Table 2.
Interventions, dosage, drop-out and adherence, results of primary and secondary outcomes, and adverse effects in included studies.
| Study | Interventions, number of participants and exercises | Dosage | Drop-out and adherence | Results for DRA presence or IRD in cm, mean ± SD | Results for secondary outcomes | Adverse effects |
|---|---|---|---|---|---|---|
| Walton et al. 201630 |
Experimental group (n = 5)
|
Duration: 6 weeks Dosage: 3 × 10 repetitions, 3x/week. (Gradually increase repetitions during the period) |
Total drop-out: 1 Adherence: Not reported |
Post-test: Experimental: IRD: 0.76 ± 0.2 Traditional: IRD: 0.66 ± 0.17 No significant difference in decrease in IRD between groups, at the level at the umbilicus: 0.10 (95% CI: −0.14, 0.34) |
|
Not reported |
| Kamel & Jousif 201732 |
Abdominal exercise + NMES (n = 30)Group A NMES was applied first, followed by the abdominal exercisesAbdominal exercise with abdominal binding (n = 30)Group B
|
Duration: 8 weeks Dosage: 20 repetitions, 3x/week (Increase with 4 repetitions/week) |
Total drop-out: 3 Abdominal exercise (n = 2) Abdominal exercise + NMES (n = 1) Adherence: Analysis on patients who finished all sessions (same as described in drop-out) |
Post-test: Abdominal exercise + NMES: IRD: 1.43 ± 0.38 Abdominal exercise: IRD: 2.09 ± 0.35 Significant difference in decrease in IRD between groups: −0.65 (95% CI: −0.85, −0.46) |
|
Not reported |
| Bobowik & Dąbek, 201831 |
Physical therapy program (n = 20) Part 1: Prone lying for 20 min. Part 2: Three supine abdominal exercises with respiratory maneuver (headlift, sit-up, and “cycling”) Part 3: Education (in/out of bed, lifting the baby, breastfeeding++) (Elastic tape was used once a week) Minimal intervention group (n = 20) Contained no exercise or tape, only education |
Duration: 6 weeks Dosage: Hold: 10 s, 10 repetitions/exercise, every day |
Drop-out and adherence not reported |
Post-test: Minimal intervention: DRA: 1.68 ± 0.7 Physical therapy: DRA: 0.4 ± 0.23 Significant difference in IRD between groups: −1.28 (95% CI: −1.60, −0.69) |
Not reported | |
| Tuttle et al. 201828 |
TRA training (n = 10) Home exercise, in-drawing in four different positions with respiratory maneuver Tape (n = 8) Participants taped themselves with a x-shape, and used the tape for 4–5 days, then 2–4 days off before a new intervention period with tape TRA+tape (n = 5) Combination of TRA training and kinesiotape Minimal intervention group (n = 7) Instructed to maintain normal level of activity |
Duration: 12 weeks Dosage: 10 repetitions, 4–5 days/week |
Total drop-out: 3 TRA (n = 1), TRA + tape: (n = 1), tape (n = 1) Adherence: Average all groups: 79% TRA training only: 95% |
Post test1 TRA: IRD: 1.34 ± 0.37 Minimal intervention: IRD: 2.1 ± 0.99 Close to a significant difference in IRD between groups: −0.76 (95% CI: −1.53, 0.01) Significant better decrease in IRD at rest and during head lift in the groups with TRA training compared to control/tape (post hoc t-test) |
|
Not reported |
| Gluppe et al. 201825 |
Postpartum training program (n = 87) Weekly supervised exercise class with strength training of PFM in 5 different positions in addition to strength exercises for abdominal,2 back, arm, and thigh muscles. Daily PFM training at home Minimal intervention group (n = 88) Received only standard information about exercise postpartum |
Duration: 16 weeks Dosage: 3 × 8–12 repetitions. PFM training daily, group training once a week |
6 months Total drop-out: 13; intervention (n = 10), control (n = 3) 12 months Total drop-out: 5; intervention (n = 1), control (n = 4) Adherence: Postpartum training program: 80% adherence to training for 96% of women |
Post-test 6 months: Exercise: DRA, 43.7% Minimal intervention: DRA, 44.3% 12 months: Exercise: DRA, 41.4% Minimal intervention: DRA, 39.8% No significant difference between groups 6 months PP, (RR: 0.99 [0.71, 1.38]) or 12 months PP, (RR: 1.04 [0.73, 1.49]) |
Not reported | |
| Thabet & Alshehri 201933 |
Deep core stability-strengthening program (+ traditional exercises) (n = 20) Group A Use of abdominal binding, respiratory maneuver, PFM exercises, plank and isometric abdominal contraction Traditional abdominal exercises (n = 20)Group B Static abdominal contractions, posterior pelvic tilt, reverse sit-up, trunk twist and reverse trunk |
Duration: 8 weeks Dosage: 3 × 20 repetitions, 3/week |
No drop-out Adherence: Not reported |
Post-test: Deep core training: IRD: 2.01 ± 0.07 Traditional exercises: IRD: 2.37 ± 0.11 Significant difference in IRD between groups = −0.36 (95% CI: −0.42, −0.30) |
|
Not reported |
| Keshwani et al. 201929 |
Exercise therapy (n = 8) Weekly individual sessions and daily home exercise including exercises for isolated activation of TRA Abdominal binding (n = 8) Wear binding during waking hours Combination therapy (n = 8) Combination of exercise therapy and abdominal binding Minimal intervention group (n = 8) Contained no intervention or education |
Duration: 12 weeks Dosage: 3 × 10 repetitions, 7x/week |
6 months Total drop-out: 5; exercise therapy (n = 2), control (n = 1), exercise therapy+abdominal binding (n = 2) Adherence: Exercise therapy; 73% (home exercise) and 10/12 of the weekly sessions Abdominal binding; 60% Combination group was similar to the interventions delivered alone |
Post-test: 6 months Exercise therapy: IRD: −0.93 ± 0.88 Abdominal binding: IRD: −1.34 ± 0.34 Combination: IRD: −1.24 ± 0.73) Minimal intervention: IRD: −1.31 ± 1.08 No significant difference between groups. When comparing exercise therapy to control, no significant difference between groups was found: −0.38 (95% CI: −1.45, 0.68) |
|
Not reported |
DRA, diastasis recti abdominis; IFSAC, inventory of functional status after childbirth; IRD, inter-recti distance; NMES, neuromuscular electrical stimulation; ODI, Oswestry Disability Index; PFDI, Pelvic Floor Distress Index; PF10, the Physical Functioning scale; PFM, pelvic floor muscle; PP, postpartum; RCT, randomized controlled trial; RMDQ, the Roland-Morris Disability Questionnaire; TrA, transversus abdominis; UDI, Urinary distress inventory (1/3 subscales of PFDI).
1
Results are presented for measurements at the level at the umbilicus at rest.
2
The weekly exercise class included 3 sets of 8–12 contractions of each of the following abdominal exercises; draw-in (on all fours), draw-in (prone), half-plank, side-plank, oblique sit-up or sit-up.