An exercise training and healthy eating group program (ATHENA) for overweight and obese women with urinary incontinence: translating evidence into practice

Dr Shelley Roberts1,2, Ms Zara Howard1, Dr Kelly Weir1,2, Ms Jennifer Nucifora1, Ms Leanne Smith1, Ms Nadine Baker1, Ms Heidi Townsend1, Dr Lynda Ross3

1Gold Coast Hospital and Health Service, Gold Coast, Australia, 2School of Allied Health Sciences, Griffith University, Gold Coast, Australia, 3School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia

Evidence-based guidelines recommend supervised pelvic floor muscle training (PFMT) as first-line treatment for women with urinary incontinence (UI); and weight loss and exercise for obese women with UI. Our multidisciplinary team of clinicians, researchers and a health consumer translated these recommendations into a 12-week, group-based intervention (ATHENA), involving supervised PFMT, general exercise training, healthy eating education and pelvic health education.

A mixed-methods, implementation-effectiveness hybrid design was used to concurrently assess ATHENA’s implementation (process evaluation) and clinical effectiveness, in a Women’s Health Physiotherapy service at a Queensland public hospital. Participants were overweight/obese women with UI. Process data included reach, dose, fidelity, and participant responses to ATHENA (satisfaction surveys, interviews). Effectiveness data included pre/post surveys (UI symptoms, quality of life, eating behaviours) and change in body mass index (BMI). Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were analysed thematically.

Of 156 eligible patients, 37 (24%) participated in and 29 (78%) completed ATHENA. Median (IQR) age and BMI were 53 (47–65) years and 30.8 (29.1–34.8) kg/m2. ATHENA was feasible to implement with high participant satisfaction. Most participants (97%) reported improvements in UI symptoms, pelvic floor function and quality of life (p<0.01). While BMI did not significantly change, body-food choice congruence improved (p<0.01). In interviews, participants described high satisfaction with ATHENA; improved UI knowledge, attitudes, behavior and symptoms; and said the group setting facilitated ATHENA’s success.

ATHENA was feasible, acceptable and clinically effective for overweight/obese women with UI in our setting. Further research into longer-term outcomes and cost-effectiveness is recommended.


Dr Shelley Roberts is an Allied Health Research Fellow in a conjoint position between Griffith University and Gold Coast Hospital and Health Service. Her background is in nutrition and dietetics, and she is an Accredited Practicing Dietitian. Dr Roberts’ research focuses on improving nutrition among hospitalised patients, with particular interests in patient participation in care and patient centred care; healthcare technologies; and integrated knowledge translation.

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