Urinary incontinence (UI) has a profound negative impact on quality of life and associated with increased risk of hospitalizations or nursing home admissions in older women. UI leads to functional decline and mobility limitations. More importantly, mobility limitations are predictive of UI onset and severity. The bidirectional relation between UI and mobility limitations in older women suggests common causal mechanisms with generalized poor muscle function contributing to the development of UI and mobility limitations. The current UI treatments in older women miss the critical components to improve mobility in older women suffering from UI. Therefore, older women with UI and mobility limitations may not have optimal improvement of their symptoms, especially in the context of maintenance of functional independence. Our long-term goal is 1) to improve quality of life in older women suffering from UI and mobility limitations that have common etiological causes and 2) to evaluate the role and contribution of atrophy and fat infiltration in pelvic floor (levator ani, internal obturator) and lower body (gluteus maximus, medius, minimus) muscles as causal mechanisms in the development of UI and mobility limitations in older women. Our central hypothesis is that a muscle strengthening and aerobic conditioning rehabilitation program designed to improve endurance and lower body mobility combined with the strengthening of pelvic floor muscles will reduce pelvic floor and lower body muscle dysfunction and weakness, enhance strength and endurance, and improve continence and mobility in older women. The rationale for the proposed research is that a multimodal rehabilitation program targeting to improve physical function through strengthening pelvic floor and lower body muscles will have greater efficacy in reducing UI symptoms and improving physical function than current PFMT alone in older women suffering from UI. We will test our hypothesis with a randomized controlled trial in older women with symptomatic UI with the following aims: 1) Evaluate UI symptoms and mobility limitations after a three-month multimodal strengthening and aerobic conditioning rehabilitation program combined with PFMT as compared to current standard PFMT alone in women ? 70 years with symptomatic UI; 2) Examine changes in the quality of pelvic floor and gluteal muscles before and after a three-month multimodal strengthening and aerobic conditioning rehabilitation program combined with PFMT and PFMT alone based on muscle Magnetic Resonance Imaging. The primary outcome in the study is the reduction UI episodes after the intervention. This proposal is innovative because we propose a multimodal rehabilitation program that will treat both UI and mobility as well as new biomarkers in lower body muscles dysfunction in older women with UI and mobility limitations. The study will allow the PI to transition to independent research to improve quality of live in older women with UI by decreasing UI and mobility limitations. The knowledge obtained from this research will enhance our fundamental understanding in the development of UI and mobility limitations. This proposal will fulfill the Institute of Medicine goals to increase clinical research that will lead to improved care and more effective treatments for older patients with multiple medical conditions.
The proposed research is relevant to public health because discovery of muscle dysfunction role and multimodal rehabilitation intervention will improve lives of millions of older women suffering from urinary incontinence and mobility limitations. The proposed research is relevant to the part of NIA?s mission to foster and develop clinical research in aging and to disseminate information about aging and advances in research to the public, health care professionals, and the scientific community.
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