TO STUDY THE INFLUENCE OF SWISS BALL EXERCISE ON DIASTASIS RECTI IN POST PARTUM WOMEN

Research Paper

E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 9 | SEP 2017

TO STUDY THE INFLUENCE OF SWISS BALL EXERCISE ON DIASTASIS RECTI IN POST PARTUM WOMEN DR.K.MADHAVI 1 | DR.G.KAMESHWARI 2 | S.R.DIVYA 3 1 MPT

(CT), PHD, PROFESSOR, PRINCIPAL, COLLEGE OF PHYSIOTHERAPY, SVIMS. MPT (NEURO), LECTURER, COLLEGE OF PHYSIOTHERAPY, SVIMS. 3 MPT(CT),COLLEGE OF PHYSIOTHERAPY, SVIMS. 2

ABSTRACT Introduction: Diastasis recti abdominis is defined as separation of right and left rectus abdominis muscle bellies within their respective sheath as a result of partitioning at the linea alba. .A widening of > 2.7 cm at the level of the umbilicus is considered a pathological diastasis of the rectus abdominis muscle. Diastasis recti abdominis occurs in 60% of postpartum women. 52% of DRA cases occurs at umbilicus. 36% arises above the umbilicus. 11% occurs below the umbilicus.

Aim: To study the influence of Swiss ball exercise on diastasis recti in post partum women.

Objectives: 1. To evaluate the influence of swiss ball exercises on diastasis recti measurement through vernier caliper in post-partum women with diastasis recti.

2. To evaluate the influence of swiss ball exercises on abdominal muscle activity through EMG in post-partum women with diastasis recti.

3. To evaluate the influence of swiss ball exercises exercises on abdominal muscle strength through MMT in post partum women with diastasis recti.

4. To evaluate the influence of swiss ball exercises on waist hip ratio and body mass index in post partum women with diastasis recti.

5. To evaluate the influence of abdominal exercises on diastasis recti measurement through vernier caliper in post-partum women with diastasis recti.

6. To evaluate the influence of abdominal exercises on abdominal muscle activity through EMG in post-partum women with diastasis recti.

7. To evaluate the influence of abdominal exercises exercises on abdominal muscle strength through MMT in post partum women with diastasis recti.

8. To evaluate the influence of abdominal exercises on waist hip ratio and body mass index in post partum women with diastasis recti.

Methodology: 30 samples are randomly divided into 2 groups, 15samples in each group. For Experimental group – I Swiss ball exercises, Experimental group –II abdominal exercises are given. Pre and post values of diastasis rectus abdominis muscle gap through vernier caliper, muscle activity by EMG biofeedback, MMT through MRC grading, BMI and WHR were measured.

Result: The pre and post group-1 mean values, t-values and p-values of all the five outcomes that is diastasis recti gap, muscle activity, Muscle strength, Waist Hip Ratio and Body Mass Index shows statistically highly significant values then the group-1.

Conclusion: The study concluded that the swissball exercises showed more improvement than the abdominal exercises on diastasis recti among the postpartum women.

Keywords: Diastasis Recti, EMG Biofeedback, Vernier Caliper, Swiss Ball. leads to postnatal haemorrhage, endometriosis, INTRODUCTION depression, diastasis recti. Diastasis rectus is the most Of all the creations of nature, the most beautiful is common complication after pregnancy. evolution of women. “Ability to procreate” is the gift of Diastasis recti abdominis is defined as separation of right women. “Pregnancy” is considered as the most important and left rectus abdominis muscle bellies within their phase in a women’s life. Many changes occur during respective sheath as a result of partitioning at the linea pregnancy and after delivery. Anatomical, physiological alba.1 A widening of >2.7cms at the level of umbilicus is and hormonal changes occurring in the postpartum period considered a pathological diastasis of the rectus abdominis

INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL

43

Research Paper

E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 9 | SEP 2017

muscle.2 The severity ranges from mild 2.5 to 3.4cms wide and upto 12cms long with or without bulging, to severe greater than 5cms wide and upto the entire length of rectus muscle.1 Diastasis recti abdominis occurs in 60% of postpartum women. 52% of DRA cases occurs at umbilicus. 36% arises above the umbilicus. 11% occurs below the umbilicus.3,4 DRAM occurs due to hormonal elastic changes of the connective tissue, mechanical stresses placed on the valve by the growing fetus and displacement of the abdominal organs. Elevated levels of progesterone and the hormone relaxin cause laxity in the joints and soft tissue in order to pre prepare the body for the growing uterus and for childbirth. The hormones also act inside the muscles of the rectus abdominis and on the connective tissue between them (the linia alba), causing the two halves of the rectus abdominis drift apart from their normally parallel position.5, 6 This is the common condition that varies in severity from woman to woman. It will mechanically interfere with the supportive and expulsive function of the abdominal wall unless it is recognised and treated. In some women gross diastasis will actually be visible when they try to sit up or lie down. It is essential that any woman who has an initial diastasis of more than 4 fingers wide is reviewed at 6-8weeks. It is not advisable for a woman to begin another pregnancy before full recovery of the recti.5, 6 The risk factors of diastasis recti are age, women over the age of 35, high birth weight of child, multiple birth pregnancy, caesarean section.7, 8 In DRAM patients the common problems are pain , muscle weakness, urinary incontinence abdominal bulge, abdominal obesity that will leads to complications such as diabetes mellitus, pelvic organ prolapse, general fatigue, faecal incontinence, inability or difficulty with exercise, poor posture, muscular imbalance, pain in the pelvis and in the lower extremities.7,8 Diastasis recti can be corrected conservatively and surgically. Diastasis rectus is also corrected during the cosmetic surgery procedure known as an abdominoplasty.

Conservative treatment includes abdominal strengthing exercises, Bracing, Tupler technique, and electrical stimulation. Exercises program during pregnancy and after childbirth are designed to minimize impairments, to regulate tone and structural normality.8 Studies included in the systematic review of Benjamin et al. (2014) found that exercise may or may not reduce the size of the gap in postpartum women with diastasis recti and another study by Acharry and Kutty (2015) suggested that abdominal exercises with bracing can reduce diastasis recti among postpartum women.2, 9 Manual therapy (38.4%), abdominal binding (35%), and electrical stimulation (34%), were used by the participants to decrease DRAM. Studies have proved that all the above methods were useful in reducing DRAM. The long-term usage of the above regimens in continuation of

institutional based programmes for longer periods is found to be lacking. Home based exercises are found to be more comfortable and accessible for postpartum women.1 Abdominal exercises and swiss ball exercises can be used as a home based exercises regimen. Apart from regular abdominal exercises, objective swiss ball exercises can be incorporated to enhance abdominal tone and muscle structure. Swiss ball (size-75, NLW exercise ball) is type of therapeutic tool used to enhance the muscle tone, structure, balance, control and coordination of movements. Hence it is proposed to study the influence of swiss ball exercises on diastasis recti in postpartum women as a part of home based exercises.

Swiss ball is constructed of soft elastic with a diameter of approximately 35 to 85centimeters and filled with air. The principle of using swiss ball is the instability of the ball caused by its round shape with the smooth, hard surface of the floor which is stable. The primary benefit of swiss ball is opposed to exercising directly on a hard flat surface is that the body responds to the instability of the ball to remain balanced, achieving a greater activation of core musculature. The major benefit of using an unstable surface is the ability to recruit more muscle units without the need to increase the total load. 10

NEED OF THE STUDY: Many of the studies were done

to find out the effectiveness of abdominal binder and exercises in post partum individuals. Very few studies were done to improve the muscle strength of abdominals through swiss ball. There is a need to improve the abdominal muscle strength in postpartum women as there is much evidence on prevalence of complications like abdominal weakness leading to umbilical hernia, abdominal obesity and back pain which in long run leads to diabetes. Hence the aim of this study is to influence of swiss ball exercises on diastasis recti inpost partum women.

AIM OF THE STUDY: To study the influence of swiss ball exercise on diastasis recti in post partum women.

OBJECTIVES OF THE STUDY 1.

To evaluate the influence of swiss ball exercises on diastasis recti measurement through vernier caliper in post-partum women with diastasis recti.

2.

To evaluate the influence of swiss ball exercises on abdominal muscle activity through EMG in post-partum women with diastasis recti.

3.

To evaluate the influence of swiss ball exercises exercises on abdominal muscle strength through MMT in post partum women with diastasis recti.

4.

To evaluate the influence of swiss ball exercises on waist hip ratio and body mass index in post partum women with diastasis recti.

5.

To evaluate the influence of abdominal exercises on diastasis recti measurement through vernier

INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL

44

Research Paper

E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 9 | SEP 2017

caliper in post-partum women with diastasis recti.

6.

To evaluate the influence of abdominal exercises on abdominal muscle activity through EMG in post-partum women with diastasis recti.

7.

To evaluate the influence of abdominal exercises exercises on abdominal muscle strength through MMT in post partum women with diastasis recti.



Hernia.

STUDY SETUP: Thirty patients with age between 20-35 years old individuals who are delivered and admitted in department of OBG (maternity) and department of physiotherapy in Svims University, Tirupati, Andhra Pradesh were taken up for the study.

STUDY PERIOD AND DESIGN:

HYPOTHESIS

The study design adopted for the study was Prospective Randomised Clinical Trail, the course of selection of study samples, their hospital investigation, data recording etc, were conducted during a period of 3 months October 2016 to January 2017.

Alternative Hypothesis:

SAMPLE SIZE AND METHOD:

The swiss ball exercises has positive impact on diastasis recti gap, abdominal muscle activity, abdominal muscle strength, waist hip ratio and body mass index.

In a total of thirty samples, the control group was represented by 15 samples while the study group consists of 15 samples who met the inclusion criteria were taken up for the study. Samples were selected through simple random sampling technique. 1 to 30 numbers are written on the small slips of paper. The papers slips are thoroughly mixed and slips are picked up for the study group and control group equally. Patients were randomly divided into 2 groups of 15 patients in each group. Group-1(swiss ball exercises), Group–2 (abdominal exercises), which are supervised. Baseline values like, diastasis recti measurement, Muscle activity, manual muscle testing, waist hip ratio, BMI are recorded before intervention and 3months after intervention.

8.

To evaluate the influence of abdominal exercises on waist hip ratio and body mass index in post partum women with diastasis recti.

Null hypothesis: The swiss ball exercises may not have any impact on diastasis recti gap, abdominal muscle activity, abdominal muscle strength, waist hip ratio and body mass index.

MATERIALS AND METHODOLOGY After reviewing the problems of diastasis recti , review of literature, aims and objectives let us discuss the materials and methodology of the present study

Materials: 

Swiss ball to train abdominal muscles.(NLW exercise ball)



EMG to measure abdominal muscle activity (Enraf nonius 6-series CE0197).



Vernier Caliper is used to measure diastasis recti in centimeters (IME type made of stainless steel).



Muscle power: Manual Muscle Testing in units



Inch tape to measure WHR in centimetres



BMI (grandiometry height and weight)

STUDY SUBJECTS: Inclusive Criteria: 

Post partum –caesarian from 12 day to 3months



Multiple pregnancies



Polyhydroaminos



Diastasis recti distance above 3cms.

Exclusive Criteria: 

Medical disorders



Normal delivery



Anemia



Hypertension

At baseline, recruited patients will undergo a detailed clinical examination as per the attached proforma.

Diastasis recti gap is measured using Vernier calliper.

Abdominal muscle activity is assessed by using EMG biofeedback (Enraf nonius 6-series CE0197). To record the rectus abdominis activity, a pair of electrodes was placed on both left and right aspects of the umbilicus in such a way oriented parallel with the muscle fibers. For the left and right external obliques, a pair of electrodes was placed above the anterior superior iliac spine, half way between the iliac crest. A ground electrode is placed on the tibial tuberosity and then patient is asked to perform 5 different exercises. Manual muscle testing for upper abdominal, lower abdominal and lumbar stabilisation muscles strength has to be done of grades 0 to 5. A detailed anthropometric assessment including measurement of weight, height will be taken and body mass index will be calculated. Waist/hip ratio was calculated by dividing the waist circumference by the hip circumference. Waist circumference was measured at the narrowest level between the costal margin and the iliac crest at the end of gentle expiration, and the hip circumference was measured at the widest level over the buttocks with the patient standing.

After recording the baseline values for experimental group-1, who met the inclusive criteria, underwent swiss ball exercises with intensity-10 repetitions, frequency-3sets, and duration-20minutes for 3times in a

INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL

45

Research Paper

E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 9 | SEP 2017

week for 3 months. For experimental group-2 underwent abdominal exercises with intensity-10 repetitions, frequency-3sets, and duration-20minutes for 3times in a week for 3 months.

The exercise protocol consists of 5 exercises for both the groups.

1.

2.

3.

4.

5.

Hallowing exercises Straight arm crunch Bent knee crunch Double straight leg rising Head lift with pelvic tilt.

Outcome Measures: 1.

2.

3.

4.

5.

Diastasis recti measurement in centimeters through vernier caliper and finger palpation technique.

Muscle activity through EMG biofeedback in millivolts.

Manual Muscle Testing through MRC grading scale in units.

BMI through formula (weight in kgs/height in mts²).

WHR through formula (waist circumference/hip circumference) in ratio.

diastasis recti gap in group-1 and group-2.

Grou ps

N

Intervent ion

Mean ± SD (cms)

D f

Group -1

3 0

Pre interventi on

8.71±0.

17

Post interventi on

5.38±0.

87

Pre interventi on

6.14±1.

22

Post interventi on

3.55±0.

79

Group -2

3 0

t-te st

p-valu es

1 4

2.41

0.000

1 4

1.86

0.000

Graph-1: graphical representation of pre and post mean values of diastasis recti gap in group-1 and group-2. x-cms 10

8.71

8

Diastasis recti gap 6.14

5.38

6

3.55

4 2

Figure-1 represents the measuring diastasis recti gap through vernier caliper

Figure -2: represents the Measuring muscle activity through EMG biofeedback

STATISTICAL ANALYSIS Statistical analysis has been carried out to analyze the significant impact of the protocol issued to the subjects of both the groups by using SPSS 20.0 version. For that the data has entered into Microsoft excel sheet and tabulated then it has subjected to statistical analysis. Normally distributed continuous variables will be presented as mean ± standard deviation (SD). Within group comparison between pre and post values will be done by the paired‘t’ test for normally distributed data and the repeated measures. P < 0.01 will be taken as significant.

According to the obtained values, the pre and post group-1 mean values, t-values and p-values of all the five outcomes that is diastasis recti gap, abdominal muscle activity, abdominal muscle strength, Waist Hip Ratio and Body Mass Index shows statistically highly significant values then the group-1.

RESULTS

0 group-1 pre intervention

post intervention

group-2

The graphical representation shows that the pre and post mean values of diastasis recti gap are significant in both the groups, the post group-1 mean values are highly significant than group-2.

Table no 2: analysis of pre and post mean values of abdominal muscle activity in group-1 and group-2.

Groups

Group-1 minimu m

Group-1 maximu m

N

3 0

3 0

Interventi on

Mean ± SD(µv)

Pre interventio n

8.61+1.7 2

Post interventio n

12.53+2.

56

Pre interventio n

1.96+0.3 1

t-tes t

P value s

1 4

4.11

0.000

1 4

3.02

0.000

D f

Table no 1: analysis of pre and post mean values of INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL

46

Research Paper

Group1 average

Group-2 minimu m

Group-2 maximu m

Group-2 average

3 0

3 0

3 0

3 0

E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 9 | SEP 2017

Post interventio n

4.22+0.7 0

Pre interventio n

16.22+3.

13

Post interventio n

22.61+4.

16

Pre interventio n

2.31+0.5 1

Post interventio n

4.16+0.8 1

Pre interventio n

3.61+0.4 2

Post interventio n

5.24+1.6 3

Pre interventio n

15.43+2.

88

Post interventio n

19.31+3.

86

Grou ps

1 4

5.26

N

Grou p-1 UA

0.000

1 5

Grou p-1 LA 1 4

1 4

1 4

1.97

1 5

0.00 Grou p-1 LS

2.06

3.88

Grou p-2 UA

0.000

1 5

Grou p-2 LA

0.000

Graph-2: graphical representation of pre and post mean values of abdominal muscle activity group-1 and group-2.

1 5

1 5

Grou p-2 LS

1 5

Table no 3: analysis of pre and post mean values of abdominal muscle strength in group-1 and group-2.

Mean ± SD (units ) 3.02+ 0.68

Pre

5.15+ 1.62

Post

3.64+ 0.70

Pre

6.25+ 1.71

Post

2.16+ 0.46

Pre

5.73+ 1.66

Post

3.81+ 0.56

Pre

5.16+ 1.66

Post

1.69+ 0.34

Pre

4.55+ 0.87

Post

3.61+ 0.79

Pre

6.15+ 1.70

Post

d f

t-val ues

p-val ues

1 4

2.86

0.000

1 4

3.01

0.000

1 4

2.89

0.000

1 4

1.97

0.00

1 4

2.11

0.000

1 4

2.88

0.000

Graph -3: graphical representation of pre and post values of Manual Muscle Testing in group-1 and group-2.

un 7 its

The graphical representation shows that the pre and post mean values of EMG biofeedback are significant in both the groups, the post group-1 mean values are highly significant than group-2.

Interve ntion

6 5 4 3 2 1 0

6.25 5.15

3.02

Muscle strength 5.73

5.16

UA

4.55

3.81

3.64 2.16

LA

6.15 3.61 1.69

LA LS UA LS group-1 pre intervention group-2

The graphical representation shows that the pre and post mean values of Manual Muscle Testing are significant in both the groups, the post group-1 mean values are highly significant than group-2.

Table no 4: analysis of pre and post mean values of INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL

47

Research Paper

E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 9 | SEP 2017

WHR in group-1 and group-2.

Group s Group -1

Group -2

N

1 5

1 5

Interventi on

Mean± SD (units)

d f

t-valu es

p-valu es

Pre interventio n

0.89±0.

18

1 4

2.17

0.000

Post interventio n

0.84±0.

16

Pre interventio n

0.87±0.

17

1 4

1.94

0.000

Post interventio n

0.83±0.

15

Graph-4: graphical representation of pre and post mean values of Waist Hip Ratio in group-1 and group-2.

Post interventi on

24.13+5.

22

Graph-5: graphical representation of pre and post mean values of Body Mass Index in group-1 and group-2.

The graphical representation shows that the pre and post mean values of BMI are significant in both the groups, the post group-1 mean values are highly significant than group-2.

DISCUSSION In the present study total 30 samples were taken up for the study and randomly allocated into 2 groups (group-1 and group-2). Group-1 underwent swissball exercises, group 2 underwent abdominal exercises for diastasis recti gap, muscle activity, muscle strength, waist hip ratio and body mass index are the outcome measures recorded pre and post therapeutically in both groups.

Pre and post mean values of diastasis recti gap (in cms) in group-1 and group-2: (table-1) The graphical representation shows that the pre and post mean values of WHR are significant in both the groups, the post group-1 mean values are highly significant than group-2.

Table no 5: analysis of pre and post mean values of BMI in group-1 and group-2.

Grou ps

N

Group -1

1 5

Group -2

1 5

Interventi on

Mean± SD (units)

Pre interventi on

31.35+6.

84

Post interventi on

25.10+5.

31

Pre interventi on

28.88+6.

01

d f

t-valu es

p-valu es

1 4

7.82

0.000

1 4

5.14

0.000

The Pre and post mean values of diastasis recti gap in group-1 has shown decreased mean value of 8.71±0.17 (pre) to 5.38±0.87 (post). Where as in group-2, have shown decreased mean value of diastasis recti gap 6.14±1.22 (pre) to 3.55±0.79 (post). The mean percentage change of diastasis recti gap values is 2.41% in group-1, where as 1.86% in group-2. The values are significant at p=0.00l level.

Exercises using swiss ball improves the intra abdominal pressure that contributes to mechanical spine stability through co-activation of trunk flexors and extensors musculature. As the abdominals contract, intra abdominal pressure increases and converts the abdomen into a rigid cylinder that greatly increases the stability of the spine, improves abdominal strength and decreases rectus abdominis separation. Abdominal exercises performed on a Swiss ball have been widely used in both rehabilitation and clinical settings. The unstable surface of the Swiss ball may ease the stress around the hip and low back region and alter proprioceptive demands thereby enhance motor control of the local core muscles which are important for

INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL

48

Research Paper

E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 9 | SEP 2017

balance and stability. The swiss ball enables the patient to move without strain. Hanan S. El-Mekawy et al concluded that postpartum women after performing abdominal exercises program resulted in a greater increase in abdominal muscles strength and significant decrease in inter-recti distance.21 Sanjivani Ramesh Khandale, Deepali Hande stated that abdominal exercises are very effective in reducing diastasis recti in early postpartum women. It helps to increase the abdominal muscle strength and restoring postpartum abdominal efficiency.22 Nisha Acharry, Rahul Krishnan Kutty stated that abdominal exercise was very effective in reducing diastasis recti in early post partum females.9 Snijders et al reported that therapeutic exercises activates both slow twitch (ST) and fast twitch (FT) fibers of skeletal muscles, with increased fiber ATPase and cross-bridge cycling speed might be attributable to an increased expression of fast MLCs in the slow fibers. Gauri Shankar, vinod chaurasia concluded that core stabilization exercises with swiss ball is effective in improving trunk endurance.21All the above studies reveal that swiss ball exercises are effective in reducing diastasis recti gap in post partum women which supports group-2 of present study.

Pre and post mean values of muscle activity through EMG biofeedback in group-1 and group-2: (table-2) The Pre and post mean values of muscle activity in group-1 shows increased mean value of 16.22+3.13 (pre) to 22.61+4.16 (post). Where as in group-2 showed an enhanced mean value of muscle activity 15.43+2.88 (pre) to 19.31+3.86 (post). The mean percentage change of muscle activity values is 5.26% in group-1, where as 3.88% in group-2. The values are significant at p=0.001.

By using swiss ball exercises, the increase in muscle activity is probably due to increased requirement. The use of swiss ball appears to increase muscle activity levels and co-activation. The labile surface of the Swiss ball contributes to the contrasting activation strategies of the rectus abdominis muscles. It has been speculated, that the unstable surface provided by the ball alters proprioceptive demands thereby stimulating the core muscles to a greater extent than stable services. Clark,K.M., et al proves that exercises on swiss ball yields a greater amount of muscle activity compared to exercises on stable platform.24 Emil Sundstrup, Markus D. Jakobsen stated that exercises on a Swiss ball with added elastic resistance induces high rectus abdominis activity accompanied by low hip flexor activity which could be beneficial for individuals with low back pain.18 Michael Duncan et al concluded that more than 60%of muscle activity is recorded in both URA and LRA using swiss ball.17 Escamilla and colleagues established that both Swiss Ball and traditional elicited the greatest activity in a number of “core” muscles.15 The above studies reveal that muscle activity recorded in core muscles is significant with usage of swiss ball exercises which supports the group-1 of present study.

Pre and post mean values of muscle strength

through MMT in group-1 and group-2: (table-3) The Pre and post mean values of muscle strength of abdominal muscles in group-1 shows increased mean value of 3.02±0.68 (pre) to 5.15±1.62 (post). Where as in group-2 enhanced mean values of abdominal muscle strength is 3.81±0.56 (pre) to 5.16±1.66 (post). The mean percentage change of muscle strength values is 2.86% in group-1, where as 1.97% in group-2. The values are significant at p=0.001 level.

The adaptive changes in the muscles caused by exercise as the metabolic capabilities of the muscles are progressively overloaded. Muscle, which is a contractile tissue, becomes stronger as a result of hypertrophy of the muscle fibers and increases the recruitment of its motor units. It has a profound influence on the metabolic demand associated with a given target muscle force leads to increase in muscular endurance and power. The use of the swiss ball helps to unload the muscles and a more moderate exercise environment has the potential of helping the muscles to regain power and endurance without creating excessive chemical imbalance. The swiss ball enables the patient to move without strain. Snijders et al., reported that therapeutic exercises activates both slow twitch (ST) and fast twitch (FT) fibers of skeletal muscles, with increased fiber ATPase and cross-bridge cycling speed might be attributable to an increased expression of fast MLCs in the slow fibers. As the high content of FT fibers, it is responsible for the improvement of muscle strength.21 Since decades studies have been made available on the use of various abdominal exercises to strengthen the abdominal muscles as well as to reduce abdominal fat.

Abdominal exercises on swiss ball have been proven their efficacies in activating the abdominal muscles while performing exercises. Aarti Welling stated that performing exercises on the swiss ball is better method of strengthening abdominal muscles since exercises are performed on an unstable surface that stresses the musculature and result in increased muscle activity.16 The above studies reveal the enhancement of abdominal muscle strength is significant with usage of swiss ball exercises which supports the group-1 of present study.

Pre and post mean values of waist hip ratio and body mass index in group-1 and group-2: (table-4&5) The Pre and post mean values of waist hip ratio group-1 showed decreased mean value of 0.89±0.18 (pre) to 0.84±0.16 (post). Where as in group-2 have shown decreased mean values of waist hip ratio 0.87±0.17 (pre) to 0.83±0.15 (post). The mean percentage change of waist hip ratio values is 2.17% group-1, where as 1.94% in group-2. The values are significant at p=0.001 level.

The Pre and post mean values of body mass index group-1 shows decreased mean value of 31.35+6.84 (pre) to 25.10+5.31 (post). Where as in group-2 have shown decreased mean value of body mass index 28.88+6.01 (pre) to 24.13+5.22 (post). The mean percentage change of body mass index values is 7.82% group-1, where as 5.14%

INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL

49

Research Paper

E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 9 | SEP 2017

in group-2. The values are significant at p=0.001 level. The reduction which occurs waist hip ratio after performing the exercise on swiss ball burns glycogen, fat and other nutrients stored in the muscle. In the present study, the subjects in the swiss ball exercise group showed significant reduction in abdominal fat due to exercises induces loss of body fatness, especially the intra abdominal fat, associated with reduced glucose tolerance, LDL cholesterol and increases HDL cholesterol. Irving et al reported that abdominal exercises provides high boosting intensity workouts which induce acceleration of fat burning, especially abdominal fats, resulting in significant reduction of waist circumference.21 Aarti Welling stated that the improvement seen on reduction of fat using swiss ball.16 The above studies co-states that significant changes are noted in WHR and BMI by using swiss ball exercises which supports the group-1 of present study. In the present study, the use of swiss ball (group-1) exercises produced statistically significant changes in abdominal muscles strength and muscle activity and a statistical significant changes in diastasis recti gap, BMI and waist hip ratio.

CONCLUSION Alternative hypothesis is accepted, null hypothesis is rejected. The study concluded that the swissball exercises are effective in reducing diastasis recti gap, muscle activity, muscle strength, waist hip ratio and body mass index.

Limitations 1.

The study was conducted with a small number of patients.

2.

We only measured the functional improvement for a period of only 3 months.

REFERENCES 1. Jessica Keeler, Melissa Albrecht, Lauren Eberhardt, Laura Horn, Chantal Donnelly, Deborah Lowe diastasis recti abdominis: A survey of women’s health specialists for current physical therapy clinical practice for post partum women. 2012 vol 36 journal of women’s health physical therapy.

2. Benjamina, vandeWaterb, C.L.Peiris Effects of exercise on diastasis of the rectus abdominis muscle inthe antenatal and postnatal periods: a systematic review 2013 Chartered Society of Physiotherapy.

3. Jill Schiff biossonnault and MARY JO blaschak: incidence of diastasis recti abdominis during the childbearing year. July 1998 journal of physical therapy.

4. Roshan adkitte, khyati bhatt, ujwal yeole, pravin gawali and gaurai gharote: prevalence of diastasis of rectus abdominis muscle in immediate post partum

women of urban and rural areas.

5. Jill mantel, Jeanette haslam, sues barton: text book of physiotherapy in obstetrics and gynaecology 2nd 2005.

6. Joanne borg-stein, Sheila A. Dugan. Musculoskeletal disorders of pregnancy, delivery and postpartum.

Physical medicine and rehabilitation clinics of north America vol-18, 2007 pg. 459-476.

7. Jorun bakken sperstad, merete kolberg tennfjord, gunvor hilde, marie ellstrom: diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain, 2016.

8. Diastasis Recti: An Overview 21 September, 2015 boot camp and military fitness institute.

9. Nisha Acharry, Rahul Krishnan Kutty. Abdominal exercise with bracing, a therapeutic efficacy in reducing diastasis-recti among post partal females International Journal of Physiotherapy and Research, Int J Physiother Res 2015, Vol 3(2):999-05.

10. Carrier, beate: text book “The swiss ball theory, basic exercises and clinical application” springer 1998.

11. Rafael f. escamilla, Clare lewis, DunCan Bell, Gwen BramBlet, Jason Daffron, steve lamBert, amanDa PeCson, roDney imamura, lonnie Paulos, James r. anDrews, Core Muscle Activation During Swiss Ball and Traditional Abdominal Exercises journal of orthopaedic & sports physical therapy, volume 40 number, 5 may 2010.

12. Aarti Welling, Peeyoosha Nitsure. Comparative study between mat, swiss ball and theraband exercises on abdominal girth International Journal of Physiotherapy and Research, 2015, Vol 3(4):1142-49.

ISSN 2321-1822.

13. Emil sundstrup, markus D.jakobsen, christoffer H.andersen, Kenneth jay, lars L.andersen. swiss ball abdominal crunch with added elastic resistance is an effective alternative to training machines.

International journal of sports physicaltherapy, vol 7, august 2012, page 372.

14. Francisco J vera-garcia, sylvain G grenier, stuart M mcgill: abdominal muscle response during curl-ups on both stable and labile surfaces. Journal of physical therapy, vol 80, june 2006.

15. Hanan S. El-Mekawy, Abeer M. Eldeeb, Marzouk A. El- Lythy, and Adel F. El-Begawy, Effect of Abdominal Exercises versus Abdominal Supporting Belt on Post-Partum Abdominal Efficiency and Rectus Separation. International Journal of Medical, Health, Biomedical, Bioengineering and Pharmaceutical Engineering Vol:7, No:1, 2013.

INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL

50

Research Paper

E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 9 | SEP 2017

16. Sanjivani ramesh khandale, deepali hande: Effects of abdominal exercises on reduction of diastasis recti in post natal women. International journal of health sciences and research, vol.6, issue.6, june 2016.

17. Michael Duncan, muscle activity of the upper and lower rectus abdominis during exercises performed on and off a swiss ball. Journal of bodywork and movement therapies, 2009, vol 13, 364-367.

INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL

51