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Barriers to Exercise Among Women With Urgency Urinary Incontinence: Patient and Provider Perspectives

Khanijow, Kavita D., MD*; Pahwa, Avita K., MD; Newman, Diane K., DNP; Arya, Lily A., MD*; Andy, Uduak U., MD*

Female Pelvic Medicine & Reconstructive Surgery: July/August 2018 - Volume 24 - Issue 4 - p 301–306
doi: 10.1097/SPV.0000000000000460
Original Articles

Objective The aim of this study was to describe important barriers to exercise in older women with urgency urinary incontinence (UUI) from the patient and provider perspectives.

Methods Six focus groups (2 in active women, 2 in sedentary women, and 2 in providers) were conducted with 36 women with UUI and 18 providers. Focus group discussions were transcribed verbatim. All transcripts were coded and analyzed by 2 independent reviewers. Investigators identified emergent themes and concepts using a modified biopsychosocial conceptual model.

Results A wide range of physical, psychological, social, and environmental factors were perceived to influence exercise. Although women with UUI identified pain as a strong barrier to exercise, providers did not. Both women with UUI and providers identified shame associated with incontinence as a significant barrier, and, conversely, satisfaction with UUI treatment was noted as an enabler for exercising. Women and providers had incongruent views on the need for supervision during exercise; women viewed supervision as a barrier to exercise, whereas providers viewed lack of supervision as a barrier to exercise. Opportunity for socialization was noted as a major enabler of exercise by all groups and suggests that exercise programs that promote interactions with peers may increase exercise participation. The importance of financial incentive and reimbursement was congruent between women and their providers.

Conclusions Women with UUI have unique perspectives on barriers to exercise. Understanding women's perspective can aid clinicians and researchers in improving exercise counseling and in creating exercise programs for women with UUI.

Patient and provider perspectives on barriers to exercise in older women with urgency urinary incontinence are unique and clinically meaningful.

From the *Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;

Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; and

Division of Urology, Department of Surgery, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA.

Correspondence: Kavita Khanijow, Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, 585 Dulles, Philadelphia, PA 19104. E-mail: Kavita.Khanijow@uphs.upenn.edu.

The authors have declared they have no conflicts of interest.

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