Improvements in physical activity and functioning after undergoing midurethral sling procedure for urinary incontinence.
OBJECTIVE
The primary objective was to estimate the effect of the midurethral sling on improving leisure physical activity levels and physical functioning in women with stress urinary incontinence (SUI). Our secondary objective was to identify possible risk factors for postoperative insufficient physical activity.


METHODS
We conducted a prospective, observational study of women undergoing outpatient midurethral sling for SUI. Women completed validated questionnaires for incontinence, leisure physical activity, and physical functioning at baseline and 6 months postoperatively. The primary outcome was leisure physical activity level. We used multiple logistic and linear regression to estimate the effect of improvements in urinary symptoms and life effect on physical activity levels and physical functioning scores.


RESULTS
Ninety women underwent surgery and 85 returned for follow-up. At baseline, 38% had sedentary, 18% had moderate, and 44% had sufficient leisure physical activity levels. Postoperatively, this modestly improved to 26% sedentary, 20% moderate, and 54% sufficient levels. The median leisure physical activity energy expenditure increased from 396 to 693 metabolic equivalent-minutes per week (P=.04). Physical functioning scores also significantly improved (mean score 44 compared with 55 points, P<.001). On multiple logistic regression, improvements in incontinence life effect were associated with increased odds of leisure physical activity improvement (adjusted odds ratio 1.66; 95% confidence interval 1.08-2.54). On multiple linear regression, improvements in both urinary incontinence severity and effect were associated with improvements in physical functioning scores (P<.01 for both). Factors associated with insufficient postoperative physical activity included low baseline physical activity levels and smaller improvements in urinary effect scores.


CONCLUSIONS
Midurethral sling and subsequent improvements in urinary incontinence are associated with improved leisure physical activity levels and physical functioning.
Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island 02903, USA. vsung@wihri.org
Vivian W
VW
Sung
Nadine
N
Kassis
Christina A
CA
Raker
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007899:Leisure Activities; D016014:Linear Models; D016015:Logistic Models; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation; D020127:Recovery of Function; D012307:Risk Factors; D057185:Sedentary Behavior; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000534:rehabilitation / Q000601:surgery*