What do current guidelines recommend about the use of abdominal exercises in the presence of diastasis recti abdominis?

Current guidelines and recommendations, both national (Norway) and international, advise against abdominal exercise where the rectus abdominis muscle is the main muscle targeted for pregnant women.

It is believed that such exercise may increase the inter-recti distance (IRD) further and cause a diastasis recti abdominis (DRA).

DRA occurs as the linea alba is stretched due to the growing foetus and this condition is common in most pregnant women in the third trimester.

There are many postulations regarding other factors that can increase the DRA and exercise of the rectus abdominis muscles during pregnancy is one of them.

This has caused both professionals and pregnant women to avoid strengthening exercise of the abdominal muscles during pregnancy and the postpartum period.

Is there strong evidence to support that recommendation?

My answer to that question must be no.

Our study is the first randomised controlled trial with a large sample size investigating the effect of abdominal exercise on DRA during pregnancy.

To be honest, I am not quite sure what evidence-based knowledge these recommendations originate from, probably clinical practice and postulations.

Certainly not high-quality studies.

Nina Theodorsen is looking at whether abdominal and pelvic floor exercises during pregnancy affect the inter-recti distance in women with diastasis recti abdominis.

What participants did you enrol in the study?

Ninety-six healthy pregnant women completed the study, all presenting with a DRA of greater than or equal to 28 millimetres at gestation week 24, measured at rest.

Both primiparous and parous women were included and both single and multiple pregnancies.

Can you tell us a bit more about the exercise protocol that you tested?

Prior to the randomised controlled trial, we conducted a basic study investigating the immediate effect of pelvic floor and abdominal exercises on the IRD in pregnant women in gestation weeks 27 and 37.

Based on these findings, we included pelvic floor muscle exercise and exercises targeting all the abdominal muscles.

It was also important that the exercise protocol could easily be implemented in clinical practice.

The exercises were functional and included other large muscle groups as well.

The load applied was in line with recommendations and the pregnancy itself acted as natural progression.

What did the control group receive?

The control group did not receive any intervention.

However, they were advised to follow the national guidelines for physical activity and general exercise during pregnancy. 
This implies 30 minutes of cardio every day and general strengthening exercises for large muscle groups and the pelvic floor.

What outcomes did you measure?

The main outcome was change in the IRD, measured with ultrasound immediately post-intervention during gestation week 37 and six weeks postpartum.

To what extent did the exercise protocol affect the IRD?

There were no differences between the experimental group and the control group at the two measurement time points, so the exercise protocol did not affect the IRD either way, which I think is a good result.

We don’t want to increase the IRD and we don’t want to decrease it either because the widening of the linea alba is necessary to make enough space for the growing foetus.

This means that exercise of the abdominal muscles is safe for pregnant women.

Where does research in this area need to go now?

We have also collected data at six and 12 months postpartum so it will be interesting to see whether exercise during pregnancy has a long-term effect or not.

We are also doing a prospective cohort study looking at possible risk factors for developing DRA during pregnancy.

We need studies on the larger DRAs and it would be interesting to look at the effect of exercise on DRA in a population of parous women but not during the postpartum period.

>> Nina Theodorsen is a women’s health and pelvic floor physiotherapist working in a private clinic in Bergen, Norway. She is completing her PhD at the University of Bergen and the trial is part of this work.

Course of interest: 

Effective pelvic floor physiotherapy via telehealth