74: An exercise intervention program in older community-dwelling women with urinary incontinence: A mixed methods feasibility study

Abstract

Older women with urinary incontinence (UI) are at high risk for falls. Prior studies show that exercise interventions can reduce the risk for falls. 1) To assess suitability of a home based integrated strength, balance, and urgency suppression exercise program using a DVD among older community-dwelling women with UI. 2) To explore the feasibility of instituting a randomized control trial (RCT) of this exercise intervention program vs. usual care of UI in this population. We conducted a mixed methods study design via 1) focus groups and 2) a pilot RCT of ambulatory community-dwelling women, age ≥ 65 years, with moderate-severe UI based on the Incontinence Severity Index, recruited from senior centers. Focus groups were conducted by a physician and continence nurse specialist using a script based on literature review and interviews with specialists. Primary outcome was to identify themes that inhibit or facilitate exercise, identify exercise program preferences and explore the impact of UI on physical activity. Based on the focus group findings, we implemented a 6-week pilot RCT of a home-based DVD exercise program vs. usual care in this population to assess changes in UI symptoms and physical activity through symptom questionnaires, physical function tests, and accelerometer data. Primary outcome was to measure feasibility of this intervention by participants’ willingness to enroll, recruitment rate, acceptability of study design, and compliance. Focus Groups: Median (range) age of participants (n=14) was 69 (65-84) years. Physically active participants (n=6) preferred group classes, instructors and exercise variety. Socializing and fitness instruction were motivators to exercise. Barriers of exercise included family caretaking, work obligations, insurance coverage, and weather. UI was not perceived as a barrier to exercise. Sedentary participants (n=8) preferred one-on-one programs and the ability to exercise at home for privacy. Improved health, monetary rewards, and fitness goals were motivators to exercise. Barriers to exercise included UI, fear of falling, pain, and existing medical issues. RCT: Mean (SD) age of participants (n=37) was 74.0 (8.4) years. Of 66 eligible women approached for participation from clinical settings and senior centers, 38 (57.6%) consented for participation during the six-month enrollment period (recruitment rate 6.3). Thirty-seven participants underwent randomization into the exercise arm (n=19) or usual care arm (n=18). At completion of the trial, 14 participants (73.6%) completed questionnaires and 16 (84.2%) contributed accelerometer data in the exercise arm, while 16 (88.8%) completed questionnaires and 17 (94.4%) contributed accelerometer data in the usual care arm. Two (10.5%) participants within the exercise arm and zero participants in the usual care arm were lost to follow up. A home-based DVD exercise program is a suitable mode of structured physical exercise in physically active and sedentary community-dwelling older women with UI. A larger RCT to examine the effect of an exercise intervention vs. usual care on physical function and urinary symptoms is feasible in this population.