A randomized controlled trial comparing a behavioral weight loss program, including diet, exercise, and behavioral modification, with a structured education program found a reduction in incontinence symptoms. Participants in the intervention group lost 6.3 kg more weight than those in the control group and experienced about 26% fewer incontinence episodes at 6 months follow-up «Subak LL, Wing R, West DS ym. Weight loss to treat...»1.
Another randomized trial measured the impact of lifestyle intervention compared to metformin or education and found a decrease in the risk of having incontinence symptoms. At 1-year follow-up, the lifestyle intervention group lost 7 kg more weight compared to the control and saw a decrease in the odds of having urinary incontinence at follow-up (odds ratio 0.80, 95% CI 0.65 to 0.98) «Phelan S, Kanaya AM, Subak LL, et al. Weight loss ...»2.
The level of evidence was downgraded one time due to indirectness and imprecision.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Subak LL, Wing R, West DS ym. Weight loss to treat...»1 | RCT | >30 years, BMI 25-50 and min. 10 incontinence episodes per week | weight loss program vs structured education |
7 days incontinence diary, UDI and IIQ Weight (kg) |
Low |
| «Phelan S, Kanaya AM, Subak LL, et al. Weight loss ...»2 | RCT | Obese or overweight women with type 2 diabetes | intensive lifestyle weight loss intervention vs metformin or education | weight loss, risk of urinary incontinence | Moderate |
| Reference | Comments |
|---|---|
| «Subak LL, Wing R, West DS ym. Weight loss to treat...»1 | Risk of bias: under 10 % loss to follow up, no blinding (however both groups having and semi-intensive intervention and measurement may decrease performance bias), randomization procedure ok |
| «Phelan S, Kanaya AM, Subak LL, et al. Weight loss ...»2 | Prevalence of urinary incontinence at baseline 27 %. Risk of bias: under 10 % loss to follow up, no blinding, masked outcome assessors, randomization procedure ok |
Results
| Reference | Number of studies and participants | Follow-up | Mean (sd) I | Mean (sd) C | Mean difference (95 % confidence interval) |
|---|---|---|---|---|---|
| Level of evidence: moderate The quality of evidence is downgraded one time due to indirectness (Interventions may not be applicable to Finnish context, control group differs from the main study question of effectiveness compared to no intervention) and imprecision. I=intervention; C=comparison; CI=confidence interval |
|||||
| «Subak LL, Wing R, West DS ym. Weight loss to treat...»1 | I=226, C=112 | 6 months | Any incontinence -47 % (-54 to -40 %) SUI: -58 % UI: -33 % weight loss -8 % (-7,8 kg) |
Any incontinence -28 % (-41 to -13 %) SUI:-33 % UI:-26 % weight loss -1.6 % (1,5 kg) |
-19 % (-33 to -5 %) relative decrease -26% |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: low The quality of evidence is downgraded one time due to risk of bias and one time due to indirectness (Interventions may not be applicable to Finnish context, control group differs from the main study question of effectiveness compared to no intervention) and imprecision. I=intervention; C=comparison; CI=confidence interval |
|||||
| «Phelan S, Kanaya AM, Subak LL, et al. Weight loss ...»2 | 1385/1354 | 1 year | 350 (25, 3 %) | 387 (28,6 %) | odds ratio 0.80 (0,65–0,98) |