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）：美国超过2000万妇女遭受尿失禁，导致抑郁症，社会隔离，功能下降，功能下降，以及失去独立生活的能力。对尿失禁的一线治疗包括行为管理策略，例如骨盆底肌肉运动，这些策略很难在常规护理过程中有效地倾斜地倾斜。二线治疗具有有问题的副作用或其他局限性，可降低许多人的安全性和可及性女性。结果，需要替代的治疗策略，这些策略不仅有效，而且更易于访问和更好的耐受性。瑜伽是一种互补的行为干预措施，具有通过多种机制改善膀胱控制的潜力。当以一种强调对特定身体结构的意识的方式进行实践时，瑜伽可用于增加妇女对骨盆底肌肉的控制，改善其自主神经系统平衡，并减轻潜在的压力和焦虑，所有这些都可能减轻尿不可感性。为了探索瑜伽治疗尿失禁的初步疗效和安全性，我们的研究团队开发了一个结构化的，基于小组的瑜伽疗法计划，涉及每周两次的瑜伽课两次，每周一次家庭瑜伽练习。在一项频繁压力，紧迫性或混合尿失禁的46至75岁室内妇女的试验试验中，随机分配到该计划的妇女在6周内失禁频率平均降低了66％，而随机分配到对照的人中降低了16％。所有开始瑜伽计划的女性都参加了90％以上的小组课程，但除了一个人报告说，继续练习瑜伽以治疗尿液泄漏很容易。现在，我们建议进行为期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，安全地增强一线行为管理，从而导致尿失禁。所有妇女都将获得有关患者指导的骨盆地板肌肉运动，膀胱训练以及其他与通常的一线护理一致的行为技术的书面信息和简短的面对面指导。随机分配瑜伽疗法的妇女还将每周两次参加小组课程，并且每周一次的家庭练习，专注于选定的瑜伽姿势和技术，而随机控制的妇女将参加同等时间的伸展课程和家庭伸展课程，以控制参与者的时间和注意力。此外检查尿失禁频率，麻烦和影响的变化，我们将检查尿失禁的变化是否是由骨盆底强度，自主平衡或压力和焦虑的变化介导的。如果成功的话，这项研究可能会减轻女性最常见的慢性疾病之一的负担，并提供对治疗反应基础机制的新见解。