SynthesisHernia : the journal of hernias and abdominal wall surgery2026
What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? An updated systematic review and meta-analysis of randomized clinical trials and trial sequential analysis.
Synthesis in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
introductionThis systematic review and meta-analysis seeks to evaluate the effectiveness of abdominal and pelvic floor muscle (PFM) exercise programs in the treatment of postpartum diastasis recti abdominis (DRA). Specifically, we aim to update the current evidence by reassessing the impact of exercise-based interventions on inter-recti distance (IRD).
methodsA comprehensive online search was conducted using MEDLINE/PubMed, Cochrane Library, EMBASE, Web of Science, and LILACS, from inception until January 2025 without any filter applied. Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. To maintain rigor and mitigate bias in the analysis and results, a search for studies was conducted using the same search strategy employed in the previous study. The primary outcome was change in IRD or presence of DRA. Study quality was assessed using the Rob 2 approach. Meta-analyses were performed using R software (version 4.4.2), with pooled effects expressed as mean differences (MD) and 95% confidence intervals (CI). Statistical heterogeneity was assessed using the I2 statistic.
resultsA total of 93 records were screened, of which 11 studies met the inclusion criteria. Four additional studies were retrieved from the prior systematic review, yielding a total of 15 studies and 803 participants. Among these, three studies provided sufficient homogeneity to be included in the meta-analysis. The pooled analysis demonstrated no statistically significant difference in IRD between participants undergoing transversus abdominis (TrA) focused exercise and those receiving minimal or no intervention (MD -0.06 cm; 95% CI -1.19 to 1.08; p = 0.92). Considerable heterogeneity was observed, likely reflecting differences in intervention protocols, participant characteristics, and outcome assessment methods.
conclusionThis updated systematic review and meta-analysis found no evidence to support the effectiveness of exercise-based interventions as a standalone treatment for reducing IRD in postpartum women. Although exercise may provide functional or symptomatic benefits, its impact on anatomical correction appears limited. These findings highlight the need for well-designed randomized controlled trials and suggest that, in selected cases, alternative or adjunctive therapeutic strategies, including surgical approaches, may be required to achieve meaningful anatomical restoration. STUDY REGISTRATION: This systematic review was registered in the PROSPERO database CRD420251276159.
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