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Research Article
Alba Nieves-Gómez, Natalia Millán-Isasi, Amelia Lara-Bolinches, Lucía Marcos-Hernández,
Laura Fuentes-Aparicio, Ferran Cuenca-Martínez* and Núria Sempere-Rubio
Effects of a single session of motor imagery and
action observation plus physical exercise on
lumbo-pelvic sensorimotor function in healthy
women: a randomized controlled pilot trial
https://doi.org/10.1515/jirspa-2024-0018
Received February 22, 2024; accepted July 11, 2024;
published online August 13, 2024
Abstract
Objectives: The main aim of this study was to assess the effects
of a single session motor imagery (MI) and action observation
(AO) plus physical exercise (PE) on lumbo-pelvic sensorimotor
function.
Methods: Thirty-six healthy women were randomized into
three groups: MI (n=12), AO (n=12), or sham observation (SO)
group (n=12). All the groups performed PE consisting of a
combination of aerobic and strengthening exercises. The
outcome measures included lumbo-pelvic motor control,
pressure pain threshold (PPT) in lumbar and tibialis anterior
region, and pelvic floor muscle (PFM) strength. A pre- and
post-intervention evaluation was conducted.
Results: Regarding the lumbo-pelvic motor control, only the
AO group showed significant within-group differences with a
moderate effect size (mean difference (MD)=−3.55 mmHg (−6.6
to −0.5), p=0.023, d=−0.56). With respect to the PPT in the
lumbar region, only the MI group showed significant within-
group differences with a small effect size (MD=0.775 kg/cm2
(0.35–1.2), p=0.001, d=0.44). No statistically significant PFM
strength gain was found (p>0.05). Finally, no between-group
differences were found (p>0.05).
Conclusions: MI and AO training plus PE had a slight impact
on lumbo-pelvic sensorimotor function such as motor control
or local pain sensitivity when applied in a single session.
Keywords: women’s health; motor imagery; action obser-
vation; physical exercise
Introduction
Motor imagery (MI) is defined as a cognitive ability
that involves the representation of an action, internally,
without its actual motor execution [1]. MI training elicits
an activation of brain areas related to the planning and
execution of voluntary movement in a similar way as
when the action is actually performed [2]. In fact, Lebon
et al [3] argued that the coincidence in cortical activation
of such areas between actual motor execution and motor
imageryisareliablemeanstoassessthequalityofmental
representation. Motor programs stored in procedural
memory systems allow the generation of MI without the
need for an external stimulus although it has been shown
that bringing visual information prior to the MI task
facilitates the imagery task and elicits greater neuro-
physiological activity than if performed in isolation [4–6].
The MI allows the practice of movements without the need
to physically perform them, and that is why it has been
widely used in the training of technical ability in both
athletes, as well as in neurorehabilitation [7, 8].
On the other hand, action observation (AO) training is also
awidelyusedmovementrepresentationtechniqueinthefield
of rehabilitation and physical performance [9, 10]. AO training
is considered as an internal representation of the set of real
movements evoked by that visualized by the spectator [11]. In
the same way as MI, the AO training is able to elicit neuro-
physiological activation of premotor, supplementary motor,
ANG and NMI contributed equally to this work.
*Corresponding author: Professor Ferran Cuenca-Martínez,
Department of Physiotherapy, University of Valencia, Gascó Oliag 5,
Valencia 46010, Spain, E-mail: Ferran.Cuenca@uv.es. https://orcid.org/
0000-0003-4644-3758
Alba Nieves-Gómez, Natalia Millán-Isasi, Amelia Lara-Bolinches, Lucía
Marcos-Hernández and Núria Sempere-Rubio, Department of
Physiotherapy, University of Valencia, Valencia, Spain. https://orcid.org/
0000-0002-6564-0936 (N. Sempere-Rubio)
Laura Fuentes-Aparicio, Physiotherapy in Motion Multispecialty Research
Group (PTinMOTION), Department of Physiotherapy, University of Valencia,
Valencia, Spain. https://orcid.org/0000-0001-8830-9958
J Imag. Res. Sport Phys. Act. 2024; 19(1): 20240018
Open Access. © 2024 the author(s), published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 International License.
primary somatosensory and posterior parietal cortex areas in
a qualitatively equal but quantitatively lesser manner than
when the action is actually performed [2, 12]. Both movement
representation techniques have been shown to result in
greater strength gains [13], greater improvements in motor
control [14], and greater decreases in pain intensity [15] when
added to physical exercise intervention as compared to when
physical exercise is performed in isolation, without mental
practice. However, research using movement representation
techniques such as MI or AO performs several sessions on
different days of intervention. We do not know whether
movement representation techniques would have a clinical
impact in a single session. Moreover, the study of movement
representation techniques in women’s health is currently
starting [16, 17] and we do not know almost everything at the
moment.Thisisafirst pilot study where we want to combine
mentally and physically a set of global exercises to see the
generalization effects on the functioning of the lumbo-pelvic
sensorimotor system as well as the maximal strength of the
pelvic floor musculature (PFM) in healthy women. Women
with musculoskeletal disorders commonly present with loss of
maximal PFM strength [18], as well as lumbo-pelvic pain and
motor control aberrations [19]. If we assume that therapeutic
exercise has a significant impact on these variables in women
with musculoskeletal disorders [20, 21], it is likely that adding
mental practice will result in greater improvements when
combined with therapeutic exercise than just exercise alone.
Even in specific problems, such as vestibulodynia or in the
immediate postpartum period, movement representation
techniques alone could be applied to improve some clinical
variables of interest, although for the moment, we want to see
what happens in healthy women at the physiological level.
Thereby the main aim of this study was to assess the
effects of a single session motor imagery and action obser-
vation plus physical exercise on lumbo-pelvic sensorimotor
function in healthy women.
Methods
Study design
This study was a randomized, single-blind, placebo
controlled pilot trial, planned, and conducted in accor-
dance with Consolidated Standards of Reporting Trials
(CONSORT) requirements, and was approved by The Ethics
Committee of Research in Humans of the Ethics Commis-
sion in Experimental Research of University of Valencia
(2699494). This study was registered in the United States
Randomized Trials Registry on clinicaltrial.gov (trial reg-
istry number: NCT06073210).
Participants
Between October and December 2023, healthy women were
recruited. Advertisements, social networks, and emails were
used for this purpose. Prior to final inclusion, all signed the
informed consent. All women participants received a detailed
explanation of the study procedures, which were planned ac-
cording to the ethical standards of the Helsinki Declaration. The
criteria for inclusion were: (1) being an asymptomatic woman,
and (2) be aged between 18 and 30 y/o. The exclusion criteria
were: (1) suffering from any pathology that presents pain, (2)
suffering pathologies of a pelvic floor origin, (3) having any
musculoskeletal disorders in the upper/lower limbs and (4)
having a metabolic disease, all assessed by personal interview.
Randomization
Randomization was performed using a computer-generated
random sequence table with a balanced three-block design
(GraphPad Software, Inc., CA, USA). An independent researcher
generated the randomization list, and a member of the
research team who was not involved in the assessment of the
participants or the intervention was in charge of the random-
ization and maintained the list. The patients included were
randomly assigned to one of the three groups using the random
sequence list, ensuring concealed allocation.
Blinding
The assessments and interventions were performed by two
different physiotherapists. The evaluator was blinded to the
participants’group assignment. All the intervention pro-
cedures were performed by the same physiotherapist who
had experience in the women’s health field and was blinded
to the purpose of the study. All participants were blinded to
their group allocation.
Interventions
All women conducted a single intervention session of mental
practice (MI, AO, or sham observation (SO) training) plus PE,
lasting about 1 h.
Physical exercise
All women underwent a PE program that combined aerobic
exercise with strengthening exercises. Firstly, aerobic ex-
ercise was performed for 20 min at an intensity between 12
2Nieves-Gómez et al.: Motor imagery & women’s health
and 14/20 on the perceived fatigue scale (“somewhat hard”)
[22]. The strengthening program consisted of a combo of
three exercises: non-weighted free squats (4 sets of 45 s),
followed by abdominal isometric exercise (4 sets of 30 s) and
specific exercise of the PFM (4 sets of eight maximum
voluntary pelvic floor contractions). Between sets there was
a 30 s rest, and between exercises there was a 1 min rest. In
total, the exercise program lasted approximately 45 min.
Motor imagery
The MI group performed 10 min of mental training prior to
aerobic exercise. The participants were taken to the training
track to see the place where they would later train to facil-
itate the imagining task. MI was dosed as follows: 10 sets of
50 s (followed by a 10 s rest) were performed imagining in
first person (or egocentric) and kinesthetically (5 sets) and in
third person (or allocentric) and visually (5 sets). Some ver-
bal cues were provided in order to facilitate the imagination:
“keep imagining”,“imagine running faster”,“imagine how
you overtake the person in front of you”,“try to feel how
your feet step on the ground”,“feel how your heart speeds
up”,“feel how you breathe faster and faster”. Subsequently,
4 sets of 30 s each of the strengthening exercises were per-
formed in third person and visually with the exception of the
maximum voluntary contraction of the PFM, which was
performed only kinesthetically to try to feel the contraction
they had just performed in a real way. The MI sets were
performed during the rest between sets of the actual exer-
cises. Therefore, MI’s total intervention lasted 16 min.
Action observation
The AO group made a 10 min observation of a womanrunning
on the same training track where they would later train. The
video had two 5 min parts, one where the perspective was in
first person, and the other, where the perspective wasin third
person. Subsequently, the participants watched for 4 sets of
30 s each of the strengthening exercises in third person
perspective. The AO sets were visualized during the rest be-
tween sets of the actual exercises. The AO training performed
on PFM contraction was through an illustrative video. The
AO’s total intervention lasted 16 min.
Sham action observation
Women in this group underwent a SO protocol. This group
performed the same visualization training as the AO group,
but the video showed images of interstellar space (without
visualizing any motor gesture). This kind of SO protocol has
been used in previous research [23, 24]. The duration of this
placebo mental training lasted exactly the same as the two
groups of effective mental practice (16 min).
Outcome measures
Baseline outcomes
Baseline measurements included physical activity levels and
motor imagery ability and were performed to ensure that all
women had the same conditions of physical activity levels
and ability to imagine at the beginning of the study.
Physical activity levels
The level of physical activity was evaluated using the inter-
national physical activity questionnaire (IPAQ) [25]. This
questionnaire has shown an acceptable validity to measure
total physical activity. The level of METs expended in the
previous week is estimated by applying a formula. The
reliability of this questionnaire was approximately 0.65
(r=0.76; 95 % CI 0.73–0.77) [26].
Motor imagery ability
The motor imagery ability was measured with the revised
version of the movement imagery questionnaire (MIQ-R). The
MIQ-R is an 8-item self-report inventory that assesses visual
and kinaesthetic motor imagery ability. Four different move-
ments are included in MIQ-R, which is comprised of four visual
and four kinaesthetic items. Participants are required to read
a description of each movement, physically performed the
movement, and then we were instructed to return to the
starting position before engaging in the mental task, imaging
the movement visually or kinaesthetically. Each participant
then rates the ease or difficulty of generating that image on a
7-point scale in which 7 indicates “very easy to see/feel”and 1
“very difficult to see/feel”. The internal consistencies of the
MIQ-R have been consistently adequate, with Cronbach’sα
coefficients above 0.84 for the total scale, 0.80 for the visual
subscale and 0.84 for the kinaesthetic subscale [27].
Primary outcome
Lumbo-pelvic motor control
Motor control of the lumbar region was evaluated through a
stabilizer pressure biofeedback unit (Chattanooga Group
Inc., Chattanooga, TN). We employed a modification of the
neutral position test (developed by Azevedo et al. [28]) based
Nieves-Gómez et al.: Motor imagery & women’s health 3
on the stabilizer instructions; the measurement was based
on a protocol validated in a previous study and presents an
intraclass correlation coefficient of 0.94 (95 % confidence
interval [CI] 0.87–0.97) [28]. The women were positioned in
supine decubitus with the stabilizer in the lumbar region
with an initial pressure of 40 mmHg and a knee flexion of
90°. The women were then instructed to perform a 90°hip
and knee flexion with one limb and then the same action
with the opposite limb. According to the stabilizer’s treat-
ment protocol, the pressure will increase between 8 and
10 mmHg during the exercise. The evaluator performed
three measurements and calculated the total mean pressure
of both lower limbs.
Secondary outcomes
Pain sensitivity
Pain sensitivity was examined through the pressure pain
threshold (PPT). PPT is defined as the minimum amount of
pressure needed to elicit pain. Measurements of PPT were made
using a digital algometer (Model FDX 10®, Wagner Instruments,
Greenwich, CT, USA). This instrument measures the pressure in
kg/cm2. The PPTs were measured on two locations on the body:
(a) the medial plane of the lumbar zone, just below the fifth
lumbar vertebra (local region), and (b) on the dominant leg,
4 cm distal of the tuberositas tibiae (distal region). The evalua-
tion points of the PPTs were chosen following the research work
carried out by Grundström et al. [29]. The average of three
measurements was recorded, with an interval of 30 s between
each measurement to avoid a temporal summation effect. PPT
has shown good reliability and internal consistency [30].
Pelvic floor muscle strength
The PFM strength was objectively measured with a commer-
cially plastic intravaginal dynamometry speculum (Pelvimeter
Phenix, Montpellier, France) in g.Threemaximumeffort
PFM contractions was performed and the mean value of the
three trials was retained for analysis as reported by Navarro
Brazález et al. [31]. The test was connected to a Phenix USB2
biofeedback system (Vivaltis, Montpellier, France), interfaced
with an IBM compatible computer, and protected by latex or
polyethylene covers.
Procedures
After consenting to participate, all the women were received
an initial evaluation prior to the intervention process. Once
the pre-intervention assessment was completed, the inter-
vention was performed, which consisted of 45 min of aerobic
and strength training, together with 16 min of mental prac-
tice (depending on the assignment group) in a single session.
Finally, the outcome measures were assessed at the end of
the intervention again.
Data analysis
The statistical data analysis was performed using statistical
SPSS software version 25.0 (SPSS Inc., Chicago, IL, USA). The
normality of the variables was evaluated by the Shapiro–Wilk
test. Descriptive statistics were used to summarize the data for
continuous variables and are presented as mean±standard
deviation, 95 % confidence interval. For the inferential analysis
of continuous variables, a mixed two-factor analysis of vari-
ance (ANOVA) was conducted with a between-subject factor
“intervention group”having three categories (MI, AO, and SO)
and a within-subject factor “time measurements”having two
categories (pre- and post-intervention). A post hoc analysis with
Bonferroni correction was performed in the case of significant
findings for multiple comparisons between variables. Effect
sizes (d) were calculated according to Cohen’smethod,inwhich
the magnitude of the effect was classified as small (0.20–0.49),
moderate (0.50–0.79)orlarge(0.8)[32].Theαlevel was set at
0.05 for all tests.
Results
A total of 36 women were included in the study, were randomly
allocated into three groups (n=12 per group) (Figure 1). There
were no adverse events reported in either group. All the var-
iables presented a normal distribution. No statistically signifi-
cant between-group differences were found at baseline for any
demographic data or self-report variables (Table 1).
Lumbo-pelvic motor control
The ANOVA revealed significant changes in the lumbo-pelvic
motor control during time (F=4.102, p=0.048, ƞ
p
2=0.11) but
not, during group*time interaction (F=1.47, p=0.24, ƞ
p
2=0.08).
The post hoc analysis revealed significant within-group dif-
ferences only in the AO group with a moderate effect size
(mean difference (MD)=−3.55 mmHg (−6.6 to −0.5), p=0.023,
d=−0.56). No other within-group differences were found
(p>0.05) (Figure 2). No between-group differences were
observed (p>0.05) (Table 2). These results show that the AO
group performed the lumbo-pelvic motor control test
4Nieves-Gómez et al.: Motor imagery & women’s health
statistically significantly more accurately at the end of the
session than at the beginning, although this result was not
enough to be statistically different from that found in the
rest of the groups at the end of the intervention.
Pain sensitivity
Local pain sensitivity (lumbar region)
The ANOVA revealed significant changes in the lumbar PPT
during time (F=7.086, p=0.012, ƞ
p
2=0.16) but not, during
group*time interaction (F=2.02, p=0.11, ƞ
p
2=0.09). The post
hoc analysis revealed significant within-group differences
only in the MI group with a small effect size (MD=0.775 kg/
cm2(0.35–1.2), p=0.001, d=0.44). No other within-group
differences were found (p>0.05) (Figure 3). No between-
group differences were observed (p>0.05) (Table 2). These
results show that the MI group increased PPTs significantly
at the end of the session with respect to the PPTs reported
at baseline, although this result was not enough to be sta-
tistically different from that found in the rest of the groups
at the end of the intervention.
Distal pain sensitivity (tibialis anterior region)
The ANOVA revealed no significant differences in the
tibialis anterior PPT during time (F=0.26, p=0.61, ƞ
p
2=0.01),
nor in during group*time interaction (F=0.04, p=0.96,
ƞ
p
2=0.001).
Figure 1: Flowchart according to CONSORT
statement for the report of randomized trials.
MI, Motor imagery; AO, Action observation;
SO, Sham observation.
Table :Descriptive statistics of baseline outcomes.
Measures MI (n=) AO (n=) SO (n=) p-Value
Age, y/o .±..±..±..
BMI, kg/m.±..±..±..
IPAQ ,.±, ,.±, ,.± .
MIQ-R
MIQR-K .±..±..±..
MIQR-V .±..±..±..
MIQ-R (total) .±..±..±..
Values are presented as mean±standard deviation; y/o, Years old;MI, Motor
imagery; AO, Action observation; SO, Sham observation; MIQ-R, the Revised
Movement Imagery Questionnaire; MIQR-K, Kinaesthetic subscale; MIQR-V,
Visual subscale; IPAQ, International Physical Activity Questionnaire. Figure 2: Results of lumbo-pelvic motor control variable.
*p<0.05. mmHg, millimeters of mercury; MI, Motor imagery; AO, Action
observation; SO, Sham observation.
Nieves-Gómez et al.: Motor imagery & women’s health 5
Pelvic floor muscle strength
The ANOVA revealed no significant differences in the PFM
strength during time (F=0.78, p=0.38, ƞ
p
2=0.02), nor in during
group*time interaction (F=0.05, p=0.95, ƞ
p
2=0.002).
Sample size calculation
The sample size was estimated with the program G*Power
3.1.7 for Windows (G*Power© from University of Dusseldorf,
Germany) [33]. The sample size calculation was considered
as a power calculation to detect statistically significant
between-group differences in the primary outcome mea-
sure. We considered three groups (MI, AO, and SO) and two
measurements (pre- and post-intervention) to obtain 80 %
statistical power (1-βerror probability) with an αerror level
probability of 0.05 using ANOVA, repeated measures, be-
tween factors, and an obtained effect size f=0.344 from our
results. This generated a sample size of total of 66 partici-
pants (22 per group).
Discussion
The main aim of this study was to analyze the effects of a
single session MI and AO plus PE on lumbo-pelvic sensori-
motor function in healthy women. The results obtained in
the present study showed that AO training added to PE
resulted in significant improvements in lumbo-pelvic motor
control. In addition, we also found that adding MI to PE
resulted in improvements in pain sensitivity in the local area
(specifically lumbar area) and we found no changes in
maximal PFM strength.
If we consider the first result, it seems that AO training
facilitates the process of acquisition of fine motor skills, i.e., it
facilitates the motor learning process. This intra-session
change was not found either in the PE group or in the group of
adding MI to PE. AO training is able to improve sensorimotor
control probably because, at the neurophysiological level, the
premotor cortex has a direct functional connection pathway
with the striate cortex. Visual information is integrated into a
brain area that is responsible for planning voluntary move-
ment, so it seems that motor transfer is greater when the
information provided is visual prior to exercise. Pascual-
Leone et al. [34] found the importance of the premotor and
prefrontal cortex in acquiring motor gestures, and its role in
the working memory, the latter of which requires activation
of temporal regions. Visual information, therefore, appears to
play an important role in the functioning of working memory
Figure 3: Results of pain sensitivity variable in lumbar region. *p<0.05;
**p<0.01; kg, kilogram; cm, centimeter; MI, Motor imagery; AO, Action
observation; SO, Sham observation.
Table :Comparative analysis of motor control and pain sensitivity variables.
Measure Group Mean difference ( % CI);
effect size (d)
Pre Post Pre vs. post
L-P motor control MI .±..±.−.(−.to .); d=−.
AO .±..±.−.a(−.to −.); d=−.
SO .±..±..(−.to .); d=.
Mean difference ( % CI); effect size (d) MI vs. AO −.(−.to .); d=. −.(−.to .); d=−.
MI vs. SO −.(−.to .); d=−. −.(−.to .); d=−.
AO vs. SO −.(−.to .); d=−. −.(−.to .); d=−.
Lumbar pain sensitivity MI .±..±..b(.–.); d=.
AO .±..±..(−.to .); d=.
SO .±..±..(−.to .); d=.
Mean difference ( % CI); effect size (d) MI vs. AO .(−.to .); d=. .(−.to .); d=.
MI vs. SO .(−.to .); d=. .(−.to .); d=.
AO vs. SO .(−.to .); d=..(−.to .); d=.
ap<.;bp<.; CI, Confidence interval; MI, Motor imagery; AO, Action observation; SO, Sham observation; L-P, Lumbo-pelvic.
6Nieves-Gómez et al.: Motor imagery & women’s health
and, consequently, in motor learning [35]. The obtained result
in motor control variable is consistent with that found in
other similar investigations. For example, Cuenca-Martínez
et al. [36] found that AO training resulted in improvements in
lumbar motor control significantly faster when added to an
exercise program than exercise alone. In addition to this,
Cuenca-Martínez et al. also found that AO training resulted in
greater improvements in motor learning, as well as, in the
acquisition of fine motor ability through cervical joint posi-
tion sense in patients with persistent neck pain [36, 37]. All of
these findings are consistent with those found in this study.
Regarding the pain sensitivity variable, only the group that
combined MI to an exercise program showed statistically sig-
nificant differences between before and after the intervention.
This result is consistent with others found in the scientific
literature. For example, La Touche et al. [38] found that mental
practice in combination with physical practice applied in the
orofacial region obtained hypoalgesia faster than the group
that only performed physical exercise in isolation. So far, we
do not know the exact mechanisms by which hypoalgesia is
generated by the application of movement representation
techniques such as MI. It is possible that the excitatory sym-
pathetic system participates in this generation of hypoalgesia
as mentioned by Suso-Martí et al. [39]. However, another
mechanism by which hypoalgesia could be explained would
be distraction. This argument has already been used by other
researchers such as Hayashi et al. [40] or Peerdeman et al. [41].
MI involves a conscious process and therefore requires
concentration and high cognitive demand on the part of the
individual, which may involve greater attentional focus than
motor execution [42, 43], especially in complex movements [44].
All this could explain the results obtained.
Finally, we found no improvement in the variable PFM
strength. This result is not surprising as a recent meta-analysis
concluded that several training sessions are necessary to
improve strength through MI with or without combined with
real exercise [45]. However, we wanted to check whether this
also occurred in the PFM, as the Paravlic et al. study does not
include any trials in this body region. It is indeed more than
proven that MI improves strength parameters [8, 13, 46, 47],
however, it seems that a single session is not enough to
improve PFM strength. Therefore, more training sessions
would be necessary in order to observe significant changes
within, and between groups. Finally, this is an exploratory and
pilot study in a field yet to be discovered and investigated in
depth in the coming years. This study leads us to think that a
single session is insufficient, and that we should add more
intervention sessions if we want to expect more robust results.
In addition, MI and AO training should be implemented on
what you intend to improve (e.g., imagining and observing
motor control exercises if you want to improve motor control)
as there seems to beno generalization effect of the results. This
initial and pilot work would make more sense in a population
that had difficulty performing the global exercises (aerobic
and strengthening), since through mental practice, one could
help them to perform them, and thus, secondarily, have a
greater clinical impact on the variables of interest. However,
before going to patients, we wanted to evaluate what happens
in healthy people.
Study limitations
The present study has a number of limitations that should be
considered. First, the present study is a pilot study, so the
sample size is very small.This is an important limitation asthe
results should be interpreted with considerable caution. In
addition, this is a preliminary study and should be considered
as such, to see a first general idea of the behavior of the data in
this field of study. Finally, this research was conducted in
healthy women. It is not possible to extrapolate the results to
patients who have pain or sensorimotor disorders.
Conclusions
In conclusion, our results showed that MI and AO training
plus PE had a slight impact on lumbo-pelvic sensorimotor
function such as motor control or lumbar pain sensitivity
when applied in a single session. Future studies are needed
to evaluate the impact of applying movement representation
techniques together with therapeutic exercise-based reha-
bilitation programs on strength or somatosensory variables
in women with pelvic floor musculoskeletal disorders and
related structures.
Acknowledgments: We would like to thank Marta Aznar
Marín for the help provided during the interventions in this
research.
Research ethics: This study was approved by The Ethics
Committee of Research in Humans of the Ethics Commis-
sion in Experimental Research of University of Valencia
(2699494).
Informed consent: Prior to final inclusion, all signed the
informed consent.
Author contributions: FCM and NRS: Conceptualization;
Methodology; Formal analysis; Investigation; Data curation;
Writing –original draft; Writing –review and editing;
Visualization and Supervision. LFA: Methodology; Investi-
gation; Writing –original draft; Writing –review and editing
and Visualization. All authors: Investigation and Writing –
original draft.
Nieves-Gómez et al.: Motor imagery & women’s health 7
Competing interests: None declared.
Research funding: None declared.
Data availability: Contact with the corresponding author.
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