Effect of a Mobile App-Based Exercise Program on Diastasis Recti Abdominis, Muscle Strength, Anthropometric Measures, and Satisfaction Among Post-Cesarean Primiparous Mothers: A Randomized Controlled Trial

Curl-up exercises improve abdominal muscle strength without worsening inter-recti distance in women with diastasis recti abdominis postpartum: arandomised controlled trial.

The objective was to investigate whether diastasis recti abdominis (DRA) can cause adverse outcomes for different long-term postpartum women. We recruited 437 long-term postpartum women at five different time points (3, 5, 10, 20, and 30years postpartum respectively). Inter-recti distance (IRD) and linea alba or umbilical hernia were measured by ultrasound. Strength of abdominal muscle was measured by a manual muscle test. Low back pain (LBP), urinary incontinence (UI) and quality of life (QOL) were measured by questionnaires including the Oswestry Disability Index, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, 36-Item Short Form Health Survey respectively. Women with DRA experienced more severe LBP, and poorer QOL only 10years postpartum according to the diagnostic criterion of IRD > 2cm. However, when the diagnostic criterion was raised to IRD > 3cm, women with DRA reported weaker abdominal muscle strength, more severe LBP 3, 5, and 10years postpartum, poorer QOL 3, 5, 10, and 20years postpartum, and higher incidence of linea alba or umbilical hernia 5 and 20years postpartum. When using IRD > 2cm as the diagnostic criterion, the impact of DRA is minimal. However, when utilizing IRD > 3cm as the diagnostic criterion, DRA is associated with increased linea alba or umbilical hernia, weakened abdominal muscle strength, increased LBP, and decreased QOL. Most of the effects are particularly evident within 3-10 years postpartum, but becomes insignificant 20 and 30years postpartum. Therefore, it is necessary to consider whether the diagnostic criterion of DRA need to be improved.

Relationship between inter-recti distance, abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with diastasis recti abdominis

Diastasis recti abdominis (DRA) is defined as an impairment with midline separation of the two rectus abdominis muscles along the linea alba. The condition affects a significant number of women during the antenatal- and postnatal period and is hypothesized to cause abdominal-, pelvic-, and low back pain, decreased abdominal muscle strength, as well as cosmetic concerns. A study among US physical therapists found that the most commonly used exercises in treatment of DRA were indrawing and pelvic floor muscles (PFM) exercises. However, experimental studies have found that both indrawing and PFM contraction increase the inter-recti distance (IRD). Randomized controlled trials (RCT) are few, and both interventions and results differ between studies. PURPOSE: To investigate the immediate effect of different abdominal- and PFM exercises on IRD in women with DRA. METHODS: Following power calculation of sample size, 38 parous women were included in this cross-sectional study. 2D ultrasound was used to measure IRD at rest and in random order of eight different exercises. A paired t-test was used to compare IRD at rest with IRD recorded during each of the exercises and differences between exercises. Means with 95% confidence intervals (CI) are reported. P-value was set to <0.05. RESULTS: Head lift and twisted crunch significantly decreased the IRD, both above and below the umbilicus. Above the umbilicus, the mean difference between rest and head lift was 10 mm (95% CI: 7, 13.2, p˂.001) and twisted crunch 9.4 mm (95% CI: 6.3, 12.5, p˂.001). Below the umbilicus, the mean difference between rest and head lift was 6.1 mm (95% CI: 3.2, 8.9, p˂.001) and twisted crunch 3.5 mm (95% CI: 0.5, 6.4, p =.02). PFM contraction, maximal in-drawing and PFM contraction+maximal in-drawing increased the IRD below the umbilicus, mean difference; -2.8 mm (95% CI: -5.2, 0.5, p =.02), -4.7 mm (95% CI: -7.2, -2.1, p˂.001) and -5.0 mm (95% CI: -7.9, -2.1, p˂.001), respectively. CONCLUSION: Head lift and twisted crunch decrease, while maximal in-drawing and PFM contraction increase the IRD. RCTs are needed to investigate whether head lift and twisted crunch are effective in permanently narrowing the IRD. The Norwegian Women`s Public Health Association fully founded the study.

The biomechanical implications of diastasis recti abdominis (DRA) are unknown. To (1) investigate the impact of DRA, measurement site, and task on inter-rectus distance (IRD), linea alba (LA) stiffness, and LA distortion measured at rest and during head-lift and semi-curl-up tasks; and (2) describe the relationships among IRD, LA stiffness, and LA distortion. In this cross-sectional, observational cohort study, brightness-mode ultrasound imaging and shearwave elastography were used on a sample of 20 women. Inter-rectus distance, LA stiffness, and LA distortion were measured at 3 locations, while at rest and during head-lift and semi-curl-up maneuvers. All outcomes were compared between groups (DRA versus no DRA), sites, and tasks. Linear regression models were used to evaluate the relationships among IRD, mean and peak LA stiffness, and LA distortion. Eleven women with and 9 without DRA participated. Women with DRA demonstrated lower peak and mean LA stiffness and higher LA distortion compared to women without DRA. In women with DRA, IRD and LA distortion were not influenced by measurement site; IRD decreased, LA distortion increased, and LA stiffness did not change during the head lift and semi-curl-up compared to rest. In women without DRA, the LA was least stiff closest to the umbilicus; it increased in stiffness during the head lift and semi-curl-up and did not distort or change compared to rest. Diastasis recti abdominis was associated with low LA stiffness and with LA distortion during a semi-curl-up task; the amount of distortion was a function of IRD and LA stiffness. J Orthop Sports Phys Ther 2019;49(9):656-665. Epub 26 Mar 2019. doi:10.2519/jospt.2019.8543.

Diastasis recti abdominis (DRA) is the separation of the rectus abdominis muscles along the linea alba, often occurring during pregnancy due to hormonal and mechanical changes. While DRA usually resolves post-childbirth, some women experience persistent issues. Exercise may help reduce the inter-rectus distance, though more research is needed. Analyze the immediate and long-term effects of hypopressive and conventional abdominal exercises on inter-rectus distance (IRD) in postpartum women, focusing on parity differences. Twenty-eight women who met specific inclusion criteria were randomly assigned to either the hypopressive group (n = 14) or the conventional group (n = 14). The exercise programs for both groups lasted 6 weeks. Ultrasound measurements were taken of the IRD at two locations above the umbilicus, 2 cm (AB2) and 5 cm (AB5), before and after exercise programs. The IRD decreased after both exercise programs compared to baseline measurements in AB2 (mean difference: 3.06 mm, 95% CI: 1.06 to 5.05) and in AB5 (mean difference: 2.88 mm, 95% CI: 1.59 to 4.17), confirming the long-term effect of exercise. No differences were found between the application of the conventional exercise program or the hypopressive exercises, indicating that both had a similar positive effect. Regarding the immediate effect, after the performance of both programs, the IRD was greater during rest compared to abdominal contraction. This effect was more pronounced at AB5 location (mean difference: 1.00mm, 95% CI: 0.97 to 1.89). Conventional exercises result in a reduction during resting condition (mean difference: 4.52mm, 95% CI: 2.62 to 6.79), whereas with hypopressive exercises, the reduction occurs during muscle contraction (mean difference: 3.43mm, 95% CI: 1.21 to 5.65). With regard to parity, multiparous women benefit most from the application of exercise programs. A reduction in IRD has been achieved with the implementation of both exercise programs in postpartum women, with multiparous women benefiting the most. Specifically, at 5 cm above umbilicus, conventional exercises result in a reduction during the rest condition, whereas with hypopressive exercises, the reduction occurs during muscle contraction. Clinical trial registration: NCT05439668.

This randomized controlled study investigated the effectiveness of a novel progressive motor control-based exercise program (The Denizoglu Method) on IRD, abdominal endurance, pelvic floor dysfunctions, and body image satisfaction in women with diastasis recti abdominis (DRA). This was a randomized controlled study of 50 women diagnosed with DRA within 1-3 years of the postpartum period. The progressive motor control-based exercise program and the conventional exercise program were performed 5 times a week for 8 weeks in a home-based and telerehabilitation setting. The primary outcome measured was inter-recti distance (IRD), while secondary outcomes included the static abdominal flexion endurance test, the Pelvic Floor Distress Inventory-20 (PFDI-20-20), and the Multidimensional Body-Self Relations Questionnaire (MBSRQ). All assessments were conducted both pre- and post-intervention. The Denizoglu Methodgroup demonstrated significant improvements in IRD, static abdominal flexion endurance, PFDI-20-20, and MBSRQ scores. Similarly, the conventional exercise training group exhibited statistically significant enhancements in IRD and PFDI-20-20 scores. However, theDenizoglu Method was found to be superior in improving IRD and abdominal endurance in women with DRA 1 to 3 years postpartum. TheDenizoglu Method emerges as a promising approach for managing DRA in clinical practice. It can be effectively implemented as a supervised home-based exercise program or integrated in women's health care centers during the 1 to 3 years postpartum period.

There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study was to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous. In this cross-sectional study, 38 women who were parous, with a mean age of 36.2years (SD=5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported. Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10mm (95% CI=7 to 13.2), whereas during twisted curl-up it was 9.4mm (95% CI=6.3 to 12.5). Below the umbilicus, the corresponding values were 6.1mm (95% CI=3.2 to 8.9) and 3.5mm (95% CI=0.5 to 6.4), respectively, but PFM contraction, maximal in-drawing, and PFM contraction + maximal in-drawing increased the IRD (mean difference=-2.8mm [95% CI=-5.2 to 0.5], -4.7mm [95% CI=-7.2 to -2.1], and-5.0mm [95% CI=-7.9 to -2.1], respectively). Head lift and twisted curl-up exercises decreased the IRD both above and below the umbilicus, whereas maximal in-drawing and PFM contraction exercises only increased the IRD below the umbilicus. A randomized controlled trial is needed to investigate whether head lift and twisted curl-up exercises are effective in permanently narrowing the IRD. To date there is scant scientific knowledge of which exercises to recommend in the treatment of DRA. In-drawing and PFM contraction leads to an acute increase in IRD, while head lift and twisted curl-up leads to an acute decrease in IRD in postpartum women. There is a need for high-quality randomized controlled trials to investigate if there is a long-term reduction in IRD by doing these exercises over time. The acute IRD increase and decrease during the different exercises is also present in a sample of women with larger separations.

ObjectiveTo investigate the effect of acute contraction of the pelvic floor muscles (PFM) and abdominal exercises on the inter-rectus distance (IRD) compared to resting values, and differences between gestation weeks 27 and 37, in pregnant women with diastasis recti abdominis (DRA). DesignExperimental longitudinal design. SettingPhysiotherapy clinic, primary health care. ParticipantsThirty-eight pregnant women with DRA ≥ 2.8 cm. InterventionsTwo-dimensional ultrasound images of IRD 2 cm above and below the umbilicus were taken at rest and during PFM and abdominal exercises at gestation week 27 and 37. Repeated measures analyses of variance (ANOVAs) with post hoc tests was performed for each exercise for both locations and timepoints. Main outcome measuresChange in IRD. ResultsThere was a mean increase of the IRD from rest during a PFM contraction (2 mm, 95% CI: 2, 3), drawing-in (4 mm, 95% CI: 3, 5) and a combination of these (5 mm, 95% CI: 4, 6) There was a mean decrease of the IRD from rest during the headlift (−3 mm, 95% CI: −4, −2), the curl-up (−3 mm, 95% CI: −4, −2) and the diagonal curl up (−4 mm, 95% CI: −5, −3). Effect of time from gestation week 27–37 was a mean increase of 8 mm (95% CI: 6, 9). ConclusionPelvic floor and drawing-in exercise increased the IRD, whilst headlift, curl up and diagonal curl up decreased the IRD in pregnant women with DRA at gestation week 27 and 37. Contribution of the paper•This is the first study to investigate the acute effect of exercise on IRD in pregnant women with DRA.•Diagonal curl-up, headlift and curl-up reduced the IRD in pregnant women with DRA at both gestation week 27 and 37. The drawing-in exercise and a PFM contraction increased the IRD at the same timepoints.•As exercise involving the rectus abdominis muscle decrease the inter-rectus distance in pregnant women, clinicians should reconsider advising against such exercises.

Background Diastasis recti abdominis (DRA) is a common musculoskeletal problem, which is defined as a separation of the inter-recti distance between the two bellies of the rectus abdominis muscle at the linea alba.1 Due to the hormonal, postural and musculoskeletal changes, and mechanical strain, the anterior abdominal wall becomes stretched and elongated during pregnancy. Studies have shown that DRA may occur between 27% and 100% in the second and third trimesters of pregnancy2. Although it has been reported that imbalance in the strength of the abdominal wall muscles altered with the facial tension, the role of abdominal muscle strength on DRA has not been clarified yet. Objectives The present study assessed the relation between the severity/amount of DRA and the degree of abdominal muscle (rectus abdominis (RA), external and internal oblique muscles) strength in pregnant women. Methods A total of 153 pregnant women between 14 and 35 weeks of a singleton pregnancy were included in the present study. The finger width method was used to measure the amount of DRA. The amount of separation was determined by the palpation of the medial sides of RA at three reference points: on the umbilicus, 4.5 cm above and 4.5 cm below of the umbilicus. After the subject contracts RA in hook lying position when her arms were in extended position, the size of the diastasis was measured by the number of finger.3 The strength of abdominal muscles was assessed by the manual muscle test in supine hook lying position. The correlation between the amount of DRA and the degree of abdominal muscle strength was analyzed by the Spearmans correlation. Results The mean age was 28.40±3.69 years, mean Body Mass Index was 27.01±1.26 kg/m2, and mean gestational age was 28.12±5.03 weeks. A negative correlation was found between the amount of the diastasis at 4.5 cm below of the umbilicus and the strength of the RA (r=0.219, p=0.007), right (r=0.296, p=0.015) and left external oblique muscles (r=0.293, p=0.017). Conclusion Based on the findings of the present study, the separation of RA on the lower level of umbilicus may be negatively associated with the strength of RA and oblique abdominal muscles. Therefore, to decrease the severity of DRA, abdominal strengthening programs should be provided to pregnant women.

Background: Diastasis rectus abdominis (DRA) is characterized by a widening between the rectus abdominis muscles and thinning of the linea alba. It is common during pregnancy and may contribute to postpartum low back pain (LBP) and stress urinary incontinence (SUI). Core strengthening is thought to improve DRA, but there is no widely accepted exercise program. Objectives: To assess changes in interrectus distance (IRD) and participant-reported outcomes (PROs) after an online core strengthening program in postpartum women with DRA. Study Design: Prospective observational study. Methods: Forty-three postpartum women (36.7 ± 3.5 years) with DRA, which was diagnosed as an IRD 2.0 cm or more using musculoskeletal ultrasound, participated in a 12-week online core strengthening program focused on daily transversus abdominis activation with coordinated breathing and pelvic floor muscle engagement. IRD and PROs were assessed at baseline and 12 weeks. A subset of 19 women participated in an additional 12-week maintenance phase, and outcomes assessments were performed at 24 weeks. Results: The 12-week online core strengthening program significantly decreased IRD above and below the umbilicus at rest (slope [95% confidence interval]: −0.56 [−0.74, −0.38] and −0.26 [−0.45, −0.06]; P &lt; .001 and P = .009, respectively) and below the umbilicus during contraction (−0.39 [−0.58, −0.20]; P &lt; .001). Improvements in LBP-related disability (P = .002) and SUI (P = .001) were also observed. Participation in the maintenance phase significantly improved IRD at 24 weeks compared with 12 weeks (P &lt; .0125). Satisfaction averaged 7.43 ± 2.23. Conclusions: The 12-week online core strengthening program reduced IRD and improved LBP-related disability and SUI. Program participation for 12 additional weeks further reduced IRD. These results suggest that the online core strengthening program can be used in postpartum women with DRA.

A separation of the abdominal muscles at the linea alba, known as diastasis recti abdominis (DRA), can occur after childbirth. However, the impact of DRA on abdominal muscle function is not clear. The objective was to determine if differences exist in trunk muscle function and self-reported pain and low back dysfunction between women with and without DRA at 12 to 14 months postpartum and if differences that emerge from the data are associated with the magnitude of the interrectus distance (IRD). This study was a prospective, observational, case-control study. Women with (IRD≥2.2 cm; n=18) and without DRA (IRD<2.2 cm; n=22) participated. Maximal trunk flexion, extension, and rotation torque-generating capacity (Newton-meters), the Sit-Up test (0 to 3 points), and the Sitting-Rising Test (0 to 10 points), and trunk flexion, extension, and lateral flexion endurance (seconds) were measured. Pain and disability were assessed using numerical pain rating scales (0 to 100) and the Roland Morris Low Back Pain Questionnaire (0 to 24 points). Women were compared using independent t tests and Mann-Whitney U Tests. Pearson product-moment and Spearman rank correlation coefficients were used to determine associations; a=.05 was used for all tests. Women with DRA demonstrated significantly lower trunk muscle rotation torque and scored lower on the sit-up test than those without DRA. IRD was negatively correlated with both trunk rotation torque (rho=-0.367) and sit-up test score (rho=-0.514). The results of this study should not be generalized to women who present with moderate-to-severe IRDs or to multiparous women. The presence of DRA in primiparous women at 1 year postpartum is associated with trunk rotation strength and ability to perform a sit-up.

Diastasis recti abdominis (DRA), commonly occurring in postpartum women, is not only an aesthetic issue but is also highly associated with functional impairments. Various conservative treatment modalities have been employed in clinical practice to alleviate DRA. However, the comparative efficacy of these non-surgical treatments for improving the inter-recti distance (IRD) remains to be determined. This current network meta-analysis (NMA) aims to compare the efficacy and acceptability of different non-surgical treatments with or without exercise for improving DRA in postpartum women. This NMA adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ClinicalKey, Cochrane Library, CINAHL, Embase, PubMed, Web of Science, and ClinicalTrials.gov were systematically searched for randomized controlled trial (RCT) studies up to April 2024. The analysis included studies that met the following criteria: (1) postpartum women diagnosed with DRA defined as an IRD greater than 2cm; (2) intervention: any non-surgical treatments for at least 2weeks; (3) comparator: no-treatment control; and (4) outcome: changes in IRD and acceptability. The relative efficacy between the non-surgical treatments tested and the probability of treatments were evaluated. Twenty-one RCTs comprising 1195 participants aged from 18 to 45years old were included. The forest plot revealed that exercise coupling with neuromuscular electrical stimulation systems (NMES) [mean difference (MD) - 1.12cm, 95% confidence interval (CI) - 1.66 to - 0.58], acupuncture (MD - 0.81cm, 95% CI - 1.54 to - 0.08), corset (MD - 0.65cm, 95% CI - 1.24 to - 0.06), and exercise alone (MD - 0.48cm, 95% CI - 0.80 to - 0.16) led to significant reductions in IRD compared with control. Further, the treatment ranking indicated that the combination of NMES with exercise has the highest probability (91.0%) of being the best treatment for reducing IRD, followed by acupuncture with exercise (71.1%). Treatments combined with exercise demonstrated better rankings for reducing IRD than individual treatments without exercise. Acceptability did not significantly differ between the groups. This NMA encountered limitations due to participant variability, differing measurement methods, and sparse data, necessitating careful interpretation of findings regarding postpartum DRA interventions. This NMA suggests NMES combined with exercise as the best treatment tested for DRA in postpartum women. CRD42024541345.

The aim of this study was to investigate the prevalence of diastasis recti abdominis (DRA) and to find the possible risk factors for DRA based on two diagnostic criteria among women in long-term postpartum period. A cross-sectional study was conducted on 1000 postpartum women at five different time points (3, 5, 10, 20, and 30 years after partum, respectively). Inter-recti distance (IRD) was assessed using ultrasound imaging, while basic data were collected through self-reported questionnaires. Two diagnostic criteria, IRD > 2 cm and IRD > 3 cm, were used to present the prevalence of DRA. Univariate and multivariate analyses were employed to explore the risk factors for DRA. When using the diagnostic criterion of IRD > 2 cm for DRA, the prevalence was 36%, 31%, 22%, 26%, and 30% at 3, 5, 10, 20, and 30 years postpartum, respectively. When using the diagnostic criterion of IRD > 3 cm for DRA, the prevalence was 13%, 8%, 6%, 8%, and 10%, respectively. The results revealed that higher body mass index (BMI) was a risk factor for DRA at 10 years postpartum (p = 0.000), bigger number of parturitions was a risk factor at 3, 5, and 10 years postpartum (p = 0.000, 0.004 and 0.000), twins was a risk factor at 3 years postpartum (p = 0.001), and diabetes was a risk factor at 20 and 30 years postpartum (P = 0.000 and 0.004). (1) The prevalence of DRA in the long-term postpartum period was high, especially when IRD > 2 cm was used as the diagnostic criterion. (2) Higher BMI, bigger number of parturitions, twins and diabetes were independently associated with higher odds of DRA at different long-term postpartum time points. (3) The diagnostic criterion for DRA should be further improved to avoid excessive clinical diagnosis and treatment. (1) This study elucidated the prevalence and risk factors associated with long-term postpartum DRA, thereby enhancing clinical awareness and advocating for early intervention and prevention measures to mitigate serious adverse outcomes. (2) This study presented the research results using two diagnostic criteria, increasing comparability with existing studies. In addition, discussions on reasonable diagnostic criterion for DRA were also conducted to avoid excessive clinical diagnosis and treatment.

A prospective longitudinal study. Diastasis recti abdominis (DRA) is defined as an increase in the inter-recti distance (IRD), or width of the linea alba. It is a common occurrence in women postpartum. Little information exists on the short- and long-term recovery of IRD and the relationship between changes in IRD and the functional performance of the abdominal muscles. To investigate the natural recovery of IRD and abdominal muscle strength and endurance in women between 7 weeks and 6 months postpartum, and to examine the relationship between IRD and abdominal muscle function. Forty postpartum (25-37 years of age) and 20 age-matched, nulliparous females participated. IRD was measured at 4 locations (upper and lower margin of the umbilical ring, and 2.5 cm above and below the umbilical ring) with a 7.5-MHz linear ultrasound transducer. Trunk flexion and rotation strength and endurance were measured with manual muscle testing and curl-ups. Evaluation was conducted at 4 to 8 weeks and 6 to 8 months after childbirth in postpartum women, and only once for the nulliparous female controls. During follow-up, the IRD at 2.5 cm above the umbilical ring and at the upper margin of the umbilical ring decreased (P = .013 and P = .002, respectively). The strength and static endurance of the abdominal muscles improved over time (P<.05). A negative correlation between IRD and abdominal muscle function at 7 weeks and 6 months postpartum was found (r = 0.34 to 0.51; P<.05, except for trunk flexion strength at 6 months postpartum [P = .064]). In addition, IRD changes between 7 weeks and 6 months postpartum were correlated with improvement in trunk flexion strength (Spearman rho = 0.38, P = .040). At 6 months after childbirth, postpartum women had greater mean ? SD IRDs at all 4 locations (from cranial to caudal: 1.80 ± 0.72, 2.13 ± 0.65, 1.81 ± 0.62, and 1.16 ± 0.58 cm) than those of nulliparous females (0.85 ± 0.26, 0.99 ± 0.31, 0.65 ± 0.23, and 0.43 ± 0.17 cm) (all P<.001). All abdominal strength and endurance measurements were less than those of nulliparous females (all P<.001). The IRD and abdominal muscle function of postpartum women improved but had not returned to normal values at 6 months after childbirth. Future research is essential to explore the need for intervention and, if needed, the effectiveness of specific intervention to reduce the size of IRD in postpartum women.