Physical activity (PA) and sedentary behavior (SB) are associated with medical co-morbidity, mood disorders, and overall well-being. Prior studies suggest that moderate leisure-time PA is associated with a lower prevalence of lower urinary tract symptoms (LUTS). However, this may be explained by the fact that LUTS can be a barrier to PA. Sedentary behavior has been associated with increased LUTS in men, but the temporal and directional relationships between PA, SB and LUTS in women remain unclear. The aims of this analysis were to assess baseline PA, measured in metabolic equivalent (MET) hours/week, and SB, measured in hours/week, and their association with prevalent, incident, and progressive LUTS over 2 years.

The RISE FOR HEALTH Study, conducted by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium was a population-based cohort study of U.S. women designed to identify factors that prevent LUTS and promote bladder health across the lifecourse.  Adult women residing in 57 counties surrounding nine research centers were selected from a marketing database using random and stratified-probability sampling. Participants completed two baseline surveys, an optional in-person assessment, and annual follow-up surveys. This analysis examined associations for baseline PA and SB and prevalent, incident, and progressive LUTS over 2-years. PA was assessed using the Activities in the Past Year Questionnaire, which measured average minutes/week across nine common activities. Energy expenditure was calculated using assigned MET values multiplied by time spent in each activity. SB was assessed using the Sedentary Behavior Questionnaire, which measured total sitting time on weekdays and weekends in hours/week. LUTS during the past 7-days were assessed using the Lower Urinary Tract Dysfunction Research Network Symptom Index (LURN SI-10).  

Potential confounders included age, race, income, vaginal parity, cigarette smoking, and menopausal status. To describe baseline associations, PA was categorized into quintiles and SB into quartiles based on the study population distribution. Incident LUTS analyses included participants with no or minimal LUTS at baseline who developed moderate or severe LUTS at follow up. In addition to composite LUTS, analyses were performed for stress incontinence (SUI), urgency incontinence (UUI), urgency, and urinary pain. For SUI, UUI, and urgency, progression analyses included participants with mild or moderate symptoms who progressed to moderate or severe symptoms at follow up.

1,827 participants (mean age 50.3 years) completed the required baseline surveys and at least one follow-up survey. RISE participants were similar to the U.S. adult population with respect to race and ethnicity, and age, BMI, and menopausal status were well distributed. At baseline, more PA and less SB were associated with fewer LUTS in multivariable analysis adjusting for potential confounders. Incidence of moderate to severe LUTS (n=1,262 at risk at baseline) was greater in those with less PA and more SB in unadjusted analyses but were not statistically significant when controlling for potential confounders; incident UUI was associated with less PA while incident SUI and urinary  pain were associated with greater SB. Progression of SUI on unadjusted analysis was greater among those with less PA and progression of urgency and UUI was greater among those with more SB.

More PA and less SB were associated with fewer LUTS at baseline. Less PA and more SB may contribute to the development and progression of moderate to severe LUTS over time. Specifically, less PA was associated with incident UUI and progression of SUI; greater SB was associated with incident SUI and urinary pain and with progression of urgency and UUI.

These findings support the hypothesis that PA and SB are modifiable factors that may be targeted in prevention efforts to reduce LUTS and promote bladder health in women.