Which exercise is the most effective to contract the core muscles: abdominal drawing-in maneuver, maximal expiration, or Kegel exercise?

코어 안정화를 위한 운동의 효과 비교: 복부 드로우 인 기법, 최대 호기, 케겔 운동

  • Kim, Ji-Seon (Department of Physical Therapy, College of Health, Kyungwoon University) ;
  • Kim, Yang-Hyun (Department of Physical Therapy, College of Medical Science, Kyunyang University) ;
  • Kim, Eun-Na (Department of Physical Therapy, College of Medical Science, Kyunyang University) ;
  • Kim, Chae-Rin (Department of Physical Therapy, College of Medical Science, Kyunyang University) ;
  • Seo, Dong-Kwon (Department of Physical Therapy, College of Medical Science, Kyunyang University)
  • 김지선 (경운대학교 보건대학 물리치료학과) ;
  • 김양현 (건양대학교 의과학대학 물리치료학과) ;
  • 김은나 (건양대학교 의과학대학 물리치료학과) ;
  • 김채린 (건양대학교 의과학대학 물리치료학과) ;
  • 서동권 (건양대학교 의과학대학 물리치료학과)
  • Received : 2015.11.25
  • Accepted : 2015.12.29
  • Published : 2016.02.29


PURPOSE: There are several methods, such as the abdominal drawing-in maneuver (ADIM), maximal expiration (ME), and Kegel exercise, to strengthen the core muscles. However, to date no study has been conducted to compare the effects of the ADIM, ME, and Kegel exercise on the transverses abdominis (TrA), internal oblique (IO), external oblique (EO), and pelvic floor muscles (PFMs). The purpose of this study was to find out which of the three aforementioned exercises is most effective for contracting the core muscles. METHODS: The thickness of the TrA, IO, EO and PFMs was measured by ultrasonographic imaging during the ADIM, ME and Kegel exercise in 34 healthy participants. RESULTS: There was the significant difference between ADIM and Kegel exercise in the thickness of the TrA (p<0.05). There were the significant differences between ADIM and ME and between ME and Kegel exercise in the thickness of the IO and PFM (p<0.01). There was no significant activation in the thickness of the EO (p>0.05). Measurement reliability was assessed using intraclass correlation coefficients (ICC) and the standard error of measurement (SEM). An ICC value of >0.77 indicated that reliability measurements was good. CONCLUSION: Kegel exercise was the most effective exercise for the TrA and the PFM, and ME was the most effective exercise for the IO muscles.



  1. 김진희, 김난수, 장준혁. 영상피드백을 적용한 골반저근 수축이 복부 근 두께에 미치는 영향. 대한물리의학회지. 2012;7(4):533-9.
  2. 하유, 이건철, 배원식 등. 초음파 영상을 이용한 교각운동시 복부 드로잉-인 운동이 복부 근육의 두께에 미치는 영향. 대한물리의학회지. 2013;8(2):231-8.
  3. Abe T, Kusuhara N, Yoshimura N, et al. Differential respiratory activity of four abdominal muscles in humans. J Appl Physiol. 1996;80(4):1379-89.
  4. Akuthota V, Ferreiro A, Moore T, et al. Core stability exercise principles. Curr Sports Med Rep. 2008;7(1):39-44.
  5. Arab AM, Chehrehrazi M. The response of the abdominal muscles to pelvic floor muscle contraction in women with and without stress urinary incontinence using ultrasound imaging. Neurourol Urodyn. 2011;30(1):117-20.
  6. Beazell JR, Grindstaff TL, Hart JM, et al. Changes in lateral abdominal muscle thickness during an abdominal drawing-in maneuver in individuals with and without low back pain. Res Sports Med. 2011;19(4):271-82.
  7. Behm DG, Drinkwater EJ, Willardson JM, et al. The use of instability to train the core musculature. Appl Physiol Nutr Metab. 2010;35(1):91-108.
  8. Crisco JJ, Panjabi MM, Yamamoto I, et al. Euler stability of the human ligamentous lumbar spine. Part II:Experiment. Clin Biomech. 1992;7(1):27-32.
  9. Critchley D. Instructing pelvic floor contraction facilitates transversus abdominis thickness increase during low-abdominal hollowing. Physiother Res Int. 2002;7(2):65-75.
  10. Ferreira PH, Ferreira ML, Hodges PW. Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine. 2004;29(22):2560-6.
  11. Frawley HC, Galea MP, Phillips BA, et al. Reliability of pelvic floor muscle strength assessment using different test positions and tools. Neurourol Urodyn. 2006;25(3):236-42.
  12. Hodges PW, Pengel LH, Herbert RD, et al. Measurement of muscle contraction with ultrasound imaging. Muscle Nerve. 2003;27(6):682-92.
  13. Hodges PW, Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Phys Ther. 1997b;77(2):132-42; discussion 142-4.
  14. Hodges PW, Richardson CA. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res. 1997a;114(2):362-70.
  15. Hodges PW. Is there a role for transversus abdominis in lumbo-pelvic stability? Man Ther. 1999;4(2):74-86.
  16. Huxel Bliven KC, Anderson BE. Core stability training for injury prevention. Sports Health. 2013;5(6):514-22.
  17. Ishida H, Hirose R, Watanabe S. Comparison of changes in the contraction of the lateral abdominal muscles between the abdominal drawing-in maneuver and breathe held at the maximum expiratory level. Man Ther. 2012;17(5):427-31.
  18. Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56(2):238-48.
  19. Kennedy B. An Australian programme for management of back problems. Physiotherapy. 1980;66(4):108-11.
  20. Mannion AF, Pulkovski N, Gubler D, et al. Muscle thickness changes during abdominal hollowing: an assessment of between-day measurement error in controls and patients with chronic low back pain. Eur Spine J. 2008;17(4):494-501.
  21. Marshall PW, Murphy BA. Core stability exercises on and off a Swiss ball. Arch Phys Med Rehabil. 2005;86(2):242-9
  22. Portney LG, Watkins MP. Foundations of clinical research:Applications to practice. 3rd ed. Upper saddle river (NY): Prentice Hall Inc.;2009.
  23. Rankin G, Stokes M, Newham DJ. Abdominal muscle size and symmetry in normal subjects. Muscle Nerve. 2006;34(3):320-6.
  24. Richardson C, Jull G, Hodges P, et al. Therapeutic exercise for spinal segmental stabilization in low back pain:scientific basis and clinical approach. Edinburgh (NY): Churchill Livingstone;1999.
  25. Richardson CA, Jull GA. Muscle control-pain control. What exercises would you prescribe? Man Ther. 1995;1(1):2-10.
  26. Richardson CA, Snijders CJ, Hides JA, et al. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 2002;27(4):399-405.
  27. Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther. 2004;9(1):3-12.
  28. Sapsford RR, Hodges PW, Richardson CA, et al. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20(1):31-42.<31::AID-NAU5>3.0.CO;2-P
  29. Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Arch Phys Med Rehabil. 2001;82(8):1081-8.
  30. Teyhen DS, Miltenberger CE, Deiters HM, et al. The use of ultrasound imaging of the abdominal drawing-in maneuver in subjects with low back pain. J Orthop Sports Phys Ther. 2005;35(6):346-55.
  31. Urquhart DM, Hodges PW, Allen TJ, et al. Abdominal muscle recruitment during a range of voluntary exercises. Man Ther. 2005b;10(2):144-53.
  32. Urquhart DM, Hodges PW, Story IH. Postural activity of the abdominal muscles varies between regions of these muscles and between body positions. Gait Posture. 2005a;22(4):295-301.
  33. Whittaker JL, Stokes M. Ultrasound imaging and muscle function. J Orthop Sports Phys Ther. 2011;41(8):572-80.

Cited by

  1. The effects of visual biofeedback using ultrasonograpy on deep trunk muscle activation vol.28, pp.12, 2016,
  2. 플랭크 운동과 케겔 운동이 코어 근육 두께에 미치는 효과 비교 vol.6, pp.1, 2016,
  3. 플랭크 운동이 비대칭 골반 앞기울임을 가진 대상자의 복부근육 두께 변화에 미치는 영향 vol.6, pp.3, 2016,