Evidence Summary
A systematic review of the effect of more than 12 weeks of consistent pelvic floor muscle training showed that there was an improvement in urogenital symptoms including vaginal prolapse and urinary incontinence (1). This was versus standard pessary treatment for prolapse.
However, there was inconsistent evidence in the systematic review and other studies to suggest that resistance or aerobic symptoms led to a reduction in urinary incontinence or prolapse (2,3,4,5).

Quality of Evidence
Grade A – a systematic review supports the use of pelvic floor muscle training for prolapse and incontinence symptoms.
Strength of Recommendation
Strength of Recommendation: Grade 1

Conclusion
Menopausal women would be best served undertaking regular pelvic floor muscle training to manage any continence symptoms they suffer from. Pelvic floor muscle training would require patient education to ensure they are performing them correctly. There is little evidence that higher levels of physical activity help manage continence or prolapse symptoms so more definite randomised-controlled trials are needed.

References

1. Carcelén-Fraile, M. D. C., Aibar-Almazán, A., Martínez-Amat, A., Cruz-Díaz, D., Díaz-Mohedo, E., Redecillas-Peiró, M. T. and Hita-Contreras, F. (2020) ‘Effects of Physical Exercise on Sexual Function and Quality of Sexual Life Related to Menopausal Symptoms in Peri- and Postmenopausal Women: A Systematic Review’, Int J Environ Res Public Health, 17(8).
2. Pettee Gabriel, K., Mason, J. and Sternfeld, B., 2015. Recent evidence exploring the associations between physical activity and menopausal symptoms in midlife women: perceived risks and possible health benefits. Women’s Midlife Health, 1(1).
3. Javadivala, Z., Allahverdipour, H., Jafarabadi, M. A. and Emami, A. (2020) ‘An Interventional strategy of physical activity promotion for reduction of menopause symptoms’, Health Promotion Perspectives, 10(4), pp. 383-392.
4. Bauer, S. R., Kenfield, S. A., Sorensen, M., Subak, L. L., Phelan, S., Gupta, L. R., Chen, B., Suskind, A. M., Park, A. J., Iglesia, C., Gass, M., Hohensee, C. and Breyer, B. N. (2021) ‘Physical Activity, Diet, and Incident Urinary Incontinence in Postmenopausal Women: Women’s Health Initiative Observational Study’, Journals of Gerontology Series a-Biological Sciences and Medical Sciences, 76(9), pp. 1608-1618.
5. Dabrowska-Galas, M., Dabrowska, J., Ptaszkowski, K. and Plinta, R. (2019) ‘High Physical Activity Level May Reduce Menopausal Symptoms’, Medicina-Lithuania, 55(8).