today , many middle - aged women suffer from urinary incontinence , because of the decrease in 
 the strength of their pelvic floor and urethral sphincter muscles due to pregnancy , delivery 
 and aging1,2,3,4 .
urologic diseases , particularly urinary incontinence , tend to 
 decrease people s self - esteem and cause them to feel anxiety and humiliation1 , 2 . 
 the number of urinary incontinence patients has gradually increased every year and a medical 
 industry has grown up around this problem1 , 2 . in other words ,
more and more people are 
 likely to be diagnosed with urinary incontinence and incur a heavy financial burden 
 attempting to treat it1 , 2 .
urinary incontinence can be mitigated by several types of 
 treatment , including surgery , medication , and behavior therapy3 , 4 .
particularly , behavior 
 therapy , such as pelvic muscle strength training , is actively applied as a primary 
 treatment , since it tends to have a lower incidence of side effects compared to surgical 
 treatment or medication3 , 4 .
although physical exercise is recommended for patients , 
 muscle strength training through dumbbells or weight machines would increase the possibility 
 of injury among middle - aged females with diminished physical ability2 .
in addition , physical exercise programs need to be more 
 interesting and recreational if they are to succeed in engaging the continuous participation 
 of the patients .
thus , this study investigated the effect of pelvic muscle strength training 
 through belly dancing , one of well - known recreational dances , on the urinary 
 incontinence - related muscles and vaginal pressure in middle - aged women , in order to provide 
 practical data for establishing an effective training program focusing on mitigating and 
 preventing urinary incontinence .
a total of 24 middle - aged women , who were diagnosed with urinary incontinence by doctor , 
 from d city , south korea participated in this study .
the subjects were randomly divided into 
 two groups : the experimental group ( n=12 ; age=52.3  4.1 yrs ; height=157.3  2.2  cm ; weight 
 59.2  3.4  kg ) and the control group ( n=12 ; age=51.4  5.1 yrs ; height=158.4  3.2  cm ; 
 weight 59.8  2.9  kg ) .
the experimental group was requested to participate in a belly 
 dancing program ( 90  min , 2 times a week , for 12 weeks ) , while the control group did not 
 participate in such a program .
the belly dancing program , focusing on pelvic muscle strength 
 training ( table 1table 1.belly dance exercise programtypeexercisetime ( min)warm - upleg shimmy , body shimmy , pelvic tilt , hip drop / lift , hip slide , hip 
 thrust , hip circle , hip bump20belly dance movesleg shimmy , body shimmy , pelvic tilt , hip drop / lift , hip slide , hip 
 thrust hip circle , hip bump , hip twist , belly roll , undulation , figure eight rib 
 cage , hip shimmy , choo choo - shimmy60cool - downsame as warm - up10intensity = rpe 810 ( week 1 to 2 ) , rpe 1112 ( week 3 to 
 8) , rpe 1314 ( week 9 to 12 ) ) , was established with two sports training and conditioning experts and three 
 current belly dancing instructors .
the intensity of the training was decided by rating the 
 perceived exertion ( rating of perceive exertion : rpe)5 .
the rpe was gradually increased from 8 to 14 ( week 1 to 2 : rpe 
 810 , week 3 to 8 : rpe 1112 , week 9 to 12 : rpe 1314 ) .
all of the subjects underwent the 
 measurement of their vaginal pressure and urinary incontinence - related muscles pre- and 
 post - experiment .
their vaginal pressure was measured by vaginal pressure measurement 
 equipment ( hmt-2000 , hmt , korea ) .
particularly , the maximum pressure and duration of their 
 pelvic floor muscle contraction were recorded by one well - trained and experienced nurse .
the 
 strength of their urinary incontinence - related muscles , specifically their adductor muscle , 
 was measured by a one repetition maximum strength test ( 80% of 1 repetition maximum ) by 
 using a hip adductor weight machine ( t-8003 , technogym , italy ) after sufficient warm - up 
 exercises .
the data obtained were processed using spss 18.0 . and standard deviations of the 
 two groups were calculated and the paired t - test was conducted to examine the difference 
 between the pre- and post - experimental values .
all of the subjects were educated about the content and purpose 
 of the experiment and provided written informed consent before beginning the study , in 
 accordance with the ethical principles of the declaration of helsinki .
intensity = rpe 810 ( week 1 to 2 ) , rpe 1112 ( week 3 to 
 8) , rpe 1314 ( week 9 to 12 )
the results of the paired t - test by group are presented in table 2table 2.result of pared t - testtypebaseline12 weeksexercise group ( n=12)adductor muscle ( repeat)8.35  0.6512.54  0.70**maximum vaginal contraction pressure ( mmhg)18.70  1.5032.50  3.59**maximum vaginal contraction duration ( sec)3.88  0.506.55  0.35**control group ( n=12)adductor muscle ( repeat)8.55  0.508.53  0.65maximum vaginal contraction pressure ( mmhg)19.50  1.7519.35  2.30maximum vaginal contraction duration ( sec)3.95 
0.203.91  0.27values are mean  sd . significantly different ( * * p<0.001 ) between pre and post in 
 the experimental group .. after 12 weeks of the belly dancing intervention , the experimental group 
 showed a significant difference between their pre- and post - experiment values , while the 
 control group did not demonstrate any significant change .
firstly , the maximum pressure of 
 the pelvic floor muscle contraction was significantly increased from 18.7  1.5 mmhg to 32.5 
  3.6 mmhg in the experimental group ( p<0.05 ) .
secondly , the experimental group showed a 
 significant increase in the duration of their maximum pelvic floor muscle contraction from 
 3.9  0.5 sec to 6.6  0.4 sec .
thirdly , the one repetition maximum of the adductor muscle 
 was significantly increased from 8.4  0.7 to 12.5  0.7 .
values are mean  sd . significantly different ( * * p<0.001 ) between pre and post in 
 the experimental group .
about 55.7% of korean middle - aged women experience symptoms of urinary incontinence , which 
 is considered as one of the most important health issues around the world by the world 
 health organization ( who ) and needs to be controlled consistently6 , 7 .
for instance , over 
 30% , 50% and 53.7% of middle - aged women in the u.s . , canada and taiwan , respectively , are 
 considered as urinary incontinence patients8,9,10 .
thus , this study tried to examine the effect of a belly dancing program on the urinary 
 incontinence - related muscles and vaginal pressure in middle - aged women .
the result of this 
 study indicated that 12 weeks of the belly dancing intervention significantly increased the 
 maximum pressure of the pelvic floor muscle contraction and its duration and the adductor 
 muscle strength .
s study11 , 10 weeks of pelvic 
 exercise increased the maximum pressure of the pelvic floor muscle contraction among 
 middle - aged women .
mun et al.12 also 
 found that the degree of urinary incontinence was improved by a pelvic muscle exercise 
 intervention , due to the resulting increased maximum pressure of the pelvic floor muscle 
 contraction and its duration .
shin & park13 indicated that 12 weeks of pelvic exercise significantly improved 
 many symptoms of urinary incontinence , such as urinary frequency and nocturia .
na et 
 al.2 found that the weakened muscles 
 around the pelvis caused by aging and delivery could be strengthened through regular 
 physical activity , thereby , in turn , relieving or preventing urinary incontinence .
ko et 
 al.14 suggested that belly dancing , in 
 particular , increases the bone density in middle - aged women .
yoon et al.15 found that 6 weeks of adductor exercise 
 increased the adductor muscle strength and pressure of the pelvic floor muscle contraction , 
 showing similar effects to the kegel and other sphincter exercises . in conclusion , a regular pelvic exercise program could be actively applied as an effective 
 non - surgical treatment for urinary incontinence .
this study included a pelvic exercise 
 program , in the form of recreational dancing , that females could follow more easily and 
 participate in for longer by engaging their interest .
although the results of this study 
 indicated the effectiveness of pelvic exercise in reducing urinary incontinence , more 
 specific and diverse research is necessary to identify how such exercises can be tuned to 
 the patient s individual characteristics ( e.g. , age , gender , previous exercise experience , 
 degree of urinary incontinence , etc . ) .
in addition , future study would identify the effect 
 of exercise on urinary incontinence by types such as stress , urge , overflow , and functional 
 incontinence .
 [ purpose ] this study examined the effect of belly dancing on the urinary 
 incontinence - related muscles and vaginal pressure in middle - aged women to provide 
 fundamental data for establishing an effective training program focusing on mitigating and 
 preventing urinary incontinence . [ subjects and methods ] the subjects included 24 
 middle - aged women , who have been diagnosed with urinary incontinence . 
 the subjects were 
 randomly divided into two groups , viz . the experimental group ( n=12 ) and control group 
 ( n=12 ) . 
 the experimental group underwent a belly dancing program focusing on pelvis moves . 
 
 [ results ] in the experimental group , the urinary incontinence - related muscle strength and 
 vaginal pressure were increased , while the control group showed no significant change . 
 
 [ conclusion ] belly dancing focusing on pelvis moves had a positive effect on the urinary 
 incontinence - related muscle strength and vaginal pressure , suggesting that a recreational 
 dance program focusing on pelvic exercise can be used to prevent and relieve the symptoms 
 of urinary incontinence as a non - surgical treatment . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION