​​​Pelvic floor exercises are recommended as first-line treatment within current NICE guidance for preventing and treating mild to moderate incontinence and prolapse [1]. Despite this there is still often poor awareness of and adherence to pelvic floor exercises within the general population. A recent RCOG survey showed only 22% of women do their pelvic floor exercises regularly and only one in five women in the age group 18-35 know what the pelvic floor is [2].  

There is increasing evidence that more people are using social media platforms to access health information. A novel approach to pelvic floor exercises called SqueezeAlong were created as a fun way to do pelvic floor exercises on social media, aiming to promote engagement with pelvic health content and education. Shared on Know Your Floors’ social media platforms, this content has amassed over 630K followers, with many reporting improvements in adherence to pelvic floor exercise and symptoms. However, social media algorithms are not consistent, and followers made requests for a reminder system. This feedback prompted this pilot. We aimed to investigate if an email SqueezeAlong challenge could be used to improve confidence and adherence to pelvic floor exercises. A secondary outcome was to see if there were any clinical improvements to symptom scores.

A Christmas themed SqueezeAlong challenge was developed and promoted on social media channels and through clinical networks. Individuals were able to sign up for the challenge to receive a daily email from December 1st-24th with new pelvic health education and a daily SqueezeAlong to complete. At sign up, participants were encouraged to fill in demographic data including age, location, ethnicity and gender. They were asked to rate their adherence, confidence and pelvic floor symptoms on a 10-point Likert scale. We chose a Likert scale for this pilot for simplicity in the hope to maximise completion of the data. Consent was tacit as individuals were at liberty to participate or not and they could still join the challenge without filling in any data. Participants could also join part way through the challenge or could unsubscribe at any point. Challenge emails were sent through a marketing platform to ensure GDPR compliance. This also enabled engagement data to be reviewed though open (opening of email) and click though rates (click for content) for each email. We also collated the number of emails each person opened during the challenge. At the end of the challenge, we asked participants for their feedback and to rate their adherence, confidence and symptoms on the Likert scales again.

570 participants started the challenge on day 1, reaching a maximum of 721 participants by day 21. 42 people unsubscribed during the challenge and 250 did not open any emails.  Despite this the open and click through rates were above expected ranges, with an average 44.4% open rate and 21.4% click-through rate. By the end of the challenge 523 participants had engaged with at least one day, 343 participants viewed 1-7 of the emails and 89 participants viewed the emails between 15-27 times. Over the last week of the challenge there were 84-104 people clicking through to the SqueezeAlong content.   

673 participants completed the data sets pre-challenge. 64% of participants had heard about the challenge from social media. Participants joined the challenge from 39 different countries, with the majority being in the UK (60%). The age range was16-85years, with the largest cohort being 31-40years old (247 participants). 

At the end of the challenge 82 participants gave feedback and post-challenge scores. Of these, 60% had improved confidence and 82% felt they had better adherence to pelvic floor exercises. Likert scoring for pelvic floor symptoms showed signs of small improvements in 48% of participants, no change in 25% and slight worsening for 27% of participants. Feedback from the 82 participants demonstrated that they had found the challenge fun, that email reminders were useful, and they wanted further challenges and content.

​​Our primary objective was to assess if the challenge would help with adherence and confidence with pelvic floor exercises as NICE guidelines stipulate that at least 3 months of training is required [3]. The data shows some promising signs that this type of challenge may help improve adherence and confidence​. The next step would be to compare this type of programme with established​ tools.​ Around half of participants who completed feedback noted an improvement in clinical symptoms. This was a​n unexpected change​ given the short time frame of the challenge. Of the remaining participants, 27% noted slight worsening in their bladder and bowel symptoms.​ The reasons for this could not be defined from the data received in the feedback questionnaire and may ​indicate the need for individualised assessment​ for some participants​. ​     ​

This small challenge has demonstrated that SqueezeAlong​ shows promise​ as a tool to gain adherence and confidence in pelvic floor exercises and​ ​may improve clinical symptom​s​. ​​Further ​investigation is ​required to ​understand how following a Squeezealong may promote engagement and adherence to an exercise programme. Inclusion of ​a control group, alternative adherence tools,​ and ​use​ of​ validated clinical outcome tools ​would give a more robust investigation of this innovative exercise format.​

NHS (2019) The NHS Long Term Plan. NHS Long Term Plan v1.2 August 2019 (england.nhs.uk) (Accessed 4th April 2024)
RCOG (2023) RCOG calling for action to reduce number of women living with poor pelvic floor health | RCOG (accessed 4th April 2024)
NICE (2019) Urinary incontinence and pelvic organ prolapse in women: management. Overview | Urinary incontinence and pelvic organ prolapse in women: management | Guidance | NICE (accessed 5th April 2024)

Continence 12S (2024) 101415
DOI: 10.1016/j.cont.2024.101415