Lifetime physical activity and pelvic organ prolapse in middle-aged women. Nygaard IE, Shaw JM, Bardsley T, et al. Am J Obstet Gynecol 2014;210:477.e1-12.

Outline for March 2015 Pelvic PT Journal Club
Presenter: Sallie Rediske, PT, WCS
·         Background and Purpose:

·         Little information on modifiable behaviors in young women that may affect incidence of pelvic organ prolapse (POP) as middle-aged women.

·         Analysis of self-report of lifetime and specifically teen-year activity levels compared to incidence of POP as middle-aged women.

                Subjects:

·         N=382.

·         Characteristics: 39 -65 years of age; not pregnant or in past six months; no surgical treatment for POP or UI; independent gait; no medical conditions associated with pelvic floor conditions or low physical activity; no urge UI; no current cancer treatment; could fill out forms; BMI 18.5 kg/m2 to 40 kg/m2; POP present >+1 cm, POP absent <-1cm .="" span="">

·         Study Design/Method:

·         Case-control study.

·         17 primary care family medicine/gynecological clinics in Utah.

·         Trained research nurses used POP-Q subjects.

·         Lifetime Physical Activity Questionnaire (LPAQ) to quantify activity over four age periods from menarche to 65 years of age. Occupational Questionnaire (OQ) also used.

·         Metabolic equivalents (METS) calculated for both questionnaires.

·         Risk factors for pelvic floor disorders also collected via Prolapse and Incontinence Questionnaire.            

·         Blinding:

·         Nurses to LPAQ and OQ scores.

·         Exercise science researchers to POP vs. no POP.

                Results:

·         No association with lifetime overall, leisure or strenuous activities and increased odds of POP.

·         Strenuous physical activity in teen years identified as a risk factor for POP (> 21 hours strenuous activity/week).

·         Lower levels of strenuous lifetime activity may be protective against POP.

·         Limitations:

·         Cannot establish causality by cross-sectional nature of data collection.

·         Possible over-reporting of activity.

·         Homogeneous population.

·         Strengths:

·         Minimized bias by recruiting patients not seeking care for POP.

·         Masking of nurses to SRM responses and researchers to group assignment.

·         Used validated POP assessment tool; reliable SRM for women.

·         Did nested reproducibility study with little difference in outcome.

                Discussion:

·         Limited research between POP and physical activity.

·         Mixed outcomes in what does exist: no association between exercise and POP in others; 2 report association between heavy work/POP, but no adjustment for parity; contradicting outcomes for heavy lifting/job classification and bulging, but non-validated measures used. In 3 studies with validated measures: heavy work associated with POP.

                Conclusion:

·         Recommend women to be physically active over lifespan and not restrict activity to prevent POP. Teen years and during pregnancy may be times of greater risk for promotion of POP. This research to not be used to counsel.