary, bowel and rectal disorders, prolapse, pelvic pain and certain sexual dysfunctions) are quietly starting to lift too.

The numbers alone make the case. Globally, between one-in-three and one-in-four women will experience some form of pelvic floor problem in their lifetime.
Urinary disorders (losing urine against your will) is one of the most prevalent disorders of the pelvic floor. German clinical guidelines put the figure for urinary incontinence at around 30% of all women. That is an estimated 15 million people in this country alone. Between the ages of 20 to 30, around 10% of women are affected. By 40 to 50, this grows to 25%. For women over 80, we’re looking at +40% in the general population, and over 70% in care homes. I do wonder if these numbers are representative as a lot of women do not talk about it until it really influences their life. Instead we avoid jumping on the trampoline, and cross our legs when we sneeze. Women are up to four times more likely than men to be affected by a pelvic floor disorder overall. Most of us know that childbirth is one of the biggest contributing factors, but did you know that 50% of women report at least one pelvic floor disorder within ten years of their first delivery?
However pregnancy and birth are far from the whole story. Even in women who have never been pregnant, pelvic floor disorders affect up to 25% at any given time. And around menopause, the drop in oestrogen accelerates the weakening of both the muscles and connective tissue, making this a critical and often overlooked window where symptoms can appear or significantly worsen.

The German head start: postnatal recovery classes

This is not a niche issue. It’s an ordinary part of female anatomy that most of us are never taught to think about until something goes wrong.
I was pleasantly surprised to learn that Germany has implemented something that other countries do not have: Every new mother is entitled to postnatal recovery classes. Or as you call it here: the Rückbildungskurs and it is fully covered by health insurance.
But the course was designed for new mothers, which means it leaves out everyone else. And it raises a broader question: why aren’t we talking about this before the problems appear?
From what I hear in my work the experience varies, some women find these postnatal recovery classes valuable Others, often already active before pregnancy, find the pace too gentle or the content too basic to feel relevant. And some simply leave without really understanding why they were doing what they were doing. A course that doesn’t meet you where you are is easy to deprioritise, especially in those early weeks.

What the research actually shows

When looking into training the pelvic floor the research is actually pretty striking. A major Cochrane review, the gold standard of medical evidence, found that women who did supervised pelvic floor training were eight times more likely to report being ‘cured’ of stress urinary incontinence than women who did nothing. Eight times! And when training is combined with things like education and other physical approaches, cure and improvement rates can reach up to 97%. That’s not a number you see very often in medical research.
But here’s the catch that doesn’t make it into most conversations about pelvic floor health: those results don’t come from a six-week course. Clinical guidelines consistently recommend a minimum of three months of supervised training as a starting point, and the evidence is pretty clear that having guidance makes a meaningful difference to outcomes compared to exercising alone at home. Which brings me back to the Rückbildungskurs. Germany building postnatal recovery into the healthcare system is genuinely something to be proud of! Most countries haven’t got there yet.
It should cover pelvic floor awareness, basic strengthening, breathing, and relaxing exercises. Unfortunately a one weekly group session with a mixed group of fitness levels for six to ten weeks is unlikely to be enough on its own, based on what the research tells us about duration and guidance.
What I find interesting is that despite this course being offered to virtually every new mother in Germany, its outcomes have never been formally evaluated in a systematic review. For something so widely used, that feels like a conversation worth starting.

It’s not just about childbirth

Besides this the evidence increasingly points to the fact the pelvic floor cannot be treated in isolation. That is true for all women whether you’ve had children or not. The diaphragm and pelvic floor function as a connected pressure system, they work together constantly with every breath we take.
This pressure system can be disrupted by multiple factors. One of the main factors next to birth are sports.
High-impact sports place significant repetitive load through increases in intra-abdominal pressure. Pelvic floor dysfunction affects around 25% of runners, up to 80% of trampolinists and gymnasts, and between 41% and 54% of female weightlifters and powerlifters. Does this mean we should stop training? The answer is no, the pelvic floor needs to be included in our training.
The pelvic floor responds to everything happening in the body around it. Which is exactly why training the pelvic floor as part of a connected system consistently outperforms isolated Kegel exercises. A 2026 study found that women in an integrated core training group achieved 50% or more reduction in urine loss in 70% of cases, compared to 46.6% in the Kegel-only group. A 2025 randomised controlled trial concluded that core stabilisation enhanced pelvic floor strength and endurance more sustainably over time. Next to birth and sport, two other major reasons for pPelvic floor dysfunction are chronic coughing from conditions like asthma or COPD places continuous pressure on the pelvic floor through the same mechanism, with research showing these women are 55 to 63% more likely to develop severe urinary incontinence than women without chronic cough.
The second is psychological stress. Stress activates the sympathetic nervous system, causing reflexive pelvic floor tension that over time can lead to both tightness and weakness.
What all of this tells us:, the research on training, the role of sport, stress, hormones, chronic cough, is that the pelvic floor is not a postpartum problem. It is a lifelong part of female anatomy that responds to everything happening around it. And yet most women only encounter this information after something has already gone wrong. That’s what I’d like to change. Whether it’s through reels, seminars or simply talking about it more openly, I hope more women get this information, so we can make our own informed decisions.
And as someone who believes a better world starts with you: I’m planning a Core & Pelvic Seminar. Stay tuned. And if you’re postpartum: the Rückbildungskurs is a chance worth taking seriously.

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The Science of Doing Less and Gaining More

Eline Vring — Mon, 27 Oct 2025 14:17:37 +0000

The Science of Doing Less and Gaining More – Especially for Women

In 2024 an article named: „Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality“ by Hongwei Ji, MD, et al was published.

Although I consider it a positive research, not only for the results, but also for the fact that so many women were involved. It does give us less excuses to not train. The often heard: I don’t have time for exercise and I don’t like strength training, are reduced to small, not realistic excuses.

The study published in the Journal of the American College of Cardiology followed over 400,000 adults for nearly 20 years. 55% of the adults were women aged between 18 and 85!

They were ordinary adults representative of the general population, which makes it even more applicable to all of us.

They discovered something remarkable: Women get significantly more health benefits from the same amount of exercise as men! We are not talking small differences, but almost double in some cases! The cardiovascular benefits showed an even bigger gap: women achieved a 36% reduction in cardiovascular mortality compared to just 14% for men.

Personal trainer or not, “I get enthusiastic when seeing researches done involving so many women and giving me a good excuse to spend some extra time indoors with my little family then leaving the house in the rainy autumn weather.

The Hard Numbers That Eliminate Our Excuses

For those „I don’t have time“ moments: Women achieved the same mortality reduction that men got from 300 minutes of cardio per week with just 140 minutes. That’s 20 minutes a day. If you’re telling me you can’t find 20 minutes while scrolling social media for an hour, we both know that’s not about time.

For the ‚I hate strength training‘ crowd: One session per week. ONE. That single session gives women the same benefit men get from three sessions. Still hate it? Fine, but you can surely tolerate one session weekly for a 19% reduction in mortality risk. Plus, strength training is proven to reduce risks of osteoporosis, diabetes, and high blood pressure and other diseases, but that’s beyond what this particular study measured.

What They Actually Found

The researchers tracked how exercise affected death rates – both all-cause and cardiovascular. Here’s what 20 years of data showed:

Cardio benefits:

Men maxed out benefits at 300 min/week (18% lower mortality)
Women hit equivalent benefits at 140 min/week and kept gaining up to 300 min/week (24% lower mortality)
For vigorous exercise specifically: men peaked at 110 min/week, women at just 57 min/week

Strength training benefits:

Women: 19% mortality reduction from regular strength training
Men: 11% mortality reduction
And the best part? Women needed fewer sessions for better results

Why Women’s Bodies Respond Better

The physiology is fascinating. Women have higher capillary density per muscle unit, meaning better oxygen delivery during exercise due to more blood. Different muscle fiber composition too – more Type I oxidative fibers that excel at endurance activities. When women strength train, they see greater relative improvements because they’re typically starting from a different baseline than men.

Think of it like this: men might have bigger engines, but women have better fuel efficiency.

Why This Challenges Everything

This research fundamentally challenges the „one-size-fits-all“ exercise guidelines we’ve been following for decades. Current German public health recommendations (like those from the WHO adopted by German health authorities) make no distinction between sexes – everyone gets told to aim for 150-300 minutes of moderate activity or 75-150 minutes of vigorous activity plus two strength sessions weekly. But if women achieve equivalent health benefits at roughly half the cardio volume and one-third the strength training frequency, shouldn’t guidelines reflect these biological differences?

The German „Nationale Bewegungsempfehlungen“ similarly recommend identical targets for all adults regardless of sex. Continuing to push identical targets for all may actually discourage women who don’t realize they’re already achieving meaningful health benefits at lower volumes. This isn’t about lowering standards – it’s about recognizing that optimal exercise prescriptions might need to account for biological sex differences, just as we adjust recommendations for age and health conditions.

Questions the study doesn’t yet answer.

The study didn’t tell us everything:

What about HIIT versus steady-state cardio?
Does the timing of exercise matter (morning vs evening)?
How do rest days affect these outcomes?
What about + 300 min training effectiveness (more than 5 hours a week)?

But here’s the thing: this research studied average women doing whatever exercise they chose – morning walks, evening gym sessions, classes, running – and the benefits appeared regardless.

There is no need to decide on a running class, Crossfit or swimming, if you’re currently doing zero exercise, regardless of what you will choose you will get benefits.

The „perfect“ workout you never do will always lose to the „imperfect“ one you actually complete. Start with whatever you can maintain – even 20 minutes daily or one strength session weekly. The benefits are there regardless of the details.

Before we get too excited, some caveats: All exercise was self-reported, which means people might have overestimated (or underestimated) their activity. The study only looked at leisure exercise, not occupational or household activity – so all that running after kids or physical work doesn’t count in these numbers.

They also focused on mortality, not fitness levels or athletic performance. So if you’re training for a marathon, these findings don’t mean you should cut your training in half. Although some other studies have suggested this might work.

So stop comparing yourself to your male training partner and feeling inadequate. Your workout is doing more for your longevity than you realize.

If you’re skipping strength training entirely: reconsider. One quality session weekly is meaningful, not token effort.

And if you love long workouts keep going! Benefits continue accumulating up to 300 minutes/week and plateau (not decline) after that.

Bottom Line

This research doesn’t lower the bar for women’s fitness. It reveals that women’s bodies are remarkably efficient at converting exercise into health benefits. That efficiency isn’t weakness – it’s optimization.

For the under-exercisers: Next time you’re debating whether that 20-minute session is „worth it“ or feeling guilty about doing „just“ one strength workout this week, remember: the science says you’re getting more bang for your buck than you think. The rainy autumn weather is no longer an excuse – your indoor workout is more valuable than you realized.

For the over-exercisers: Feeling guilty you didn’t hit your 6-day training quota? You already maximized your mortality benefits when you finished your third session. The study shows benefits plateau (not increase) after 300 minutes weekly. It’s okay to sit down and skip that run after work in the dark – you won’t lose the benefits you’ve already earned this week.

For everyone: Whether you’re struggling to start or struggling to rest, this data works in your favor. Women’s bodies are designed to thrive with moderate, consistent movement – not endless grinding. Quality beats quantity, and consistency beats perfection.

No more guilt, no more excuses. The data is in, and it supports whatever sustainable routine keeps you moving.

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