Lifetime physical activity and female stress urinary incontinence

Abstract

Objective To estimate whether moderate/severe stress urinary incontinence (SUI) in middle-aged women is associated with overall lifetime physical activity (including leisure, household, outdoor, and occupational), as well as lifetime leisure (recreational), lifetime strenuous and strenuous activity during the teen years. Study design Recruitment for this case-control study was conducted in primary care level family medicine and gynecology clinics. 1538 enrolled women ages 39–65 years underwent a Pelvic Organ Prolapse Quantification examination to assess vaginal support. Based on Incontinence Severity Index scores, cases had moderate/severe and controls no/mild SUI. We excluded 349 with vaginal descent at/below the hymen (pelvic organ prolapse), 194 who did not return questionnaires, and 110 with insufficient activity data for analysis. 213 cases were frequency-matched 1:1 by age group to controls. Physical activity was measured using the Lifetime Physical Activity Questionnaire, in which women recall activity from menarche to present. We created separate multivariable logistic regression models for activity measures. Results SUI odds increased slightly with overall lifetime activity (OR 1.20 per 70 additional MET-hrs/wk; 95% CI 1.02, 1.41), and were not associated with lifetime strenuous activity (OR 1.11; 95% CI 0.99, 1.25). In quintile analysis of lifetime leisure activity, which demonstrated a non-linear pattern, all quintiles incurred about half the odds of SUI compared to reference (2nd quintile; p=0.009). Greater strenuous activity in teen years modestly increased SUI odds (OR 1.37 per 7 additional hours/week; 95% CI 1.09, 1.71); OR 1.75; 95% CI 1.15, 2.66 in sensitivity analysis adjusting for measurement error. The predicted probability of SUI rose linearly in women exceeding 7.5 hours of strenuous activity/week during teen years. Teen strenuous activity had a similar effect on SUI odds when adjusted for subsequent strenuous activity during ages 21–65 years. Conclusion In middle-aged women, a slight increased odds of SUI was noted only after substantially increased overall lifetime physical activity. Increased lifetime leisure activity decreased and lifetime strenuous activity appeared unrelated to SUI odds. Greater strenuous activity during teen years modestly increased SUI odds.

Performing high-level sport is strongly associated with urinary incontinence in elite athletes: a comparative study of 372 elite female athletes and 372 controls

“…Because this behaviour seems to have persisted in the last two decades, there is a need to implement educational programs for healthcare providers, fitness instructors and coaches 15. Some studies indicates that presence of UI at a young age40 41 and strenuous activity during teen years42 may be a risk factor for later UI. Hence, interventions to prevent and treat the condition at an early stage is important 5.…”

Physical activity and the pelvic floor

“…Consistent with this hypothesis, several studies have shown that current leisure activity is associated with lower odds of SUI while lack of exercise increases these odds. 30–32 After adjusting for confounders, habitual walking decreases the odds of SUI by roughly one-half in older women from various ethnic backgrounds. 33,34 …”

“…40 In a large cross-sectional study in which middle-aged women recalled PA during the teen years, those that reported very high levels of strenuous PA as teenagers (more than 7.5 hours per week) had increased odds of reporting SUI in middle age; subsequent strenuous activity adjusted for teen strenuous activity was not associated with SUI. 32 The teen years may represent a particularly vulnerable time period, given the dramatic changes in hormones, muscle and bone structure and weight. Given increased risk for connective tissue injury during adolescence in girls 41 , it is biologically plausible that high strenuous activity during this period may affect future pelvic floor function.…”

Mulheres idosas com incontinência urinária apresentam menor nível de atividade física habitual

“…Other studies claim that the practice of moderate physical activity can minimize the reduction in the strength of pelvic floor muscles 11 or even reduce the occurrence of UI with increasing age 12 . Thus, it was observed that the level of scientific evidence on the influence of physical activity on urinary incontinence is still undefined and bidirectional 13 , as it may be a risk factor (OR = 1.37; CI 95% = 1.09-0.71) 15 or a protection factor for urinary incontinence (OR = 0.62; CI 95% = 0.44-0.89) 14 . Moreover, according to the theoretical model proposed by Nygaard et al 13 , the fact that the influence of physical activity on UI and vice versa is controversial is also due to the use of different public targets with distinct risk factors and levels of physical activity.…”