EFFECT OF THE LOW PRESSURE FITNESS (LPF) TECHNIQUE ON DIASTASIS OF THE RECTO ABDOMINAL IN POSTPARTUM WOMEN: RANDOMIZED CLINICAL TRIAL
Rectus Abdominis; Diastasis, Muscle; Postpartum Period
Introduction: Rectus Abdominis Diastasis (RAD) refers to an excessive separation between the segments of the rectus abdominis muscle. Persistent RAD, aside from being an aesthetic concern, has negative effects on functionality, trunk strength, and quality of life in postpartum women. Abdominal exercises are commonly recommended as an important physiotherapeutic intervention for RAD, with the Low Pressure Fitness (LPF)® technique being a potential alternative treatment. Objectives: To evaluate the effects of LPF® on rectus abdominis diastasis, pelvic floor muscle function, trunk strength, pain, functionality, quality of life, posture, global effect perception, and expectations in postpartum women with RAD undergoing the treatment. Methods: This is a pilot, double-blind, randomized controlled trial with concealed allocation and intention-to-treat analysis, conducted from January to July 2024. Women with RAD, at least 12 weeks postpartum, with a separation of the rectus abdominis muscles >2 cm and ≥2 fingers in width above, below, or at the level of the navel, were recruited. After consenting to participate, women were randomly allocated into two groups: control (GC, kinesitherapy) and experimental (GE, Low Pressure Fitness (LPF)®). All participants underwent an 8-week intervention, with assessments conducted after 8 and 16 sessions. During the 8-week intervention, both groups attended treatment sessions twice a week, each lasting 30 to 45 minutes, and were instructed to perform daily home exercises. The GC (n=5) performed a kinesitherapy regimen including abdominal crunches, posterior pelvic tilts, transverse abdominis muscle activation, and Russian twists, while the GE (n=5) performed LPF® exercises with varying postures. Data were analyzed using SPSS® software (version 21.0). Bootstrapping was employed to adjust quantitative variables for parametric distribution assumptions. Effects of interventions and comparison of outcome variables were assessed using two-way repeated measures Analysis of Variance (ANOVA). A significance level of 5% and a 95% confidence interval (CI) were adopted. Results: The study included 10 women with a mean age of 31.00±5.35 years (range 25 to 39 years). Participants in the GC had a mean postpartum duration of 30.80±13.21 weeks, while those in the GE had a mean duration of 31.40±6.91 weeks. No statistically significant differences in diastasis assessment were observed between groups at any time point, whether using palpation or a caliper. A change in diastasis measurements at the navel, assessed with a caliper, was observed over time in both groups [(pre vs after 4 weeks of treatment: mean difference (MD) 0.58 cm; 95% CI 0.1 to 0.9; p=0.008) and pre vs after 8 weeks of treatment: MD 0.64 cm; 95% CI 0.2 to 1.0; p=0.006)]. Conclusion: The LPF® treatment was not superior to Kinesiotherapy in reducing abdominal diastasis measurements in postpartum women. Diastasis decreased over time regardless of the treatment group.