Musculoskeletal and respiratory adaptations of a holistic therapeutic exercise program targeting diastasis recti abdominis in women
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Date
2025-11-27
Authors
Σκούρα, Αναστασία
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Abstract
Background: Diastasis recti abdominis (DRA) is a common postpartum dysfunction, for which exercise therapy is the primary recommendation. Most rehabilitation protocols, however, are undertaken in the early postpartum period (≤ 6 months), apply low training loads insufficient for progression and focus on abdominal strengthening, though evidence suggests that the diaphragm, pelvic floor and transversus abdominus have a central role in trunk stability and function. This randomized controlled trial (RCT), developed through a systematic multistage preparatory process, evaluated the effectiveness of a holistic rehabilitation program combining progressive stabilization exercises and inspiratory muscle training (IMT) delivered via a blended in-person and telerehabilitation model. Methods: Parous women with DRA were randomized into three groups: (1) trunk exercise group (TEG) performing supervised progressive stabilization exercises through a blended (in-person, synchronous and asynchronous telerehabilitation) protocol, (2) IMT+TEG performing supervised TEG plus IMT, and (3) control group (CG), performing basic unsupervised trunk exercises; all groups trained three times weekly for 12 weeks. The primary outcome was inter-recti distance (IRD) measured ultrasonographically (US). Secondary outcomes included diaphragm thickness and excursion (US), inspiratory muscle testing (POWERbreathe KH2), four trunk endurance tests (front and side planks, curl-up test, McGill endurance test), and selfreported abdominal wall-related function, quality of life (QoL), and body image. Analyses involved repeated measures mixed-model ANOVA and linear regression (SPSS v. 29). Results: Sixty-four participants (aged 38.9±4.5, 30.98±20.12 months postpartum; TEG=21, IMT+TEG=21, CG=22) completed the intervention. Repeated measures ANOVA showed significant improvements in IRD, trunk endurance, inspiratory muscle performance, functional outcomes, QoL, and body image across all groups following the interventions (p<0.05, η2=0.08-0.63). TEG yielded greater front plank endurance performance compared to CG, while IMT+TEG demonstrated trends towards higher diaphragm excursion and inspiratory muscle strength, though differences between groups were not statistically significant. Linear regression analysis showed that baseline IRD values and trunk endurance performance (through side plank test) predicted postintervention outcomes in IRD and side plank, and that baseline IRD and BMI predicted maximum inspiratory pressure (MIP).
Conclusions: In women with DRA in the later postpartum period, a 12-week blended rehabilitation program significantly improved IRD, trunk, and respiratory muscle performance, overall abdominal function, QoL and body image. Although adding IMT did not produce statistically superior outcomes, promising trends towards significance were revealed in respiratory parameters. Basic unsupervised trunk exercises also improved outcomes, supporting their use when structured rehabilitation is not feasible. Further research should explore the role of IMT through more intensive protocols.
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Keywords
Diastasis recti, Postpartum rehabilitation, Telerehabilitation