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

项目总结 美国有超过2000万女性患有尿失禁，这种情况与 抑郁、社交孤立、缺乏运动、跌倒和骨折，以及失去独立生活的能力。 目前对大小便失禁的一线治疗包括行为策略，如盆底锻炼， 对于大多数妇女来说，在常规护理课程中被教授时，很难有效地练习。第二条线 药物或手术等治疗方法有问题的副作用，使它们不适合或不安全 许多妇女，特别是大小便失禁风险最大的老年妇女。因此，有一个紧急的 需要替代的治疗策略，不仅有效，而且耐受性更好。 瑜伽是一套相互补充的身体和精神练习，有可能改善大小便失禁 通过多种机制。当以一种强调仔细解剖排列的方式练习时， 意识到特定的身体结构，并在练习过程中注意放松和深呼吸 身体瑜伽姿势，瑜伽可以用来增加女性对盆底肌肉的控制，改善 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 改善对膀胱的控制。探索将瑜伽作为一种行为管理策略的可行性 大小便失禁，我们的调查团队之前开发了一个结构化的、基于小组的瑜伽项目，包括 每周两次小组课程，辅之以每周一次的家庭瑜伽练习，与专家合作 瑜伽板。在一项涉及至少每天都有尿失禁的中老年女性参与的试点试验中， 参加这项瑜伽干预的女性表现出平均~74%的减少 大小便失禁3个月以上。除了一名被分配到瑜伽组的女性外，其他所有人都完成了瑜伽项目，坚持参加小组练习 瑜伽课3个月以上者占90%以上，未发现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，以提供严格的证据来证明这种方法的有效性。 瑜伽对50岁及以上女性尿失禁的干预。随机选择参加瑜伽的女性 干预措施将参加每周两次的小组课程和一次以学习为重点的每周家庭练习- 特定的瑜伽姿势和技巧，而那些随机接受对照干预的人将参与 等值时间，非特定肌肉伸展课程和练习。除了评估 我们将探讨盆底力量、外周自主神经功能和 下肢的生理功能是改善大小便失禁的潜在媒介。如果成功，这将是 研究有可能减轻中年最常见的慢性病之一的负担 为老年妇女提供信息，并为影响治疗反应的因素提供新的见解。

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.