PROJECT ABSTRACT/SUMMARY Urinary incontinence (UI) is a highly prevalent (up to 50% of community-living older women) condition associated with profound morbidity and psychosocial consequences. Treatment options of UI are limited for older women due to adverse effects related to medications or surgery, thus conservative management, including pelvic floor muscle (PFM) exercises, are often the only available option. Despite the unique physiologic changes associated with aging, traditional PFM exercises use the same protocol for women across all ages, failing to address aging-related physical and functional decline. There is growing evidence that the surrounding anatomic structures of the pelvic floor play an important role in maintaining PFM function and strength through dynamic muscle coactivation. The obturator internus (involved in hip external rotation) shares facial attachment with PFMs. Previous studies have demonstrated that strengthening the hip external rotator muscles improved intravaginal squeeze pressures (a validated measurement for voluntary PFM contraction involved in PFM training) in both young and postmenopausal women. However, the impact on UI symptoms was not examined in these studies. Thus, the effect of hip muscle exercises on older women with UI remains unknown. The current preliminary data further demonstrated that older women with UI had significantly lower baseline hip strength compared to those without UI, and hip external rotation had the highest correlation with pelvic floor strength. Thus, the overarching goal of this project is to assess the impact of hip external rotation exercises on pelvic floor strength and function (contributing to the continence mechanism), specifically targeting older women with UI. The proposed study will include 30 older women (ages 65 or older) with UI, aiming to 1) investigate changes in PFM strength from pre- to post-standardized 12-week hip muscle exercises, progressively increasing resistance over time (an evidence-based exercise strategy for aging associated muscle weakness), 2) examine the impact of hip muscle exercises on UI symptoms, and 3) assess barriers in hip muscle exercises, specifically cognitive function, physical function, and self-efficacy. Results from this study will provide insight into the dynamic interaction of anatomic support structures on pelvic floor strength and function and will be utilized to design a future randomized controlled trial comparing the traditional PFM training versus a novel exercise regimen including hip muscle exercises in older women with UI. The long-term goal is to develop an innovative intervention incorporating the potential synergistic effect of intermuscular interactions between hip and pelvic floor muscles as a non-surgical treatment of UI in older women.