In order to prevent urological dysfunction, including overactive bladder (OAB), in overweight women it is important to reduce weight through regular physical exercise. Regular exercise at a reasonable intensity has a positive effect on the adjustment of several parameters of body composition (Ko, 2013). The effect of exercise in relation to weight and OAB in younger women is not sufficiently supported by existing studies. The aim of our study was to reduce symptoms of OAB through a 3-month exercise program in young overweight women with OAB.

The research group consisted of university students. They were selected from two universities according to the inclusion and exclusion criteria. The sample size of our study was determined considering a power test of 0.80, a significance level alpha of 0.05. The number of women in the treatment group will be 34, in the control group 34 and we expect 40% drop out rate. A screening questionnaire with demographic data such as age, weight and height was completed by 118 women. 

After completing the questionnaire, 25 women were excluded due to not meeting the criteria of the study. The 93 remaining women were then randomly divided into two groups. Randomization was performed in Microsoft Office Excel 2010 by an independent person who did not participate in further course of the study. Twenty-three women did not complete the exercise programme. The training programme was completed by 70 women in total (34 in treatment and 36 in control groups). All data collection was anonymous.  

Inclusion Criteria: Women aged 18-35, body mass index (BMI) 25 - 29.9, waist circumference greater than 88 cm, OAB-urgency with urination frequency during the day 8 times or more, at night 2 times or more. 
Exclusion criteria: SUI, surgical treatment of gynaecological and urological diseases, urinary tract infection, oncological and neurological urinary tract disease, incomplete questionnaires, refusal to participate in the study. 

We used a 3-day voiding diary, Overactive Bladder Questionnaire (OAB-q), The Patient Perception of Intensity of Urgency Scale (PPIUS) to assess OAB symptoms. Body composition was measured using direct segmental multi-frequency bioelectrical impedance analysis with a body composition analyser, with assessment of skeletal muscle mass (kg), body fat mass (kg), body fat percentage (%), visceral fat area (cm2/level) and waist to hip ratio. A proband was defined as having OAB if she had urinary urgency, voiding eight and more times per day and two and more times per night, with or without urgency urinary incontinence. 

Women in the treatment group underwent 12 weeks of training. Exercise was performed three times a week for 60-80 minutes under the supervision of a sports trainer and physiotherapist. During this study, women did not change their everyday life activities. Also their eating habits were not changed during this study.

The training programme was designed for the reduction of abdominal fat with elements of: 
1. Aerobic training - stationary bicycle - 20 minutes, 
2. Dynamic warm-up - stretching muscles by slow and controlled movements - 10 minutes, 
3. Strength training - for reduction of abdominal fat - deep abdominal muscle activation (m.transversus abdominis, m.obliquus abdominis internus) - 20 minutes, strengthening of superficial abdominal muscles (m. obliquus abdominis externus, m. rectus abdominis 
4. Static stretching - passive stretching of lower limbs and abdominal muscles - 10 minutes. 

The control group did not undergo the exercise program but was evaluated after the 12-week period.

The sample consisted of 34 women in the treatment group and 36 women in the control group who were overweight and had OAB, with an average age of 26.8 years. There were no significant differences in the observed baseline parameters recorded before the intervention between the groups. Significant differences in favour of the treatment group were recorded for all parameters of the voiding diary, OAB-q overactive bladder symptom questionnaire and PPIUS scale after the training program (p <0.0001) . For body composition evaluation, significant differences were recorded in favour of the treatment group in terms of reduction of BMI, body weight, body fat percentage, visceral abdominal fat and waist circumference (p <0.0001). The treatment group also had a significantly larger increase in the volume of muscle mass as compared to the control group (p <0.0001). These results are summarized in Table 1. 

Table 1. Mean scores and statistical comparison between groups before and after 12-week training

In the treatment group, a significant reduction in BMI, body weight, body fat percentage,  visceral abdominal fat and waist circumference, and a significant increase in the volume of muscle mass as compared to the control group were recorded. We believe that the loss of fatty tissue in the abdominal cavity through specific exercise is associated with a reduction in intraabdominal and intravesical pressure, and that these factors influenced the reduction in OAB symptoms.

A 12-week training program for the reduction of abdominal fat by strengthening superficial and deep abdominal muscles, with elements of aerobic training and stretching, significantly reduced symptoms of OAB.

Ko G.,  Lim, MH,   Choi, PB et.al. Effect of Long-term Exercise on Voiding Functions in Obese Elderly Women. Int Neurourol J 2013;17(3): 130–138.