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

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.

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.

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).

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.

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

International urogynecology journal. 2021 Mar 17 [Epub ahead of print]

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

Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD, 4215, Australia. ., School of Exercise and Nutrition Services, Queensland University of Technology, Kelvin Grove Campus, Brisbane, QLD, 4059, Australia., Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD, 4215, Australia., Consumer researcher, Gold Coast, Southport, QLD, 4215, Australia.