EFFECTIVENESS OF POSTPARTUM EXERCISES ON REDUCING INTERRECTI DISTANCE: A QUASI EXPERIMENTAL STUDY AMONG
POSTPARTUM MOTHERS
Salma Nabilah Fauziyyah.
Faizah Betty Rahayuningsih Muhammadiyah University of Surakarta Corresponding Email: fbr200@ums.
ABSTRACT
Keywords Diastasis rectus abdominis (DRA) is a common postpartum condition characterized by a widening of the inter-recti distance (IRD), which may lead to postural changes, lower back pain, and decreased quality of life.
Postpartum exercise is a nonpharmacological intervention designed to strengthen abdominal muscles, improve core stability, and support the reduction of IRD.
This study aims to analyze the effectiveness of postpartum exercises in reducing inter-recti distance and improving abdominal muscle recovery among postpartum women.
A quasi-experimental pretestposttest control group design was conducted involving 90 postpartum women who met the inclusion and exclusion criteria.
Participants were assigned to treatment and control groups, with the intervention group receiving validated postpartum exercise videos performed routinely for six weeks.
IRD was measured using a standardized palpation technique with proven validity and reliability.
Additional instruments included observation sheets, muscle strength assessments, pain scales, and a postpartum quality-of-life questionnaire using the MPQOL-I (Maternal Postpartum Quality of Life Instrumen.
Data were analyzed using paired t-tests and independent t-tests with statistical significance set at p < 0.
A significant reduction in IRD was observed in the treatment group compared with the control group .
= 0.
The treatment group demonstrated greater improvement in abdominal muscle approximation, indicating a positive effect of postpartum exercises on abdominal wall Postpartum exercise is effective in reducing inter-recti distance and promoting abdominal muscle recovery in postpartum women.
It is recommended as a simple, safe, and evidence-based intervention for postpartum care.
Diastasis Rectus
Abdominis, inter recti
INTRODUCTION
The postpartum period is a crucial phase experienced by mothers after childbirth, when the body undergoes a anatomical changes that occur during pregnancy (Thabet & Alshehri, 2.
During this period, pregnancy hormone levels decrease, uterine involution occurs, and the musculoskeletal system adapts to restore the body's functions to their original state (Tadi, 2.
International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 One of the most common musculoskeletal changes during and after pregnancy is diastasis rectus abdominis (DRA), which is the separation of the rectus abdominis muscles along linea alba due to stretching of the abdominal wall to accommodate fetal growth (Benjamin et al.
This condition is commonly found in the late trimester of pregnancy through the postpartum period and can persist for a long (Radhakrishnan & Ramamurthy, 2.
The study by Aiolfi et al.
reported that the prevalence of DRA in postpartum mothers reached more than DRA is characterized by a distance of more than 2 cm between the two sides of the rectus abdominis muscle, which can affect abdominal muscle function, posture, balance, and physical appearance (Du et , 2.
This condition also affects daily activities, increases the risk of lower back pain, and reduces mothers' self-confidence (Skoura et al.
, 2.
It can also affect psychological well-being during early maternal role adaptation (Thabet & Alshehri, 2.
Several factors influence the occurrence of DRA, including maternal age, parity, fetal weight, increased body mass index, and low levels of physical activity (Mota et al.
, 2.
Increased intra-abdominal pregnancy further stretches and weakens the linea alba, which frequently does not return to normal without structured exercise (Aiolfi et al.
, 2.
A study by Rochmaedah .
stated postpartum exercise is widely recognized as an effective intervention to support maternal recovery.
It promotes muscle and joint function, strengthens pelvic floor and abdominal muscles, enhances posture, and facilitates uterine involution (Shohaimi et al.
, 2.
Evidence further shows that corestability and video-based postpartum exercise programs effectively reduce DRA and improve physical function (Laframboise et al.
,2.
However, the implementation of postpartum exercise programs in Indonesia remains suboptimal due to limited maternal knowledge, lack of guidance, and minimal emphasis on (Julianti & Astuti, 2.
Existing studies rarely use standardized and validated instructional videos, and most research evaluates outcomes separately, without assessing multiple domains such as IRD, muscle strength, mobility, pain, and quality of life within a single study.
This creates a clear gap in comprehensive, evidence-based postpartum rehabilitation research in Indonesia.
This study offers novelty by combining validated postpartum exercise measurements of IRD, and multi-domain outcome assessments within a quasiexperimental design.
The study is also guided by KolcabaAos Comfort Theory, which emphasizes enhancing physical and psychological comfort to support postpartum recovery(Smith, 2.
Therefore, this study aims to analyze the effectiveness of postpartum
exercises in reducing inter-recti distance, improving abdominal muscle strength, enhancing physical mobility, reducing postpartum pain, and improving the quality of life among postpartum
METHOD
This study employed a quasiexperimental pretestAeposttest control group design and was conducted in Tlogowungu District.
Pati Regency, and Miri District.
Sragen Regency, from July to September 2025.
A total of 90 postpartum mothers were selected using purposive sampling based on the following inclusion criteria: postpartum period of 1Ae6 weeks, inter-recti distance (IRD) greater than 2.
5 cm measured by complications, good physical condition to perform exercises, and willingness to participate in the study.
Participants were assigned to two groups consisting of 45 mothers in the intervention group and 45 mothers in the control group, with baseline characteristics assessed to ensure The independent variable International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 was postpartum exercise, while the dependent variables included IRD, abdominal muscle strength, physical mobility, postpartum pain, and postpartum quality of life.
Potential confounders such as parity, mode of delivery, and physical activity level were controlled through inclusion criteria and baseline matching.
The intervention was delivered over six weeks, three times per week, with each session lasting 10Ae20 minutes.
The postpartum exercise program comprised diaphragmatic breathing, pelvic tilts, glute bridges, heel slides, toe taps, abdominal drawing-in maneuver (ADIM), knee fallouts, head lift, and catAecow All exercises were provided through validated instructional videos accessible at the following link:
https://youtu.
be/XNoUX3wDiVg.
Participant adherence was monitored through attendance checklists and weekly supervision by trained health workers.
The control group did not receive any structured postpartum exercise program and was not given access to the instructional exercise video.
Instead, they continued receiving standard postpartum care routinely provided by local health centers, such as general health education and clinical monitoring.
To maintain equal attention and minimize Hawthorne bias, the control group underwent evaluation visits with the same frequency as the intervention group.
These evaluations included IRD measurement, abdominal muscle strength assessment using MMT, mobility assessment, postpartum pain measurement using the NRS, and MAPP-QoL All assessments in both groups were conducted by trained health personnel who were blinded to group allocation .
ingle-blin.
to ensure unbiased outcome measurement.
Diastasis rectus abdominis was measured using a standardized palpation technique at three anatomical points: 2 cm below the umbilicus, at the umbilicus, and 3 cm above the umbilicus.
To ensure uniformity of technique across assessors, standardized using an instructional video https://youtu.
be/bPs9Uacw5QA.
The palpation technique has demonstrated high validity .
= 0.
75Ae0.
(Benjamin et al.
, 2.
and excellent reliability (ICC = 0.
99Ae1.
wK Ou 0.
(Mota et al.
, 2.
Additional instruments included a functional mobility observation sheet.
Manual Muscle Testing (MMT) for abdominal strength, the Numeric Rating Scale (NRS) for postpartum pain, and the Indonesian version of the Maternal Postpartum Quality Life (MAPP-QoL) questionnaire, which has a CronbachAos Alpha Ou 0.
Data analysis began with the ShapiroAeWilk test to determine normality.
For normally distributed data, preAepost differences within each group were analyzed using the paired t-test, while comparisons between the intervention and control groups were performed using the independent t-test.
For nonparametric data, the Wilcoxon Signed-Rank Test and MannAeWhitney U Test were applied as A significance level of p < 05 was used for all statistical analyses.
Ethical approval for this study was obtained from the Health Research Ethics Committee of the Faculty of Medicine.
Muhammadiyah University of Surakarta (Approval No.
5787/B.
1/KEPK-FKUMS/Vi/2.
All participants received detailed information procedures, benefits, and potential risks, and each provided written informed Participant confidentiality and anonymity were maintained throughout the research and publication process.
RESULTS
Table 1.
Frequency Distribution of Respondent Characteristics Based on Age.
Birth Weight.
Education.
Occupation.
Number of Children.
Type of Delivery, and Physical Activity During Pregnancy .
International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025
Group
Character MotherAos Postpartu
Birth
Weight
Category Treatm
< 20
20Ae25
26Ae30
Category Private 31Ae35
3Ae4
> 35
Normal
< 2500
(BBLR)
Caesar 2500Ae (Norma.
Light Moderate -heavy Elementa ry school Occupati Character Treatm Ou 4000 (Macroso 0 Educatio Group Junior High Bachelor' s degree Housewi Entrepre Number Type of Physical Table 1 describes the baseline characteristics of the 90 postpartum mothers.
The two groups were statistically comparable .
> 0.
05 for all comparison.
, indicating successful random allocation and minimizing baseline bias.
The age distribution was similar, with the largest proportion falling within 26Ae30 years .
0% in the treatment group and 2% in the control grou.
Most newborns had normal birthweight .
1% in the treatment group and 86.
7% in the control High school education was the most prevalent level .
8% in both group.
The majority were housewives .
6% vs 8%).
Regarding parity, 51.
1% of mothers in the treatment group had two children, 3% of mothers in the control group had one child.
Most respondents delivered vaginally .
7% vs 73.
3%) and engaged in International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 light physical activity during pregnancy .
4% vs 86.
7%).
Overall, chi-square tests confirmed no significant differences between groups across all baseline variables .
> 0.
ensuring both groups were homogeneous before the intervention.
Table 2.
Average Abdominal Rectus Diastasis (IRD) Measurements per Point Before and After Postnatal Exercise IRD Measur Points Pret st Treatment Point A 3.
cm 3 Above Umbili Point B 8 .
t Umbili Point P .
cm Below Umbili Control Point A .
cm Above Umbili Point B .
t Umbili Differ .
<0.
<0.
<0.
<0.
<0.
Pret st
IRD
Measur Points Differ .
Treatment Point P .
cm Below Umbili Based on Table 2, there was a significant reduction in inter-recti distance (IRD) at all measurement points among mothers in the intervention group after six weeks of postpartum exercise.
IRD
decreased by 1.
36 cm above the umbilicus, 17 cm at the umbilicus, and 1.
03 cm below the umbilicus .
aired t-test, p < 0.
These reductions represent strong clinical improvements with a large effect size.
Meanwhile, the control group showed only minimal natural reductions .
54 cm, 0.
cm, and 0.
20 c.
Independent t-tests confirmed that the magnitude of IRD reduction in the intervention group was significantly greater than in the control group .
< 0.
These findings indicate that postpartum exercise accelerates recovery of abdominal muscle separation more effectively than spontaneous healing.
Table 3.
Posttest Continuous Outcomes (Total IRD.
Pain, and Quality of Lif.
with t-Test and Effect Size (CohenAos .
Variable Treatm contr t/Z/ pCohen
value sAod
Mean A Mea
n A Total
IRD
25 A 6.
<0.
International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 Variable Treatm contr t/Z/ pCohen value sAod Mean A Mea n A Size .
Postpart 3.
13 A 6.
21 <0.
um Pain 0.
Quality 71.
87 A 66.
<0.
of Life 2.
0 A 60
Based on Table 3, the post-test analysis of continuous outcomes shows significant differences between the intervention and control groups across all The mean total IRD in the intervention group was substantially lower than in the control group .
25 A 0.
20 cm vs 16 A 0.
26 c.
, with t = Ae39.
49 and p < The CohenAos d value of 8.
33 indicates an extremely large effect size, demonstrating that postpartum exercise produced a highly meaningful reduction in IRD.
Regarding postpartum pain, the intervention group reported noticeably lower pain scores .
13 A 0.
than the control group .
21 A 1.
The difference was statistically significant .
= Ae7.
23, p < 0.
with CohenAos d = 3.
08, showing that the intervention had a strong effect in reducing pain intensity.
In terms of quality of life (QoL), the intervention group achieved higher mean scores .
87 A 2.
compared to the control group .
80 A 2.
This difference was also significant .
= 10.
60, p < 0.
and the effect size was large (CohenAos d = .
, indicating that postpartum exercise contributed meaningfully to improving the overall quality of life among postpartum Table 4.
Post-test Comparison of Abdominal Muscle Strength and Physical Mobility Between Groups Varia Categ Treat con NA
ment trol
n (%) Abdo
Muscl
Stren
Weak
Norm
Stron
(%)
Physi Mobil Diffic Norm Free <0.
<0.
Based on Table 4, there was a significant difference in abdominal muscle strength between the intervention and control groups.
Most participants in the intervention group were categorized as strong .
7%), whereas the control group was predominantly classified as normal or The Chi-square test confirmed that the difference in distribution was highly significant (NA = 35.
27, p < 0.
These findings indicate that postpartum exercise effectively improved abdominal muscle For the variable of physical mobility, the distribution of categories did not differ significantly between the two Although the intervention group showed a higher proportion of participants in the free movement category, the Chi-square test indicated no statistically significant difference (NA = 4.
46, p = 0.
This suggests that the postpartum exercise program in this study did not have a significant impact on physical mobility DISCUSSION DRA Changes After Intervention Based on the findings of this study, most postpartum mothers in both Tlogowungu (Pat.
and Miri (Srage.
exhibited a widened diastasis recti abdominis (DRA) during the early postpartum period.
At the pre- International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 intervention assessment, the majority of respondents demonstrated an inter-recti separation greater than 2,5 cm at all three measurement points, with the largest gap typically observed supra-umbilically .
bove the umbilicu.
This pattern is consistent with the findings of Benjamin et al.
who reported that the supraumbilical region is the most vulnerable to widening due to increased intraabdominal pressure during pregnancy.
After completing a six-week exercise program, the intervention group showed a significant reduction in DRA across all three measurement points, whereas the control group experienced only a slight decrease, likely attributable to natural postpartum healing.
This outcome aligns with evidence from Aiolfi et al.
and Thabet & Alshehri .
, which indicates that active exercises involving tranversus abdominis and rectus abdominis activation accelerate linea alba closure through improved core stability and increased fascial tension.
Theoretical Framework (KolcabaAos Comfort Theor.
KolcabaAos Comfort Theory supports the findings of this study because the postpartum exercise program enhanced physical comfort through pain reduction, psychospiritual comfort by reducing anxiety and improving confidence, and functional comfort through improved mobility and strength.
By fulfilling these dimensions, the intervention aligns with Comfort Theory and demonstrates that structured postpartum exercise can serve as an effective, holistic nursing intervention (Smith, 2.
Abdominal Muscle Strength Abdominal intervention group after six weeks, whereas the control group exhibited only This enhancement resulted from targeted exercises such as the Abdominal Drawing-in Maneuver (ADIM), bridging, heel slides, and pelvic tilts that specifically activate the transversus abdominis and rectus abdominis.
Yulianti et al.
stated that repeated core activation over 4Ae6 weeks induces neuromuscular adaptation, leading to increased muscle strength.
Structural support this improvement.
Skoura et al.
reported that core-focused exercise enhances fascial tension and contributing directly to stronger abdominal wall support.
Lee et al.
further found that transversus abdominis activation increases abdominal muscle thickness and overall trunk stability, aligning with the strength improvements observed in this study.
Improvement in Physical Mobility Physical mobility also improved markedly in the intervention group.
Core and rhythmic movements enhance neuromuscular coordination, flexibility, and blood flow, resulting in reduced stiffness and better movement tolerance (Ma et al.
, 2.
These results are consistent with Prasetyaningati et al.
, , who reported improved functional mobility following structured postpartum exercise.
Physiologically, mobility may be attributed to increased blood circulation and oxygen delivery to the musculature, accelerating tissue repair and reducing stiffness (Purnami et , 2.
Postpartum Pain The intervention group showed a more pronounced reduction in postpartum pain compared with the control group.
Widyaningsih .
explained that postpartum exercises reduce muscle tension, improve circulation, and lower Deep-breathing movements and controlled exercises stimulate the release of endorphins, natural analgesics that enhance comfort and mood.
Aisyah et al.
also found that gentle postpartum exercise reduces perineal discomfort and improves sleep Meanwhile, minimal activity in the control group contributed to slower pain reduction.
Quality of Life International Journal of Nursing and Midwifery Science (IJNMS).
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December 2025 After six weeks, the intervention improvements in quality of life, particularly in physical function, emotional well-being, and daily activity These findings align with Rahayuningsih .
, who highlighted that postpartum exercise enhances mood, reduces stress, and promotes physical fitness through increased endorphin and serotonin production.
Wahdakirana .
also reported that postpartum exercise improves social functioning and maternal confidence.
In this study, the instructional videos and adherence monitoring encouraged consistent exercise among the intervention group, leading to greater Meanwhile, the control group experienced only limited gains Geographical access further influenced outcomes, with mothers in Miri benefiting more due to easier access to health services.
Influence of Cultural and Geographical Factors Postpartum cultural practices strongly influenced DRA reduction, participation in this study.
Many mothers in Tlogowungu and Miri avoided physical activity due to persistent pain and cultural beliefs that Aumothers must rest and avoid excessive movementAy during the postpartum period.
This decreased early motivation to exercise, especially in the control group, which did not receive education or instructional This aligns with Belema et al.
, who showed that cultural fear of postpartum activity slows abdominal muscle recovery.
Geographical factors also shaped the outcomes.
Miri District has easier access to health facilities compared with Tlogowungu, allowing more frequent contact with health workers and better understanding of the safety and benefits of postpartum exercise.
This explains higher adherence in MiriAos intervention Mechanisms Underlying Improvements Improvements across all outcome variables stem from interconnected psychosocial mechanisms.
Core muscle activation increases linea alba tension and enhances abdominal wall support (Aiolfi et al.
, 2.
Rhythmic movements improve blood circulation, facilitating tissue regeneration and reducing stiffness.
Exercise also modulates the autonomic nervous system by increasing parasympathetic activity, reducing muscle tension and pain.
Psychologically, release improves emotional stability and reduces anxiety.
Cultural factors modulate these mechanisms: mothers with initial fear of movement gained demonstrations, improving adherence and accelerating recovery.
These combined pathways highlight postpartum exercise as a holistic intervention beneficial for both physical and psychological recovery.
Comparison With Existing Literature These findings are consistent with earlier studies demonstrating that postpartum exercise reduces IRD (Rochmaedah et al.
, 2.
, increases abdominal strength (Yulianti et al.
, reduces pain (Widyaningsih, 2.
, and improves quality of life (Rahayuningsih.
Minor improvements in the control group align with Anggraini .
, who noted that natural physiological recovery continues during the postpartum period.
Clinical Implications The importance of integrating video-guided postpartum exercise programs into Such interventions are practical, low-cost, and can be delivered in both urban and rural Nurses can incorporate these evidence-based postpartum care and provide follow-up support through community visits or digital platforms (Mhsc et al.
, 2.
International Journal of Nursing and Midwifery Science (IJNMS).
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Limitations and Potential Measurement Bias Despite positive outcomes, several limitations exist.
Palpation, although validated, may introduce measurement bias compared with ultrasound (Mota et , 2.
The absence of long-term follow-up limits conclusions regarding Self-reported adherence may introduce reporting bias.
Geographical differences in access to health services may influence motivation and baseline knowledge.
Cultural beliefs discouraging movement may also influence participation, particularly in early postpartum weeks.
Future studies measurements, objective adherence monitoring, and longitudinal design.
Overall Summary of Discussion postpartum exercise supported by validated instructional videos effectively reduced DRA, increased strength, improved mobility, reduced pain, and enhanced quality of life.
These improvements were achieved through psychological mechanisms.
Despite some limitations, the findings strongly support the integration of postpartum exercise into routine postpartum care.
CONCLUSIONS
This study demonstrates that postpartum exercise is an effective and practical intervention to support maternal recovery in the early postpartum period.
The six-week program significantly reduced diastasis recti abdominis, improved abdominal muscle strength and physical mobility, decreased postpartum pain, and enhanced quality of life compared with natural recovery.
Although cultural beliefs and access to health services influenced video-guided successfully increased maternal confidence and participation.
Therefore, postpartum exercise should be integrated into routine postpartum care as a safe, accessible, and evidence-based approach to promote holistic maternal health.
REFERENCES