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

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 = 10), Pilates training will be provided by a Pilates trainer 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. Pilates 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. Warm-up exercises for Pilates will include: roll down, leg springs, walking, frog, circles, single leg stretch, scissors, lower and lift, spine stretch, swan prep, and crisscross. Pilates training will include: Pilates breathing, neutral pelvis, knee folds, knee sways, heel slides, elevator, pelvic clock, pelvic rocks, coccyx curl, pelvic lift, bridging, and abdominal stabilization. "Arm 3: Yoga" For participants assigned to Yoga group (n = 10), Yoga will be provided by a certificated Yoga trainer with 500 hours of Yoga training in the Yoga school. The trainer will provide the intervention once a week for 4 weeks, with each session lasting 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. The yoga postures used are as follows: Hatha yoga styles, which include 8 postures, will be performed: Tadasana, Utkatasana, Trikonasana, Malasana, Viparita Karani Variation, Salamba Set Bandhasana, Supta Baddha Konasana, and Savasana. "Adherence to Schedules" Researchers will telephone each patient every week to ensure patients’ adherence to schedules over the period of 8 weeks of CD-guided unsupervised home exercises.