S. Gluppe1, M. Ellström Engh2, K. Bø1,2
1Norwegian School of Sport Sciences, Institute of Sports Medicine, Oslo, Norway, 2Akershus University Hospital, Department of Obstetrics and Gynaecology, Lørenskog, Norway
Background: Diastasis recti abdominis (DRA) is a prevalent condition in the postpartum period. Systematic reviews have concluded with low-quality methodology of studies and insufficient evidence for recommending specific exercises for women with the condition.
Purpose: The primary aim was to evaluate the effect of a 12 weeks home-based abdominal exercise program on prevalence of DRA and change in inter-recti distance (IRD). Secondary outcomes were abdominal muscle strength, endurance, and thickness, prevalence on abdominal-, low-back and pelvic girdle pain, pelvic floor disorders (PFD), and perceived change of the condition.
Methods: This was an assessor blinded two-arm parallel group randomized controlled trial conducted from January 2020 to December 2022. Inclusion criteria were; being 6-12 months postpartum, primi- or multiparous, having a single- or multiple pregnancy following any mode of delivery, with a diagnosis of DRA. IRD and muscle thickness was assessed with ultrasound, abdominal muscle- strength and endurance with a dynamometer and a curl-up test. If women responded yes to abdominal-, low-back or pelvic girdle pain, or PFD they further responded to valid and reliable questionnaires for these specific conditions. At post-test women reported whether they perceived improvement of DRA. For the intervention group a 5-days a week standardized exercise program was prescribed, consisting of head lift, abdominal curl-up and twisted abdominal curl-up. The control group received no intervention. Difference in change between groups for continuous variables was assessed with ANCOVA, with posttest value as the dependent variable and grouping- and pretest variable as the independent variables, reported with 95% CI. Analyzes were based on intention-to-treat.
Results: Seventy women were randomized to exercise- (n=35) or control group (n=35). Three women (8.6%) dropped out of the exercise group. Twenty-one (65.6%) of women in the exercise group adhered to 80% or more of prescribed exercise sessions. There were no statistically significant differences in any IRD measurements between groups at post-test and no difference in change between the two groups from pre- to posttest; IRD at rest 2 cm above umbilicus (1.24 mm, CI -0.83, 3.31, p=0.24). Women in the exercise group reported significantly better improvement of DRA than the control group and showed a significant increase in abdominal muscle strength compared to the control group. No effect was found in prevalence of PFD, low back-, pelvic girdle- and abdominal pain.
Conclusions: An exercise program containing curl-ups was not effective in decreasing IRD or low-back-, pelvic girdle-, and abdominal pain, and PFD. However, the exercise program was effective in increasing abdominal muscle strength and self-reported DRA improvement. Women with DRA can improve abdominal strength through curl-ups with no negative effect on IRD.
Implications: This study contributes to improved knowledge about the effect of specific abdominal exercises on DRA and that women with DRA can improve strength without reducing IRD. There is a need for further high quality RCTs of different exercise programs to enable guidance of women returning to exercise postpartum.
Funding acknowledgements: The study was fully funded by The Norwegian Women`s Public Health Association.
Keywords:
Diastasis recti abdominis
Randomized controlled trial
Abdominal exercises
Diastasis recti abdominis
Randomized controlled trial
Abdominal exercises
Topics:
Musculoskeletal
Disability & rehabilitation
Pelvic, sexual and reproductive health
Musculoskeletal
Disability & rehabilitation
Pelvic, sexual and reproductive health
Did this work require ethics approval? Yes
Institution: The Norwegian School of Sport Sciences
Committee: Regional Medical Ethics Committee, Norwegian Centre for Research Data
Ethics number: REK South East 2018/2312 and 440860
All authors, affiliations and abstracts have been published as submitted.
