Functional exercise therapy for stress and mixed urinary incontinence in women: A systematic review and meta-analysis

Objective To assess the effect of functional exercise therapy on urinary incontinence symptoms, quality of life and pelvic floor muscle in women with stress or mixed urinary incontinence (UI). Methods PubMed, Web of Science, EMBASE, Scopus, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang and SinoMed were electronically searched for relevant articles from their inception to October 2025. We included randomized controlled trials comparing functional exercise therapy with conventional pelvic floor muscle training (PFMT) in adult women with stress or mixed UI. The primary outcome was UI symptom severity assessed using validated patient-reported outcome measures (PROMs). Secondary outcomes were urine leakage measured by pad testing, QoL, and PFM strength. Risk of bias was assessed using RoB 2, and meta-analyses were performed using Review Manager 5.4. Results A total of 10 clinical trials involving 489 participants were included in this review. Functional exercise was associated with improved QoL compared with PFMT (SMD = -0.48, 95% CI -0.78 to -0.18; P = 0.002; I 2 = 47%), although the certainty of evidence was low. No statistically significant between-group differences were observed for PROM-based UI symptom severity (SMD = -0.16, 95% CI -0.47 to 0.14; P = 0.30; I 2 = 65%), pad-test outcomes (SMD = -0.17, 95% CI -0.74 to 0.39; P = 0.55; I 2 = 80%), or PFM strength (MD = 0.27, 95% CI -0.43 to 0.96; P = 0.45; I 2 = 92%). Conclusions Compared with conventional PFMT, functional exercise was associated with better QoL, but did not demonstrate a statistically significant advantage in patient-reported UI symptom severity, pad-test outcomes, or PFM strength. The certainty of evidence was low for most outcomes, and substantial heterogeneity was present for several analyses. Further adequately powered RCTs using standardized interventions and outcome measures are needed. Registration number (Prospero) CRD420251170077