Hypopressive Abdominal Exercise in Postpartum Abdominal Diastasis

Study Overview
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Brief Summary
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The prevalence of abdominal diastasis is high in postpartum. The abdominal diastasis can impair the body posture, the of lumbo-pelvic stability and movement, or breathing. Exercises focused on the transversus abdominis muscle have been proposed as a therapeutic approach for abdominal diastasis. Hypopressive abdominal exercises have been used for postpartum recovery, for specific pathologies related to pregnancy (low back pain, pelvic floor dysfunction ...) and even for the rehabilitation of spinal pathologies. However, there is a lack of studies that determine its effectiveness and clinical utility. The aim of the study will be to analyze the effects of Hypopressive abdominal exercises on postpartum abdominal diastasis, the tone of the transverse abdominal muscle and the pelvic floor musculature. A case series design will be applied, with weekly assessment of the outcomes after the intervention and two months after the intervention.

Official Title
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Hypopressive Abdominal Exercise Effectiveness in Postpartum Abdominal Diastasis, Tone of the Transverse Muscle and the Pelvic Floor Muscles - Case Series

Conditions
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Abdominal Diastasis

Intervention / Treatment
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* Other: Hypopressive abdominal exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: primiparous or multiparous abdominal diastasis previously diagnosed commitment to perform, at least, 80% of the exercises signed informed consent Exclusion Criteria: BMI > 40 Kg/m2 pelvic floor disorders before childbirth drugs with effects on continence or functional properties of the pelvic floor muscles treatment for abdominal diastasis in the last 6 months systemic disease that impairs pelvic floor physiology and urination menopause contraindications to the practice of physical exercise and physical therapy

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hypopressive abdominal exercises<br>Hypopressive abdominal exercises will be performed in basic postures (standing, sitting and supine position). In each posture, three slow cost-diaphragmatic respiration will be performed followed by an expiratory apnea and a rib cage opening, during 2 to 10 seconds, and an exhalation of 10 to 30 seconds. Each exercise will be repeated three times. There will be 3 stages of application throughout the 12 intervention sessions, supervised by a physical therapist: First stage: To explain the concept of hypopressive respiration and how to perform it. Second stage: To explain and apply the hypopressive abdominal exercises: 1. Axial auto-elongation (reducing curvatures in the sagittal plane); 2. Cervical auto-elongation (chin toward the neck); 3. Moving forward of gravity axis; 4. Activation of the shoulder girdle (shoulder joint decoaptation); 5. Slight knee flexion; 6. Dorsal ankle flexion. Third stage: To review and update all the exercises, increasing their intensity. | Other: Hypopressive abdominal exercises<br>* Three sessions per week during four consecutive weeks (Total: 12 sessions). Each session time: 30 minutes.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Abdominal Diastasis - Baseline | Supraumbilical distance between the rectus abdominis Assessment tool: caliper (electronic, calibrated, precision: 1 mm) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | Pre-intervention | 
| Abdominal Diastasis - post-intervention 1 | Supraumbilical distance between the rectus abdominis Assessment tool: caliper (electronic, calibrated, precision: 1 mm) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | Immediately after the intervention | 
| Abdominal Diastasis - post-intervention 2 | Supraumbilical distance between the rectus abdominis Assessment tool: caliper (electronic, calibrated, precision: 1 mm) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | One month after the intervention | 
| Abdominal Diastasis - post-intervention 3 | Supraumbilical distance between the rectus abdominis Assessment tool: caliper (electronic, calibrated, precision: 1 mm) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | Two months after the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Abdominal tonometry - Baseline | Tonometric evaluation on the white line (linea alba) and the abdominal muscles Assessment tool: (MyotonPro (R)) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | Pre-intervention | 
| Perineal tonometry - Baseline | Tonometric evaluation on the perineal muscles Assessment tool: (MyotonPro (R)) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | Pre-intervention | 
| Waist circumference - Baseline | Waist circumference Assessment tool: tape measure (flexible, precision: 1mm) Subject position: standing Localization: minimum perimeter | Pre-intervention | 
| Chest circumference - Baseline | Chest circumference Assessment tool: tape measure (flexible, precision: 1mm) Subject position: standing Localization: maximum perimeter | Pre-intervention | 
| Abdominal tonometry - post-intervention 1 | Tonometric evaluation on the white line (linea alba) and the abdominal muscles Assessment tool: (MyotonPro (R)) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | Immediately after the intervention | 
| Perineal tonometry - post-intervention 1 | Tonometric evaluation on the perineal muscles Assessment tool: (MyotonPro (R)) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | Immediately after the intervention | 
| Waist circumference - post-intervention 1 | Waist circumference Assessment tool: tape measure (flexible, precision: 1mm) Subject position: standing Localization: minimum perimeter | Immediately after the intervention | 
| Chest circumference - post-intervention 1 | Chest circumference Assessment tool: tape measure (flexible, precision: 1mm) Subject position: standing Localization: maximum perimeter | Immediately after the intervention | 
| Abdominal tonometry - post-intervention 2 | Tonometric evaluation on the white line (linea alba) and the abdominal muscles Assessment tool: (MyotonPro (R)) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | One month after the intervention | 
| Perineal tonometry - post-intervention 2 | Tonometric evaluation on the perineal muscles Assessment tool: (MyotonPro (R)) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | One month after the intervention | 
| Waist circumference - post-intervention 2 | Waist circumference Assessment tool: tape measure (flexible, precision: 1mm) Subject position: standing Localization: minimum perimeter | One month after the intervention | 
| Chest circumference - post-intervention 2 | Chest circumference Assessment tool: tape measure (flexible, precision: 1mm) Subject position: standing Localization: maximum perimeter | One month after the intervention | 
| Abdominal tonometry - post-intervention 3 | Tonometric evaluation on the white line (linea alba) and the abdominal muscles Assessment tool: (MyotonPro (R)) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | Two months after the intervention | 
| Perineal tonometry - post-intervention 3 | Tonometric evaluation on the perineal muscles Assessment tool: (MyotonPro (R)) Subject position: supine Localization: 3 cm, 6 cm, 9 cm, 12 cm supraumbilical | Two months after the intervention | 
| Waist circumference - post-intervention 3 | Waist circumference Assessment tool: tape measure (flexible, precision: 1mm) Subject position: standing Localization: minimum perimeter | Two months after the intervention | 
| Chest circumference - post-intervention 3 | Chest circumference Assessment tool: tape measure (flexible, precision: 1mm) Subject position: standing Localization: maximum perimeter | Two months after the intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Postpartum, Hypopressive abdominal exercises, Pelvic floor muscles