Use of Exercise in the Management of Postpartum Diastasis Recti: A Systematic Review

Supplemental Digital Content is Available in the Text. Background: Diastasis rectus abdominis (DRA) is a condition commonly prevalent in the immediate postpartum period and decreasing in prevalence during the first year after delivery. The condition is pathologic when it interferes with activities and quality of life. The condition is frequently assessed using the interrectus distance. Objectives: The purpose of this systematic review was to pool and analyze studies examining the use of exercise and companion modalities for the treatment of DRA among postpartum women. Study Design: Systematic review (PROSPERO CRD42021277067). Methods: A systematic search for articles published in CINAHL, MEDLINE, and PubMed was conducted. Included articles identified exercise as a component of treatment for DRA for postpartum women. The quality of the studies was evaluated using the appropriate NHLBI quality assessment tool. Risk of bias was assessed using the Cochrane ROB-2 and ROBINS-1 tools. Results: The database search yielded 38 titles; 16 more were located as secondary searches. Fourteen articles remained for final inclusion: 9 randomized controlled trials (RCT) and 5 cross-sectional studies. Interventions with significant DRA improvements included traditional abdominal exercises (AE) with deep core stability, AE with pelvic floor muscle exercises, crunch exercises, drawing-in exercises with AE, and neuromuscular electrical stimulation with AE. Article quality varied from poor to good across RCTs and poor to fair for non-RCTs. Conclusion: Although these findings support the use of AE to reduce interrectus distance and improve quality of postpartum life, future research should investigate exercise selection based on the results of more multifaceted and clinically meaningful assessments.