Discussion
incontinence, pelvic floor muscle, anxiety, pelvic muscle, stress urinary incontinence, depression
LEAKAGE URINE, INCONTINENCE, CONTRACTION, PAD, LEAKAGE, STRESS URINARY INCONTINENCE, DISEASES
Considering the practicality of the dancing movement applied in middle-aged females, we developed a modified lumbo-pelvic coordination exercise, which is a simple rhythmic hip movement that incorporated with ADIM, to encourage core stability, and voluntary contraction of the pelvic floor muscles. This study examined the effects of a 16-week modified lumbo-pelvic coordination exercise training on perceived incontinence, urinary function, and pelvic muscle activation in middle-aged females. Our results indicated that the exercise program can improve anthropometric and body composition; and reduce perceived incontinence, frequency of leakage, and pad testing index. Furthermore, our female participants showed better pelvic floor function and vital capacity after the 16-week exercise program.Body anthropometric and composition variables are predictors of cardiorespiratory diseases. Our positive findings of these variables aligned with those reported in previous dancing studies in middle-aged or older femalesBiomechanically, our modified lumbo-pelvic coordination exercise involved the rhythmic pelvic tilting/rotation in left, right, anterior and posterior directions, which emphasizes core stability, contraction control and regulation of abdominal and pelvic floor musclesMore importantly, our modified lumbo-pelvic movement exercises effectively improved incontinence in middle-aged women, as they reported lower perceived incontinence scores (i.e., I-QOL and ICIQ-UI), lower frequency of leakage urine, and pad testing index and also demonstrated better pelvic floor function and vital capacity. Higher pelvic floor function indicates better conscious control of pelvic floor muscle and bladder neck, which is associated with the increased urethral pressure to reduce urinary leakageThere are some limitations when interpreting our results. First, only the participants with mild stress urinary incontinence were recruited in this study. The results may not be generalizable to different severities. Second, we did not assess the mental health of the participants in this study. Music and exercises could remedy psychological depression, distress, and anxiety, which might moderate the self-reported outcomes. The assessment of mental health may help further examine the underlying working mechanism including biomechanical, muscle control, perceptual-motor aspects to improve stress urinary incontinence. To date, while most interventions had been proven effective, pragmatic implementation in real-life settings is limited and behavioral research might be necessary to promote future use. In the future, smartphone technology with music, exercise guidance and activity trackers can be integrated into exercise intervention to assess the stages of behavioral change.In conclusion, a 16-week modified lumbo-pelvic coordination exercise for middle-aged females was introduced and evaluated in this study. The exercise program is simpler than dance training program and could be more engaging than traditional pelvic floor muscle training. Our training program demonstrated improvements in perceived incontinence, urinary function, and pelvic muscle activation.