Effectiveness of Yoga and Pilates Training for Urinary Incontinence in Elderly Women: A Clinical Trial

INTERVENTION: An assessor‐blinded, prospective, three‐arm parallel group randomized controlled pilot trial will be conducted over a period of 12 weeks with elderly women (n = 30) presenting with symptoms of stress or mixed urinary incontinence. The three intervention groups include Pilates (n = 10), Yoga (n = 10) and Standard Care as an active control group (n = 10). "Arm 1: Standard Care" For participants assigned to standard care group (n = 10), pelvic floor muscle training (PFMT) will be provided by a certified perineal therapist. The trainer will provide the intervention once a week for 4 weeks, with each session lasting 45 minutes to one hour, in the form of group classes to a group of 10 in an elderly centre in Hong Kong. At the end of this 4‐week training, all participants will receive a CD with videos taken when the trainer conducts her sessions at the centre. All study participants will be required to perform CD‐guided unsupervised home exercises 3 to 6 times per week for 8 weeks. Each of the home exercise sessions last 30 to 45 minutes. PFMT will first be taught in a position in which gravity is eliminated (lying) and will gradually progress to positions in which gravity is partially eliminated, followed by movements that are against gravity. The procedures of PFMT are as follows: Step 1: women will be asked to contract their pelvic floor muscles (urethra) and hold the contraction for 3‐6 seconds, then relax for another 10 seconds. Step 2: women will be asked to control the bowel action (or control passage of wind), hold it for 3‐6 seconds and then relax for another 10 seconds. Step 3: women will be asked to contract their urethral orifice and control bowel action, draw the vagina up and hold it for 3‐6 seconds and then relax for another 10 seconds. This exercise will improve the strength of the entire pubococcygeus muscle i.e., the pelvic floor muscles. "Arm 2: Pilates" For participants assigned to Pilates group (n = 1 CONDITION: Physical Medicine / Rehabilitation ‐ Other physical medicine / rehabilitation Renal and Urogenital ‐ Other renal and urogenital disorders Urinary Incontinence; ; Urinary Incontinence PRIMARY OUTCOME: One‐hour pad test combined with stress test will be used to measure the amount of urinary leakage. Women are asked to first empty their bladders, wear pads and drink 500 ml of water. They are then instructed to perform a standardized set of activities for 30 minutes, including walking, climbing up and down stairs, sit‐to‐stand, coughing vigorously, running on the spot, bending to pick up an object from the floor and washing hands in running water. Before and after the test, the weight of the pad is measured with a high‐precision balance in order to determine the amount of leakage.[The outcome measure will be conducted 3 times, at baseline, at the end of 4 weeks of training by certified instructors and after that at the end of 8 weeks of CD‐home guided exercise.] SECONDARY OUTCOME: The International Consultation on Incontinence Questionnaire ‐ Urinary Incontinence Short Form (ICIQ‐UI SF) will be used. Both the English version and the Chinese (traditional) version will be provided.[The outcome measure will be conducted 3 times, at baseline, at the end of 4 weeks of training by certified instructors and after that at the end of 8 weeks of CD‐home guided exercise.] INCLUSION CRITERIA: 1. Women aged 60 or above 3. International Consultation on Incontinence Questionnaire for Urinary Incontinence Short Form (ICIQ‐UI‐SF) at least 6 points (out of 21) 4. Provision of written informed consent 2. Women presenting with symptoms of stress urinary incontinence at a bladder volume 200 to 250 ml (involuntary loss of urine on effort or physical exertion, or on sneezing or coughing), or mixed urinary incontinence (stress and urgency incontinence)