Exploring the Impact of Hypopressive Abdominal Gymnastics on Sleep Quality: Insights from a Pilot Study

Hypopressive Abdominal Gymnastics (HAG) is a postural technique developed to reinforce abdominal and pelvic floor muscles. It is mainly practised by pregnant and post-partum women and subjects with rectus abdominis diastasis, prolapse, urinary incontinence, pelvic floor dysfunction, and chronic low-back pain. This technique combines expiratory apnoea with abdominal contraction manoeuvres to relax the diaphragm and reduce intra-abdominal pressure while activating the abdominal and pelvic floor muscles (1). Since no studies have evaluated sleep in relation to HAG practice, this study assesses if HAG might exert beneficial effects on sleep quality. METHODS Twenty-eight women (mean age 43.23 ± 7.03 yrs) with rectus abdominis diastasis were randomised into an intervention (INT, 17 women) and control (CTRL, 11 women) group. INT underwent a 2-month HAG intervention, with one supervised HAG session per week, while CTRL was recommended to practice a 2-month home HAG. Both groups filled in the Mini Sleep Questionnaire (MSQ) to assess sleep subjectively and wore an actigraph to assess sleep objectively. MSQ and actigraphic assessment were performed one week before and one week after the HAG intervention. ANCOVA analysis (adjusted by age) evaluated differences in delta values between INT and CTRL groups. RESULTS Delta MSQ total score (INT: -2.67 ± 1.19 a.u.; CTRL: -0.94 ± 0.24 a.u.), delta sleep MSQ component (INT: -1.7 ± 0.92 a.u.; CTRL: -0.99 ± 0.74 a.u.), and delta wake MSQ component (INT: -0.97 ± 0.46 a.u.; CTRL: 0.05 ± 0.03 a.u.) showed a slightly greater reduction, indicating a sleep improvement, in INT group compared to the CTRL group. However, the differences were not statistically significant (p = 0.67, p = 0.82, p = 0.63, respectively). Among the actigraphic parameters, the delta percentages of sleep and immobile time were positive in the INT group (sleep time: 0.62 ± 0.35 %; immobile time: 0.43 ± 0.14 %) and negative in the CTRL group (sleep time: -0.38 ± 0.22 %; immobile time: -0.32 ± 0.25 %), indicating a trend of sleep improvement in the INT compared to the CTRL group. Also in this case, differences were not statically significant (p = 0.49, p = 0.23). No differences were visible for the percentage of sleep efficiency (INT: 1.48 ± 1.02 %; CTRL: 2.01 ± 1.49 %) CONCLUSION This pilot study shows that two-month HAG seems to contribute to some encouraging effects on sleep quality, showing some positive trends, especially on subjective sleep quality. However, no marked and significant results were visible, probably due to the shortness of the intervention protocol. A longer intervention and a bigger sample size could probably lead to more evident results. 1. Hernández Rovira, E, et al., What Is Known from the Existing Literature about Hypopressive Exercise? A Compliant Scoping Review. Journal of Integrative and Complementary Medicine. 2024.30(10): pp 913–924.