Varying In-Person Coaching: Effects on Weight and Urinary Incontinence in Women with Obesity in a 20-Week Randomized Controlled Trial

Urinary incontinence (UI) affects 25–45% of women and is more common in those with body mass index (BMI) ≥ 30 kg/m 2 . UI may limit physical activity and quality of life, increasing weight gain and symptom severity. Although exercise may improve body composition and UI, adherence is low. We examined the effect of varying levels of in-person and online individualized exercise coaching on urinary incontinence and weight-related outcomes among low-active women with obesity. Low-active women with obesity ( N = 188, 42.5 ± 10.4 years) participated in this 20-week randomized controlled trial, assigned to one of four groups: high-contact in-person coaching (once weekly, n = 47); medium-contact in-person (twice monthly, n = 47) with online support; low-contact in-person (once monthly, n = 47) with online support; and control group (CG, n = 47). UI was measured using the International Consultation on Incontinence Questionnaire (ICIQ) Short Form, alongside body weight and height at baseline ( n = 155) and immediately following the 20-week intervention ( n = 132). Additional questions regarding pelvic floor muscle training (PFMT) participation and supervision were collected as a part of a 1-year follow-up. Post-intervention, no between-group differences were observed in UI prevalence or ICIQ scores ( p = 0.38 and p = 0.20). All groups lost weight ( p < 0.01), with greater reductions in the intervention groups (−4.3 to −5.2 kg) than in the CG (−2.9 kg), and between-group differences ranged from 1.4 to 2.3 kg ( p = 0.06–0.19). BMI reductions showed a similar pattern. PFMT was reported by 14.7%, with limited correct technique and minimal supervision. The intervention did not improve UI symptoms. Low PFMT adherence and supervision, likely due to the absence of a standardized protocol, underscore the need for more structured interventions.