Physical activity is associated with improved health outcomes across the lifespan and, in women overall, higher physical activity levels are associated with lower odds of urinary incontinence (UI).[1] However, evidence specific to older women and the relative contributions of objectively measured activity volume versus intensity to lower urinary tract symptoms (LUTS) remain limited. This study examined associations between physical activity levels and LUTS in a cohort of community-dwelling older women. We hypothesized that greater daily physical activity volume would be associated with fewer and less severe LUTS, but that higher daily physical activity intensity would be associated with greater UI.

This cross-sectional analysis included 337 women (47 nulliparous, 290 parous) enrolled in the Study of Muscle, Mobility and Aging (SOMMA), a prospective cohort of adults aged ≥70 years, with available accelerometer, LUTS questionnaire, and parity data.[2] Forty-four women were excluded due to missing accelerometer data,136 due to completing their visit before the LUTS questionnaire was implemented, and 3 for missing parity status. 
Physical activity volume (daily step count) and intensity (daily time spent in moderate-to-vigorous activity, MVPA) were assessed for seven days using a wrist-worn accelerometer (ActiGraph GT9X) and analyzed using the GGIR package in R. Lower urinary tract symptoms were assessed using the Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index (LURN SI-10), a valid 10-item self-reported questionnaire.[3] Scores range from 0 to 38, with higher scores indicating greater LUTS severity. Urinary incontinence was defined as self-reported leakage of urine or a wet pad after feeling a sudden urge to urinate, while laughing, sneezing, or coughing, or when doing physical activities at least a few times (score of 1) in the past 7 days. Severe UI was similarly defined but with symptoms occurring about half the time (score of 2) or greater. 
Unadjusted and multivariable-adjusted linear regression models were calculated to assess associations between physical activity and LURN SI-10 scores. Logistic regression models examined associations between physical activity and UI. Multivariable models adjusted for age, site, hysterectomy, number of pregnancies, and number of live births.

Compared to the highest tertile of daily step count (6025-16499 steps), women in the lowest tertile (559-3553 steps) were slightly older (mean age 77.7 vs 74.6 years), reported more pregnancies (2.9 vs 2.1), and had a higher waist circumference (95.1 vs 83.1 cm). Those in the lowest tertile of daily step count also reported a greater history of hormone replacement therapy (60.9% vs 50.5%) and history of hysterectomy (44.6% vs 29.5%) compared to those in the highest tertile. When stratified by parity status, nulliparous and parous women reported similar LURN SI-10 scores (5.36±3.38 vs 5.34±3.51, p=0.97). 
Overall, greater physical activity volume (SD=3,056 steps), but not intensity (SD=64.6 min/day), was significantly associated with lower total LURN SI-10 scores (β=-0.42, 95% CI: -0.80 to -0.05). However, these associations were fully attenuated after multivariable adjustment (Table 1). 
Greater physical activity volume and intensity were also associated with a reduced likelihood of reporting UI, particularly severe UI (Steps: OR=0.61, 95% CI 0.40–0.88; MVPA: OR=0.68, 95% CI 0.46, 0.96). Except for physical activity volume and risk of severe UI (OR=0.65, 95% CI 0.42, 0.96), all associations were fully attenuated after multivariable adjustment; however, much of this attenuation was due to adiposity surrogates (Table 2).

Higher daily physical activity volume, but not intensity, was associated with fewer LUTS and reduced odds of severe UI among older community-dwelling women.

Longitudinal data are needed to disentangle the temporal sequence between daily physical activity and the development of severe UI among older community-dwelling women.

Sánchez-Martín C, Vila-Maldonado S, Leal-Martín J, et al. Association of physical activity and sedentary behavior with urinary incontinence in adult women: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. Published online November 21, 2025. doi:10.1016/j.ajog.2025.11.024
Cummings SR, Newman AB, Coen PM, et al. The Study of Muscle, Mobility and Aging (SOMMA): A Unique Cohort Study About the Cellular Biology of Aging and Age-related Loss of Mobility. J Gerontol A Biol Sci Med Sci. 2023;78(11):2083-2093. doi:10.1093/gerona/glad052
Cella D, Smith AR, Griffith JW, et al. A New Brief Clinical Assessment of Lower Urinary Tract Symptoms for Women and Men: LURN SI-10. J Urol. 2020;203(1):164-170. doi:10.1097/JU.0000000000000465