Yoga to Enhance Behavioral Self-Management of Urinary Incontinence in Women

瑜伽增强女性尿失禁的行为自我管理

基本信息

批准号：
9085101
负责人：
Alison Huang
金额：
$ 5.88万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-01 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9085101
关键词：
Address Adverse effects Affect Anatomy Anxiety Attention Autonomic nervous system Awareness Behavior Therapy Behavioral Bladder Bladder Control Caring Chronic Clinical Trials Control Groups Data Educational process of instructing Equilibrium Exercise Extravasation Frequencies Goals Group Structure Health Home environment Impedance Cardiography Incontinence Instruction Life Measures Mediating Mental Depression Mental Health Mixed Incontinence Operative Surgical Procedures Participant Patients Pelvic Floor Muscle Pelvic floor structure Persons Pharmaceutical Preparations Posture Procedures Quality of life Questionnaires Randomized Randomized Controlled Trials Relaxation Reporting Research Safety Self Management Social isolation Stress Stretching Structure Techniques Therapeutic Therapeutic Intervention Time Training United States Urinary Incontinence Urine Woman Writing Yoga aged alternative treatment base design diaries expectation experience follow-up functional decline heart rate variability improved insight muscle strength physical conditioning pilot trial programs randomized trial routine care success treatment response treatment strategy

项目摘要

DESCRIPTION (provided by applicant): Over 20 million women in the United States suffer from urinary incontinence, a condition leading to depression, social isolation, functional decline, and loss of ability to live independently. First-line treatment for incontinence consists of behavioral management strategies such as pelvic floor muscle exercises that are difficult for women to lean to practice effectively in course of routine care. Second-line treatments have problematic side effects or other limitations that decrease their safety and accessibility for many women. As a result, alternate treatment strategies are needed that are not only effective but also more accessible and better tolerated. Yoga is a complementary behavioral intervention with the potential to improve bladder control through multiple mechanisms. When practiced in a way that emphasizes mindful awareness of specific bodily structures, yoga can be used to increase women's control over their pelvic floor muscles, improve their autonomic nervous system balance, and decrease underlying stress and anxiety, all of which may alleviate incontinence. To explore the preliminary efficacy and safety of yoga to treat incontinence, our research team developed a structured, group-based yoga therapy program involving twice weekly group yoga classes supplemented by once weekly home yoga practice. In a pilot trial of 19 ambulatory women aged 46 to 75 years with frequent stress, urgency, or mixed incontinence, women randomized to this program reported a average 66% decrease in the frequency of incontinence over 6 weeks, versus a 16% decrease among those randomized to control (P=.05). All women starting the yoga program attended more than 90% of group classes, and all but one reported that it would be easy to continue practicing yoga to treat their urine leakage. We now propose to conduct a 12-week randomized trial to provide rigorous evidence of whether yoga training can effectively and safely enhance usual first-line behavioral management for incontinence. All women will receive written information and brief in-person instruction on patient-directed pelvic floor muscle exercises, bladder training, and other behavioral techniques consistent with usual first-line care. Women randomized to yoga therapy will also take part in twice-weekly group classes and once weekly home practice sessions focused on selected yoga postures and techniques, while those randomized to control will engage in equivalent-time stretching classes and home stretching sessions that will control for participants' time and attention. In addition to examining changes in incontinence frequency, bothersomeness, and impact, we will examine whether changes in incontinence are mediated by changes in pelvic floor strength, autonomic balance, or stress and anxiety. If successful, this research may reduce the burden of one of the most common chronic conditions in women, as well as provide new insights into mechanisms underlying treatment response.

描述（由申请人提供）：美国有超过 2000 万女性患有尿失禁，这种疾病会导致抑郁、社交孤立、功能衰退、并丧失独立生活的能力。失禁的一线治疗包括行为管理策略，例如盆底肌肉锻炼，而女性在日常护理过程中很难有效地进行这些锻炼。二线治疗存在副作用或其他限制，降低了许多人的安全性和可及性女性。因此，需要替代的治疗策略，这些策略不仅有效，而且更容易获得和更好的耐受性。瑜伽是一种补充性行为干预，有可能通过多种机制改善膀胱控制。当以强调对特定身体结构的正念意识的方式练习时，瑜伽可以用来增强女性对盆底肌肉的控制，改善自主神经系统的平衡，并减少潜在的压力和焦虑，所有这些都可以缓解失禁。为了探索瑜伽治疗失禁的初步功效和安全性，我们的研究团队开发了一种结构化的、基于团体的瑜伽治疗计划，包括每周两次的团体瑜伽课程，辅以每周一次的家庭瑜伽练习。在一项针对 19 名年龄在 46 至 75 岁、经常出现压力、尿急或混合性失禁的流动女性的试点试验中，随机接受该计划的女性报告称，在 6 周内，失禁频率平均降低了 66%，而其他女性的失禁频率平均降低了 16%。随机分配至对照（P=.05）。所有开始瑜伽课程的女性参加了超过 90% 的团体课程，除了一名女性外，所有女性都表示继续练习瑜伽来治疗漏尿是很容易的。我们现在建议进行一项为期 12 周的随机试验，以提供严格的证据，证明瑜伽训练是否可以有效、安全地增强失禁的常规一线行为管理。所有女性都将收到有关患者指导的盆底肌肉锻炼、膀胱训练以及与通常的一线护理一致的其他行为技巧的书面信息和简短的现场指导。随机接受瑜伽治疗的女性还将参加每周两次的团体课程和每周一次的家庭练习课程，重点关注选定的瑜伽姿势和技巧，而随机接受控制的女性将参加同等时间的伸展课程和家庭伸展课程，这些课程将控制参与者的时间和注意力。此外通过检查失禁频率、困扰性和影响的变化，我们将检查失禁的变化是否是由盆底力量、自主平衡或压力和焦虑的变化介导的。如果成功，这项研究可能会减轻女性最常见的慢性病之一的负担，并为治疗反应的机制提供新的见解。