Table 1.
Characteristics of the included studies.
| Study/Reference | Assessments | Interventions | Sample size | Duration of Treatment protocol | Main findings | Variables |
|---|---|---|---|---|---|---|
| Kamel et al. [27] 2017 Egypt | Ultrasound | Group A received NMES in addition to abdominal exercises; Group B received only abdominal exercises. |
60 women | NMES (34 ± 5 mA) and then followed by the abdominal exercises; 8 weeks: three times per week |
In postnatal women, NMES reduces DRAM; if combined with abdominal exercises, its effect is amplified. | NA |
| Gluppe et al. [20] 2018 Norway |
Finger widths | PFM, combined with strengthening exercises. | Intervention group: n = 85; Control group: n = 88 |
PFM exercises: 5 different positions and 8–12 attempts of maximal contraction; 16 weeks, the intervention lasted for 45 min in each time. |
There were 55.2 % and 54.5 % of participants in the intervention and control groups with diastasis at 6 weeks postpartum, respectively. At baseline, there was no significant difference in prevalence between groups (RR = 1.01, 95%CI: 0.77–1.32), as well as at 6 months postpartum (RR = 0.99, 95%CT: 0.71–1.38), or at 12 months postpartum (RR = 1.04, 95%CI: 0.73–1.49). There were no significant reductions in DRA prevalence with a weekly comprehensive exercise program focusing on PFM strength training and home training. | Age, BMI, Child's birth weight, hypermobility, physical activity |
| Thabet et al. [28] 2019 Egypt | Digital nylon calipers | Deep core stability strengthening program (+ traditional exercises). Group A: application of abdominal binding, breathing maneuvers, PFM exercises, planks, and isometric abdominal contractions. Deep core stability strengthening program (+ traditional exercises). Group B: Traditional abdominal exercises static abdominal contractions, posterior pelvic tilt, reverse sit-up, trunk twist and reverse trunk. |
40 women: two groups (n = 20 in each group) | Deep core stability-strengthening program: abdominal bracing, diaphragmatic breathing, pelvic floor contraction, plank, and isometric abdominal contraction; 8 weeks, 3 times a week |
There is a significant difference between the group doing Deep Core Training and the group doing Traditional exercises (P = 0.0001). Women with diastasis recti can benefit from deep core stability exercises that improve their quality of life postpartum. | NA |
| Depledge et al. [21] 2021 New Zealand | Ultrasound | Exercises performed: 1): abdominal drawing in with pelvic floor activation; 2): trunk curl up with scapula just off the plinth; 3): Sahrmann leg raise with hip flexion to 90°; 4): modified McGill side lying plank. |
32 women | NA 3 weeks |
Among the exercises tested, curl-ups were most effective in reducing the inter-rectus distance. In the absence of any exercises that induced diastasis of the rectus muscle, they could not be considered potentially harmful. In these exercises, both tuggrip and taping did not enhance results. | Age, BMI, height, parity |
| Hu et al. [29] 2021 China |
Ultrasound | Standardized rehabilitation group (SR) and non-standardized rehabilitation group (non-SR) | 294 women: SR group (n = 171) and non-SR group (n = 123) | 20 days: including 40 min of manual massage (Part 1) and 30 min of treatment with electrophysiological equipment (Part 2). Once every other day, and 10 times. | SR experienced significant reductions in rectus abdominis separation compared to non-SR (P < 0.0001). An analysis of multiple linear regression models showed that standardized rehabilitation had an independent effect on parturients' prognosis for DRA (p < 0.0001). Furthermore, the quality of life of the study group (SR) was significantly improved (p < 0.0001). | Age, BMI, numbers of pregnancies |
| Laframboise et al. [30] 2021 USA |
Nylon calipers | ‘Virtually’ exercise intervention | 8 women | A wide range of exercise variations: glute bridges, lying supine, lift glutes while shoulders stay planted, etc. 12 weeks: three exercise sessions per week |
Two sites measuring DRA width showed a significant interaction between group and time, 2 inches above navel (rest) (P = 0.007, d = 0.67) and 2 inches above navel (active) (P = 0.005, d = 0.69). Postpartum women may benefit from virtual exercise interventions to decrease DRA severity. | NA |
| Liu et al. [31] 2021 China |
Ultrasound | Acupuncture and physical training | 144 women (three group, n = 48 in each): Acupuncture and physical training, the sham group received sham acupuncture and physical training, and the physical training group received physical training | Acupuncture group: 7 acupoints were selected; 2 weeks: 30 min once/day, five times a week. Physical training group: abdominal breathing, leg rotation, stretch legs, and ventral flat training; 10 times on each side. |
This is a Randomized Controlled Clinical Trial study protocol, thus no results on the effectiveness were presented. | NA |
| Keshwani et al. [23] 2021 Canada | Ultrasound | 1) exercise therapy alone; 2) abdominal binding alone; 3) combination therapy: both exercise therapy and abdominal binding; 4) control: no intervention) | 32 women: four groups (8 women in each) | Weekly individualized sessions were provided by a registered physiotherapist. Total 12 weeks: 8 to 12 sessions, first session 1 h, subsequent sessions 30–45 min. | Both abdominal binding alone and combination therapy had positive effects on body image (Cohen's d (d) = 0.2–0.5). The combination therapy group showed a positive effect on trunk flexion strength (d = 0.7). Combining abdominal binding with exercise therapy has been associated with positive, clinically meaningful effects not only on body image outcomes but also on trunk flexion strength. Urogynecological symptoms or overall function did not appear to be affected by any of the interventions, positive or negative. | Weight, BMI, physical activity |
| Kirk et al. [32] 2021 USA |
Finger-width | Manual therapy: e.g. visceral manipulation (VM), myofascial release, muscle energy technique, and trigger point release therapies. | 3 women | Each patient received over four treatments of visceral manipulation. Case one:18 weeks once every three to four weeks; Case two: 12 sessions of physical therapy more than 36 weeks. Case three: six sessions of physical therapy that lasting over 26 weeks. |
Three women with DRA experienced a reduction in IRD, a decrease in numeric pain rating scores, and an improvement in functional activities by the use of VM. Additionally, bladder and bowel symptoms also improved. | NA |
| Depledge et al. [22] 2022 New Zealand | Ultrasound | Wearing either Tubigrip or a rigid abdominal belt | 62 women | Wear the Tubigrip for as many hours as a patient was comfortable during the day; Record the hours the Tubigrip was worn each day. A total of 8 weeks |
As a result of the eight weeks intervention, the mean RA diastasis reduced by 46 % to 2.5 cm, but the difference was not statistically significant across groups (P > 0.05). Compared to the belt group (median: 81 h), the Tubigrip group wore them for significantly more hours (p < 0.05) than the belt group (median: 275 h). Neither Tubigrip nor the belt were associated with a percentage reduction of RA diastasis among women who wore them for a specific period of time (P > 0.05). Baseline diastasis levels did not differ significantly between vaginal delivery and Caesarean section. A significant difference was found in the percent reduction of the RA diastasis between interventions (vaginal delivery mean: 48 % vs C-section: 40 %, P < 0.05). | NA |
| Liang et al. [33] 2022 China | Ultrasound | Study group: BAPFMT and NMES; Control group: NMES | 66 women (n = 33 in each): study group and control group | BAPFMT sessions: the MLD B8Plus Pelvic Floor Biofeedback Rehabilitation System; NMES: electrode probe was placed intra-vaginally, with two surface patch electrodes on the abdomen. A total of 6 weeks |
At 6 weeks, there was a significant reduction in IRD in the study group. After 6 weeks, the study group showed a significant improvement on the physical component summary, which is an integral part of the SF-36 questionnaire. It is feasible to implement a postpartum programme including BAPFMT for women with RD and to improve the physical quality of life of those women. | Abdominal exercises |
| Liu et al. [34] 2022 China | Ultrasound | Electro-acupuncture (EA) combined with physical exercise compared to only physical exercise | 110 women: control group (n = 55) and EA group (n = 55). | EA intervention: 6 acupoints, with vertical acupuncture of 25–40 mm; Physical exercise: fascial abdominal breathing, supine head training, left and right-side leg rotation, and supine cycling. 2 weeks: the treatment was for 30 min once/day, five times a week |
Based on the difference between baseline and week 2 and 26 of IRD in both groups, both groups showed statistically significant reductions compared to before treatment (P < 0.05). At week 2, the EA group had a smaller mean IRD at the horizontal line of the umbilicus than the control group, but the difference was not statistically significant (P > 0.05). As compared to the control group, the EA group had a significantly smaller mean IRD at the horizontal line of the umbilicus in head-up and flexed knee states (P < 0.05) at week 26. There were five (9.1 %) and thirteen (23.64 %) adverse events reported in the EA and control groups, respectively. | NA |
| Kim et al. [35] 2022 Korea |
Ultrasound | Online exercise intervention; a real-time video conferencing platform (ZOOM) | 37 women: the online (n = 19) and offline (n = 18) groups | 6 weeks:40 min trunk stabilization exercise sessions twice a week for six weeks | A significant improvement was observed in both groups in terms of inter-recti distance between the rectus abdominis, abdominal muscle thickness, and static trunk endurance, as well as maternal quality of life (all P < 0.001); In the offline group, improvements were more significant. Videoconferencing-based exercise interventions improved various parameters, including the interrecti distance, trunk stability, and the quality of life of the sufferers. It might be an alternate to face-to-face intervention for those postpartum women with DRA. | NA |
| Wei et al. [36] 2022 China |
Finger measurement and ultrasound | Electrical stimulation and strengthening exercises of oblique muscles | 32 women in two groups (n = 16 in each group): control group and the intervention group | Referred to the published protocols. 6 weeks: once a day, each lasting 5 s, followed by a 10-s rest; and repeating 20 times for each. |
After six weeks of intervention, both areas of the rectus abdominis muscle in the experimental group showed significant reductions in distance between the two blocks (above the umbilicus = 0.001 and below the umbilicus P = 0.03), while this distance in the control group did not had a significant change (P > 0.05). Also, During the intervention, there were significant differences between two groups in the distance between the rectus abdominis muscle blocks in the upper part of the umbilicus (P = 0.04). In women with rectal diastasis, electrical stimulation coupled with strengthening exercises of internal and external oblique muscles could reduce the condition and increase the thickness of these muscles. | Age, BMI, number of children |
| Yalfani et al. [37] 2022 Iran | Digital caliper | 1): STS group 2): ISoM-ISoT group 3): Control group |
36 women: three groups (n = 12 in each) | Both STS and ISoM-ISoT training programs in 24 sessions. 8 weeks: 3 sessions a week; exercises were performed for 50 min in 1 session. |
The results of the minimal clinically important difference (MCID) and minimal detectable change (MDC) suggested that the STS exercises outperformed ISoM-ISoT training regarding IRD, pain, disability, and proprioception, whereas ISoM-ISoT training had a better effect in lumbopelvic control and balance. | IRD, pain, disability, proprioception |
| Ramirez-Jimenez et al. [38] 2023 Spain | Stainless steel caliper | Therapeutic Exercise Interventions. | 12 women | Hypopressive exercise program: hypopressive breathing, axial auto-elongation, cervical elongation, forward displacement of the body's gravity axis, activation of the shoulder girdle, slight knee flexion, and ankle dorsiflexion. 4 weeks; The entire protocol lasted four consecutive weeks, three sessions per week (12 sessions in total), each of which lasted 30 min. |
A reduction in IRD was observed among participants (P < 0.05); some participants no longer showed AD following the intervention. A median of 2 cm of decrease in thoracic respiratory expansion was observed at follow-up, while the abdominal circumference increased primarily at follow-up. When assessed at 3 and 6 cm supraumbilical, the LA's tension and stiffness decreased. Finally, there was a decrease in tension and elasticity in TA/IO and the PF after the intervention, as well as a decrease in PF elasticity. | NA |
Note: DRA: Diastasis rectus abdominis; IRD: inter-rectus distance; STS: suspension training system; ISoM-ISoT: isometric-isotonic; PFM: pelvic floor muscle; HE: hypopressive exercises; AD: Abdominal diastasis; LA: linea alba; SR: standardized rehabilitation; non-SR: non-standardized rehabilitation group; BAPFMT: electromyographic-biofeedback assisted pelvic floor muscle training; NMES: neuromuscular electrical stimulation; ZOOM: a real-time video conferencing platform; VM: visceral manipulation; TrA: transversus abdominis.