title: Lifetime physical activity and female stress urinary incontinence.
abstract: OBJECTIVE
  We sought to estimate whether moderate/severe stress urinary incontinence (SUI) in middle-aged women is associated with overall lifetime physical activity (including leisure, household, outdoor, and occupational), as well as lifetime leisure (recreational), lifetime strenuous, and strenuous activity during the teen years.
  
  
  METHODS
  Recruitment for this case-control study was conducted in primary-care-level family medicine and gynecology clinics. A total of 1538 enrolled women ages 39-65 years underwent a Pelvic Organ Prolapse Quantification examination to assess vaginal support. Based on Incontinence Severity Index scores, cases had moderate/severe and controls had no/mild SUI. We excluded 349 with vaginal descent at/below the hymen (pelvic organ prolapse), 194 who did not return questionnaires, and 110 with insufficient activity data for analysis. In all, 213 cases were frequency matched 1:1 by age group to controls. Physical activity was measured using the Lifetime Physical Activity Questionnaire, in which women recall activity from menarche to present. We created separate multivariable logistic regression models for activity measures.
  
  
  RESULTS
  SUI odds increased slightly with overall lifetime activity (odds ratio [OR], 1.20 per 70 additional metabolic equivalent of task-h/wk; 95% confidence interval [CI], 1.02-1.41), and were not associated with lifetime strenuous activity (OR, 1.11; 95% CI, 0.99-1.25). In quintile analysis of lifetime leisure activity, which demonstrated a nonlinear pattern, all quintiles incurred about half the odds of SUI compared to reference (second quintile; P = .009). Greater strenuous activity in teen years modestly increased SUI odds (OR, 1.37 per 7 additional h/wk; 95% CI, 1.09-1.71); OR, 1.75; 95% CI, 1.15-2.66 in sensitivity analysis adjusting for measurement error. The predicted probability of SUI rose linearly in women exceeding 7.5 hours of strenuous activity/wk during teen years. Teen strenuous activity had a similar effect on SUI odds when adjusted for subsequent strenuous activity during ages 21-65 years.
  
  
  CONCLUSIONS
  In middle-aged women, a slight increased odds of SUI was noted only after substantially increased overall lifetime physical activity. Increased lifetime leisure activity decreased and lifetime strenuous activity appeared unrelated to SUI odds. Greater strenuous activity during teen years modestly increased SUI odds.
authors: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT. Electronic address: Ingrid.nygaard@hsc.utah.edu.
authors: Ingrid E
authors: IE
authors: Nygaard
authors: Department of Exercise and Sport Science, University of Utah School of Medicine, Salt Lake City, UT.
authors: Janet M
authors: JM
authors: Shaw
authors: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
authors: Tyler
authors: T
authors: Bardsley
authors: Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT.
authors: Marlene J
authors: MJ
authors: Egger
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007899:Leisure Activities; D016015:Logistic Models; D008875:Middle Aged; D009043:Motor Activity; D059952:Pelvic Floor Disorders / Q000453:epidemiology; D012307:Risk Factors; D014550:Urinary Incontinence, Stress / Q000453:epidemiology*
keywords: pelvic floor disorder; physical activity; strenuous activity; stress urinary incontinence
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