QUESTIONS: What are the effects of transversus abdominis (TrA) or rectus abdominis (RA) activation exercises, compared with general exercise without specific abdominal activation, on the inter-recti distance (IRD) in pregnant women? How do TrA and RA activation exercises compare with general exercise for their effects on pelvic floor dysfunction? DESIGN: Three-arm randomised controlled trial with assessor blinding, concealed allocation and intention-to-treat analysis. PARTICIPANTS: Sixty-three primigravida pregnant women at 18 to 21 gestational weeks. INTERVENTION: The control group performed general exercises without abdominal focus. In addition to the control group intervention, the drawing-in group added TrA activation exercises, and the abdominal crunch group added RA-targeted exercises. All groups completed 24 sessions over 12 weeks. OUTCOME MEASURES: The primary outcome was change in IRD (mm), measured 2 cm above and below the umbilicus, at rest and during active trunk flexion. The secondary outcome was the Pelvic Floor Bother Questionnaire, which scores the severity of symptoms of pelvic floor dysfunction. RESULTS: All groups showed a similar increase in IRD after intervention. No substantial differences were observed between either targeted exercise group and the control group. At 2 cm above the umbilicus, general exercises had a similar effect to the in-drawing TrA exercises (between-group difference 6 mm, 95% CI -3 to 15) or the RA exercises (4 mm, 95% CI -5 to 12) at rest. Similar or smaller between-group differences occurred below the umbilicus and during trunk flexion. Similar or smaller between-group differences occurred between the drawing-in and abdominal crunch groups. No substantial between-group differences were found in pelvic floor dysfunction symptoms. CONCLUSION: A 12-week abdominal exercise program focusing on TrA or RA activation did not substantially change IRD or pelvic floor dysfunction symptoms compared with general exercise; this suggests that pregnant women do not need to avoid targeted TrA or RA exercises. REGISTRATION: RBR-4v2r4bg.

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