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

Official title

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

Overview

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.

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.

Interventions

• 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
• 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

Primary outcome measures

• Numeric pain rating scale [Time frame: 8 weeks]
• Manual muscle testing [Time frame: 8 weeks]
• Finger width method [Time frame: 8 weeks]

Eligibility criteria

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

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Treatment

Study locations

Pakistan · 2 centers

• UOL teaching hospital and sehat medical complex lahore — Lahore
• UOL teaching hospital and sehat medical complex — Lahore

Publications

• Vesting S, Olsen MF, Gutke A, Rembeck G, Larsson MEH. Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: an inter-rater reliability study. BMJ Open. 2021 Sep 2;11(9):e049082. doi: 10.1136/bmjopen-2021-049082. PMID 34475166
• 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.
• Kaufmann RL, Reiner CS, Dietz UA, Clavien PA, Vonlanthen R, Kaser SA. Normal width of the linea alba, prevalence, and risk factors for diastasis recti abdominis in adults, a cross-sectional study. Hernia. 2022 Apr;26(2):609-618. doi: 10.1007/s10029-021-02493-7. Epub 2021 Oct 5. PMID 34609664
• 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 Apr;26(2):599-608. doi: 10.1007/s10029-021-02484-8. Epub 2021 Aug 25. PMID 34432175
• 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.

Identifiers

NCT: NCT07521085 · REC/RCR&AHS/25/0516

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗