A Randomized Controlled Trial of a Group-Based Therapeutic Yoga Intervention for Urinary Incontinence in Ambulatory Older Women

项目摘要 在美国，超过2000万女性患有尿失禁，这是一种与尿失禁相关的疾病。 抑郁、社交孤立、缺乏运动、福尔斯和骨折，以及丧失独立生活的能力。 目前失禁的一线治疗包括行为策略，如骨盆底锻炼， 对大多数妇女来说，在日常护理过程中学习这些知识很难有效地实践。二线 诸如药物或手术的治疗具有有问题的副作用， 许多妇女，特别是老年妇女，她们最有可能失禁。因此，迫切需要 需要替代治疗策略，不仅有效，而且耐受性更好。 瑜伽是一套互补的身体和精神的做法与潜力，以改善失禁 通过多种机制。当以一种强调仔细解剖对准的方式练习时， 对特定身体结构的认识，以及在练习过程中的正念放松和深呼吸 身体瑜伽姿势，瑜伽可以用来增加女性对骨盆底肌肉的控制，提高 外周自主神经功能，并增加潜在的身体功能，所有这些都有可能 改善膀胱控制。探讨瑜伽作为行为管理策略的可行性， 失禁，我们的调查小组以前制定了一个结构化的，基于小组的瑜伽计划， 每周两次小组课程，辅以每周一次的家庭瑜伽练习，与专家合作 瑜伽小组在一项涉及至少每日尿失禁的非卧床中年和老年妇女的试点试验中， 被分配到瑜伽干预的女性表现出平均约74%的任何频率下降， 尿失禁超过3个月。除了一名被分配到瑜伽的女性外，所有人都完成了该计划， 3个月以上的瑜伽课程超过90%，没有检测到与瑜伽相关的不良事件。 我们现在建议进行一项全面的随机试验，以提供严格的证据证明这种治疗的有效性。 50岁及以上女性尿失禁的瑜伽干预被随机分配到瑜伽组的女性 干预将参加每周两次的小组课程和每周一次的家庭实践，重点是学习- 具体的瑜伽姿势和技术，而那些随机对照干预将从事 同等时间，非特定的肌肉拉伸课程和实践。除了评估 尿失禁，我们将探讨是否改变骨盆底的力量，外周自主神经功能， 下肢生理功能作为改善尿失禁的潜在介质。如果成功，这 研究有可能减轻中年最常见的慢性病之一的负担， 老年妇女，以及提供新的见解影响治疗反应的因素。

PROJECT SUMMARY Over 20 million women in the United States suffer from urinary incontinence, a condition associated with depression, social isolation, physical inactivity, falls and fractures, and loss of ability to live independently. Current first-line treatment for incontinence consists of behavioral strategies such as pelvic floor exercises that are difficult for most women to practice effectively when taught in course of routine care. Second-line treatments such as drugs or surgery have problematic side effects that make them inappropriate or unsafe for many women, particularly older women who are at greatest risk of incontinence. As a result, there is an urgent need for alternate treatment strategies that are not only effective, but also better tolerated. Yoga is a set of complementary physical and mental practices with the potential to improve incontinence through multiple mechanisms. When practiced in a way that emphasizes careful anatomic alignment, awareness of specific bodily structures, and mindful relaxation and deep breathing during the practice of physical yoga postures, yoga can be used to increase women's control over the pelvic floor muscles, improve peripheral autonomic function, and increase underlying physical function, all of which have the potential to improve bladder control. To explore the feasibility of using yoga as a behavioral management strategy for incontinence, our investigative team previously developed a structured, group-based yoga program involving twice weekly group classes supplemented by once weekly home yoga practice, in collaboration with an expert yoga panel. In a pilot trial involving ambulatory midlife and older women with at least daily incontinence, women assigned to this yoga intervention demonstrated an average ~74% decrease in frequency of any incontinence over 3 months. All but one woman assigned to yoga completed the program, adherence to group yoga classes over 3 months was greater than 90%, and no adverse events related to yoga were detected. We now propose to conduct a full-scale randomized trial to provide rigorous evidence of the efficacy of this yoga intervention for urinary incontinence in women aged 50 years and older. Women randomized to the yoga intervention will take part in twice-weekly group classes and once weekly home practice focused on study- specific yoga postures and techniques, while those randomized to the control intervention will engage in equivalent-time, non-specific muscle stretching classes and practice. In addition to assessing changes in incontinence, we will explore whether changes in pelvic floor strength, peripheral autonomic function, and lower extremity physical function as potential mediators of improvement in incontinence. If successful, this research has the potential to reduce the burden of one of the most common chronic conditions in midlife and older women, as well as provide new insights into factors influencing treatment response.