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.

项目摘要 在美国，超过2000万妇女患有尿失禁，这种情况与 抑郁，社会隔离，身体不活动，跌倒和断裂以及失去独立生活的能力。 当前的尿失禁的一线治疗包括行为策略，例如骨盆底演习 在常规护理过程中，大多数女性很难有效地练习。二线 诸如药物或手术等治疗的副作用有问题，使它们不适当或不安全 许多妇女，尤其是老年妇女，她们处于尿失禁的风险最大。结果，紧急 需要替代治疗策略，这些策略不仅有效，而且可以更好地容忍。 瑜伽是一组互补的身体和心理实践，有可能提高尿失禁 通过多种机制。当以一种强调仔细的解剖对齐方式练习时， 意识到特定的身体结构，并在实践中的正念放松和深呼吸 物理瑜伽姿势，瑜伽可用于增加妇女对骨盆底肌肉的控制，改善 外围自主功能，并增加潜在的身体功能，所有这些都有可能 改善膀胱控制。探索使用瑜伽作为行为管理策略的可行性 尿失禁，我们的调查团队先前制定了一个结构化的，基于小组的瑜伽计划，涉及 每周两次补充一次每周家庭瑜伽练习，并与专家合作 瑜伽面板。在一项试验审判中，涉及非门诊中年和至少每天尿失禁的老年妇女 分配给这种瑜伽干预的妇女的频率平均降低了74％ 3个月内尿失禁。分配给瑜伽的一名女性除了遵守瑜伽的所有女子都完成了该计划 3个月以来的瑜伽课大于90％，未检测到与瑜伽有关的不良事件。 现在，我们建议进行全面的随机试验，以提供严格的证据证明这一点的功效 50岁及以上的妇女尿失禁的瑜伽干预。妇女随机到瑜伽 干预将每周两次参加小组课程，每周一次的家庭实践专注于学习 - 特定的瑜伽姿势和技术，而随机进行控制干预的姿势将参与 等效时间，非特异性的肌肉伸展课程和实践。除了评估变化 尿失禁，我们将探讨骨盆底强度的变化，周围自主功能和 下肢身体机能是尿失禁改善的潜在介体。如果成功，这 研究有可能减轻中年最常见的慢性疾病之一的负担 老年妇女以及对影响治疗反应的因素的新见解。