An interventional study of Standard Postpartum Education and 6-Week Home-Based Abdominal Exercise Program in Diastasis Recti Abdominis (Postpartum), sponsored by Medical University of Gdansk. Completed at 1 site in Poland. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-10-20.
Sponsored by Medical University of Gdansk · Not applicable, Interventional, and Treatment
The main purpose of this study is to evaluate the effectiveness of a 6-week home-based abdominal exercise program combined with education on diastasis recti abdominis (DRA) and abdominal wall function in women during the early postpartum period.
The study includes healthy women over 18 years of age, recruited within the first 3 days after childbirth, who have been diagnosed with diastasis recti abdominis. Participants are assigned to either a control group or an experimental group. The control group receives standard postpartum education regarding ergonomics, safe lifting, and toilet habits. The experimental group receives the same standard education along with a specific 6-week home-based abdominal exercise program and breathing instructions, supported by video materials.
Researchers will assess the inter-recti distance (IRD), abdominal muscle strength, back pain-related disability, body esteem, and kinesiophobia. IRD measurements are taken twice: at baseline (during hospitalization) and after the 6-week intervention. Assessments of back pain-related disability, body esteem, and kinesiophobia are conducted once, at 6 weeks postpartum.
Diastasis recti abdominis (DRA) affects a significant majority of women in the early postpartum period. While spontaneous recovery can occur, abdominal wall changes often persist, potentially leading to functional limitations, lumbopelvic pain, and reduced quality of life. This prospective, controlled interventional study aimed to evaluate the effect of a 6-week home-based abdominal exercise program combined with standard education on the inter-recti distance (IRD) and overall abdominal wall function in women during the early postpartum period.
Participants were recruited at the maternity ward (Uniwersyteckie Centrum Kliniczne) between days 0 and 3 postpartum. Following informed consent and confirmation of eligibility based on physical examination (presence of DRA or midline bulging during increased intra-abdominal pressure), participants were allocated into two groups: control and experimental.
Control Group:
Participants received standard postpartum care, consisting of individual consultations with a physiotherapist. The education covered ergonomic position changes, safe lifting principles, and healthy toilet habits. Educational materials were also provided in the form of a printed brochure and via email.
Experimental Group:
Participants received the same standard educational consultation as the control group. In addition, before starting the online program, participants received in-person instruction on correct breathing patterns (diaphragmatic breathing) and basic pelvic movements (anterior and posterior tilt). The experimental group then performed a six-week home-based exercise program three times per week, developed based on current scientific evidence regarding DRA management. The program included three exercises emphasizing the synchronization of movement with prolonged exhalation, featuring progressive increases in repetitions and sets every two weeks. Instructional videos were provided via private YouTube links sent by email. To monitor compliance, each participant received both a paper and an electronic training diary to record exercise adherence.
Study Procedures:
Baseline physical assessments were conducted during the initial hospitalization (0-3 days postpartum) and focused on measuring the inter-recti distance (IRD) using an electronic caliper at three anatomical locations: at the umbilicus, 2 cm above, and 2 cm below.
After the 6-week intervention period, a follow-up assessment was conducted. This included a re-evaluation of the IRD and an assessment of abdominal muscle strength using the American College of Sports Medicine (ACSM) curl-up test. Furthermore, the 6-week follow-up included subjective assessments of back pain-related disability using the Oswestry Disability Index, body perception using the Body Esteem Scale (BES), and kinesiophobia using the Tampa Scale of Kinesiophobia (TSK-11).
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Exclusion Criteria:
Behavioral: Standard Postpartum Education
Behavioral: 6-Week Home-Based Abdominal Exercise Program
The intervention consists of standard postpartum care provided as an individual consultation with a physiotherapist. The education covers ergonomic position changes, safe lifting principles, and healthy toilet habits. Educational materials are provided to the participants in the form of a printed brochure and via email.
The intervention consists of a six-week home-based exercise program performed three times per week. Before starting the online program, participants receive in-person instruction on correct diaphragmatic breathing patterns and basic pelvic movements (anterior and posterior tilt). The main program includes three exercises emphasizing the synchronization of movement with prolonged exhalation, featuring progressive increases in repetitions and sets every two weeks. Instructional videos are provided via private YouTube links. To monitor compliance, each participant receives both a paper and an electronic training diary. Participants in this group also receive the standard postpartum education.
Change in Inter-Recti Distance
Inter-recti distance measured in millimeters (mm) using a digital electronic caliper with an accuracy of 0.01 mm. Participants are positioned supine with knees flexed at 90 degrees. Measurements are taken at three anatomical locations (2 cm above, directly at, and 2 cm below the umbilicus) under two conditions: at rest and during a standardized curl-up maneuver (abdominal crunch until the inferior angles of the scapulae clear the bench).
Time frame: Baseline (0-3 days postpartum) and 6 weeks postpartum.
Assessment of Abdominal Muscle Function by the ACSM Curl-up Test
Abdominal muscle endurance and performance evaluated using the American College of Sports Medicine (ACSM) Curl-up Test protocol. The assessment includes two parameters: the total number of correctly completed repetitions (unit of measure: number of repetitions) and the movement distance of the fingertips along the measuring strip (unit of measure: centimeters).
Time frame: 6 weeks postpartum
Assessment of linea alba bulging
Visual observation and classification of midline abdominal bulging during three functional maneuvers: curl-up test, straight leg raise in supine position, and spinal extension in standing position. Outcome is reported as a binary classification ("Bulging - YES" vs. "Bulging - NO"). The occurrence of bulging in any of the performed tests results in assignment to the "YES" category, regardless of the specific maneuver in which it was observed.
Time frame: Baseline (0-3 days postpartum) and 6 weeks postpartum.
Assessment of kinesiophobia using the Tampa Scale for Kinesiophobia
Assessment of kinesiophobia using the unabbreviated 11-item Tampa Scale for Kinesiophobia (TSK-11). Total scores range from 11 to 44 points, where higher scores indicate a worse outcome.
Time frame: 6 weeks postpartum
Assessment of back pain-related disability using the Oswestry Disability Index
Assessment of low back pain-related disability using the unabbreviated Oswestry Disability Index (ODI). Total scores range from 0% to 100%, where higher percentages indicate a worse outcome.
Time frame: 6 weeks postpartum
Assessment of body perception using the Body Esteem Scale BES
The Polish version of the Body Esteem Scale (BES) is a 35-item self-report questionnaire measuring attitudes toward one's body on a 5-point Likert scale from 1 ("strong negative feelings") to 5 ("strong positive feelings"). For females, items are grouped into three subscales: Sexual Attractiveness, Weight Concern, and Physical Condition. Higher scores represent a more positive body image and higher body esteem. Raw scores are transformed into age-adjusted sten scores (scale 1-10), interpreted as low (1-3 sten), moderate (4-7 sten), or high (8-10 sten) body esteem.
Time frame: 6 weeks postpartum
Plan to share: Yes — Anonymized individual participant data will be made available upon reasonable request to the corresponding author via email.
Supporting information: Study protocol, Informed consent form
Time frame: Data will become available starting 6 months after publication of the main study results in a peer-reviewed journal and will remain accessible for up to 3 years.
Access criteria: Anonymized data will be shared with academic researchers for valid scientific purposes. Requests must be emailed to the corresponding author for approval. A data access agreement may be required. Please note that the original supporting documents, such as the Study Protocol and Informed Consent Form, are available in Polish.
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