What motivated you to investigate the effects of specific abdominal exercises on inter-recti distance during pregnancy? 

My curiosity stemmed from the persistent uncertainties and controversies in clinical guidelines about abdominal exercise safety during pregnancy. Even though many women worry about diastasis recti and physical limitations in this period, there was a lack of robust evidence regarding which exercises should be encouraged or avoided. As a physiotherapist and academic specialising in women’s health, I wanted to provide clearer guidance on these issues to help both clinicians and pregnant people make informed decisions. 

Your trial found that both transversus abdominis and rectus abdominis activation exercises were safe. What message would you like physiotherapists and pregnant people to take from this finding? 

The main message is reassurance: targeted exercises for the abdominal muscles do not appear to worsen inter-recti distance or pelvic floor symptoms during pregnancy. This means that, when appropriately prescribed and supervised, these exercises can safely be part of prenatal care. I hope clinicians feel more confident including such exercises and that pregnant women and other birthing parents feel less apprehensive if they want to maintain core strength during this important time. 

Many clinicians discourage rectus abdominis (crunch-type) exercises in pregnancy. Is your trial the only trial to have debunked that recommendation? 

Our study is one of the most rigorous to directly compare both transversus abdominis and rectus abdominis-focused protocols with general exercise in this population, using a controlled trial. Previous work suggested possible links between certain exercises and increased diastasis but the evidence was scarce and conflicting. By showing no negative impact after 12 weeks, our trial adds critical evidence supporting a nuanced approach rather than a blanket restriction. 

You also looked at pelvic floor symptoms. What did you learn about the relationship between abdominal exercise and pelvic floor health in pregnancy? 

We observed that neither protocol—whether focused on transversus abdominis or rectus abdominis—worsened pelvic floor symptoms in pregnancy. Scores for pelvic floor complaints remained stable across all groups, suggesting that these types of exercises do not harm pelvic floor health in this context. However, our study did not find that abdominal exercise alone improved symptoms either, indicating that pelvic floor muscle training should remain the central approach for dysfunction treatment.

Adherence in your trial was high. What factors do you think helped women stay engaged with the program and what can clinicians learn from this? 

High adherence was likely due to the supportive environment, the group-based sessions and the clarity of communication about both the benefits and the safety of the protocols. The sense of community and encouragement fostered a positive attitude and commitment. Clinicians may benefit from incorporating group dynamics and providing ongoing education about exercise safety to help keep pregnant clients engaged. 

Looking ahead, what research questions remain about exercise, inter-recti distance and pelvic floor health in pregnancy and postpartum? 

Future studies should include more diverse populations and settings, objective assessments of pelvic floor function and longer follow-up into the postpartum period. Research should also explore different intensities and combinations of abdominal and pelvic floor exercises to determine if specific protocols offer benefits beyond safety—such as symptom relief or improved quality of life. 

>>Alana Leandro Cabral is a physiotherapist and university professor specialising in women’s health physiotherapy. She holds a PhD in Health Sciences from the Federal University of Uberlândia, Brazil. Alana is committed to advancing safe and effective prenatal care through evidence-based physiotherapy.

• References