Yakıt Yeşilyurt, S.Şahiner Pıçak, G.Başol Göksülük, M.Balıkoğlu, M.Özengin, N.2025-08-252025-08-2520250003-99931038-34411839-4205https://doi.org/10.1016/j.apmr.2025.06.019https://hdl.handle.net/20.500.14365/6375Objective: To compare the effects of pelvic floor muscle exercises (PFME) combined with standard diaphragm exercises and 360° expanded diaphragm exercises on urinary symptoms, pelvic floor muscle (PFM) function, and respiratory function in women with stress urinary incontinence (SUI). Design: Randomized controlled study. Setting: The study conducted between November 2023 and 2024. Participants: Women with SUI (n=74). Interventions: Participants were randomly allocated into 2 groups: (1) PFME + standard diaphragm (n=37) and (2) PFME + 360° expanded diaphragm exercises (n=37). The 360° exercises were taught using 2 sensor-based biofeedback devices. Both groups completed an 8-week program with weekly sessions. Main Outcome Measures: The primary outcome was precontraction of the PFM. Secondary outcomes included the Incontinence Severity Index, The International Consultation on Incontinence Questionnaire-Short Form, PFM, and respiratory functions [maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP)]. Results: The sociodemographic and clinical characteristics of the PFME + standard diaphragm (49.29±6.73y) and the PFME + 360° expanded diaphragm exercises groups (50.97±7.70y) were similar (P>.05). Before and after the 8-week exercise program, both groups showed significant improvement in PFM functions as well as in incontinence severity index, incontinence questionnaire-short form, and MIP and MEP values (P<.05). Additionally, the initiation time for PFM contraction during the Valsalva maneuver (precontraction of PFM) was reduced in the PFME + 360° expanded diaphragm exercises group after treatment (P=.010). Conclusions: This study demonstrated that PFME combined with various diaphragm exercises improved urinary symptoms and PFM function in women with SUI. Specifically, PFME with 360° expansion diaphragm exercises reduced the initiation time of PFM contraction during Valsalva. This approach may enhance PFME effectiveness in women with impaired precontraction ability. As this study focused only on women, future research should explore the efficacy of similar interventions in sex-diverse populations. © 2025 American Congress of Rehabilitation Medicineeninfo:eu-repo/semantics/closedAccessDiaphragmatic BreathingPelvic Floor Muscle TrainingPrecontractionRehabilitationSensorStress Urinary IncontinenceArticle10.1016/j.apmr.2025.06.0192-s2.0-105012371103