Training principles that are important in any exercise program include the overload principle, the specificity principle, and the maintenance principle. The overload principle states that, for pelvic muscles to strengthen, they must be exercised beyond their limit. If muscles are underex-ercised, they are not challenged enough to increase in strength, endurance, or speed; therefore, length and resting tone remains the constant. The specificity principle states that the pelvic muscles are composed of fast- and slow-twitch fibers in roughly a 35% : 65% ratio; some fibers have a combination of fast- and
slow-twitch components. Fast-twitch fibers improve in speed and strength with quick contractions, while slow-twitch fibers strengthen and gain optimal resting length and tone with longer "hold" contractions. Fast-twitch fibers fatigue quickly while slow-twitch fibers are designed for endurance and postural tone; there-fore,repetitions are low for fast-twitch fibers and higher for slow-twitch fibers. The maintenance principle describes exercising for continence as a lifelong endeavor. The pelvic muscle strength is maintained by one daily 7- to 10-minute session. The reversibility principle states that, after exercising and symptomatic improvement, discontinuing exercises will result in symptom reoccurrence over time.15
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