Efficacy of Pilates Training on Diastasis Recti Abdominis in overweight and obesity Males

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INTRODUCTIONThe separation of two rectus abdominis muscles at Linea alba which covers the front surface of the abdomen is known as Diastasis recti abdominis DRA In the Linea alba collagen fibers from both sides of the abdominal wall muscle sheets cross in an interwoven pattern this structural characteristic ensures core stability under abdominal muscle tension which allows the accommodation of intraabdominal volume by chronic separation of the medial borders of the rectus muscles In DRA it involves gradual thinning and widening of Linea alba with general laxity of ventral abdominal wall The space formed by separation of the Linea alba in DRA called as an inter recti distance IRD DRA can develop at three levels with respect to umbilicus above below or at the umbilicus and distance of 2 cm is considered normal and larger than it called as rectus diastasis

This condition is commonly seen in the childbearing woman although it is not exclusive to this population and can also be found in men Current concepts about rectus diastasis are based on the development and treatment of RD in females but in males hormones and intra abdominal pressure play a role in the development of rectus diastasis The risk factors associated with males are increasing age weight fluctuations weightlifting full sit ups familial weakness of abdominal muscles Increased intra abdominal pressure causes tissue expansion of the abdominal wall particularly at the line alba Although certain conditions such as genetic predisposition aging obesity ascites and chronic obstructive pulmonary disease increase the risk of developing rectus diastasis

Rectus diastasis is associated with epigastric and umbilical hernias and some of researchers believe that the male abdominal wall is stiffer which contributes to the coexistence of these hernias The overall prevalence of RD in males is unknown Other common causes for Diastasis Recti are Obesity Obesity being a chronic metabolic disease leads to ill health and a common cause of disability and death as there are increased fat stores of body Approximately one third of the worlds adult population is overweight and is a growing public health concern

The Pilates method is based on six basic principles concentration control centering fluidity precision and diaphragmatic breathing The core also called the Powerhouse according to the Pilates method includes the abdominal muscles low back muscles hip extensors hip flexors and the pelvic floor muscles The exercises can be performed on specialized equipment ie equipment based Pilates or the ground using a mat with body weight serving as resistance ie mat Pilates Mat Pilates is a method of exercise that has been increasing in popularity among practitioners due to its beneficial effects We conducted this study using mat Pilates based on accessibility to a larger number of participants as equipment was not required Pilates based exercises are currently in use for several rehabilitative purposes improving isokinetic torque of the knee extensors and flexors postural balance physical fitness and reducing the risk of falls in the elderly rehabilitation improving quality of life in patients with postmenopausal osteoporosis pelvic floor muscle function and low back pain treatment

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NEED FOR THE STUDYNow a days one third of worlds population is overweight and obese which leads to morbid effect of obesity Diastasis recti abdominis DRA is a separation of two rectus abdominis muscles at Linea alba which covers the front surface of the abdomen As compared to male population large scale studies are carried out in female population and rehabilitation program is also researched to overcorrect it but very few studies are conducted in male population and is under negligence There is scant knowledge on the prevalence risk factors prevention or management about this condition There is a need for more research about the presence of DRA in overweight males so we can help to reduce the risk of associated factors like urinary incontinence fecal incontinence urogenital prolapse hernia low back pain etc and can start with early intervention strategies to correct it And hence it becomes pivotal to gather more evidence and to carry out research in this specific population

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RESEARCH QUESTIONHow Effective is the Pilates training in Approximating Diastasis recti abdominis and core muscles strength in overweight and obesity males

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AIM AND OBJECTIVES OF THE STUDYAimTo Evaluate effectiveness of Pilates based exercise training program on the Diastasis Recti Abdominis in overweight males

ObjectivesTo Assess the diameter of Diastasis Recti Abdominis muscles using Dial Vernier calliper To assess the strength of core muscles using biofeedback pressure

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HYPOTHESISNull Hypothesis H0 There will be no significant effect of Pilates based exercise training program on the Diastasis Recti Abdominis in overweight males

Altered Hypothesis H1 There will be significant effect of Pilates based exercise training program on the Diastasis Recti Abdominis in overweight males

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REVIEW OF LITERATUREShraddha Sanjay Varma Dr Jaywant Nagulkar Dr Pradnya Mahajan 2024 study was conducted to aim to investigate the prevalence and severity of DRA among overweight males a demographic often underrepresented in existing research Using a cross sectional observational design 96 male participants aged 35 years and older with a Body Mass Index BMI ranging from 25 to 29 9 kgm2 were assessed using a dial vernier calliper to measure inter recti distance Results indicated that 54 16 of participants exhibited DRA with 22 classified as having mild 28 moderate and 2 severe DRA The findings highlight the significant occurrence of DRA in overweight males suggesting a need for further research to explore its implications for health particularly concerning associated conditions like hernias and chronic pain Early intervention strategies may be necessary to mitigate the risks associated with DRA reinforcing the importance of recognizing this condition as a relevant health issue in the male population This study underscores the necessity for targeted research focusing on DRA in males to better understand its prevalence severity and associated health implications

As Gaonkar B Khedekar P 2021 conducted a study on Assessment of Diastasis Recti Abdominis using Dial Calliper in Overweight and Obese Adults and Its Relationship with Lumborhythmic pain in 90 overweight and obese adults out of which 30 overweight 30 obese 1 and 30 obese 2 and it is correlated with BMI and therefore it is concluded that there is presence of Diastasis Recti Abdominis in overweight obese 1 and obese 2 adults and they are at equal risk of having DRA it can occur in both males and females Subjects with DRA are not more likely to have lumbopelvic pain than subjects without DRA

Nienhuijs S Berkvens E Vries Reilingh T Mommers E Bouvy N J Wegdam 2021 conducted study on the male rectus diastasis a different concept as the middle aged males living with obesity are the second most common group of rectus diastasis patients the type was a non systematic review explorative free text multi database bibliographic search Study type language or time period describing aetiology symptoms classification and or treatment options were eligible for inclusion and it is concluded that Rectus diastasis affects both men and women but absolute intra abdominal pressure increase by visceral obesity and relative pressure increase by exercise seem to apply more to men

A T M van de Water a D R Benjamin a b 2015 conducted study to identify the best methods to screen for DRAM presence and monitor DRAM width Thirteen studies evaluated measurement properties of the finger width method tape measure calipers ultrasound CT and MRI Ultrasound was most evaluated Methodological quality of these studies varied widely Pearson correlations of r 0 66 to 0 79 were found between calipers and ultrasound measurements Calipers and ultrasound had Intraclass Correlation Coefficients ICC of 0 78 to 0 97 for test retest inter and intra rater reliability The finger width method had weighted Kappas of 0 73 to 0 77 for testeretest reliability but moderate agreement 63 weighted Kappa 0 53 between raters Comparing calipers and ultrasound low measurement error was found above the umbilicus and the methods had good agreement 83 weighted Kappa 0 66 for discriminative purposes The available information supports ultrasound and calipers as adequate methods to assess DRAM For other methods limited measurement information of low to moderate quality is available and further evaluation of their measurement properties is required

Private Practice Maguiresbridge County Fermanagh Northern Ireland 2019 study was conducted to Diastasis rectus abdominis DRA refers to thinning and widening of the linea alba and is associated with increased laxity of the anterior abdominal wall It is currently diagnosed in relation to inter recti distance however no definitive consensus currently exists about either relevant diagnostic criteria or the prevalence of the condition Developments in the limited research base have highlighted the importance of considering other factors beyond the gap including the function of the abdominal wall In order to assist clinicians in evaluating and managing DRA a proforma has been developed that is called PPP RR LD This acronym stands for person patterns posture respiration ribcage load and defect and represents the different aspects of assessment and management that must be addressed in individuals with DRA There is also a need for physiotherapists to increase their profile in order to become better recognized for what they can offer in the conservative management of this condition and develop services that will establish the role of physiotherapy in the pre and postoperative rehabilitation of individuals who undergo surgical repair of DRA

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