EP736 - The LEAP Study: Exploring Lifestyle, Exercise And Prolapse Through Patient and Clinician Perspectives

Purpose/Background: Physical activity is central to healthy living, with inactivity linked to numerous adverse health outcomes. While general guidelines for aerobic activity and resistance training exist, recommendations rarely account for health conditions that may be impacted by exercise. Conflicting evidence suggests specific movements that increase intraabdominal pressure may weaken pelvic floor supports and exacerbate rectal and pelvic organ prolapse, yet there is limited research focused on individuals with rectal prolapse. Other pillars of lifestyle medicine, including nutrition, sleep, social engagement, relationships, and stress mitigation, are similarly underexplored in this population.

This study aimed to evaluate the impact of prolapse on exercise practices and other lifestyle domains, using real-world perspectives from both clinicians and patients.

Methods/Interventions: Patients with rectal and/or vaginal prolapse were recruited from an established registry. Clinicians, including colorectal surgeons, urogynecologists and pelvic floor physical therapists were recruited locally and internationally. Patient surveys assessed demographics, exercise habits, barriers, and the impact of prolapse on lifestyle medicine pillars. Clinician surveys assessed demographics, physical activity, and perspectives on lifestyle and exercise recommendations in practice.

Results/Outcomes: 101 clinicians (55.7% female, 44.3% male; mean age 48.7 ± 10.7) and 33 patients (92.9% female, 7.1% male; mean age 68.9 ± 11.7) responded to the surveys. Most clinicians (69.3%) identified as colorectal surgeons, with the majority being from North America (53.0%) or Europe (21.0%).

Among patients, exercise was the most negatively impacted lifestyle pillar (strongly agree 46.7%, agree 33.3%). Regardless, patients remained physically active (36.6% more than 3x per week, 16.8% more than 5x per week), including activities such as strength training (64.1%). Despite the strong impact of prolapse on exercise identified by patients, clinicians reported discussing exercise 'often' or 'always' in only 52.5% of consultations. Sleep was the least discussed lifestyle pillar (never 31%, rarely 29%) (Figure 1). Barriers to lifestyle discussions included time restriction (73.3%), competing priorities (81.0%), perceived irrelevance (32.3%), lack of training (30.6%), and reliance on team members (14.3%). While 74.3% of clinicians believed certain exercises worsen prolapse, 68.3% did not restrict activity before surgery.

Conclusion/Discussion: Prolapse negatively impacts multiple pillars of lifestyle medicine, with ability to exercise most affected. Regardless, patients remain engaged in physical activity, including activities such as strength training. Disparity exists in clinical practice, with the majority of clinicians believing that certain exercises can worsen prolapse, yet lifestyle discussions are not routine and restrictions on activity before surgery are uncommon. This study is the first to comprehensively integrate patient and clinician perspectives on lifestyle and prolapse, and highlights opportunities to align patient needs with clinical care. These findings support the development of evidence-based guidance on safe exercise, promote holistic consultation practices, and strengthen shared decision-making to optimize outcomes for patients with prolapse.

Figure 1. Patient reported impact of prolapse versus clinician discussion of lifestyle factors