Comparative Effects of Hypopressive and Split Tummy Exercises in Postpartum Diastasis Recti

Comparative Effects of Hypopressive and Split Tummy Exercises on Lifestyle, Inter Recti Distance, Strength and Function of Pelvic Floor Muscles in Postpartum Diastasis Recti

To compare the effects of hypopressive exercises and split tummy (transverse abdominal activation-based) exercises on inter-recti distance (IRD), pelvic floor muscle strength and function, and overall quality of life improvements in postpartum women with diastasis recti. This study will be randomized clinical trial and will be conducted in Hameed Latif Hospital Lahore and Civil Hospital Sukkur. The total duration of treatment will be 8 week. Non-probability convenience sampling technique will be used and 50 participants will be recruited in study after randomization. The subjects will be divided into two groups. Group A will receive hypopressive exercise with baseline treatment abdominal binding. Group B will receive baseline treatment with split tummy exercises.

Study Overview

• Status: Recruiting
• Conditions: Diastasis Recti
• Intervention / Treatment: Other: hypopressive exercise; Other: split tummy exercises

Detailed Description

Postpartum diastasis recti abdominis (DRA) is a common condition affecting women after childbirth, characterized by the separation of the rectus abdominis muscles along the linea alba. This condition can lead to core instability, pelvic floor dysfunction, back pain, and a negative impact on daily function and quality of life. Rehabilitation through exercise is considered a primary non-surgical treatment. However, the most effective approach to improving both physical parameters and overall lifestyle remains under investigation.

To compare the effects of hypopressive exercises and split tummy (transverse abdominal activation-based) exercises on inter-recti distance (IRD), pelvic floor muscle strength and function, and overall quality of life improvements in postpartum women with diastasis recti. This study will be randomized clinical trial and will be conducted in Hameed Latif Hospital Lahore and Civil Hospital Sukkur. The total duration of treatment will be 8 week. Non-probability convenience sampling technique will be used and 50 participants will be recruited in study after randomization. The subjects will be divided into two groups. Group A will receive hypopressive exercise with baseline treatment abdominal binding. Group B will receive baseline treatment with split tummy exercises. The tools that will be used are digital vernier scale use for inter recti distance, oswestry disability index (ODI), Oxford Grading scale system use for strength and function of pelvic floor muscles and quality of life questionnaire. Data will be analyzed using SPSS version 21. With the significant P value < 0.05.

• Study Type: Interventional
• Enrollment (Estimated): 50
• 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
    • Sukkur, Punjab Province, Pakistan, 65200
      • Recruiting
      • Civil Hospital Sukkur
      • Principal Investigator: Sarah Abid, MSWHPT

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Age: 24 to 40years
• Weight: 50 to 70kg
• Height: 4.5 to 6ft
• BMI: Both underweight and overweight/ obese individuals can experience DRA.
• Parity: Multiparous
• Mode of delivery: vaginal delivery in split tummy.
• Subjects who gave vaginal birth with or without episiotomy in multiparous women in hypopressive.

Exclusion Criteria:

• Undergoing a severe illness
• Uncompleted inter-rectus distance (IRD) records
• Have a history of pelvic floor dysfunction
• Primiparous, polyhydramnios, uterine fibroids during pregnancy, previous abdominal, surgery caesarean delivery
• Subjects with untreated high blood pressure, cardiovascular illness, hernia, pregnant and underwent any recent surgeries.

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
Active Comparator: hypopressive exercise; For participants in Group A, series of postural and breathing-based sequences will be given. Base-line is abdominal binding I will performed hypopressive exercises in various positions (lying, sitting, leaning forward, standing and quadruped) to improve breath control, abdominal contraction and pelvic floor engagement. Each session began with focused breathing, full increasing based on tolerance. Exercises were repeated in different postures to assess endurance in each, as individual holding each contraction 5 seconds and relax for 10 seconds capacity varied by position. Participants engaged in these exercises for 20 minutes, 3 times per week, over a 8 week period, with moderate to high intensity based on breath-hold duration and postural demand.	Other: hypopressive exercise; For participants in Group A, series of postural and breathing-based sequences will be given. Base-line is abdominal binding I will performed hypopressive exercises in various positions (lying, sitting, leaning forward, standing and quadruped) to improve breath control, abdominal contraction and pelvic floor engagement. Each session began with focused breathing, full increasing based on tolerance. Exercises were repeated in different postures to assess endurance in each, as individual holding each contraction 5 seconds and relax for 10 seconds capacity varied by position. Participants engaged in these exercises for 20 minutes, 3 times per week, over a 8 week period, with moderate to high intensity based on breath-hold duration and postural demand.
Experimental: split tummy exercises; Base-line abdominal binding I will perform isometric exercises (1) Modified plank hold (2) Pelvic tilts (3) Transverse abdominis engagement. For modified plank hold in this position participants with their knees on the ground instead of toes. Engage core muscles and hold for 30 to 60 seconds. For pelvic tilts participants lie on back with knees bent and feet flat on the floor. Tilt the pelvic upwards and then back down again, repeating the motion in a slow and controlled manner. Hold for 30 to 60 seconds. For transverse abdominis engagement participants lies on back with knees bent and feet flat on the floor. Engage transverse abdominis muscle and drawing belly button towards spine. Hold for 30 to 60 seconds. 3 times in a week involving at least three sets of 10 repetitions each. To improved core strength and stability, increased muscle endurance and isometric exercises can be low-impact, making them suitable for individuals with diastasis recti.	Other: split tummy exercises; Base-line abdominal binding I will perform isometric exercises (1) Modified plank hold (2) Pelvic tilts (3) Transverse abdominis engagement. For modified plank hold in this position participants with their knees on the ground instead of toes. Engage core muscles and hold for 30 to 60 seconds. For pelvic tilts participants lie on back with knees bent and feet flat on the floor. Tilt the pelvic upwards and then back down again, repeating the motion in a slow and controlled manner. Hold for 30 to 60 seconds. For transverse abdominis engagement participants lies on back with knees bent and feet flat on the floor. Engage transverse abdominis muscle and drawing belly button towards spine. Hold for 30 to 60 seconds. 3 times in a week involving at least three sets of 10 repetitions each. To improved core strength and stability, increased muscle endurance and isometric exercises can be low-impact, making them suitable for individuals with diastasis recti.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Digital Vernier Calliper	The Oswestry Disability Index (ODI) and inter-recti distance were measured at the start (baseline) and again at the 8th week. A digital vernier caliper was used to assess the inter-recti distance at three specific locations: directly at the umbilicus, 4.5 cm above, and 4.5 cm below it. The ODI evaluates functional disability based on ten factors: pain intensity, ability to maintain personal hygiene, lifting, work, standing, sitting, sleeping, sexual activity, social interaction, and travel. ODI scores range as follows: 0-20% indicates minimal disability, 21-40% suggests moderate disability, 41-60% reflects severe disability, 61-80% indicates significant functional limitation, and 81-100% implies the patient is confined to bed.	8 weeks
Quality of life questionnaire	The SF-36 is regarded as a valid and reliable tool with strong discriminatory and convergent validity that allows it to differentiate across respondent groups according to age, gender, and socioeconomic position. It has eight sub scales and 36 items. (1) Physical functioning (PF), (2) Role-physical (RP), (3) Bodily pain (BP), (4) General health (GH), (5) Vitality (VT), (6) Social functioning (SF), (7) Role-emotional (RE), and (8) Emotional wellbeing (EW). Higher ratings on each subscale, which range from 0 to 100, indicate better conditions .	8 weeks
Pelvic floor strength and function	Digital assessment of PFM strength using the Oxford Grading Scale system will distributed as follows: weak (n = 1), moderate (n = 6), good (n = 10) and strong (n = 26)(16). The reliability of oxford grading scale system is 0.53.	8 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Hafiza Iqra Rubab, MSWHPT, Riphah International University

Publications and helpful links

General Publications

• Abdullah, Rehman KA, Ahmad B, Arshad MK, Saeed H, Keen MA, Anwar A, Saleem NUA, Salma Shabbar Banatwala UE, Bilal Z, Shahzad M, Shakoor P, Niazi MA. Comparative Efficacy of Abdominal Exercises and Abdominal Binding on Diastasis Recti Abdominis Reduction in Postpartum Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Physiother Res Int. 2025 Apr;30(2):e70038. doi: 10.1002/pri.70038.
• Rodriguez-Romero B, Senin-Camargo F, Sande-Fuentes J, Martinez-Bustelo S. Exercises to treat diastasis rectus abdominis and improve abdominal function: Two case reports. J Back Musculoskelet Rehabil. 2025 Sep;38(5):1180-1188. doi: 10.1177/10538127251325839. Epub 2025 Apr 10.
• Theodorsen NM, Moe-Nilssen R, Bo K, Haukenes I. Effect of exercise on the inter-rectus distance in pregnant women with diastasis recti abdominis: an experimental longitudinal study. Physiotherapy. 2023 Dec;121:13-20. doi: 10.1016/j.physio.2023.08.001. Epub 2023 Aug 23.
• Sekar R, Ramalingam V, Nirmala JG, Muniandy Y. Effectiveness of Abdominal Hypopressive Technique on Diastasis Recti among Postpartum Women. Indian Journal of Physiotherapy & Occupational Therapy. 2024;18.
• Shohaimi S, Husain NRN, Zaki FM, Atan IK. Split Tummy Exercise Program for Reducing Diastasis Recti in Postpartum Primigravidae: A Randomized Controlled Trial. Korean J Fam Med. 2023 Mar;44(2):102-108. doi: 10.4082/kjfm.22.0035. Epub 2023 Mar 20.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2025
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): July 1, 2026

Study Registration Dates

• First Submitted: June 1, 2026
• First Submitted That Met QC Criteria: June 4, 2026
• First Posted (Actual): June 5, 2026

Study Record Updates

• Last Update Posted (Actual): June 5, 2026
• Last Update Submitted That Met QC Criteria: June 4, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Exercise; Female; Exercise therapy; Pelvic floor; Postpartum period; Muscle strength.
• Additional Relevant MeSH Terms: Behavior; Motor Activity
• Other Study ID Numbers: REC/RCR & AHS/25/0512

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