The Impact of Hip Exercises on Pelvic Floor Muscle Strength and Function as a Potential Non-surgical Management for Urinary Incontinence in Older Women

项目摘要/摘要 尿失禁(UI)是一种非常普遍的情况(在社区老年妇女中高达50%) 与严重的发病率和心理社会后果有关。尿失禁的治疗选择仅限于 老年妇女由于药物或手术相关的不良反应，因此保守治疗， 包括盆底肌肉(PFM)练习，通常是唯一可用的选择。尽管有独一无二的 与衰老相关的生理变化，传统的PFM练习对不同年龄的女性使用相同的方案 所有年龄段，未能解决与衰老相关的身体和功能衰退问题。越来越多的证据表明， 盆底周围的解剖结构在维持PFM功能和功能方面起着重要作用 通过动态肌肉协同激活来增强力量。闭孔内肌(参与髋关节外旋转) 面部附着物与全氟甲烷。以前的研究表明，加强髋关节外旋转器 肌肉改善阴道内挤压压力(自愿PFM收缩的有效测量 在年轻妇女和绝经后妇女中都有参与PFM培训)。然而，对用户界面症状的影响 并未在这些研究中进行检验。因此，髋部肌肉锻炼对老年女性尿崩症的影响仍然存在。 未知。目前的初步数据进一步表明，患有尿崩症的老年女性 基线髋关节力量与没有UI的人相比，髋关节外旋与 骨盆底力。因此，本项目的首要目标是评估髋关节外旋转的影响。 锻炼盆底力量和功能(有助于控制机制)，特别是 针对患有尿崩症的老年女性。这项拟议的研究将包括30名患有尿崩症的老年女性(65岁或以上)， 目的：1)调查标准化前和标准化后12周髋部肌肉烤瓷冠强度的变化 锻炼，随着时间的推移逐渐增加抵抗力(一种循证的衰老锻炼策略 相关肌肉无力)，2)检查髋部肌肉锻炼对尿失禁症状的影响，以及3)评估 髋部肌肉锻炼的障碍，特别是认知功能、身体功能和自我效能。结果 这项研究将对盆底解剖支撑结构的动态相互作用提供深入的了解 并将被用来设计未来的随机对照试验，将传统的 老年女性尿崩症患者的PFM训练与包括髋部肌肉锻炼在内的一种新的运动方案的比较。这个 长期目标是开发一种创新的干预措施，纳入以下潜在的协同效应 老年尿崩症非手术治疗中髋部和盆底肌之间的肌肉间相互作用 女人。

PROJECT ABSTRACT/SUMMARY Urinary incontinence (UI) is a highly prevalent (up to 50% of community-living older women) condition associated with profound morbidity and psychosocial consequences. Treatment options of UI are limited for older women due to adverse effects related to medications or surgery, thus conservative management, including pelvic floor muscle (PFM) exercises, are often the only available option. Despite the unique physiologic changes associated with aging, traditional PFM exercises use the same protocol for women across all ages, failing to address aging-related physical and functional decline. There is growing evidence that the surrounding anatomic structures of the pelvic floor play an important role in maintaining PFM function and strength through dynamic muscle coactivation. The obturator internus (involved in hip external rotation) shares facial attachment with PFMs. Previous studies have demonstrated that strengthening the hip external rotator muscles improved intravaginal squeeze pressures (a validated measurement for voluntary PFM contraction involved in PFM training) in both young and postmenopausal women. However, the impact on UI symptoms was not examined in these studies. Thus, the effect of hip muscle exercises on older women with UI remains unknown. The current preliminary data further demonstrated that older women with UI had significantly lower baseline hip strength compared to those without UI, and hip external rotation had the highest correlation with pelvic floor strength. Thus, the overarching goal of this project is to assess the impact of hip external rotation exercises on pelvic floor strength and function (contributing to the continence mechanism), specifically targeting older women with UI. The proposed study will include 30 older women (ages 65 or older) with UI, aiming to 1) investigate changes in PFM strength from pre- to post-standardized 12-week hip muscle exercises, progressively increasing resistance over time (an evidence-based exercise strategy for aging associated muscle weakness), 2) examine the impact of hip muscle exercises on UI symptoms, and 3) assess barriers in hip muscle exercises, specifically cognitive function, physical function, and self-efficacy. Results from this study will provide insight into the dynamic interaction of anatomic support structures on pelvic floor strength and function and will be utilized to design a future randomized controlled trial comparing the traditional PFM training versus a novel exercise regimen including hip muscle exercises in older women with UI. The long-term goal is to develop an innovative intervention incorporating the potential synergistic effect of intermuscular interactions between hip and pelvic floor muscles as a non-surgical treatment of UI in older women.