Efficacy of core training in the treatment of diastasis recti abdominis in postpartum women: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

HUANG Danping , ZUO Jing , GAO Yixuan , KE Zhifei ,  LI Junping

Department of Sport and Science, Beijing Sport University, Beijing 100084, P. R. China;

Corresponding author：

LI Junping, Email: doctorljp@126.com

Keywords：

Core training; Postpartum; Diastasis recti abdominis; Randomized controlled trial; Meta-analysis

DOI：

10.7507/1672-2531.202302104

Video：

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Objective To systematically review the effects of core training for diastasis recti abdominis (DRA) in postpartum period. Methods The PubMed, EMbase, EBSCO, Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on core training for patients with DRA postpartum from inception to December 7, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 12 RCTs were included, involving 741 patients with DRA postpartum. The results of the meta-analysis demonstrated that core training significantly reduced inter-recti distance (IRD) above the umbilicus (SMD=−1.37, 95%CI −2.30 to −0.44, P<0.05), below the umbilicus (SMD=−0.82, 95%CI −1.28 to −0.36, P<0.05), at the level of the umbilicus during contraction of the rectus abdominis (RA) (SMD=−0.76, 95%CI −1.24 to −0.28, P<0.05) and above the umbilicus during RA contraction (SMD=−3.41, 95%CI −5.12 to −1.69, P<0.05) in patients with DRA postpartum. Additionally, the results indicated that core training could improve visual analogue scale, abdominal circumference, waist-hip ratio, lumbopelvic control impairment, lumbopelvic proprioception, the static and dynamic overall balance stability, the static and dynamic anterior-posterior balance stability, medial-lateral static balance stability and Oswestry disability index in patients with DRA postpartum (P<0.05). However, no significant improvement was observed in inter-recti distance (IRD) below the umbilicus during RA contraction, the score of inventory of functional status after childbirth questionnaire, the score of multidimensional body-self relations questionnaire, medial-lateral dynamic balance stability or the score of pelvic floor impact questionnaire in patients with DRA postpartum (P>0.05). Conclusion Core training may improve IRD, pain intensity, total abdominal fat and fat distribution and balance in patients with DRA postpartum, but its efficacy in improving postpartum functional status, body image satisfaction or the degree of dysfunction is unclear. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.

Citation： HUANG Danping, ZUO Jing, GAO Yixuan, KE Zhifei, LI Junping. Efficacy of core training in the treatment of diastasis recti abdominis in postpartum women: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(9): 1026-1032. doi: 10.7507/1672-2531.202302104 Copy

1.	Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? a systematic review with meta-analysis. Braz J Phys Ther, 2021, 25(6): 664-675.
2.	竺佳晟, 李金辉. 产后腹直肌分离的评估与治疗研究进展. 中华物理医学与康复杂志, 2019, 41(10): 793-796.
3.	周碧华, 廖丹梅, 韦林宜, 等. 1462例产后6~8周妇女盆底筛查. 中国生育健康杂志, 2014, 25(1): 50-52.
4.	封盼盼, 孙武东, 曲艺, 等. 产后腹直肌分离康复治疗研究进展. 中国康复理论与实践, 2022, 28(9): 1065-1073.
5.	谢亮, 魏海棠, 杨珺, 等. 产后腹直肌分离临床治疗研究进展. 中国康复, 2021, 36(2): 125-128.
6.	孙秀丽, 李环, 苏园园, 等. 产后腹直肌分离诊断与治疗的专家共识. 中国妇产科临床杂志, 2021, 22(2): 220-221.
7.	Oliva-Lozano JM, Muyor JM. Core muscle activity during physical fitness exercises: a systematic review. Int J Environ Res Public Health, 2020, 17(12): 4306.
8.	陈杰, 靳翠红, 申英末. 腹直肌分离的诊断与治疗. 中华消化外科杂志, 2021, 20(7): 764-768.
9.	燕铁斌, 章马兰, 于佳妮, 等. 国际功能、残疾和健康分类(ICF)专家共识. 中国康复医学杂志, 2021, 36(1): 4-9.
10.	OktaviyanI F, Pamungkasari EP, Murti B. Effect of core stability exercise in preventing diastasis recti abdominis among normal birth delivery of postpartum mothers: meta-analysis. Indones J of Med 2022, 7(2): 188-199.
11.	Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy, 2014, 100(1): 1-8.
12.	Yalfani A, Bigdeli N, Gandomi F. Comparing the effects of suspension and isometric-isotonic training on postural stability, lumbopelvic control, and proprioception in women with diastasis recti abdominis: a randomized, single-blinded, controlled trial. Physiother Theory Pract, 2022, 2(2): 1-13.
13.	黎国威, 吴大嵘, 张颖, 等. 先行性与可行性研究在医学研究领域中的价值与应用简介. 中国循证医学杂志, 2021, 21(5): 617-620.
14.	Michalska A, Rokita W, Wolder D, et al. Diastasis recti abdominis - a review of treatment methods. Ginekol Pol, 2018, 89(2): 97-101.
15.	曹泽毅. 中华妇产科学. 北京: 人民卫生出版社, 2014.
16.	Higgins JP, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons, 2019.
17.	高晶晶, 姜斌, 程鹤. 运动疗法联合神经肌肉电刺激治疗产后腹直肌分离的疗效观察. 中华物理医学与康复杂志, 2022, 44(6): 536-539.
18.	王娟, 梁旭霞. 神经肌肉电刺激联合瑜伽锻炼治疗产后腹直肌分离的临床效果. 广西医学, 2021, 43(6): 681-684.
19.	邬婉蓉, 唐静, 许明, 等. 悬吊训练联合电刺激治疗产后腹直肌分离20例临床观察. 湖南中医杂志, 2020, 36(5): 16-18.
20.	张秋君, 李哲. Flexi-bar运动训练联合神经肌肉电刺激治疗产后腹直肌分离的效果. 郑州大学学报(医学版), 2022, 57(2): 284-288.
21.	赵杨, 程芳, 刘卫平, 等. 产后早期医疗体操联合神经肌肉电刺激治疗产后腹直肌分离的临床效果. 中国医药导报, 2022, 19(12): 104-107.
22.	邹燕齐, 张光正, 安礼, 等. 盆底神经肌肉电刺激和悬吊训练治疗产后腹直肌分离的效果. 中国康复理论与实践, 2020, 26(11): 1353-1357.
23.	Awad E, Mobark A, Zidan AA, et al. Effect of progressive prone plank exercise program on diastasis of rectus abdominis muscle in postpartum women: a randomized controlled trial. 2021.
24.	El-mekawy HS, Eldeeb AM, Lythy MAE, et al. Effect of abdominal exercises versus abdominal supporting belt on post-partum abdominal efficiency and rectus separation. Inter J Medi Heal Sci, 2013, 7(1): 75-79.
25.	Keshwani N, Mathur S, McLean L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial. Physiother Theory Pract, 2021, 37(9): 1018-1033.
26.	Tuttle LJ, Fasching J, Keller A, et al. Noninvasive treatment of postpartum diastasis recti abdominis: a pilot study. J Women’s Pelv Heal Physic Thera, 2018, 42(2): 65-75.
27.	魏闻婕, 唐蔚, 白平, 等. Pilates运动配合仿生物电刺激治疗产后腹直肌分离患者的应用效果. 深圳中西医结合杂志, 2022, 32(5): 98-101.
28.	陈超, 沈磊, 王惠, 等. 产后腹直肌分离患者强化核心肌群的呼吸康复训练研究进展. 上海护理, 2022, 22(1): 53-56.
29.	Lee DG, Lee LJ, McLaughlin L. Stability, continence and breathing: the role of fascia following pregnancy and delivery. J Bodyw Mov Ther, 2008, 12(4): 333-348.
30.	Mota P, Pascoal AG, Carita AI, et al. The immediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. J Orthop Sports Phys Ther, 2015, 45(10): 781-788.
31.	史冰. 核心及功能性力量训练的概念释义与机制探究. 安阳工学院学报, 2014, 13(4): 99-102.
32.	Yalfani A, Bigdeli N, Gandomi F, et al. Proprioception and control of the lumbopelvic in women with and without diastasis rectus and their relationship with postpartum pain and disability. Scientif J Rehabilit Med, 2020, 9(4): 257-267.
33.	Yalfani A, Bigdeli N, Anvari R, et al. Comparison of static, dynamic balance and curvature of the spine in women with and without diastasis recti abdominal in the postpartum period. 2020.
34.	梁健, 施静, 袁昕, 等. 核心稳定训练治疗非特异性腰痛的研究进展. 中医正骨, 2021, 33(4): 58-61.
35.	Saeterbakken AH, Chaudhari A, van den Tillaar R, et al. The effects of performing integrated compared to isolated core exercises. PLoS One, 2019, 14(2): e0212216.
36.	陈千吉, 陈红, 张英, 等. 基于中国腰痛患者Oswestry功能障碍指数测量性能证据的COSMIN系统评价. 中国康复医学杂志, 2022, 37(1): 79-83.

1. Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? a systematic review with meta-analysis. Braz J Phys Ther, 2021, 25(6): 664-675.
2. 竺佳晟, 李金辉. 产后腹直肌分离的评估与治疗研究进展. 中华物理医学与康复杂志, 2019, 41(10): 793-796.
3. 周碧华, 廖丹梅, 韦林宜, 等. 1462例产后6~8周妇女盆底筛查. 中国生育健康杂志, 2014, 25(1): 50-52.
4. 封盼盼, 孙武东, 曲艺, 等. 产后腹直肌分离康复治疗研究进展. 中国康复理论与实践, 2022, 28(9): 1065-1073.
5. 谢亮, 魏海棠, 杨珺, 等. 产后腹直肌分离临床治疗研究进展. 中国康复, 2021, 36(2): 125-128.
6. 孙秀丽, 李环, 苏园园, 等. 产后腹直肌分离诊断与治疗的专家共识. 中国妇产科临床杂志, 2021, 22(2): 220-221.
7. Oliva-Lozano JM, Muyor JM. Core muscle activity during physical fitness exercises: a systematic review. Int J Environ Res Public Health, 2020, 17(12): 4306.
8. 陈杰, 靳翠红, 申英末. 腹直肌分离的诊断与治疗. 中华消化外科杂志, 2021, 20(7): 764-768.
9. 燕铁斌, 章马兰, 于佳妮, 等. 国际功能、残疾和健康分类(ICF)专家共识. 中国康复医学杂志, 2021, 36(1): 4-9.
10. OktaviyanI F, Pamungkasari EP, Murti B. Effect of core stability exercise in preventing diastasis recti abdominis among normal birth delivery of postpartum mothers: meta-analysis. Indones J of Med 2022, 7(2): 188-199.
11. Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy, 2014, 100(1): 1-8.
12. Yalfani A, Bigdeli N, Gandomi F. Comparing the effects of suspension and isometric-isotonic training on postural stability, lumbopelvic control, and proprioception in women with diastasis recti abdominis: a randomized, single-blinded, controlled trial. Physiother Theory Pract, 2022, 2(2): 1-13.
13. 黎国威, 吴大嵘, 张颖, 等. 先行性与可行性研究在医学研究领域中的价值与应用简介. 中国循证医学杂志, 2021, 21(5): 617-620.
14. Michalska A, Rokita W, Wolder D, et al. Diastasis recti abdominis - a review of treatment methods. Ginekol Pol, 2018, 89(2): 97-101.
15. 曹泽毅. 中华妇产科学. 北京: 人民卫生出版社, 2014.
16. Higgins JP, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons, 2019.
17. 高晶晶, 姜斌, 程鹤. 运动疗法联合神经肌肉电刺激治疗产后腹直肌分离的疗效观察. 中华物理医学与康复杂志, 2022, 44(6): 536-539.
18. 王娟, 梁旭霞. 神经肌肉电刺激联合瑜伽锻炼治疗产后腹直肌分离的临床效果. 广西医学, 2021, 43(6): 681-684.
19. 邬婉蓉, 唐静, 许明, 等. 悬吊训练联合电刺激治疗产后腹直肌分离20例临床观察. 湖南中医杂志, 2020, 36(5): 16-18.
20. 张秋君, 李哲. Flexi-bar运动训练联合神经肌肉电刺激治疗产后腹直肌分离的效果. 郑州大学学报(医学版), 2022, 57(2): 284-288.
21. 赵杨, 程芳, 刘卫平, 等. 产后早期医疗体操联合神经肌肉电刺激治疗产后腹直肌分离的临床效果. 中国医药导报, 2022, 19(12): 104-107.
22. 邹燕齐, 张光正, 安礼, 等. 盆底神经肌肉电刺激和悬吊训练治疗产后腹直肌分离的效果. 中国康复理论与实践, 2020, 26(11): 1353-1357.
23. Awad E, Mobark A, Zidan AA, et al. Effect of progressive prone plank exercise program on diastasis of rectus abdominis muscle in postpartum women: a randomized controlled trial. 2021.
24. El-mekawy HS, Eldeeb AM, Lythy MAE, et al. Effect of abdominal exercises versus abdominal supporting belt on post-partum abdominal efficiency and rectus separation. Inter J Medi Heal Sci, 2013, 7(1): 75-79.
25. Keshwani N, Mathur S, McLean L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial. Physiother Theory Pract, 2021, 37(9): 1018-1033.
26. Tuttle LJ, Fasching J, Keller A, et al. Noninvasive treatment of postpartum diastasis recti abdominis: a pilot study. J Women’s Pelv Heal Physic Thera, 2018, 42(2): 65-75.
27. 魏闻婕, 唐蔚, 白平, 等. Pilates运动配合仿生物电刺激治疗产后腹直肌分离患者的应用效果. 深圳中西医结合杂志, 2022, 32(5): 98-101.
28. 陈超, 沈磊, 王惠, 等. 产后腹直肌分离患者强化核心肌群的呼吸康复训练研究进展. 上海护理, 2022, 22(1): 53-56.
29. Lee DG, Lee LJ, McLaughlin L. Stability, continence and breathing: the role of fascia following pregnancy and delivery. J Bodyw Mov Ther, 2008, 12(4): 333-348.
30. Mota P, Pascoal AG, Carita AI, et al. The immediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. J Orthop Sports Phys Ther, 2015, 45(10): 781-788.
31. 史冰. 核心及功能性力量训练的概念释义与机制探究. 安阳工学院学报, 2014, 13(4): 99-102.
32. Yalfani A, Bigdeli N, Gandomi F, et al. Proprioception and control of the lumbopelvic in women with and without diastasis rectus and their relationship with postpartum pain and disability. Scientif J Rehabilit Med, 2020, 9(4): 257-267.
33. Yalfani A, Bigdeli N, Anvari R, et al. Comparison of static, dynamic balance and curvature of the spine in women with and without diastasis recti abdominal in the postpartum period. 2020.
34. 梁健, 施静, 袁昕, 等. 核心稳定训练治疗非特异性腰痛的研究进展. 中医正骨, 2021, 33(4): 58-61.
35. Saeterbakken AH, Chaudhari A, van den Tillaar R, et al. The effects of performing integrated compared to isolated core exercises. PLoS One, 2019, 14(2): e0212216.
36. 陈千吉, 陈红, 张英, 等. 基于中国腰痛患者Oswestry功能障碍指数测量性能证据的COSMIN系统评价. 中国康复医学杂志, 2022, 37(1): 79-83.

Chinese Journal of Evidence-Based Medicine

Efficacy of core training in the treatment of diastasis recti abdominis in postpartum women: a meta-analysis

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