The Impact of Exercising on Pelvic Symptom Severity, Pelvic Floor Muscle Strength, and Diastasis Recti Abdominis after Pregnancy: A Longitudinal Prospective Cohort Study.

The objective of this study was to evaluate whether early postpartum exercise is associated with changes in pelvic symptom severity, pelvic floor muscle strength, and diastasis recti abdominis from 3 to 12 months postpartum. In this prospective cohort study, 504 participants with and without pelvic symptoms (pelvic girdle pain, stress urinary incontinence, vaginal heaviness) were followed. At 3, 6, 9, and 12 months postpartum, we assessed pelvic symptoms, exercise behavior (by questionnaires), pelvic floor muscle strength (by vaginal palpation), and diastasis recti abdominis (by caliper measurement). Based on the 3-months questionnaire, participants were categorized as non-exercisers (n = 105), minimal low-impact exercisers (n = 249), regular low-impact exercisers (n = 117), and high-impact exercisers (n = 32). Between-group differences and within-group changes from 3 to 12 months were calculated using chi-square tests, Kruskal-Wallis tests, and Friedman's ANOVAanalysis. At 3 months, no differences in symptom prevalence were seen between the groups. Non-exercisers reported higher pelvic girdle pain severity and had weaker pelvic floor muscles. The within-group analysis showed that pelvic girdle pain severity did not change in non-exercisers or high-impact exercisers, but decreased in minimal and regular low-impact exercisers. Stress urinary incontinence increased in non-exercisers from 3 to 12 months, while it remained unchanged in regular low-impact and high-impact exercisers, and decreased in minimal low-impact exercisers. Across all groups, vaginal heaviness and diastasis recti abdominis decreased and pelvic floor strength increased from 3 to 12 months. The study indicates that early low-impact exercising is associated with reduced pelvic girdle pain severity during the first postpartum year. Minimal low-impact exercisers also showed a slight reduction in stress urinary incontinence. Conversely, non-exercisers reported an increase in stress urinary incontinence between 3 and 12 months postpartum. Physical therapists should encourage women to start with low-impact exercise early after pregnancy. This study highlights the positive effects of starting gentle, low-impact exercise early after childbirth to reduce pelvic girdle pain and urinary incontinence.

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© The Author(s) 2023. Published by Oxford University Press on behalf of the American Physical Therapy Association.