Hypopressive Abdominal Exercise in Postpartum Abdominal Diastasis (HipoDiastasi)

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

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.

Study Overview

• Status: Completed
• Conditions: Abdominal Diastasis
• Intervention / Treatment: Other: Hypopressive abdominal exercises

• Study Type: Interventional
• Enrollment (Actual): 15
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Córdoba, Spain, 14004
    • University of Cordoba

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 28 years to 48 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Hypopressive abdominal exercises; 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; Three sessions per week during four consecutive weeks (Total: 12 sessions). Each session time: 30 minutes.

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Universidad de Córdoba
• Investigators: Study Director: Daiana Priscila Rodrigues-de-Souza, PhD, Universidad de Córdoba; Principal Investigator: Miriam Ramírez Jiménez, Phys Ther, Universidad de Córdoba

Study record dates

Study Major Dates

• Study Start (Actual): January 20, 2020
• Primary Completion (Actual): July 20, 2020
• Study Completion (Actual): July 20, 2020

Study Registration Dates

• First Submitted: January 15, 2020
• First Submitted That Met QC Criteria: January 18, 2020
• First Posted (Actual): January 23, 2020

Study Record Updates

• Last Update Posted (Actual): July 21, 2020
• Last Update Submitted That Met QC Criteria: July 20, 2020
• Last Verified: July 1, 2020

More Information

Terms related to this study

• Keywords: Postpartum; Pelvic floor muscles; Hypopressive abdominal exercises
• Additional Relevant MeSH Terms: Wounds and Injuries; Joint Diseases; Musculoskeletal Diseases; Joint Dislocations; Diastasis, Muscle
• Other Study ID Numbers: HipoDiastasis4073-2018

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No