A group program for overweight and obese women with urinary incontinence (ATHENA): an implementation-effectiveness hybrid type 3 study

Zara Howard; Lynda Ross; Kelly A Weir; Nadine Baker; Leanne Smith; Jennifer Nucifora; Heidi Townsend; Shelley Roberts

doi:10.1007/s00192-021-04743-9

A group program for overweight and obese women with urinary incontinence (ATHENA): an implementation-effectiveness hybrid type 3 study

Int Urogynecol J. 2022 Apr;33(4):991-1000. doi: 10.1007/s00192-021-04743-9. Epub 2021 Mar 17.

Authors

Zara Howard¹, Lynda Ross^{2

3}, Kelly A Weir^{4

3

5}, Nadine Baker⁴, Leanne Smith⁴, Jennifer Nucifora⁴, Heidi Townsend⁶, Shelley Roberts^{4

3

5}

Affiliations

¹ Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD, 4215, Australia. zara.howard@health.qld.gov.au.
² School of Exercise and Nutrition Services, Queensland University of Technology, Kelvin Grove Campus, Brisbane, QLD, 4059, Australia.
³ School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.
⁴ Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD, 4215, Australia.
⁵ Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.
⁶ Consumer researcher, Gold Coast, Southport, QLD, 4215, Australia.

PMID: 33733697
DOI: 10.1007/s00192-021-04743-9

Abstract

Introduction and hypothesis: Supervised pelvic floor muscle training (PFMT), weight loss and exercise are recommended for overweight/obese women with urinary incontinence (UI). This study aimed to implement and evaluate the feasibility, acceptability and effectiveness of a 12-week group exercise and healthy eating program (ATHENA) for overweight/obese women with UI.

Methods: This study, using an implementation-effectiveness hybrid type 3 design, was conducted within a Women's Health Physiotherapy outpatient service at an Australian tertiary public hospital. Intervention feasibility and acceptability were assessed through process evaluation of implementation, while clinical effectiveness was assessed via pre-/post-clinical and quality of life surveys. Process data were analyzed using descriptive statistics and effectiveness data were compared pre-/post-intervention using inferential statistics.

Results: Of 156 eligible patients, 37 (24%) agreed to participate; 29 (78%) completed the ATHENA program. Median (IQR) age and body mass index were 53 (47-65) years and 30.8 (29.1-34.8) kg/m² respectively. ATHENA was feasible to implement, with all components delivered as intended and high participant satisfaction. Ninety-seven percent of participants reported improved UI symptoms (global rating of change) and significant improvements in overall pelvic floor dysfunction and quality of life utility scores (p = 0.001). While weight did not change, significant improvements were found in body-food choice congruence (intuitive eating scale-2; p < 0.01).

Conclusions: The ATHENA intervention was feasible, acceptable and clinically effective for overweight and obese women with urinary incontinence at a tertiary public hospital in Australia. Further research into longer term outcomes and the cost effectiveness of this group intervention is recommended.

Trial registration: N/A. Ethics approval, HREC/2018/QGC/46582, date of registration 14/11/2018.

Keywords: Exercise; Group therapy; Nutrition; Obesity; Overweight; Pelvic floor muscle training; Urinary incontinence.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Exercise Therapy
Female
Humans
Male
Obesity / complications
Obesity / therapy
Overweight / complications
Overweight / therapy
Pelvic Floor
Quality of Life
Treatment Outcome
Urinary Incontinence* / therapy
Urinary Incontinence, Stress*