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陳文榮 瑜珈在急迫性尿失禁婦女的治療所扮演的角色 2019/5/30 下午 04:25:20 0
原 文 題　　目 Yoga for Women With Urgency Urinary Incontinence: A Pilot Study.
作　　者 Tenfelde S, Tell D, Garfield L, Mathews H, Janusek L.
出　　處 Female Pelvic Medicine & Reconstructive Surgery, 2019 Apr 5. doi: 10.1097/SPV.0000000000000723.
出版日期 April, 2019
評 論 評論：這篇文章主要是要評估輕度的瑜珈療程對患有急迫性尿失禁的婦女之治療所扮演的角色。作者設計了一個八週的輕度瑜珈療程，並在療程開始前及結束後對患有急迫性尿失禁的受試者做評估。這個研究的主要目的是要評估患有急迫性尿失禁的婦女，瑜珈對她們的可行性及接受度如何。第二個目的是要評估在瑜珈療程完成後對於其症狀程度、心理層面、生活品質以及發炎的生物標記(inflammatory biomarkers)等的改善程度。受試者是經由社區內招募的自願者，年齡在20至70歲間，目前並未接受尿失禁治療但為急迫性尿失禁所苦者。排除條件為：健康狀況不適合做瑜珈者、懷孕中、產後六個月內者、正接受尿失禁治療者、三個月內做過瑜珈者、有認知問題者、有免疫疾病者、藥物及酒精濫用者等。結果共有12個受試者在2015年參與此項前瞻性的研究。瑜珈療程共計八週，每週兩次，每次一小時，由超過200小時教學經驗的瑜珈老師帶領。課程內容為艾楊格瑜珈(Iyengar yoga)，且設計為適合基礎初學者的課程。在症狀的評估方面，使用Pelvic Floor Distress Inventory 20(PFDI-20)的症狀問卷。其他的評量包括生活品質、沮喪的症狀、睡眠、壓力、焦慮以及發炎的生物標記。所謂發炎的生物標記包含interleukin 6 (IL-6)，C-reactive protein (CRP)及tumor necrosis factor α (TNF-α)。在結果方面，此12位受試者並無發生任何不良結果發生。在急迫性尿失禁的症狀方面，呈現有意義的改善(P = 0.01)，在生活品質方面，病患也報告在接受瑜珈治療後有顯著的改善(P = 0.04)。大部分的受試者在接受瑜珈療程後報告其症狀呈現”大幅改善(much better)”(n = 4 [33%])，報告”有些改善(a little better)” (n = 5 [42%])。而有3位受試者 (25%) 報告”未改善(no change)”。同時病患覺得沮喪的症狀改善了(P = 0.03)且睡眠品質變好了(P = 0.03)。不過壓力及焦慮卻沒有明顯的改善。而發炎生物標記TNF-α在瑜珈療程後是降低的(P = 0.009)，不過IL-6及CRP並沒有顯著的下降。故作者認為，瑜珈在患有急迫性尿失禁的婦女是個可行的治療，可以改善急迫性尿失禁的症狀、睡眠品質，生活品質及沮喪的症狀。並外還可降低血清中發炎生物標記。
abstract

OBJECTIVES:
The objective of this study was to evaluate the feasibility of a gentle yoga program for women with urgency urinary incontinence (UUI). Also, these preliminary data can evaluate if yoga improves symptom burden, quality of life, and inflammatory biomarkers for women with UUI.

METHODS:
This prospective nonrandomized single-arm pilot study evaluated the effectiveness of a twice-weekly, 8-week gentle yoga intervention to reduce UUI symptom burden. Changes in symptom burden were measured using the Pelvic Floor Distress Inventory 20. Secondary measures included quality of life, depressive symptoms, sleep, stress, anxiety, and inflammatory biomarkers. Outcomes were evaluated with paired t testing.

RESULTS:
Twelve women completed the yoga intervention with no adverse outcomes noted. Urgency symptom burden was significantly improved after the intervention (P = 0.01), and women reported an increase in quality of life (P = 0.04) after the yoga intervention. Following the yoga intervention, the majority of women reported symptoms as "much better" (n = 4 [33%]) and "a little better" (n = 5 [42%]), with 3 women (25%) reporting "no change." Women also reported significant reduction in depressive symptoms (P = 0.03) and better quality of sleep (P = 0.03). No significant changes were found in anxiety or stress perception. Plasma levels of the inflammatory biomarker tumor necrosis factor α were reduced after yoga intervention (P = 0.009); however, no significant postyoga changes were found for interleukin 6 or C-reactive protein.

CONCLUSIONS:
This study provides preliminary evidence that yoga is a feasible complementary therapy that reduces incontinence symptom burden, along with improving quality of life, depressive symptoms, and sleep quality. Additionally, yoga may lower inflammatory biomarkers associated with incontinence.

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