A Randomized Controlled Trial of a Group-Based Therapeutic Yoga Intervention for Urinary Incontinence in Ambulatory Older Women

以团体为基础的治疗性瑜伽干预治疗老年女性尿失禁的随机对照试验

• 批准号: 10179369
• 负责人: Alison Huang
• 金额: $ 68.25万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10179369
• 关键词: Address; Adherence; Adverse effects; Adverse event; Affect; Aftercare; Anatomy; Anti-Cholinergics; Awareness; Behavioral; Bladder Control; Breathing; California; Chronic; Clinical Treatment; Clinical Trials; Collaborations; Communities; Control Groups; Data; Educational process of instructing; Equilibrium; Exercise; Fracture; Frequencies; Funding; Grant; Healthcare; Home; Impedance Cardiography; Incontinence; Increased frequency of micturition; Intervention; Learning; Location; Lower Extremity; Measures; Mediating; Mediator of activation protein; Mental Depression; Muscle; Operative Surgical Procedures; Pelvic Examination; Pelvic Floor Muscle; Pelvic floor structure; Peripheral; Pharmaceutical Preparations; Physical Function; Physical Performance; Pilot Projects; Posture; Procedures; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Relaxation; Reporting; Research; Risk; Self Management; Social isolation; Specialist; Stretching; Structure; Supervision; Techniques; Therapeutic; Time; Training; United States; United States National Institutes of Health; Urinary Incontinence; Waiting Lists; Woman; Yoga; aged; alternative treatment; base; clinical care; diaries; efficacy evaluation; experience; falls; follow-up; heart rate variability; improved; insight; interest; mental practice; middle age; mindfulness; older women; patient oriented; physical inactivity; pilot trial; post intervention; programs; randomized trial; routine care; side effect; treatment effect; treatment response; treatment strategy

PROJECT SUMMARY Over 20 million women in the United States suffer from urinary incontinence, a condition associated with depression, social isolation, physical inactivity, falls and fractures, and loss of ability to live independently. Current first-line treatment for incontinence consists of behavioral strategies such as pelvic floor exercises that are difficult for most women to practice effectively when taught in course of routine care. Second-line treatments such as drugs or surgery have problematic side effects that make them inappropriate or unsafe for many women, particularly older women who are at greatest risk of incontinence. As a result, there is an urgent need for alternate treatment strategies that are not only effective, but also better tolerated. Yoga is a set of complementary physical and mental practices with the potential to improve incontinence through multiple mechanisms. When practiced in a way that emphasizes careful anatomic alignment, awareness of specific bodily structures, and mindful relaxation and deep breathing during the practice of physical yoga postures, yoga can be used to increase women's control over the pelvic floor muscles, improve peripheral autonomic function, and increase underlying physical function, all of which have the potential to improve bladder control. To explore the feasibility of using yoga as a behavioral management strategy for incontinence, our investigative team previously developed a structured, group-based yoga program involving twice weekly group classes supplemented by once weekly home yoga practice, in collaboration with an expert yoga panel. In a pilot trial involving ambulatory midlife and older women with at least daily incontinence, women assigned to this yoga intervention demonstrated an average ~74% decrease in frequency of any incontinence over 3 months. All but one woman assigned to yoga completed the program, adherence to group yoga classes over 3 months was greater than 90%, and no adverse events related to yoga were detected. We now propose to conduct a full-scale randomized trial to provide rigorous evidence of the efficacy of this yoga intervention for urinary incontinence in women aged 50 years and older. Women randomized to the yoga intervention will take part in twice-weekly group classes and once weekly home practice focused on study- specific yoga postures and techniques, while those randomized to the control intervention will engage in equivalent-time, non-specific muscle stretching classes and practice. In addition to assessing changes in incontinence, we will explore whether changes in pelvic floor strength, peripheral autonomic function, and lower extremity physical function as potential mediators of improvement in incontinence. If successful, this research has the potential to reduce the burden of one of the most common chronic conditions in midlife and older women, as well as provide new insights into factors influencing treatment response.

项目概要 美国有超过 2000 万女性患有尿失禁，这是一种与尿失禁相关的疾病 抑郁、社会孤立、缺乏身体活动、跌倒和骨折以及丧失独立生活的能力。 目前失禁的一线治疗包括行为策略，例如骨盆底锻炼， 对于大多数女性来说，在日常护理课程中教授这些知识很难有效地实践。二线 药物或手术等治疗方法会产生副作用，使其不适合或不安全 许多女性，尤其是老年女性，失禁的风险最大。结果，有一个紧急的 需要不仅有效而且耐受性更好的替代治疗策略。 瑜伽是一套互补的身心练习，具有改善失禁的潜力 通过多种机制。当以强调仔细的解剖学对齐的方式进行练习时， 练习过程中对特定身体结构的意识，以及正念放松和深呼吸 物理瑜伽姿势，瑜伽可以用来增加女性对盆底肌肉的控制力，改善 外周自主神经功能，并增强潜在的身体功能，所有这些都有可能 改善膀胱控制。探讨使用瑜伽作为行为管理策略的可行性 失禁，我们的调查团队之前开发了一个结构化的、基于团体的瑜伽计划，其中包括 与专家合作，每周两次团体课程，辅以每周一次家庭瑜伽练习 瑜伽面板。在一项涉及至少每天失禁的中年和老年女性的试点试验中， 接受这项瑜伽干预的女性表现出任何瑜伽干预的频率平均下降约 74% 失禁超过3个月。除一名分配到瑜伽的女性外，所有女性都完成了该计划，并遵守团体要求 超过3个月的瑜伽课程率大于90%，未检测到与瑜伽相关的不良事件。 我们现在建议进行一项全面的随机试验，以提供严格的证据来证明该方法的有效性 瑜伽干预治疗 50 岁及以上女性尿失禁。女性随机参加瑜伽 干预措施将参加每周两次的小组课程和每周一次的家庭练习，重点是学习- 特定的瑜伽姿势和技巧，而那些随机接受控制干预的人将参与 同等时间的非特定肌肉伸展课程和练习。除了评估变化 尿失禁，我们将探讨骨盆底力量、周围自主神经功能和 下肢身体功能是改善失禁的潜在因素。如果成功的话，这 研究有可能减轻中年和中年最常见的慢性病之一的负担 老年女性，并对影响治疗反应的因素提供新的见解。