Effects of Transverse Abdominis Activation and Rectus Abdominis Strengthening on Inter-rectus Distance and Core Stability

NCT07253844 | Not Yet Recruiting DMC

• 1 other identifier: UBAS/ERB/FoRS/25/025
• Study Type: interventional
• Target: 33
• Locations: 1 country
• Sites: 2

Brief Summary

This randomized controlled trial aims to compare the effects of Transverse Abdominis (TrA) activation, Rectus Abdominis (RA) strengthening, and their combined approach on inter-rectus distance (IRD) and core stability in postpartum women diagnosed with diastasis rectus abdominis (DRA). Thirty-three participants will be randomly allocated into three groups and will complete a six-week exercise program at the Pakistan Society for the Rehabilitation of the Disabled (PSRD) Hospital, Lahore. The study will use real-time ultrasound and pressure biofeedback assessment to evaluate changes in IRD and core stability. It is hypothesized that TrA activation and the combined intervention will produce greater improvements compared to RA strengthening alone.

Conditions

Diastasis Recti Abdominis (DRA)

Keywords

Diastasis Rectus Abdominus; Inter rectus distance; Rectus abdominus strenghtheing

Outcome Measures

Primary Outcomes (1)

• Inter-rectus Distance (IRD)

  The Inter-rectus Distance (IRD) is the measurement of the separation between the two rectus abdominis muscles along the linea alba. It is assessed using ultrasound imaging while the participant is in a supine position with knees bent.. A high-frequency (7.5 MHz) linear probe will be placed on the abdomen while the patient lies on their back. Images will be taken at three points above, at, and below the belly button.

  Baseline: Before starting the intervention Post-intervention: At the end of 6 weeks of the exercise program

Secondary Outcomes (1)

• Core stability

  Baseline (pre-intervention) and 6 weeks (post-intervention)

Study Arms (3)

Group A (Transverse abdominis activation)

EXPERIMENTAL

Other: Transverse Abdominis activation exercises

Group B (Rectus abdominis strengthening)

EXPERIMENTAL

Other: Rectus Abdominis Strengthening exercises

Group C (Transverse abdominis activation +rectus abdominis strengthening)

EXPERIMENTAL

Other: combined protocol of both transverse abdominis activation and rectus abdominis strengthening.

Interventions

Transverse Abdominis activation exercises OTHER

Group A (TAA) will perform abdominal drawing-in maneuvers (ADIM) in crook lying, side lying, and quadruped positions. They will be instructed to gently draw the belly button inward toward the spine without moving the pelvis or rib cage, emphasizing breathing coordination and pelvic floor co-activation. In the supervised phase, participants will perform 3 sets of 10 repetitions, with each contraction held for 10-20 seconds, and a rest interval of 3 minutes between sets

Group A (Transverse abdominis activation)

Rectus Abdominis Strengthening exercises OTHER

Group B (RAS) will perform exercises in supine lying with knees bent, including partial curl-ups, reverse crunches, pelvic tilts, and leg raises with abdominal bracing. The command will be tighten your abdominals as if bracing for a punch, and lift without straining your neck. Each supervised session will include 3 sets of 10-15 repetitions per exercise, progressing in difficulty using added resistance if tolerated, with a 3-minute rest interval between sets

Group B (Rectus abdominis strengthening)

combined protocol of both transverse abdominis activation and rectus abdominis strengthening. OTHER

Group C (TAA+RAS) will perform a hybrid protocol integrating both TrA activation and RA strengthening exercises. Each session will begin with ADIM in crook lying, side lying, and quadruped positions, followed by RA exercises including curl-ups, pelvic tilts, and leg raises. The command will be to activate your deep core with breathing, then strengthen your outer abdominals through controlled movements. Each supervised session will consist of 3 sets of 10 repetitions for TrA exercises (10-20 seconds hold) and 3 sets of 10-15 repetitions for RA exercises, with a rest period of 3 minutes between all sets.

Group C (Transverse abdominis activation +rectus abdominis strengthening)

Eligibility Criteria

• Age: 20 Years - 40 Years
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Postpartum women diagnosed with DRA
• Multigravida
• Delivered a singleton pregnancy via vaginal breech or instrumental delivery

You may not qualify if:

• Pregnancy
• Abdominal and pelvic hernias or severe musculoskeletal conditions
• Patients with abdominal and pelvic surgery
• Patients with disc herniation

Sponsors & Collaborators

• Lahore University of Biological and Applied Sciences: lead

Study Sites (2)

Lahore University of biological and applied sciences

Lahore, Punjab Province, Pakistan

Location

Pakistan Society for Rehabilitation of Differently Abled

Lahore, Punjab Province, Pakistan

Location

Related Publications (5)

• Benjamin DR, Frawley HC, Shields N, van de Water ATM, Taylor NF. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy. 2019 Mar;105(1):24-34. doi: 10.1016/j.physio.2018.07.002. Epub 2018 Jul 24.

  PMID: 30217494 BACKGROUND

• Olsson A, Woxnerud K, Kiwanuka O, Sandblom G, Stackelberg O. The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgery. BJS Open. 2023 Jan 6;7(1):zrac162. doi: 10.1093/bjsopen/zrac162.

  PMID: 36734959 BACKGROUND

• Gluppe SL, Hilde G, Tennfjord MK, Engh ME, Bo K. Effect of a Postpartum Training Program on the Prevalence of Diastasis Recti Abdominis in Postpartum Primiparous Women: A Randomized Controlled Trial. Phys Ther. 2018 Apr 1;98(4):260-268. doi: 10.1093/ptj/pzy008.

  PMID: 29351646 BACKGROUND

• Pascoal AG, Dionisio S, Cordeiro F, Mota P. Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case-control study. Physiotherapy. 2014 Dec;100(4):344-8. doi: 10.1016/j.physio.2013.11.006. Epub 2014 Jan 18.

  PMID: 24559692 BACKGROUND

• Berg-Poppe P, Hauer M, Jones C, Munger M, Wethor C. Use of exercise in the management of postpartum diastasis recti: a systematic review. The Journal of Women's & Pelvic Health Physical Therapy. 2022;46(1):35-47.

  BACKGROUND

Study Officials

• Muhammad tariq Shafi, BSPT,tDPT

  Lahore University of Biological and Applied Sciences

  STUDY CHAIR

Central Study Contacts

Attia Mehboob, Doctor of Physical Therapy

CONTACT

+923230016002; attiakhan455@gmail.com

Muhammad Tariq Shafi, BSPT, t-DPT

CONTACT

+923454190056; muhammad.tariq@ubas.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Due to the nature of the intervention, blinding of participants and therapists was not be feasible. However, to minimize assessment bias, outcome assessors remained blinded to group allocations which establishing a single-blind study design.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 19, 2025
• First Posted: November 28, 2025
• Study Start: November 25, 2025
• Primary Completion (Estimated): May 25, 2026
• Study Completion (Estimated): May 30, 2026
• Last Updated: November 28, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR
• Time Frame: The de-identified individual participant data (IPD) and supporting documents (study protocol, statistical analysis plan, and informed consent form) will be made available after completion of data analysis and publication of the main study results, approximately 6 months after study completion. The data will remain accessible for a period of 3 years following the publication date. Requests for data access must be submitted to the principal investigator and will be reviewed to ensure appropriate use consistent with ethical and confidentiality standards. No personally identifiable information will be shared at any stage.
• Access Criteria: De-identified individual participant data (IPD) and supporting information (study protocol, analysis plan, and informed consent form) will be available to qualified researchers, academicians, and postgraduate students conducting studies related to abdominal rehabilitation, physiotherapy, or maternal health. Access will be provided upon reasonable written request to the principal investigator, accompanied by a brief research proposal and data use agreement ensuring confidentiality. Approved users will receive the data in an electronic, password-protected format via institutional email. The data will be shared solely for academic and non-commercial research purposes, with strict adherence to ethical and privacy standards.

Locations

PA (2)