BACKGROUND: Verify the effects of conservative approaches for treating diastasis recti abdominis in postpartum women. METHODS: PubMed, Embase, CENTRAL, CINAHL, SportDiscus, LILACS, and PEDro were searched, until March 15, 2024. The methodological quality of randomized clinical trials (RCTs) was assessed using the PEDro scale. Meta-analyses were conducted using the mean difference (MD) between groups for interrectus distance (IRD) in millimeters (mm). RESULTS: After screening, 34 RCTs were included in the systematic review, of which 21 presented a low risk of bias. Very low certainty evidence demonstrated significant effects for IRD reduction in favor of abdominal exercises versus no intervention (MD -6.82 mm) and for abdominal exercises plus multi-interventions versus abdominal exercises only (MD -3.56 mm). Subgroup analyses demonstrated that significant IRD reduction occurs only with isotonic abdominal exercises (MD -3.78 mm) and that the best co-intervention with abdominal exercises is electrical stimulation (MD -4.43 mm). CONCLUSION: Isotonic abdominal exercises, especially when combined with electrical stimulation, represent the best conservative treatment option for improving postpartum diastasis recti abdominis. However, due to the very low certainty of the evidence, these results should be interpreted with caution, and further well-designed RCTs with high methodological quality are needed to confirm these findings.

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