YOGA AND PILATES COMPARED TO PELVIC FLOOR MUSCLE TRAINING FOR URINARY INCONTINENCE IN WOMEN: A PILOT RANDOMIZED CONTROLLED TRIAL

P. Kannan¹, H.W. Hin², S.W. Tung², C.L. Man², A. Assor³, H.C. Ming²

¹The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, ²The Hong Kong Polytechnic University, Hung Hom, Hong Kong, ³Stanley Wellness Centre, Hung Hom, Hong Kong

Background: There is limited evidence from randomized controlled trials regarding the use of yoga and Pilates for the management of urinary incontinence in elderly women.

Purpose: To investigate the preliminary effects and feasibility of using Pilates and yoga for improving urinary incontinence in elderly women.

Methods: An assessor-blinded, prospective, three-arm parallel-group randomized controlled pilot trial was conducted in three elderly care centres in Hong Kong. Twenty-eight women aged 60 years or above with stress urinary incontinence were included in the study. Study interventions (yoga, Pilates, and pelvic floor muscle training [standard physiotherapy care]) were randomly assigned to one of the three elderly care centres. Interventions for all three groups were provided once a week for four weeks, followed by unsupervised CD-guided home exercises for eight weeks. Study outcomes included the International Consultation on Incontinence Questionnaire-short form (ICIQ-sf) and the one-hour pad test. The feasibility measures were adherence to the intervention programme, recruitment and retention rates and safety. Outcomes were assessed at baseline, 4 and 12 weeks. Statistical analysis was performed using two-way (time and intervention) repeated measures analysis of covariance.

Results: Within-group analysis of ICIQ-sf scores at week-4 revealed statistically significant improvement in urinary incontinence in all three groups (p=0.01). These benefits were maintained at week-12 in the yoga and standard physiotherapy care groups (p=0.01) but not in the Pilates group (p>0.05). Between groups analysis of ICIQ-sf scores revealed no significant effect of yoga and Pilates compared to standard physiotherapy care (p>0.05). However, significant effects were reported for urinary incontinence measured with ICIQ-sf in the yoga group compared to the Pilates group (p=0.02). Within-group analysis of one-hour pad test data at week-4 revealed a statistically significant reduction in grams of urine lost in yoga and standard physiotherapy care groups (p < 0.017) but not in Pilates group (p>0.05). There was no significant effect of all three interventions on the one-hour pad test at week-12 (p> 0.05). Between groups analysis identified no statistically significant effect of yoga and Pilates compared to standard physiotherapy care or yoga compared to Pilates for the one-hour pad test (p>0.05). Adherence to the supervised exercise sessions was 100% and the retention rate was 96%. No adverse events were reported.

Conclusions: Results demonstrated that the methodology and interventions are applicable and feasible. Preliminary results showed improvement in urinary incontinence in all three groups. The study demonstrated that yoga has superior benefits compared to Pilates but not standard physiotherapy care.

Implications: 1. Yoga provides superior benefits for improving incontinence compared with Pilates, as measured by the International Consultation on Incontinence Questionnaire-Short Form.
2. Yoga and Pilates are as effective as pelvic floor muscle training for decreasing the severity of stress urinary incontinence.
3. The findings of this study demonstrated that the use of yoga and Pilates to strengthen the pelvic floor is applicable and feasible in elderly women.

Funding acknowledgements: This work is supported by the start-up fund (1-ZE8G) provided for early-career academics by the Hong Kong Polytechnic University.

Keywords:
Yoga
Pilates
Urinary Incontinence

Topics:
Pelvic, sexual and reproductive health

Did this work require ethics approval? Yes

Institution: Hong Kong Polytechnic University

Committee: Human Subjects Ethics Sub-Committee of the Hong Kong Polytechnic University

Ethics number: HSEARS20190509001