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, B? 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, 李金輝. 產后腹直肌分離的評估與治療研究進展. 中華物理醫學與康復雜志, 2019, 41(10): 793-796.
3.	周碧華, 廖丹梅, 韋林宜, 等. 1462例產后6~8周婦女盆底篩查. 中國生育健康雜志, 2014, 25(1): 50-52.
4.	封盼盼, 孫武東, 曲藝, 等. 產后腹直肌分離康復治療研究進展. 中國康復理論與實踐, 2022, 28(9): 1065-1073.
5.	謝亮, 魏海棠, 楊珺, 等. 產后腹直肌分離臨床治療研究進展. 中國康復, 2021, 36(2): 125-128.
6.	孫秀麗, 李環, 蘇園園, 等. 產后腹直肌分離診斷與治療的專家共識. 中國婦產科臨床雜志, 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.	陳杰, 靳翠紅, 申英末. 腹直肌分離的診斷與治療. 中華消化外科雜志, 2021, 20(7): 764-768.
9.	燕鐵斌, 章馬蘭, 于佳妮, 等. 國際功能、殘疾和健康分類(ICF)專家共識. 中國康復醫學雜志, 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.	黎國威, 吳大嶸, 張穎, 等. 先行性與可行性研究在醫學研究領域中的價值與應用簡介. 中國循證醫學雜志, 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.	曹澤毅. 中華婦產科學. 北京: 人民衛生出版社, 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, 程鶴. 運動療法聯合神經肌肉電刺激治療產后腹直肌分離的療效觀察. 中華物理醫學與康復雜志, 2022, 44(6): 536-539.
18.	王娟, 梁旭霞. 神經肌肉電刺激聯合瑜伽鍛煉治療產后腹直肌分離的臨床效果. 廣西醫學, 2021, 43(6): 681-684.
19.	鄔婉蓉, 唐靜, 許明, 等. 懸吊訓練聯合電刺激治療產后腹直肌分離20例臨床觀察. 湖南中醫雜志, 2020, 36(5): 16-18.
20.	張秋君, 李哲. Flexi-bar運動訓練聯合神經肌肉電刺激治療產后腹直肌分離的效果. 鄭州大學學報(醫學版), 2022, 57(2): 284-288.
21.	趙楊, 程芳, 劉衛平, 等. 產后早期醫療體操聯合神經肌肉電刺激治療產后腹直肌分離的臨床效果. 中國醫藥導報, 2022, 19(12): 104-107.
22.	鄒燕齊, 張光正, 安禮, 等. 盆底神經肌肉電刺激和懸吊訓練治療產后腹直肌分離的效果. 中國康復理論與實踐, 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.	魏聞婕, 唐蔚, 白平, 等. Pilates運動配合仿生物電刺激治療產后腹直肌分離患者的應用效果. 深圳中西醫結合雜志, 2022, 32(5): 98-101.
28.	陳超, 沈磊, 王惠, 等. 產后腹直肌分離患者強化核心肌群的呼吸康復訓練研究進展. 上海護理, 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. 核心及功能性力量訓練的概念釋義與機制探究. 安陽工學院學報, 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, 施靜, 袁昕, 等. 核心穩定訓練治療非特異性腰痛的研究進展. 中醫正骨, 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.	陳千吉, 陳紅, 張英, 等. 基于中國腰痛患者Oswestry功能障礙指數測量性能證據的COSMIN系統評價. 中國康復醫學雜志, 2022, 37(1): 79-83.

1. Gluppe S, Engh ME, B? 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, 李金輝. 產后腹直肌分離的評估與治療研究進展. 中華物理醫學與康復雜志, 2019, 41(10): 793-796.
3. 周碧華, 廖丹梅, 韋林宜, 等. 1462例產后6~8周婦女盆底篩查. 中國生育健康雜志, 2014, 25(1): 50-52.
4. 封盼盼, 孫武東, 曲藝, 等. 產后腹直肌分離康復治療研究進展. 中國康復理論與實踐, 2022, 28(9): 1065-1073.
5. 謝亮, 魏海棠, 楊珺, 等. 產后腹直肌分離臨床治療研究進展. 中國康復, 2021, 36(2): 125-128.
6. 孫秀麗, 李環, 蘇園園, 等. 產后腹直肌分離診斷與治療的專家共識. 中國婦產科臨床雜志, 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. 陳杰, 靳翠紅, 申英末. 腹直肌分離的診斷與治療. 中華消化外科雜志, 2021, 20(7): 764-768.
9. 燕鐵斌, 章馬蘭, 于佳妮, 等. 國際功能、殘疾和健康分類(ICF)專家共識. 中國康復醫學雜志, 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. 黎國威, 吳大嶸, 張穎, 等. 先行性與可行性研究在醫學研究領域中的價值與應用簡介. 中國循證醫學雜志, 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. 曹澤毅. 中華婦產科學. 北京: 人民衛生出版社, 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, 程鶴. 運動療法聯合神經肌肉電刺激治療產后腹直肌分離的療效觀察. 中華物理醫學與康復雜志, 2022, 44(6): 536-539.
18. 王娟, 梁旭霞. 神經肌肉電刺激聯合瑜伽鍛煉治療產后腹直肌分離的臨床效果. 廣西醫學, 2021, 43(6): 681-684.
19. 鄔婉蓉, 唐靜, 許明, 等. 懸吊訓練聯合電刺激治療產后腹直肌分離20例臨床觀察. 湖南中醫雜志, 2020, 36(5): 16-18.
20. 張秋君, 李哲. Flexi-bar運動訓練聯合神經肌肉電刺激治療產后腹直肌分離的效果. 鄭州大學學報(醫學版), 2022, 57(2): 284-288.
21. 趙楊, 程芳, 劉衛平, 等. 產后早期醫療體操聯合神經肌肉電刺激治療產后腹直肌分離的臨床效果. 中國醫藥導報, 2022, 19(12): 104-107.
22. 鄒燕齊, 張光正, 安禮, 等. 盆底神經肌肉電刺激和懸吊訓練治療產后腹直肌分離的效果. 中國康復理論與實踐, 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. 魏聞婕, 唐蔚, 白平, 等. Pilates運動配合仿生物電刺激治療產后腹直肌分離患者的應用效果. 深圳中西醫結合雜志, 2022, 32(5): 98-101.
28. 陳超, 沈磊, 王惠, 等. 產后腹直肌分離患者強化核心肌群的呼吸康復訓練研究進展. 上海護理, 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. 核心及功能性力量訓練的概念釋義與機制探究. 安陽工學院學報, 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, 施靜, 袁昕, 等. 核心穩定訓練治療非特異性腰痛的研究進展. 中醫正骨, 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. 陳千吉, 陳紅, 張英, 等. 基于中國腰痛患者Oswestry功能障礙指數測量性能證據的COSMIN系統評價. 中國康復醫學雜志, 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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