Effects of Hatha Yoga vs Physical Conditioning on Sleep in Women With Urinary Incontinence: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Yoga, an integrative health practice combining movement and mindfulness, has been recommended to improve sleep in adults with chronic conditions, but it is unclear whether it offers unique benefits for sleep compared with nonspecific exercise. Objective: To compare the effects of a yoga intervention vs a nonspecific physical conditioning intervention on sleep outcomes in women with urinary incontinence. Design, Setting, and Participants: This prespecified secondary analysis of a multicenter, investigator-blinded randomized clinical trial was conducted from 2018 to 2022, with 3 months of intervention follow-up, at 3 sites in Northern California. Interventions were delivered in person and via videoconference after the start of the COVID-19 pandemic. Women aged 45 to 90 years with daily incontinence were included. Data were analyzed from June to September 2024. Interventions: Random assignment to a 3-month yoga intervention involving twice-weekly instruction and once-weekly self-directed practice of hatha yoga techniques vs a time-equivalent physical conditioning intervention. Main Outcomes and Measures: Sleep quality and disruption were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Pittsburgh Sleep Diary. Nocturnal incontinence and voiding frequency were evaluated using voiding diaries. Results: Among 240 participants (mean [SD] age, 62.0 [8.7] years; 40 Asian [21.1%], 19 Black [7.9%], 160 White [66.7%], and 20 >1 race [8.3%]; 32 Latina [13.3%]), 133 participants (55.4%) reported poor sleep quality (PSQI >5) and 133 of 239 participants with data (55.7%) reported awakening at least once per night to use the bathroom at baseline. The mean change in PSQI score over 3 months was 0.37 points (95% CI, 0.78 to -0.04 points) in the yoga group, vs 0.66 points (95% CI, 1.07 to 0.25 points) in the physical conditioning group (between-group difference: 0.29 points [95% CI -0.28 to 0.86 points]). The mean change in wakefulness after sleep onset was 3.82 minutes (95% CI, 8.15 to -0.52 minutes) in the yoga group, and 6.97 minutes (95% CI, 11.20 to 2.74 minutes) in the physical conditioning group (between-group difference, 3.16 minutes [95% CI, -2.84 to 9.16 minutes]). Across all participants regardless of intervention, greater nocturnal voiding frequency was associated with worse sleep quality; for example, the estimated mean PSQI score was 5.83 points (95% CI, 5.35 to 6.32 points) among participants with fewer than 1 nocturnal voiding episode per night but 6.66 points (95% CI, 6.00 to 7.33 points) among those with at least 2 episodes per night (P = .02 for linear trend across increasing categories of nocturnal voiding frequency). Conclusions and Relevance: In this study, a 3-month yoga intervention did not yield superior outcomes for sleep quality or disruption compared with a general physical conditioning intervention among women with incontinence. Trial Registration: Ancillary Study of the Lessening Incontinence With Low-Impact Activity Study, ClinicalTrials.gov Identifier: NCT04776720; A Group-Based Therapeutic Yoga Intervention for Urinary Incontinence in Ambulatory Older Women, ClinicalTrials.gov Identifier: NCT03672461.