Program to Reduce Incontinence by Diet and Exercise (PRIDE)

描述(由申请人提供)： 尿失禁是女性中常见的问题，会导致痛苦、生活质量下降和日常功能严重受限。超重的女性患尿失禁的风险显著增加，超过65%的大小便失禁女性超重。来自短期初步研究的数据表明，体重减轻可能会显著减少大小便失禁。因此，减肥可能是治疗尿失禁的一种很有前途的新方法，除了减少尿失禁的频率外，还可能产生一系列更广泛的健康改善。因此，我们建议将330名患有尿失禁的超重和肥胖女性(两个临床中心各有165名)随机分配到为期6个月的强化行为体重控制计划或常规护理中，以确定减肥对尿失禁频率和生活质量的短期影响，确定最有可能从减肥中受益的女性，并开始探索减肥后尿失禁改善的尿动力学机制。 为了最大限度地减轻体重对尿失禁的持久影响，有必要进行持续的减肥。然而，在肥胖领域，保持体重仍然是一个挑战。因此，我们建议评估一项创新的、以理论为指导的体重维持计划，该计划将侧重于增加对行为改变努力的动机和承诺，并将其与更标准的、以技能为重点的体重维持计划进行比较。在完成为期6个月的减肥计划后，减肥组中的女性将被随机分为两组，一组是为期12个月的基于技能的标准维护计划，另一组是以激励为重点的维护干预。结果将包括体重减轻、大小便失禁频率和18个月后的生活质量。如果对大小便失禁的女性有效，这种创新的、以动机为重点的维持干预的方法和策略可以在其他肥胖人群中进行检验。 WIN-失禁减肥网络-汇聚了一群独特的杰出和经验丰富的研究人员，他们在三个机构拥有尿失禁、肥胖治疗和多中心协作临床试验方面的专业知识。拟议的研究设计将使我们能够有效地评估一种治疗尿失禁的新方法和一种有前景的增强体重维持的方法，从而为几个对女性健康至关重要的临床领域做出实质性贡献。

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.