Too wet to exercise? Leaking urine as a barrier to physical activity in women

Barriers and motivators to undertaking physical activity in adults over 70-a systematic review of the quantitative literature

BACKGROUND

Physical activity (PA) has multiple benefits for older adults (≥70 years old). Despite this many older adults do not undertake the World Health Organisation guideline recommended amount of PA. This systematic review examines barriers and motivators to PA in adults aged ≥70 years.

METHODS

We analysed the quantitative literature, including observational studies and baseline data from randomised controlled trials. Studies examining specific diseases (e.g. cognitive impairment), or care home residents were excluded. Database searches of ASSIA, CINAHL, Embase, Medline, PsycINFO and Web of Science were undertaken on 7 March 2023. Quality assessment was performed using the ROBANS tool. We synthesised the results using the socioecological model. The protocol was registered on PROSPERO (CRD42021160503).

RESULTS

We identified 37 papers, n = 26,961, age 70-101 years (median 78), 62% female. We undertook a narrative review; meta-analysis was not possible. Overall risk of bias was low. A total of 23 studies addressed barriers, seven motivators, seven both. The most cited barriers were: concern about physical health/fitness (14 studies), lack of motivation/interest (13 studies), fear of falls/history of falling (11 studies) and environmental barriers (10 studies). Key motivators were: support from family/friends (five studies), social interaction (five studies), personal benefits (five studies) and outside facilities (five studies). Results varied across gender, age, functional ability and geographical location.

DISCUSSION

To maximise PA in older adults, important modifiable factors identified in this review should be targeted: support from healthcare professionals; reducing fear of falls; and prioritising ease of access and safety of outdoor facilities. When considering future policy, a person-centred, age group appropriate approach will have the most impact.

Examining the factors associated with functional capacity of community-dwelling older adults using the ICF framework: a cross-sectional study from the Frailty in Brazilian Older Adults Study (FIBRA)

BACKGROUND

There are many factors associated with functioning and disability in older adults and these relationships are not clear.

OBJECTIVE

To explore the factors associated with functional capacity of older adults using the framework of the International Classification of Functioning, Disability, and Health (ICF).

METHODS

This is a cross-sectional study with a dataset from a survey of 1 377 community-dwelling older adults (≥ 65 years) in a middle-income country. Three functional outcomes were selected to represent the functioning domains: 1) muscle strength for body function; 2) walking speed for activity; and 3) advanced activities of daily living (ADL) for participation. Demographic, clinical, and social information was selected to represent the domains of health conditions and contextual factors (i.e. personal and environmental factors). Multivariate models tested the impact of these factors on each outcome.

RESULTS

Depressive symptoms, age, and physical activity were associated with the three outcomes. Muscle strength was also associated with urinary incontinence, visual deficits, female sex, and employment. Walking speed was also associated with urinary incontinence, obesity, fractures due to falls, female sex, health professionals' visits, and walking aid devices. Advanced ADL were also associated with stroke, visual deficits, education, employment, health perception, social support, and walking aid devices.

CONCLUSION

Functional capacity of older adults is associated with some non-modifiable factors, such as age and sex. The modifiable factors must be addressed by health professionals and policymakers in the geriatric area, especially depression, obesity, physical inactivity, and social support.

Sports Medicine and the Pelvic Floor

ABSTRACT

The female athlete is seen as a specialist population meaning female considerations, such as pelvic floor dysfunction, are not widely taught within sports medicine. Females have unique anatomical characteristics compared with males including a wider pelvic diameter and an additional orifice in the form of the vagina. Furthermore, symptoms of pelvic floor dysfunction are prevalent among female athletes and transitional periods in their lifespan. They also are a barrier to training and performance. Therefore, it is essential that sports medicine practitioners understand how to identify and manage pelvic floor dysfunction. This report aims to describe the anatomy and function of the pelvic floor, outline the types and rates of pelvic floor dysfunction, discuss evidence-based management, and raise awareness of perinatal bodily changes. Practical recommendations are made to aid sports organizations and sports medicine practitioners in supporting the female athlete and in using a proactive approach to manage the perinatal athlete.

Urinary Incontinence in Competitive Women Weightlifters

ABSTRACT

Wikander, L, Kirshbaum, MN, Waheed, N, and Gahreman, DE. Urinary incontinence in competitive women weightlifters. J Strength Cond Res 36(11): 3130-3135, 2022-Urinary incontinence has the potential to diminish athletic performance and discourage women from participating in sport and exercise. This study determined the prevalence and possible risk factors for urinary incontinence in competitive women weightlifters. This research was a cross-sectional, survey-based study completed by 191 competitive women weightlifters. The frequency and severity of urinary incontinence was determined using the Incontinence Severity Index. Urinary incontinence was defined as an Incontinence Severity Index score >0. The survey questions focused on risk factors, the context and triggers for urinary incontinence, and self-care strategies. Approximately, 31.9% of subjects experienced urinary incontinence within 3 months of completing the survey. Incontinence Severity Index scores were significantly correlated with parity ( r = 0.283, p = 0.01) and age ( r = 0.216, p = 0.01). There was no significant correlation between the Incontinence Severity Index score and the number of years participating in any form of resistance training ( r = -0.010, p = 0.886) or weightlifting ( r = -0.045, p = 0.534), body mass index ( r = 0.058, p = 0.422), or competition total ( r = -0.114, p = 0.115). The squat was the most likely exercise to provoke urinary incontinence. Although the number of repetitions, weight lifted, body position, and ground impact may increase the likelihood of urinary incontinence occurring during a lift, it is difficult to determine which factor has the greatest influence. Some self-care strategies used by competitive women weightlifters who experience urinary incontinence, such as training while dehydrated, have the potential to diminish athletic performance.

Designing physical activity interventions for women aged 50+: a qualitative study of participant perspectives

BACKGROUND

The Active Women over 50 trial tested a scalable program for increasing physical activity among women aged 50+. The program included information, activity tracker and email support. This study sought to describe the participant perspectives of the Active Women over 50 program and considerations for designing physical activity interventions for this demographic.

METHODS

Women who completed the Active Women over 50 trial were purposively recruited for maximum variation in age, employment, carer responsibility, medical conditions and physical activity. Individual semi-structured interviews explored their perspectives on physical activity, Active Women over 50 program components and suggestions for future iterations. Data were thematically analysed.

RESULTS

Participants' capacity to be physically active was shaped by an interplay of factors. Our analysis generated four main themes relating to physical activity in general and to the program: Age and gender matters, Physical activity is social, Strategising for physical activity and the Self-responsibility discourse. At this midlife stage, physical activity participation was challenged by personal, life-stage and cultural factors, alongside a tension of the self-responsibility discourse which also impacted the program experience. Social factors and finding a suitable strategy for motivation were deemed integral aspects of being active. Future programs could consider facilitation of social networks and accountability, life-stage health information and positive framing to support self-responsibility.

CONCLUSION

A range of strategies is key to supporting women over 50 to be more physically active due to the variety of circumstances and levels of agency experienced. We offer suggestions that do not need to be resource intensive but could be incorporated into a scaled program.

Urinary Incontinence in Competitive Women Powerlifters: A Cross-Sectional Survey

Background

Urinary incontinence (UI) can negatively affect a woman’s quality of life, participation in sport and athletic performance. The objectives of this study were to determine the prevalence of UI in competitive women powerlifters; identify possible risk factors and activities likely to provoke UI; and establish self-care practices.

Methods

This international cross-sectional study was conducted using an online survey completed by 480 competitive women powerlifters aged between 20 and 71 years. The Incontinence Severity Index (ISI) was used to determine the severity of UI.

Results

We found that 43.9% of women had experienced UI within the three months prior to this study. The deadlift was the most likely, and the bench-press the least likely exercise to provoke UI. ISI scores were positively correlated with parity (τ = 0.227, p < 0.001), age (τ = 0.179, p < 0.001), competition total (τ = 0.105, p = 0.002) and body mass index score (τ = 0.089, p = 0.009). There was no significant correlation between ISI and years strength training (τ = − 0.052, p = 0.147) or years powerlifting (τ = 0.041, p = 0.275). There was a negative correlation between ISI score with having a pelvic floor assessment (η = 0.197), and the ability to correctly perform pelvic floor exercises (η = 0.172).

Conclusion

The prevalence of UI in this cohort was at the upper limit experienced by women in the general population. Women who had undergone a pelvic floor examination or were confident in correctly performing pelvic floor exercises experienced less severe UI.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-021-00387-7.

Stress Urinary Incontinence Among Young Nulliparous Female Athletes

Urinary incontinence (UI) is described as unintentional voiding of urine that is usually seen in post-partum and post-menopausal women due to the weakening of pelvic floor muscles (PFM). Recent studies have shown an increase in the prevalence of stress urinary incontinence (SUI) among young nulliparous female athletes. The association between UI and high-impact physical activity is due to increased intra-abdominal pressure during high-impact sports exceeding intra-urethral pressure. Usually, the levator ani muscle (LAM) helps in urethral closure. However, weakening or injury of LAM can reduce the pelvic support and cause UI in young female athletes. This study aims to assess the prevalence of SUI among young nulliparous athletes and also explore the association between SUI and athletic sports in young females. We searched PubMed and Google Scholar as databases to find specific articles about the topic. After the inclusion and exclusion criteria were applied, 52 articles were selected for this review. It is found that there is an increased UI prevalence, mainly SUI, among young nulliparous female athletes, especially in volleyball players and long-distance runners. Nulliparous athletes involved in high-impact exercises were found to have an increased cross-sectional area of LAM and puborectalis muscle width. SUI is usually under-reported and underdiagnosed due to lack of knowledge and unawareness, which can negatively affect the personal and social life of young females. PFM training is considered the first line of therapy among nulliparous athletes. However, it is unclear whether the high-impact effects of sports cause UI through PFM fatigue or PFM damage. More research is needed to better understand this effect.

Diagnosis and Non-Surgical Management of Urinary Incontinence - A Literature Review with Recommendations for Practice

Urinary incontinence (UI) is a bothersome symptom with population studies suggesting a prevalence of 13.1% in women and 5.4% in men. While a significant cohort of patients with this complaint may ultimately require surgical management to achieve complete continence, a number of non-surgical measures exist to improve symptoms and quality of life. A range of guidelines exist on this topic, including those published by the European Association of Urology (EAU), the International Continence Society (ICS), the American Urological Association (AUA) and the UK's National Institute for Health and Care Excellence (NICE). The aim of our study is to provide an overview of the initial assessment of patients with UI including history taking, examination and basic investigations. Our review outlines non-surgical management strategies for UI, including conservative measures, behavioral and physical therapies and drug treatment. We shall also examine the above guidelines and present a narrative overview of the literature surrounding the diagnosis and non-surgical management of urinary incontinence.

[Urinary Continence and Mobility - two sides of the same coin]

Urinary incontinence and gait disorders are common health related problems that occur especially in old age. Therefore they are called geriatric syndromes. Do they develop independently or is there an association? Do improvements of urinary incontinence result in reduced gait disorders and vice versa? It seems, that there is an interrelation between urinary incontinence and gait disorders. And further, both syndroms seem to interact closely and can be influenced by improvements of each other. Knowing and recognizing the interaction of micturition and physical performance is essential to working towards prevention of UI and to improving quality of treatment and quality of life.

Relationships between stress urinary incontinence and trunk muscle mass or spinal alignment in older women

OBJECTIVES

Relationships between stress urinary incontinence (SUI) and physical function and spinal alignment have not been fully elucidated; therefore, we examined these relationships in older women.

METHODS

The participants of this cross-sectional study comprised 21 women with SUI (SUI group) and 41 continent women (continent group) aged >65 years who participated in a community-based health-check survey from 2018 to 2019. We examined age, body mass index, number of deliveries, age at first childbirth, and medical histories as participants' characteristics. SUI was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). We also assessed spinal alignment and physical activity, grip strength, trunk and lower limb muscle mass, gait speed, and one-leg standing time as measures of participants' physical function.

RESULTS

Body mass index was significantly higher in the SUI group compared with continents (P = 0.04), and trunk muscle mass in the SUI group was significantly lower (P < 0.01). Additionally, the thoracic kyphosis angle in the SUI group was significantly larger (P = 0.02). In the logistic regression analysis, trunk muscle mass (odds ratio = 0.546, P = 0.03) and increased thoracic kyphosis angle (odds ratio = 1.066, P = 0.045) were independent factors affecting SUI. Furthermore, there was a negative weak correlation between total ICIQ-SF score and trunk muscle mass (r = -0.36, P < 0.01), and a positive weak correlation between total ICIQ-SF score and thoracic kyphosis angle (r = 0.27, P < 0.05).

CONCLUSION

Trunk muscle mass and thoracic kyphosis angle relate to SUI status and severity among Japanese community-dwelling older women.

Does regular strength training cause urinary incontinence in overweight inactive women? A randomized controlled trial

Introduction and hypothesis

Urinary incontinence (UI) is common in women who exercise. We aimed to investigate new onset UI in formerly inactive, overweight or obese women (BMI > 25) participating in three different strength training modalities compared with a non-exercising control group.

Methods

This was a secondary analysis of an assessor blinded randomized controlled trial investigating the effect of 12 weeks of three strength training concepts for women on muscle strength and body composition. None of the programs included pelvic floor muscle training. International Consensus on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was used to investigate primary outcome; new onset UI, and secondary outcome; ICIQ-UI-SF sum score. Suissa and Shuster’s exact unconditional test was used to analyze difference in new onset UI. Difference in ICIQ-UI-SF sum score is presented as mean with 95% CI.

Results

At baseline 40 out of 128 (31.2%) participants reported UI. Three out of 27, 2 out of 17, 2 out of 23, and 0 out of 21 women in the three training and control groups respectively had new onset UI. There were no statistically significant differences in new onset UI across the groups or when collapsing new onset UI in the intervention groups compared with the controls (7 out of 67 vs 0 out of 21), p = 0.124. After the intervention the control group reported worse ICIQ-UI-SF sum score than any of the training groups; mean difference − 6.6 (95% CI: −11.9, −1.27), p = 0.012, but there was no difference in change from baseline to 12 weeks between the groups p = 0.145).

Conclusions

There was no statistically significant change in UI after strength training.

Urinary Incontinence and Women CrossFit Competitors

Purpose

Urinary incontinence is a common condition that potentially discourages women from participating in physical activity. This study aimed to determine the prevalence of urinary and athletic incontinence and establish which activities and contexts were most likely to provoke urine leakage in women CrossFit competitors.

Patients and Methods

This research was an international, cross-sectional, survey-based study. The online survey was completed by 452 women CrossFit competitors. The Incontinence Severity Index was used to determine the frequency and severity of urinary incontinence.

Results

Urinary incontinence was experienced by 41.8% of participants in the three months prior to the study and 17.7% experienced athletic incontinence. Women came to experience athletic incontinence through two different pathways. Some women were continent before commencing CrossFit (9.7%), remain continent during everyday activities but now experience urinary incontinence during exercise. Alternatively, 8% of women were incontinent before commencing CrossFit, are now continent during everyday activities but remain incontinent during exercise. High impact CrossFit activities were most likely to provoke urinary incontinence.

Conclusion

This study highlighted the importance of distinguishing between urinary incontinence that develops after commencing an exercise program in otherwise continent women and urinary incontinence that persists only during exercise in previously incontinent women.

Frequência de incontinência urinária em mulheres praticantes de crossfit: um estudo transversal

RESUMO O objetivo deste estudo foi verificar a frequência de Incontinência Urinaria (IU) em mulheres praticantes de Crossfit. Realizou-se um estudo de corte transversal com mulheres que praticavam Crossfit há, pelo menos, 6 meses ininterruptos, com idade entre 18 a 35 anos e frequência de treino de, no mínimo, três vezes por semana. Foram aplicados questionários de avaliação individual compostos por dados sociodemográficas, antropométricos e esportivos, além do International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF), para identificar a presença de IU. Também por meio do ICIQ-IU-SF foram identificados a frequência e quantidade de perda de urina e interferência da IU na qualidade de vida (QV) das mulheres incontinentes. Essas mulheres também responderam a um questionário acerca da gravidade da IU. A amostra total do estudo foi de 50 mulheres, das quais 10 (20%) apresentaram IU. A maioria das mulheres incontinentes apresentou IU de gravidade moderada e de interferência leve na QV. Ademais, observou-se associação entre ter histórico de IU e apresentar IU (RP=5,33; IC95%=1,41 a 20,10). Diante do exposto, conclui-se que a frequência de IU em mulheres praticantes de Crossfit foi de 20%, sendo a IU, em sua maioria, de gravidade moderada e de leve interferência na QV.

Urinary Incontinence Among Omani Women: Prevalence, risk factors and impact on quality of life

Objectives

Urinary incontinence (UI) in women is a common health problem which can have a negative impact on quality of life (QOL). This study aimed to determine the prevalence, risk factors and impact of UI on the QOL of Omani women attending primary healthcare centres in Muscat, Oman.

Methods

This cross-sectional study was conducted at three primary healthcare centres in Muscat from April to August 2018. Women who were 20–50 years of age, not pregnant, not in the six-month postnatal period, not seriously ill and not diagnosed with pelvic organ prolapse were included. A self-administered questionnaire using the International Consultation Incontinence Questionnaire-Short Form was used to evaluate the frequency, severity and impact of UI on QOL.

Results

A total of 1,070 women were included in this study (response rate = 92.5%). The mean age was 31.39 ± 7.64 years. UI was reported by 369 (34.5%) women, of whom 182 (49.3%) had stress UI, 97 (26.3%) had urgency UI, 88 (23.8%) had mixed UI and two (0.5%) had other UI. Age, body mass index (BMI), having been married or employed, hypertension, cough, constipation and vaginal or assisted vaginal delivery during the previous birth were significant risk factors for UI. Only 41 (11.1%) out of the 369 women with UI had ever sought medical advice despite the fact that more than two thirds of the women with UI reported negative effects on their QOL.

Conclusion

UI is a common medical problem in Oman. Several risk factors, including age and BMI, were identified. Despite its negative consequences for QOL, women were found to be reluctant to seek medical attention for the condition.

Urinary incontinence in a fitness club setting-is it a workout problem?

INTRODUCTION

The aims of the present study were to report longitudinal data on the prevalence of urinary incontinence (UI) in a fitness club setting and to investigate whether gym members are educated about and exercise their pelvic floor muscles.

METHODS

New members (125 women) from 25 fitness clubs in Oslo, Norway, filled in a 25-min online questionnaire (SurveyXact) at four time points (onset, 3, 6 and 12 months of fitness club membership). The questionnaire covered background/health information, membership dropout and exercise habits, including pelvic floor muscle training (PFMT). A modified Subjective Health Complaints Inventory (SHC Inventory) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were used to gather repeated measures of UI.

RESULTS

At onset, 3, 6 and 12 months of fitness club membership, 16.8%, 13.8%, 19.6% and 18.7% reported UI, respectively (p = 0.11). Of these, 57.1% to 76.2% reported leakage during exercise and perceived the UI to be slight. Less than 8% had received information about PFMT by the fitness club staff. Adherence to regular exercise and PFMT throughout the follow-up period (minimum two sessions/week) did not show any association with absent or present UI at 12 months (p = 0.48 and p = 0.63) and was reported by 30% and 22.2% of the participants, respectively.

CONCLUSIONS

About 17% reported UI at onset of fitness club membership, with no changes in proportions throughout the first year. Adherence to regular exercise and PFMT did not show any association with absent or present UI at 12 months. Few had been taught PFMT.

Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review

More women participate in sports than ever before and the proportion of women athletes at the Olympic Games is nearly 50%. The pelvic floor in women may be the only area of the body where the positive effect of physical activity has been questioned. The aim of this narrative review is to present two widely held opposing hypotheses on the effect of general exercise on the pelvic floor and to discuss the evidence for each. Hypothesis 1: by strengthening the pelvic floor muscles (PFM) and decreasing the levator hiatus, exercise decreases the risk of urinary incontinence, anal incontinence and pelvic organ prolapse, but negatively affects the ease and safety of childbirth. Hypothesis 2: by overloading and stretching the PFM, exercise not only increases the risk of these disorders, but also makes labor and childbirth easier, as the PFM do not obstruct the exit of the fetus. Key findings of this review endorse aspects of both hypotheses. Exercising women generally have similar or stronger PFM strength and larger levator ani muscles than non-exercising women, but this does not seem to have a greater risk of obstructed labor or childbirth. Additionally, women that specifically train their PFM while pregnant are not more likely to have outcomes associated with obstructed labor. Mild-to-moderate physical activity, such as walking, decreases the risk of urinary incontinence but female athletes are about three times more likely to have urinary incontinence compared to controls. There is some evidence that strenuous exercise may cause and worsen pelvic organ prolapse, but data are inconsistent. Both intra-abdominal pressure associated with exercise and PFM strength vary between activities and between women; thus the threshold for optimal or negative effects on the pelvic floor almost certainly differs from person to person. Our review highlights many knowledge gaps that need to be understood to understand the full effects of strenuous and non-strenuous activities on pelvic floor health.

Identifying female pelvic cancer survivors with low levels of physical activity after radiotherapy: women with fecal and urinary leakage need additional support

Objective

To investigate the frequency of physical activity among female pelvic cancer survivors (i.e., gynecological, rectal, and anal cancer survivors) and to investigate if survivors who practiced physical activity less than once a week differed from survivors practicing physical activity at least once a week with respect to urinary and fecal leakage, clinical and sociodemographic characteristics, quality of life (QoL), and depressed and anxious mood.

Methods

Female pelvic cancer survivors (n = 578, mean age 64 years) answered a questionnaire 6–48 months after radiotherapy. A multivariable regression model analyzed factors covarying with frequency of physical activity. We compared QoL and depressed and anxious mood between women practicing physical activity at least or less than once a week.

Results

Of 568 women delivering data, 186 (33%) practiced physical activity less than once a week while 382 (67%) practiced physical activity at least weekly. Women who leaked a large or all volume of stools (p = 0.01), had just elementary school level of education (p < 0.001), smokers (p = 0.049), or had lymphedema without receiving lymphedema treatment (p = 0.030) were more likely to practice physical activity less than weekly (50%, 45%, 45%, and 37%, respectively) compared with other women. Women practicing physical activity at least weekly reported better QoL (p < 0.001) and lower frequency of depressed mood (p = 0.044) compared with the others.

Conclusions

Female cancer survivors experiencing fecal leakage were less likely to practice weekly physical activity than survivors without leakage. The survivors practicing weekly physical activity experienced better QoL and experienced depressed mood less frequently than the others.

Identifying the most reliable and valid bladder health screening tool: a systematic review

Purpose: Lower urinary tract symptoms are common in advancing age and a major cause of disability through avoidance of activity and social engagement. This systematic review aimed to identify the most valid and reliable brief screening tool for these symptoms or bladder problems, to incorporate into a health promotion programme for older adults to facilitate discussion about self-management.Method: Review eligibility criteria included studies published between 1990 and November 2018, reporting the validity, reliability and/or acceptability of bladder health screening tools. Six electronic databases were searched.Results: Twenty-two studies were included. Three screening tools met the criteria: International Prostate Symptom Score (IPSS); International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form; Bladder Control Self-Assessment Questionnaire (B-SAQ). Test-retest reliability for total scores of the IPSS and International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form was acceptable. All three questionnaires showed evidence of acceptable levels of internal consistency and of convergent validity.Conclusion: Having favourable psychometric scores compared to the B-SAQ and for ease of use and trustworthiness of a simple questionnaire, the IPSS and International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form met the criteria for recommendation for raising awareness and bladder health promoting interventions to reduce associated disability.Implications for RehabilitationLower urinary tract symptoms are common in advancing age and a major cause of disability through avoidance of activity and social engagement.Lower urinary tract symptoms can be prevented or improved through self-management strategies.Help-seeking levels for lower urinary tract symptoms is low but could be improved through continence promotion interventions.The International Prostate Symptom Score and the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form are bladder health screening questionnaires which would be appropriate to use as part of a continence promotion intervention to help prompt discussions and raise awareness and subsequently improve symptoms and associated disability.

Regular exercisers have stronger pelvic floor muscles than nonregular exercisers at midpregnancy

BACKGROUND

Today all healthy pregnant women are encouraged to be physically active throughout pregnancy, with recommendations to participate in at least 30 minutes of aerobic activity on most days of the week in addition to performing strength training of the major muscle groups 2-3 days per week and also pelvic floor muscle training. There is, however, an ongoing debate whether general physical activity enhances or declines pelvic floor muscle function.

OBJECTIVES

The objectives of the study were to compare vaginal resting pressure, pelvic floor muscle strength, and endurance in regular exercisers (exercise ≥30 minutes 3 or more times per week) and nonexercisers at midpregnancy. Furthermore, another objective was to assess whether regular general exercise or pelvic floor muscle strength was associated with urinary incontinence.

STUDY DESIGN

This was a cross-sectional study at mean gestational week 20.9 (±1.4) including 218 nulliparous pregnant women, with a mean age of 28.6 years (range, 19-40 years) and prepregnancy body mass index of 23.9 kg/m² (SD, 4.0). Vaginal resting pressure, pelvic floor muscle strength, and pelvic floor muscle endurance were measured by a high-precision pressure transducer connected to a vaginal balloon. The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form was used to assess urinary incontinence. Differences between groups were analyzed using an independent-sample Student t test. Linear regression analysis was conducted to adjust for prepregnancy body mass index, age, smoking during pregnancy, and regular pelvic floor muscle training during pregnancy. The significance value was set to P ≤ .05.

RESULTS

Regular exercisers had statistically significant stronger (mean 6.4 cm H₂O [95% confidence interval, 1.7-11.2]) and more enduring (mean 39.9 cm H₂Osec [95% confidence interval, 42.2-75.7]) pelvic floor muscles. Only pelvic floor muscle strength remained statistically significant, when adjusting for possible confounders. Pelvic floor muscle strength and not regular general exercise was associated with urinary continence (adjusted B, -6.4 [95% confidence interval, -11.5 to -1.4]).

CONCLUSION

Regular exercisers at midpregnancy have stronger pelvic floor muscles than their sedentary counterparts. However, pelvic floor muscle strength and not regular general exercise was associated with urinary incontinence. There is a need for additional studies in elite athletes and women performing more strenuous exercise regimens.

Modified Pilates as an adjunct to standard physiotherapy care for urinary incontinence: a mixed methods pilot for a randomised controlled trial

Background

Urinary incontinence (UI) is a distressing condition affecting at least 5 million women in England and Wales. Traditionally, physiotherapy for UI comprises pelvic floor muscle training, but although evidence suggests this can be effective it is also recognised that benefits are often compromised by patient motivation and commitment. In addition, there is increasing recognition that physical symptoms alone are poor indicators of the impact of incontinence on individuals’ lives. Consequently, more holistic approaches to the treatment of UI, such as Modified Pilates (MP) have been recommended. This study aimed to provide preliminary findings about the effectiveness of a 6-week course of MP classes as an adjunct to standard physiotherapy care for UI, and to test the feasibility of a randomised controlled trial (RCT) design.

Methods

The study design was a single centre pilot RCT, plus qualitative interviews. 73 women referred to Women’s Health Physiotherapy Services for UI at Colchester Hospital University NHS Foundation Trust were randomly assigned to two groups: a 6-week course of MP classes in addition to standard physiotherapy care (intervention) or standard physiotherapy care only (control). Main outcome measures were self-reported UI, quality of life and self-esteem at baseline (T1), completion of treatment (T2), and 5 months after randomisation (T3). Qualitative interviews were conducted with a subgroup at T2 and T3. Due to the nature of the intervention blinding of participants, physiotherapists and researchers was not feasible.

Results

Post-intervention data revealed a range of benefits for women who attended MP classes and who had lower symptom severity at baseline: improved self-esteem (p = 0.032), decreased social embarrassment (p = 0.026) and lower impact on normal daily activities (p = 0.025). In contrast, women with higher symptom severity showed improvement in their personal relationships (p = 0.017). Qualitative analysis supported these findings and also indicated that MP classes could positively influence attitudes to exercise, diet and wellbeing.

Conclusions

A definitive RCT is feasible but will require a large sample size to inform clinical practice.

Trial registration

ISRCTN74075972 Registered 12/12/12 (Retrospectively registered).

Electronic supplementary material

The online version of this article (10.1186/s12905-017-0503-y) contains supplementary material, which is available to authorized users.

Urinary leakage during exercise: problematic activities, adaptive behaviors, and interest in treatment for physically active Canadian women

INTRODUCTION AND HYPOTHESIS

Urine loss during recreational exercise is problematic. We aimed to characterize which activities are most frequently reported as causing leakage for women, adaptive management mechanisms, and awareness and interest in treatment in a cohort of physically active women.

METHODS

We administered an anonymous questionnaire to 59 physically active women in Canada. Surveys were completed electronically or on paper. Demographic information was obtained. Questions about which specific activities caused leakage, adaptive behaviors to deal with urinary loss, and degree of bother were addressed, and knowledge and interest in therapies for leakage were queried.

RESULTS

Activities most likely to cause leakage were skipping, trampoline, jumping jacks, and running/jogging. To decrease leakage, 93.2% voided immediately before exercise, 62.7% reported voiding breaks, and some reported fluid restriction (37.3%). Leakage impacted activity level for 50% of women. Most often, activity intensity was decreased (90.3%) or specific activities avoided (80.7%). Pad use during exercise was common (49.2%). Interest in receiving treatment for urinary incontinence (UI) was high (88.1%) despite a large proportion (35.6%) not knowing of available treatments. Interest was highest for pelvic floor physiotherapy (84.6%), although interest in both pessary and surgical management (63.5% each) was significant.

CONCLUSIONS

Women experiencing UI during exercise report high-impact activities as most frequently causing loss. Adaptive behaviors are common. Physically active women are interested in treatment, and the high interest in pelvic physiotherapy presents a unique opportunity to link pelvic exercise with recreational exercise to meet both cardiovascular and continence needs in the physically active patient population.

Female reproductive factors are associated with objectively measured physical activity in middle-aged women

Physical activity improves health and may delay the onset of several chronic diseases. For women in particular, the rate of these diseases accelerates at middle age; therefore it is important to identify the determinants of health-enhancing physical activity during midlife in this population. In this study, we focused on determinants that are unique to the female sex, such as childbearing and menopause. The main objective was to characterize the level of physical activity and differences between active and inactive middle-aged Finnish women. In addition, we examined the association of physical activity with female reproductive factors at midlife. The study population consisted of 647 women aged 48 to 55 years who participated in our Estrogenic Regulation of Muscle Apoptosis (ERMA) study during the period from 2015 to 2016. Physical activity was measured objectively using hip-worn accelerometers for seven consecutive days. The outcome measures included the amounts of light intensity physical activity and moderate to vigorous intensity physical activity accumulated in bouts of at least 10 minutes (MVPA₁₀). MVPA₁₀ was used to determine whether women were placed in the active (≥150 min/week) or inactive (<150 min/week) group. Multiple linear regression models were performed with physical activity measures as dependent variables and cumulative reproductive history index, menopausal symptoms, and pelvic floor dysfunction as independent variables. We found that a large portion (61%) of Finnish middle-aged women did not meet the physical activity recommendations of 150 minutes of MVPA₁₀ per week. In the studied cohort, 78% of women experienced menopausal symptoms, and 54% exhibited pelvic floor dysfunction. Perceived menopausal symptoms were associated with greater light physical activity. Perceived pelvic floor dysfunction was associated with lower MVPA₁₀. According to the fully adjusted multiple linear regression models, reproductive factors explained 6.0% of the variation of MVPA₁₀ and 7.5% of the variation of light physical activity. The results increase our knowledge of the factors related to physical activity participation among middle-aged women and indicate that menopausal symptoms and pelvic floor dysfunction should be identified and considered when promoting physical activity for women during midlife. The results emphasize that awareness of female reproductive factors, especially menopausal symptoms and pelvic floor dysfunction, is important for physical activity counseling to effectively help women in performing and sustaining health-enhancing amounts of physical activity. Specifically, the condition of the pelvic floor should be taken into account when identifying the proper activity type and intensity level so that health benefits of physical activity can still be attained without worsening symptoms.

Stress urinary incontinence in women as a medical, social, psychological and economic problem – assessing the extent of knowledge of students graduating in medical fields

Stress urinary incontinence occurs when there is an increase in pressure inside the abdomen accompanied by involuntary leakage of urine associated with coughing, sneezing, laughing or demanding physical labour. It is a serious condition that isolates women from society, prevents efficient functioning, limits social contacts and forces a change in lifestyle. The fear of leakage of urine and odour arouses embarrassment, adversely affecting the psyche - leading to decreased self-esteem, neurosis and depression. In addition, in the absence of appropriate hygiene measures, or the lack of financial resources to acquire them, incontinence can be a factor excluding women from normal life. The aim of this study was to assess the extent of knowledge of students graduating in medical fields on stress urinary incontinence in women as a medical, social, psychological and economic problem. The study involved 1,581 students during their final year of medical studies, studying at various universities. The study involved 1,255 women and 326 men. We created a questionnaire which was verified by the CEM - Institute for Market Research and Public Opinion in Krakow. The largest percentage of respondents (95%) in all groups believes that stress urinary incontinence is primarily a medical problem, approx. 92% of respondents also regarded it as a psychological problem. It was shown that stress urinary incontinence in women was found to be a medical, social, psychological and economical problem by more than half of the students of medical, obstetric and nursing fields.

Obesity with Comorbid Stress Urinary Incontinence in Women: A Narrative Review to Inform Dietetics Practice

Stress urinary incontinence (SUI) is a common problem among women; clinical treatment guidelines include weight reduction as a strategy for controlling urinary leakage. The purpose of this review was to gather evidence on the association between obesity and SUI and to ascertain whether there are any special considerations for implementing medical nutrition therapy with community-dwelling, obese, adult females with comorbid SUI. Five key findings emerged: epidemiologic studies consistently report statistically significant associations between obesity and SUI, randomized control trials found that weight loss appears to ameliorate SUI symptoms, the SUI-activity link may affect weight management, there is a potential interplay between SUI and the obesity-sleep connection, and dietary components are associated with the exacerbation of urinary symptoms. The pathogenesis of SUI and obesity-related contributions to urinary leakage is included in the introductory discussion. Lastly, insights on special considerations for implementing nutrition interventions with this population are offered.

Functional disability and compromised mobility among older women with urinary incontinence

OBJECTIVE

Our objective was to determine the prevalence of functional disability among older women with urinary incontinence (UI).

METHODS

We conducted a secondary analysis of the 2005-2006 National Social Life, Health and Aging Project. Daily UI was defined as answering "daily" to the question, "How frequently… have you had difficulty controlling your bladder, including leaking small amounts of urine, leaking when you cough or sneeze, or not being able to make it to the bathroom on time?" We then explored functional status. Women were asked about 7 basic activities of daily living (ADLs). Statistical analyses with percentage estimates and 95% confidence intervals (CIs) were performed. Logistic regression was performed to assess the association between functional status and daily UI.

RESULTS

In total, 1412 women were included in our analysis. Daily UI was reported by 177 (12.5%) women. Functional dependence or disability with any activities of daily living was reported in 62.1% (95% CI, 54.2%-70.1%) of women with daily UI. Among women with daily UI, 23.6% (95% CI, 16.8%-30.5%) reported specific difficulty or dependence with using the toilet, signifying functional limitations which may contribute to urine leakage. After adjusting for age category, race/ethnicity, education level, and parity, women with daily UI had 3.31 increased odds of functional difficulty or dependence compared with continent older women.

CONCLUSIONS

More than 60% of older women with daily UI reported functional difficulty or dependence and one fourth of women with daily UI specifically reported difficulty or dependence with using the toilet.

Frequency and Determinants of Urinary Incontinence in Adolescent and Young Nulliparous Women

STUDY OBJECTIVE

To investigate the rate of urinary incontinence (UI) in a sample of young nulligravid women and its potential risk factors and consequences on life habits.

DESIGN AND PARTICIPANTS

The study is based on an online self-administered questionnaire taken by nulligravid women aged 15 to 25 years.

MEASUREMENTS

The Questionnaire for Urinary Incontinence Diagnosis and part of The King's Health Questionnaire. Demographics and general characteristics are also recorded.

RESULTS

We collected 1936 questionnaires (mean age of participants, 21 years); 12.4% of the sample reported any UI (95% confidence interval [CI] 10.9% to 13.9%). The estimated incidence of UI subtypes was 7.2% (95% CI 6.0% to 8.4%) stress UI, 3.4% (95% CI 2.6% to 4.3%) urge UI, and 1.9% (95% CI 1.3% to 2.6%) mixed UI. Age younger than 19 years and body mass index of 30 kg/m(2) or greater were associated in the multivariate analysis with an increased risk of UI. A self-reported history of psychological disorders increased the risk of UI (adjusted odds ratio [AOR] 1.4 and 95% CI 1.1% to 1.9%), without significant differences among the UI subtypes. A current history of constipation (AOR 1.9 and 95% CI 1.3% to 2.6%) and enuresis after the age of 5 also increased the risk of UI (AOR 2.9 and 95% CI 2.0% to 4.3%).

CONCLUSION

In a sample of young nulligravid women, UI was not associated with any chronic risk factor known for elder age, but a prevention program may be proposed to women because of their young age (eg, educational session to promote the proper functioning of the pelvic floor). More detailed analyses are needed to better assess the prevalence of UI and risk factors in young nulligravid women.

Relationships among symptom severity, coping styles, and quality of life in community-dwelling women with urinary incontinence: a multiple mediator model

PURPOSE

To investigate the relationships among symptom severity, coping styles, and quality of life (QOL) in community-dwelling women with urinary incontinence (UI).

METHODS

A total of 592 women with UI participated in this cross-sectional study. Bivariate Pearson's correlation was used to examine the correlations between symptom severity, coping styles, and QOL. Multivariate regression models and Sobel tests were used to test the mediating effect of coping styles. Additionally, a multiple mediator model was used to examine the mediating role of coping styles collectively. All regression models were adjusted for age, education, marital status, income, duration of UI, and type of UI.

RESULTS

Participants tended to use avoidant and palliative coping styles and not use instrumental coping style. Avoidant and palliative coping styles were associated with poor QOL, and partially mediated the association between symptom severity and QOL. Nearly 73% of the adverse effect of symptom severity on QOL was mediated by avoidant and palliative coping styles.

CONCLUSIONS

The use of avoidant and palliative coping styles was higher with more severe urine leakage, and QOL tended to be poorer. Coping styles should be addressed in UI management. It may be of particular value to look closely at negative coping styles and implement education and training of patients in improving their coping skills related to managing UI, which will in turn improve their QOL.

[Urinary incontinence in non-professional female marathon runners]

OBJECTIVE

To determine the prevalence of urinary incontinence within a population of female recreational runners during a marathon.

METHODS

Observational study carried on a marathon from the analysis of questionnaire handed to the participants before the beginning of the marathon. The questionnaire was handed to 800 participants and among them, 517 (64.6%) agreed to fill it. Among the participants, 268 (52.4%) were marathon runners and 243 (47.5%) were relay runners.

RESULTS

Mean age of the runners was 41.1 (±9.7), 479 (93.7%) of them were caucasian, mean body mass index was 20,7 (±1.9) kg/m(2) and 173 (34%) were nulliparous. Among responders, 157 (30.7%) runners declared to have urinary incontinence symptoms (any circumstances). Among 157 runners who declared an urinary incontinence, 83 (52,9%) presented with urinary leaks during the running. In half of the cases, these urinary leaks usually arose at the end of race. Urinary incontinence during coughing, sneezing or laughing was reported by 96/517 (18,5%) women. The prevalence of urge urinary incontinence was 63/517 (12%). Concerning the frequency of urinary incontinence, 39/517 (7.5%) women reported at least once weekly. For urinary incontinence bother, scores on the Visual Analogue Scale (VAS 0 to 100) was 1.6 (±1.7).

CONCLUSION

In this series, the prevalence of urinary incontinence was 30.7% within a population of female recreational runners. This rate seems to be similar to the current prevalence in the general population.

Long-term prevalence and predictors of urinary incontinence among women in the Diabetes Prevention Program Outcomes Study

OBJECTIVES

To examine the long-term prevalence and predictors of weekly urinary incontinence in the Diabetes Prevention Program Outcomes Study, a follow-up study of the Diabetes Prevention Program randomized clinical trial of overweight adults with impaired glucose tolerance.

METHODS

This analysis included 1778 female participants of the Diabetes Prevention Program Outcomes Study who had been randomly assigned during the Diabetes Prevention Program to intensive lifestyle intervention (n = 582), metformin (n = 589) or placebo (n = 607). The study participants completed semi-annual assessments after the final Diabetes Prevention Program visit and for 6 years until October 2008.

RESULTS

At the study entry, the prevalence of weekly urinary incontinence was lower in the intensive lifestyle intervention group compared with the metformin and placebo groups (44.2% vs 51.8%, 48.0% urinary incontinence/week, P = 0.04); during the 6-year follow-up period, these lower rates in intensive lifestyle intervention were maintained (46.7%, 53.1%, 49.9% urinary incontinence/week; P = 0.03). Statistically adjusting for urinary incontinence prevalence at the end of the Diabetes Prevention Program, the treatment arm no longer had a significant impact on urinary incontinence during the Diabetes Prevention Program Outcomes Study. Independent predictors of lower urinary incontinence during the Diabetes Prevention Program Outcomes Study included lower body mass index (odds ratio 0.988, 95% confidence interval 0.982-0.994) and greater physical activity (odds ratio 0.999, 95% confidence interval 0.998-1.000) at the Diabetes Prevention Program Outcomes Study entry, and greater reductions in body mass index (odds ratio 0.75, 95% confidence interval 0.60-0.94) and waist circumference (odds ratio 0.998, 95% confidence interval 0.996-1.0) during the Diabetes Prevention Program Outcomes Study. Diabetes was not significantly related to urinary incontinence.

CONCLUSIONS

Intensive lifestyle intervention has a modest positive and enduring impact on urinary incontinence, and should be considered for the long-term prevention and treatment of urinary incontinence in overweight/obese women with glucose intolerance.

Correlates of Physical Activity in Middle-Aged Women With and Without Diabetes

This comparative and correlational study examined personal and social-cognitive factors related to physical activity in middle-aged women with (n = 37) and without (n = 67) type 2 diabetes (T2D). Compared with those without the condition, women with T2D attained less accelerometer-measured moderate, t = -3.35(89.40), p = .001, and vigorous physical activity, t = -2.76(59.30), p = .008, and moderate-to-vigorous physical activity (MVPA), t = -3.50(91.19), p = .001, and had lower physical activity self-efficacy, t = -2.6(101), p = .01, and perceived benefits of physical activity, t = -2.4(51.0), p = .02. For the total sample, greater MVPA was related to White race, not having diabetes, lower body mass index, fewer comorbidities, less depressive symptom severity, no smoking status, more positive attitudes, higher self-efficacy, and greater perceived benefits. Enhancing attitudes, self-efficacy, and benefits may increase MVPA in middle-aged women with T2D.

[Sport and urinary incontinence in women]

Women are more attentive to their physical appearance and a quarter of French women use to practice a regular physical activity. Benefits of sport on general health are recognized. However, sport may be the cause of various diseases when it is poorly chosen or improperly performed. In literature, intensive exercise is a risk factor for urinary incontinence, defined as "the complaint of any involuntary leakage of urine". It is essentially stress urinary incontinence, occurring because of the phenomenon of intrabdominal hyperpressure, inherent with certain activities, and excess capacity of sphincters. Some sports are more risky than others, and high-level sportswomen are the most exposed. Health professionals must invest in information, screening, prevention, counseling and treatment track athletes So, the general practitioner and the doctor of sports play a vital role in informing, screening, prevention, therapeutic and monitoring of sportswomen. Better information is needed because according to the severity of incontinence and its impact, there are simple, effective, more or less invasive treatment options. The aim of this study was to establish an inventory of scientific knowledge and to improve the management of these patients.

Barriers and motivators to exercise for older adults: a focus on those living in rural and remote areas of Australia

To identify the barriers and facilitators for exercise in older adults (50 years or over) specific to those living in rural and remote areas in Australia and to identify how this relates to falls prevention exercise programs in these areas. Literature review. Search of the databases of Medline, Scopus and Social Sciences Citation Index. Rural and remote areas. Searching identified 56 articles relating to barriers or facilitators to exercise in older adults in general, of which 25 are discussed in the article. Five of these articles specifically related to rural and remote areas, of which all were from studies in the United States. No literature specifically relating to rural and remote Australia was identified. Therefore, articles included in the final review were from three different domains - world literature (excluding those specific to rural and remote areas of Australia), rural and remote literature (note not Australian), and Australian literature to enable a comparison between the different populations to occur. There are similarities and differences between the barriers and facilitators in various populations, and no one factor alone will enable exercise in older adults. Research needs to be conducted on the barriers and facilitators to exercise in older adults living in rural and remote areas in Australia. Falls prevention exercise programs need to be tailored to suit the unique needs of the rural and remote older population.

Barriers to Physical Activity in Women

Despite the clear benefits of physical activity for women, few women obtain the recommended levels of physical activity. To address adherence to physical activity in this group, it is important to understand the barriers to physical activity that affect women. These barriers may include lack of time; anticipated lack of enjoyment; self-consciousness about body size, shape, and physical activity ability; and urinary incontinence. By addressing barriers to physical activity, health care providers may experience greater success in their efforts to increase physical activity in their female patients.

Mobility impairment is associated with urge but not stress urinary incontinence in community-dwelling older women: results from the Ossébo study

OBJECTIVE

To assess the association between functional limitations related to mobility and urinary incontinence (UI) in elderly women.

DESIGN

An observational cross-sectional study.

SETTING

Nine 'balance' workshops in France.

POPULATION

A total of 1942 community-dwelling women aged 75-85 years, who were invited, based on voter registration lists, to a 'balance assessment'.

METHODS

Mobility and balance test results for incontinent women were compared with those for continent women according to the severity and type of incontinence.

MAIN OUTCOME MEASURES

Data on UI were collected using a self-administered questionnaire (International Consultation on Incontinence Questionnaire-Short Form). Motor-related physical abilities were assessed using standardised balance and functional gait tests.

RESULTS

Forty-two per cent of women had involuntary urine leakage, with daily leaks in 57% of them; 24% had stress UI, 31% had urge UI, and 37% had mixed UI. Results for each functional test were poorer for women with UI and the limitation was more pronounced when the incontinence was severe. Multivariate logistic regression analyses showed that balance and gait impairments were significantly and independently associated with urge UI (walking speed, lower versus higher quartile, odds ratio (OR) 2.2; 95% confidence interval (95% CI) 1.4-3.5; walking balance, unable versus able to do four tandem steps (OR 1.6; 95% CI 1.2-2.2) but not with stress UI.

CONCLUSIONS

In this large population of older women living at home, there was a strong association between limitation of motor and balance skills and UI, which was proportional to the severity of incontinence and related specifically to urge incontinence. These results offer new perspectives on the prevention and treatment of urge incontinence in elderly women.

Factors Influencing the Sexual Function of Women with Urinary Incontinence

PURPOSE

Sexual function involves a complex interaction of emotions, body image, and intact physical responses. The purpose of this study was to determine the sexual functioning of women who are incontinent and to identify associated factors.

METHODS

For this descriptive correlation study, data were collected from 147 women with urinary incontinence. Data were analyzed using t-test, ANOVA, and stepwise multiple regression.

RESULTS

Mean scores were 22.39 (sexual dysfunction < or =26.55) for sexual function, 13.38 (of 63) for depression, and 55.47 (range of score 17~85) for body image. Urinary symptoms and daily life symptoms averaged 36.04 (range of score 20~100) and 16.03 (range of score 8~40). Sexual function had a positive correlation with body image and negative correlation with daily life symptoms. Sexual satisfaction, daily life symptoms, marital satisfaction, and frequency of sexual intercourse were factors affecting sexual function.

CONCLUSION

Study results indicate that urinary incontinence has a negative impact on various aspects of sexual function. Nurses should be aware of the wider consideration that needs to be made in relation to general and sexual quality of life when caring for clients suffering from urological diseases.

Physical inactivity and related barriers: a study in a community dwelling of older brazilians

This study sought to investigate the prevalence of physical inactivity and related barriers in older Brazilian adults. A cross-sectional, population-based study was conducted, and a stratified random sampling procedure was used. A total of 359 older adults were interviewed. The long version of the International Physical Activity Questionnaire (IPAQ) and the Questionnaire of Barriers to Physical Activity Practice were used to assess physical activity level and barriers, respectively. No statistically significant difference was observed on the prevalence of physical inactivity in either gender or age groups. Regarding barriers, the proportion of 9 out of 22 barriers was statistically significant between men and women. Self-reported physical inactivity/activity in older Brazilian adults continues to be a concern. Uncommonly, older males reported a higher prevalence of physical inactivity compared to their counterparts. Additionally, physical inactivity prevalence continued to increase with the aging process. Yet, personal barriers such as lack of time and poor health were strongly associated with physical inactivity. The results of this study may help health professionals and public policy makers to better address the issues related to a healthy lifestyle among older adults and promote physical activity among Brazilian older adults and in other countries with similar characteristics.

Improvements in physical activity and functioning after undergoing midurethral sling procedure for urinary incontinence

OBJECTIVE

The primary objective was to estimate the effect of the midurethral sling on improving leisure physical activity levels and physical functioning in women with stress urinary incontinence (SUI). Our secondary objective was to identify possible risk factors for postoperative insufficient physical activity.

METHODS

We conducted a prospective, observational study of women undergoing outpatient midurethral sling for SUI. Women completed validated questionnaires for incontinence, leisure physical activity, and physical functioning at baseline and 6 months postoperatively. The primary outcome was leisure physical activity level. We used multiple logistic and linear regression to estimate the effect of improvements in urinary symptoms and life effect on physical activity levels and physical functioning scores.

RESULTS

Ninety women underwent surgery and 85 returned for follow-up. At baseline, 38% had sedentary, 18% had moderate, and 44% had sufficient leisure physical activity levels. Postoperatively, this modestly improved to 26% sedentary, 20% moderate, and 54% sufficient levels. The median leisure physical activity energy expenditure increased from 396 to 693 metabolic equivalent-minutes per week (P=.04). Physical functioning scores also significantly improved (mean score 44 compared with 55 points, P<.001). On multiple logistic regression, improvements in incontinence life effect were associated with increased odds of leisure physical activity improvement (adjusted odds ratio 1.66; 95% confidence interval 1.08-2.54). On multiple linear regression, improvements in both urinary incontinence severity and effect were associated with improvements in physical functioning scores (P<.01 for both). Factors associated with insufficient postoperative physical activity included low baseline physical activity levels and smaller improvements in urinary effect scores.

CONCLUSION

Midurethral sling and subsequent improvements in urinary incontinence are associated with improved leisure physical activity levels and physical functioning.

A prevalência de incontinência urinária em mulheres praticantes de jump

INTRODUÇÃO: A incontinência urinária (IU) é definida pela Sociedade Internacional de Continência (ICS) como qualquer perda involuntária de urina. Ela exerce múltiplos efeitos sobre as atividades diárias, interações sociais e percepção da saúde. A literatura afirma que a prática de atividades físicas de alto impacto e esforço pode comportar-se como um fator de risco para a IU. OBJETIVOS: identificar a prevalência de IU em um grupo de mulheres praticantes de jump. MATERIAIS E MÉTODOS:Estudo transversal quantitativo descritivo, com amostra de 32 voluntárias que responderam a questionário sobre antecedentes obstétricos e prática da atividade física e à tradução do International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). RESULTADOS:Houve relato de perdas urinárias em 37,5% das entrevistadas. A média de idade das mulheres que referem incontinência foi de 31,58 anos (DP ± 9,39). As mulheres com filhos tiveram 1,2 mais chances de apresentar IU do que as nulíparas. As que fazem jump três ou mais vezes por semana apresentaram 2,45 mais chances de apresentar IU. Nas que sentiam vontade de urinar durante o jump, a chance de IU foi seis vezes maior. 62,5% das entrevistadas referiram nenhum impacto na qualidade de vida, e a atividade física foi apontada como situação mais comum de IU. CONCLUSÃO: Existe incontinência urinária nas praticantes de jump investigadas, multíparas e nulíparas, em jovens, durante a prática de jump e em outras ocasiões, apontando a necessidade de estudos mais abrangentes sobre a temática.

Incidence of stress urinary incontinence following vaginal repair of pelvic organ prolapse in objectively continent women

OBJECTIVE

To estimate the incidence of stress urinary incontinence (SUI) following vaginal repair of pelvic organ prolapse (POP) in preoperatively continent women and to evaluate the impact of the problem.

METHODS

Women were eligible if they had undergone vaginal repairs for any degree or type of POP with no anti-incontinence procedure between July 1, 2004 and June 30, 2006, and had been continent preoperatively, as defined by a negative cough stress test with or without reduction of prolapse. Demographic, preoperative, operative, and postoperative data were retrieved from hospital charts. The incidence of postoperative SUI (POSUI) and its quality of life (QoL) impact were assessed by mailed questionnaire. The POSUI endpoint was defined by the report of SUI symptoms on the mailed questionnaire and/or affirmation of postoperative treatment for SUI.

RESULTS

Forty-two out of 100 respondents reported POSUI within the 2-year average follow-up period. Twelve of 37 symptomatic women (32%) were moderately or greatly bothered by their symptoms. The QoL impact score was generally low but was statistically greater in women with POSUI compared to those with no POSUI (13 vs. 3, P=0.0006).

CONCLUSION

The risk of POSUI following vaginal repairs of POP may be higher than previously reported and approximately one-third of women are bothered by these symptoms. These findings deserve further investigation.