Combined Effects Of Stability Oriented Breathing Exercises and Kegel's Exercises in Postpartum Women

Combined Effects Of Stability Oriented Breathing Exercises and Kegel's Exercises On Inter-recti Distance, Lumbopelvic Pain and Strength In Postpartum Women

The postpartum period often presents challenges such as increased inter-recti distance (diastasis recti), lumbopelvic pain, and reduced core strength. This study is designed as a randomized controlled trial to evaluate the combined effects of stability-oriented breathing exercises and Kegel exercises on inter-recti distance (IRD), lumbopelvic pain, and muscle strength in postpartum women. A total sample size of 66 participants per group was determined with a 10% dropout rate accounted for.

The study will use a non-probability convenience sampling technique. It will be conducted at the University of Lahore Teaching Hospital and Sehat Medical complex. Inclusion criteria include women aged 18-40 years, with a history of cesarean sections, an IRD between 3-5 cm. Outcome measures include IRD , pelvic floor muscle strength, lumbopelvic pain (measured using a 10 cm numeric pain scale). Participants will be randomly assigned to either Group A (Kegel-only) or Group B (Kegel + breathing exercises). Both groups will train three times weekly for eight weeks. All data analysis will be performed using SPSS version 27.

Study Overview

• Status: Recruiting
• Conditions: Postpartum Complication; Strength
• Intervention / Treatment: Other: Stability Oriented Breathing Training; Other: kegels exercises

Detailed Description

The postpartum period often presents challenges such as increased inter-recti distance (diastasis recti), lumbopelvic pain, and reduced core strength. This study is designed as a randomized controlled trial to evaluate the combined effects of stability-oriented breathing exercises and Kegel exercises on inter-recti distance (IRD), lumbopelvic pain, and muscle strength in postpartum women. A total sample size of 66 participants per group was determined with a 10% dropout rate accounted for.

The study will use a non-probability convenience sampling technique. It will be conducted at the University of Lahore Teaching Hospital and Sehat Medical complex. Inclusion criteria include women aged 18-40 years, with a history of cesarean sections, an IRD between 3-5 cm. Outcome measures include IRD , pelvic floor muscle strength, lumbopelvic pain (measured using a 10 cm numeric pain scale). Participants will be randomly assigned to either Group A (Kegel-only) or Group B (Kegel + breathing exercises). Both groups will train three times weekly for eight weeks. All data analysis will be performed using SPSS version 27.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Imran Amjad, PhD; Phone Number: 03324390125; Email: Imran.amjad@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Recruiting
      • UOL teaching hospital and sehat medical complex lahore
      • Contact: Masooma Saleem; Phone Number: 03320711342; Email: masooma.saleem@riphah.edu.pk
      • Principal Investigator: Areeba saleem butt, MSPT WH
    • Lahore, Punjab Province, Pakistan, 54000
      • Recruiting
      • UOL teaching hospital and sehat medical complex
      • Principal Investigator: Areeba saleem butt, MSPT WH
      • Contact: Masooma Saleem, MSWHPT; Phone Number: 03320711342; Email: masooma.saleem@riphah.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• • Age between 18-40 years

  • Postpartum duration of 42-49 days
  • Inter-recti distance (IRD) between 3-5 cm
  • Numeric pain scale score ≤ 6 for pain
  • No prior physiotherapy or exercise guidance received

Exclusion Criteria:

• • Pain during the training period

  • Patients with any heart or respiratory disease including excessive coughing and sneezing
  • Patients with any kind of pelvic or abdominal surgery
  • Significant organ dysfunction or psychiatric illness
  • Diagnosis of malignant tumors

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Stability oriented Breathing training; This group will be given combined Kegel exercises and stability-oriented breathing training group with in postpartum women. This included static breathing exercises (transverse, diaphragmatic, back, and pumping breathing) in the first two weeks, followed by resistance band breathing exercises targeting core and transversus abdominis activation in weeks 3 to 4. In the final four weeks, dynamic breathing exercises such as the pelvic clock and hundreds prep will be introduced to promote core stabilization under movement.	Other: Stability Oriented Breathing Training; This included static breathing exercises (transverse, diaphragmatic, back, and pumping breathing) in the first two weeks, followed by resistance band breathing exercises targeting core and transversus abdominis activation in weeks 3 to 4. In the final four weeks, dynamic breathing exercises such as the pelvic clock and hundreds prep will be introduced to promote core stabilization under movement
Active Comparator: kegels exercises; This group will be given kegel exercises in postpartum women. Sessions included a 10-minute warm-up of light jogging, walking, and stretching, followed by Kegel exercises starting with 10 repetitions per movement in the first two weeks and progressing to 15 repetitions in the following two weeks. In the later weeks, load was progressively increased by extending the duration of contractions (from 5 to 8 seconds) and adding dynamic limb movements. A 3-minute rest was provided between each set, and sessions concluded with a 5-minute cool-down	Other: kegels exercises; This group will be given kegel exercises in postpartum women. Sessions included a 10-minute warm-up of light jogging, walking, and stretching, followed by Kegel exercises starting with 10 repetitions per movement in the first two weeks and progressing to 15 repetitions in the following two weeks. In the later weeks, load was progressively increased by extending the duration of contractions (from 5 to 8 seconds) and adding dynamic limb movements. A 3-minute rest was provided between each set, and sessions concluded with a 5-minute cool-down

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric pain rating scale	This is the scale having that measures levels of pain from 0 to 11 it describes the intensity or severity of the pian	8 weeks
Manual muscle testing	Pelvic floor muscle strength will be evaluated using a manual assessment technique. During the assessment, the participant will be instructed to lie in a supine position with knees bent and hands resting at their sides. Manual Muscle Testing (MMT) is a widely used, valid, and reliable method for assessing muscle strength through graded resistance applied by the examiner	8 weeks
Finger width method	The measurement of diastasis recti abdominis width at the umbilicus using calipers demonstrated good reliability, with an intraclass correlation coefficient (ICC) of 0.83 (95% CI: 0.76 to 0.87).	8 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Masooma Saleem, MSPT WH, Riphah International University

Publications and helpful links

General Publications

• 1. Vesting S, Olsen MF, Gutke A, Rembeck G, Larsson ME. Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: An inter-rater reliability study. BMJ Open. 2021;11(9):e049082.
• 2. Yalfani A, Bigdeli N, Gandomi F, Anvari Ali Abad R. [Proprioception and control of the lumbopelvic in women with and without diastasis rectus and their relationship with postpartum pain and disability (Persian)]. Scientific Journal of Rehabilitation Medicine. 2020;9(4):257-67.
• 3. Kaufmann R, Reiner C, Dietz U, Clavien P, Vonlanthen R, Käser S. Normal width of the linea alba, prevalence, and risk factors for diastasis recti abdominis in adults: a cross-sectional study. Hernia. 2022;26:609-18.
• 4. Tuominen R, Jahkola T, Saisto T, Arokoski J, Vironen J. The prevalence and consequences of abdominal rectus muscle diastasis among Finnish women: An epidemiological cohort study. Hernia. 2022;26(2):599-608.
• 5. Yalfani A, Bigdeli N, Gandomi F. [The effect of isometric-isotonic exercises of core stability in women with postpartum diastasis recti and its secondary disorders (randomized controlled clinical trial) (Persian)]. Journal of Health and Care. 2020;22(2):123-37.

Study record dates

Study Major Dates

• Study Start (Actual): August 31, 2025
• Primary Completion (Estimated): September 1, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: April 2, 2026
• First Submitted That Met QC Criteria: April 2, 2026
• First Posted (Actual): April 9, 2026

Study Record Updates

• Last Update Posted (Actual): April 9, 2026
• Last Update Submitted That Met QC Criteria: April 2, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Breathing exercises; Kegel exercises; Postpartum women; Core strength; Diastasis recti abdominis; Lumbopelvic pain; Inter recti distance; Stability training
• Other Study ID Numbers: REC/RCR&AHS/25/0516

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