EFFECT OF EXERCISE ON THE INTER RECTUS DISTANCE IN PREGNANT WOMEN WITH DIASTASIS RECTI ABDOMINIS: AN EXPERIMENTAL LONGITUDINAL STUDY

N.-M. Theodorsen¹, R. Moe-Nilssen¹, K. Bø², I. Haukenes¹

¹University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway, ²Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway

Background: There is limited knowledge of how pelvic floor and abdominal exercises influence the inter-rectus distance (IRD) in pregnant women with diastasis rectus abdominis (DRA). Pregnant women are often advised against exercises involving the rectus abdominis muscle as they are believed to increase the IRD.

Purpose: This novel study aims to investigate the effect of acute contraction of the pelvic floor muscles (PFM) and abdominal exercises on the IRD compared to resting values, in pregnant women with DRA. Results at both timepoints; gestation weeks 27 and 37 were also compared.

Methods: This was an experimental longitudinal study. Based on a power calculation performed with data from previous studies, 38 pregnant women with DRA ≥ 2,8 cm prior to gestation week 27 were included. Two-dimensional ultrasound images of the IRD were recorded 2 cm above and below the umbilicus using a linear probe (5-10 MHz), at rest and during PFM and abdominal exercises at gestation week 27 and 37. Main outcome measure was change in IRD, measured in mm. Repeated-measures ANOVA with post hoc tests was performed for each exercise for the two measurements locations and the two different timepoints. Statistical significance was set at p < 0.05 with Bonferroni correction for multiple comparisons.

Results: There was a mean increase of the IRD from rest during a PFM contraction (2.3 mm, 95% CI: 1.7, 2.9), drawing-in (4.03 mm, 95% CI: 3.2, 4.8) and a combination of these (5.02 mm, 95% CI: 4.1, 5.9) There was a mean decrease of the IRD from rest during the headlift (-3.1 mm, 95% CI: -4.1, -2.1), the curl-up (-2.7 mm, 95% CI: -3.8, -1.5) and the diagonal curl up (-4.1 mm, 95% CI: -5.3, -2.9). The combined exercises drawing-in with curl-up and PFM contraction with drawing-in and curl-up showed no significant change from the resting value. These findings showed a main effect of location with 4.1 mm higher values above compared to below the umbilicus (95% CI 2.7, 5.4). There was a main effect of time with an increase from gestation week 27 to 37 of 7.8 mm (95% CI: 6.4, 9.2).

Conclusions: Pelvic floor and drawing in exercise increased the IRD, headlift, curl up and diagonal curl up decreased the IRD in a pregnant population with DRA. These findings were consistent both above and below the umbilicus, and at both gestation week 27 and 37.

Implications: The results of this study show that exercise activating the rectus abdominis muscle reduces the IRD in pregnant women with DRA, and hence clinicians should reconsider the advice given to pregnant women regarding abdominal exercise.

Funding acknowledgements: This study is part of a PhD project funded by the The Norwegian Fund for Post-Graduate Training in Physiotherapy

Keywords:
Diastasis recti abdominis
Exercise
Pregnancy

Topics:
Musculoskeletal
Primary health care
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: University of Bergen

Committee: The Regional Medical Ethics Committee, Norway

Ethics number: 76296