DOI: 10.7272/q6pn93h6
title: Program to Reduce Incontinence through Diet and Exercise (PRIDE)

description: Background Obesity is an established and modifiable risk factor for
 urinary incontinence, but conclusive evidence for a beneficial effect of
 weight loss on urinary incontinence is lacking. Methods We randomly
 assigned 338 overweight and obese women with at least 10 urinary
 incontinence episodes per week to an intensive 6-month weight-loss program
 that included diet, exercise, and behavior modification (226 patients) or
 to a structured education program (112 patients). Results The mean (±SD)
 age of the participants was 53±11 years. The body-mass index (the weight
 in kilograms divided by the square of the height in meters) (36±6) and the
 weekly number of incontinence episodes as recorded in a 7-day diary of
 voiding (24±18) were similar for both groups at baseline. The women in the
 intervention group had a mean weight loss of 8.0% (7.8 kg), as compared
 with 1.6% (1.5 kg) in the control group (P&lt;0.001). After 6 months,
 the mean weekly number of incontinence episodes decreased by 47% in the
 intervention group, as compared with 28% in the control group (P = 0.01).
 As compared with the control group, the intervention group had a greater
 decrease in the frequency of stress-incontinence episodes (P = 0.02), but
 not of urge-incontinence episodes (P = 0.14). A higher proportion of the
 intervention group than of the control group had a clinically relevant
 reduction of 70% or more in the frequency of all incontinence episodes
 (P&lt;0.001), stress-incontinence episodes (P = 0.009), and
 urge-incontinence episodes (P = 0.04). Conclusions A 6-month behavioral
 intervention targeting weight loss reduced the frequency of self-reported
 urinary-incontinence episodes among overweight and obese women as compared
 with a control group. A decrease in urinary incontinence may be another
 benefit among the extensive health improvements associated with moderate
 weight reduction. (ClinicalTrials.gov number, NCT00091988.)
description: Eligible participants were randomly assigned at a 2:1 ratio to an
 intensive 6-month behavioral weight-loss program or to a structured
 four-session education program (the control group). Randomization was
 performed with the use of randomly permuted blocks of three or six,
 stratified according to clinical center, with random assignment concealed
 in tamper-proof envelopes. The participants were aware of their treatment
 assignment, but the staff members who collected the outcome data were not.
 
 The participants completed questionnaires concerning their demographic
 characteristics, medical and behavioral history, and history of
 incontinence that were routinely used by the investigators.
 
 The participants were weighed to the nearest 0.5 kg on a calibrated
 digital scale (Tanita BWB 800) while wearing street clothes and without
 shoes. Height was measured at baseline to the nearest centimeter with the
 use of a calibrated, wall-mounted stadiometer and a horizontal measuring
 block.
 
 The participants were trained to complete a 7-day diary of voiding (see
 the Supplementary Appendix, available with the full text of this article
 at NEJM.org), and interviewers reviewed the diaries with the participants
 to answer questions and reconcile inconsistencies.15,16 The participants
 recorded the time of each void and each incontinence episode. According to
 the instructions provided, the participants identified each episode as
 stress incontinence (involuntary loss of urine with coughing, sneezing,
 straining, or Weight Loss to Treat Urinary Incontinence n engl j med 360;5
 nejm.org january 29, 2009 37 exercise), urge incontinence (loss of urine
 associated with a strong need or urge to void), or other. For the purposes
 of analysis, each woman was then classified as having stress-only
 incontinence, stress-predominant incontinence (i.e., at least two thirds
 of the total number of episodes were stress episodes), urge-only
 incontinence, urge-predominant continence (i.e., at least two thirds of
 the total number of episodes were urge episodes), or mixed incontinence
 (i.e., at least two types were reported, but no type constituted two
 thirds of the total number of episodes).
description: Weight loss to treat urinary incontinence in overweight and obese
 women. Subak LL, Wing R, West DS, Franklin F, Vittinghoff E, Creasman JM,
 Richter HE, Myers D, Burgio KL, Gorin AA, Macer J, Kusek JW, Grady D;
 PRIDE Investigators. N Engl J Med. 2009 Jan 29;360(5):481-90. doi:
 10.1056/NEJMoa0806375. PMID: 19179316 [PubMed indexed for MEDLINE] Free
 PMC Article