Program to Reduce Incontinence by Diet and Exercise (PRIDE)

描述（由申请人提供）： 尿失禁是一种常见的问题，在妇女中造成痛苦，降低生活质量和戏剧性的限制，在日常运作。超重的女性患尿失禁的风险显著增加，超过65%的尿失禁女性超重。来自短期初步研究的数据表明，体重减轻可能会显着减少尿失禁发作。因此，减肥可能是一种有前途的新方法，尿失禁的治疗，一个可能产生一系列更广泛的健康改善除了减少尿失禁的频率。因此，我们建议随机选择330名超重和肥胖的女性尿失禁患者（两个临床中心各165例）进行为期6个月的强化行为体重控制计划或常规护理，以确定体重减轻对尿失禁频率和生活质量的短期影响，确定最有可能从体重减轻中获益的女性，并开始探索体重减轻后尿失禁改善的尿动力学机制。 为了最大限度地持久的影响减肥尿失禁，这将是必要的，以产生持续的体重减轻。然而，体重维持仍然是肥胖领域的挑战。因此，我们建议评估一个创新的，理论指导的体重维持计划，将重点放在增加动机和承诺的行为改变的努力，并比较这与一个更标准的，以技能为重点的体重维持计划。在完成6个月的减肥计划后，减肥组的女性将被随机分配到12个月的标准、基于技能的维持计划或以动机为重点的维持干预。结果将包括18个月时的体重减轻、尿失禁频率和生活质量。如果对失禁女性有效，这种创新的以动机为中心的维持干预的方法和策略可以在其他肥胖人群中进行检查。 WIN-Weight Reduction for Incidence Network-汇集了一群在尿失禁，肥胖治疗和三个机构的多中心合作临床试验方面具有专业知识的优秀和经验丰富的研究人员。拟议的研究设计将使我们能够有效地评估一种新的治疗尿失禁的方法和一种有前途的方法，以提高体重维持，并因此作出实质性贡献的几个临床领域的妇女的健康至关重要。

DESCRIPTION (provided by applicant): Urinary incontinence is a common problem among women that causes distress, diminished quality of life and dramatic limitations in daily functioning. Overweight women are at significantly increased risk of urinary incontinence and over 65% of women with incontinence are overweight. Data from short-term, preliminary studies suggest that weight reduction may significantly reduce incontinence episodes. Thus, weight loss may present a promising new approach to urinary incontinence treatment, one likely to produce a cascade of broader health improvements in addition to reductions in frequency of urinary incontinence. Therefore, we propose to randomize 330 overweight and obese women with urinary incontinence (165 at each of two clinical centers) to a 6-month intensive behavioral weight control program or to usual care to determine the short-term effect of weight loss on frequency of incontinence and quality of life, to identify women most likely to benefit from weight loss and to begin to explore the urodynamic mechanisms underlying incontinence improvement following weight loss. To maximize enduring effects of weight loss on urinary incontinence, it will be necessary to produce sustained weight loss. However, weight maintenance remains a challenge in the obesity field. Therefore, we propose to evaluate an innovative, theory-guided weight maintenance program that will focus on increasing motivation and commitment to behavior change efforts and compare this with a more standard, skills-focused weight maintenance program. After completing the 6-month weight loss program, women in the weight loss arm will be randomized to either a 12-month standard, skill-based maintenance program or to a motivationally-focused maintenance intervention. Outcomes will include weight loss, incontinence frequency and quality of life at 18 months. If effective in women with incontinence, the methods and strategies of this innovative motivationally-focused maintenance intervention can be examined in other obese populations. WIN-Weight Reduction for Incontinence Network-brings together a unique group of outstanding and experienced investigators with expertise in urinary incontinence, obesity treatment and multicenter collaborative clinical trials at three institutions. The proposed study design will allow us to efficiently evaluate both a novel treatment for urinary incontinence and a promising approach to enhancement of weight maintenance, and therefore to make substantive contributions to several clinical arenas critical to women's health.