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Association of physical activity and sedentary behavior with urinary incontinence in adult women: a systematic review and meta-analysis of observational studies

Abstract:

Objective To explore the association of physical activity and sedentary behavior with urinary incontinence in adult women. Data sources PubMed, Scopus, and Web of Science were systematically searched from inception to April 30, 2025. Study eligibility criteria Observational studies (cross-sectional or longitudinal) published in English or Spanish that contained information on the association of physical activity or sedentary behavior with urinary incontinence in adult women (≥18 years). Study appraisal and synthesis methods Study quality was assessed using Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted to pool effect estimates. Heterogeneity across studies was assessed using the I<sup>2</sup> statistic, and publication bias was evaluated using Begg’s test. All statistical analyses were conducted using the Comprehensive Meta-Analysis software, version 2.0, with a significance level set at 0.05. Results Forty-three studies (n=295,513) were included in the qualitative synthesis, of which 25 (n=166,744) were eligible for meta-analysis. The quality of the studies was overall fair. Higher levels of physical activity (with definitions differing across studies) were associated with lower odds of urinary incontinence both cross-sectionally (odds ratio=0.70; 95% confidence interval, 0.60–0.82) and longitudinally (odds ratio=0.82; 95% confidence interval, 0.75–0.89). Stratified analyses showed protective associations of physical activity against the incidence of mixed urinary incontinence (odds ratio=0.66; 95% confidence interval, 0.48–0.92), urgency urinary incontinence (odds ratio=0.69; 95% confidence interval, 0.48–0.99), and stress urinary incontinence (odds ratio=0.77; 95% confidence interval, 0.65–0.92). However, no significant associations were found for sedentary behavior (odds ratio=1.02; 95% confidence interval, 0.87–1.20, only available for cross-sectional analyses). Conclusion Although robust longitudinal and intervention studies that assess physical behaviors through objective measures are warranted, higher levels of physical activity seem associated with a lower prevalence and incidence of urinary incontinence in adult women.