• Alison M Mondul, Edward Giovannucci, and Elizabeth A Platz.
• Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA. amondul@umich.edu.
• J Gen Intern Med. 2020 Aug 1; 35 (8): 2281-2288.

BackgroundLower urinary tract symptoms (LUTS), often secondary to benign prostatic hyperplasia, are a common problem for older men. Lifestyle factors, including physical activity and sedentariness, may be important LUTS risk factors and suitable targets for intervention.ObjectiveTo determine whether physical activity and sedentariness are associated with LUTS incidence and progression.DesignThe Health Professionals Follow-up Study is a prospective cohort of men that began in 1986. Follow-up for LUTS is complete through 2008.ParticipantsMen aged 40-75 years at enrollment and members of health professions.Main MeasuresTotal weekly metabolic equivalent of task (MET)-hour scores were calculated and were categorized (< 9, 9 to < 21, 21 to < 42, 42 to < 63, ≥ 63 MET-hours/week). Participants reported their average time/week spent sitting watching television as a measure of sedentariness, which was categorized (< 1, 1-3, 4-10, 11-29, ≥ 30 h/week). Participants completed the International Prostate Symptom Score survey and reported treatments for LUTS periodically. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard ratios (HR) of physical activity and television watching with LUTS incidence and progression.Key ResultsAfter multivariable adjustment, including for body mass index (BMI), men with the highest physical activity were 19% (HR = 0.81, 95% CI = 0.74-0.89; p trend < 0.0001) less likely to develop incident moderate or worse LUTS than men in the lowest category. Men who watched television ≥ 30 h/week were 24% (HR = 1.24, 95% CI = 1.05-1.45; p trend = 0.004) more likely to develop incident moderate or worse LUTS than men who watched < 1 h/week. These associations persisted after mutual adjustment. We observed no associations with LUTS progression.ConclusionsIn this large prospective study, more activity and less sedentariness were associated with lower risk of incident LUTS independent of one another and BMI. Physical inactivity and sedentariness were not associated with LUTS worsening. Increasing physical activity and reducing sedentariness may be strategies for preventing LUTS in addition to their well-established benefits for other diseases.

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