Association between physical activity, lower urinary tract symptoms (LUTS) and prostate volume
Fowke JH, Phillips S, Koyama T, Byerly S, Concepcion R, Motley SS, Clark PE. BJU Int. 2012 Jun 22. doi: 10.1111/j.1464-410X.2012.11287.x. [Epub ahead of print]


Departments of Medicine Urologic Surgery Biostatistics, Vanderbilt University Medical Center Urology Associates, Nashville, TN, USA.


Study Type - Aetiology (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Greater leisure-time physical activity (PA) levels or a lower body mass index have previously been associated with a lower risk of benign prostatic hyperplasia or less severe lower urinary tract symptoms (LUTS). However, separating the effects of PA from obesity can be difficult, and the types of PA and the mechanisms underlying any association with LUTS among older men are unclear. The present analysis used multiple validated instruments to measure PA domains across workplace, leisure time, and home domains, and finds that PAs ranging from sports to light housework are associated with lower LUTS severity. The benefits of PA were seen with irritative symptoms, and also among obese men. Furthermore, this analysis begins the investigation of mechanism by finding that the relationship between PA and LUTS is not mediated by prostate enlargement.


•  To determine the association between lower urinary tract symptoms (LUTS) severity and physical activity (PA) across workplace, home, and leisure domains. •  To determine the mediating role of prostate enlargement on LUTS severity and PA.


•  The study included 405 men without prostate cancer or prostatic intraepithelial neoplasia. •  LUTS severity was ascertained using the American Urological Association Symptom Index and prostate size by ultrasonography. •  PA was assessed using validated questionnaires, with conversion to metabolic equivalent of task (MET)-h/week to estimate leisure-time PA energy expenditure. •  Analysis used multivariable linear regression, controlling for body mass index (BMI), age, race, and treatment for benign prostatic hyperplasia, cardiovascular disease and diabetes.


•  Higher leisure-time PA energy expenditure and light housework activities were significantly associated with lower LUTS severity. •  Prostate volume was not significantly associated with PA in adjusted analyses, and controlling for prostate volume did not affect the association between LUTS severity and PA. •  Stratification by BMI showed a moderate interaction (P= 0.052), suggesting that PA was more strongly associated with LUTS severity among obese men.


•  In this cross-sectional analysis, leisure-time and home-time PA was inversely associated with LUTS severity. •  The association between PA and LUTS severity was stronger for irritative symptoms and among obese men, and was not mediated through changes in prostate size. •  Our results indicate the need for further detailed investigation of PA and LUTS.