Association between Physical Activity and Urinary Incontinence in a Community-Based Elderly Population Aged 70 Years and Over

Abstract

Objectives

The objective of the present study was to evaluate the association between physical activity (PA) levels and urinary incontinence (UI) in a community-based elderly population aged ≥70 yr.

Methods

This population-based cross-sectional survey was conducted in 2003 using an extensive health interview for each participant. A self-reported single-item questionnaire was used to estimate different levels of PA in each subject. The prevalence of UI was estimated by the self-administered International Consultation on Incontinence Questionnaire. The study population included 676 Japanese men and women.

Results

The prevalence of UI was 25% (34% in women and 16% in men). After adjustment for potential confounding factors, the odds ratio (95% confidence interval) of UI compared with the lowest PA group was 0.71 (0.47–1.09) and 0.58 (0.35–0.96) in subjects exhibiting middle and high levels of PA, respectively (p for trend = 0.02).

Conclusions

High PA level was independently related to a lower self-reported prevalence of UI in a community-dwelling elderly population aged ≥70 yr. Although this cross-sectional study cannot demonstrate a temporal relationship between PA and the onset of UI, the findings suggest that PA may have a potentially beneficial effect on the prevention of UI. A prospective study or randomized trials are required to clarify the causality.

Introduction

Urinary incontinence (UI) is a frequent and bothersome symptom that is common in the elderly population [1]. Population-based estimates of the prevalence of UI among elderly subjects (age ≥60 yr) is 47.6% for women and 14.5% for men in Japan [2]. UI is increasingly recognized as a health and economic problem that affects the physical, psychological, social, and economic well-being of individuals and their families and poses a substantial economic burden on health and social services [3], [4].

Understanding the risk factors of UI is an important step toward developing direct treatment resources and providing preventive care for UI. Based on many epidemiologic studies on UI in various populations, a number of risk factors have been identified. Some chronic medical conditions, such as diabetes and Hypertension, have also been found to be associated with the occurrence of UI [2], [5], and obesity is an especially well-established factor that can cause UI or contribute to the severity of the condition [6]. Regular physical activity (PA) was confirmed to be effective for the primary and secondary prevention of these chronic diseases or conditions (eg, diabetes, hypertension, and obesity) [7]. Furthermore, pelvic floor muscle dysfunction is also a risk factor for UI. Burgio et al have shown that pelvic floor exercise is an effective treatment for both stress and urge incontinence [8]. Because PA is a determinant of muscle strength including abdominal muscles [9], and abdominal muscle training indirectly strengthens the pelvic floor muscles [10], PA may prevent UI through an improvement in abdominal muscle strength.

Therefore, it is conceivable that PA may have a potentially beneficial effect on the prevention of UI. However, to our knowledge, only a few studies that have investigated the relationship between PA and UI [11], [12], [13], [14], [15], [16], and their results have not suggested any beneficial effect of PA on the prevention of UI. Moreover, no studies fully assessed the relationship between PA and UI in a community-dwelling elderly population. Thus, it is still unclear how PA relates to UI in community-dwelling elderly adults aged ≥70 yr among whom this condition is highly prevalent.

Thus, we designed a cross-sectional study to investigate the relationship between PA and UI in community-dwelling elderly aged ≥70 yr.