The core or cylinder formed by the diaphragm (at the top), the pelvic floor (bottom) abdominal muscles (front) and lumbar (back) all work synergistically to create stability to the spine. But an imbalance or excessive tone in any of these points will have observable repercussions on the other parts of the body. We have one clear example in the breathing pattern and it´s influence in posture and pelvic floor disorders.

At this point we should remember that the diaphragm is the most important inspiratory muscle, which sometimes can condition respiratory, postural and circulatory  function at the same time. The diaphragm works in a coordinated manner with other muscles for trunk stability and has important direct and indirect relationships through fascial chains. We cannot truly understand the breathing mechanism without understanding the involvement of the abdominal muscles as well as postural analysis. There is growing evidence for differential involvement of the abdominal wall in expiratory function. So, there is a potential role of combined pelvic floor and abdominal muscle training for the treatment of respiratory diseases. Of note, retraining and improving breathing patterns are essential for preventing injuries and for enhancing quality of life.

For breathing training: Low Pressure Fitness

The inspiratory muscles can be weakened due to aging, respiratory diseases, obesity, stress, smoke, and weight lifting. The diaphragm can be “overused” so it gets hypertonic, and descends from its natural position. When this happens, any effort would result more hyperpressive in the abdominal cavity.

For breathing training there are two different approaches: strengthening which can lead to excessive rigidity or integrating breathing patterns which can help internal and miofascial release. The second approach is the one emphasized by Low Pressure Fitness.

Low Pressure Fitness is an integrated and global training program which focuses on posture and breathing. It is performed via the bases of pranayama Uddiyana banda in yoga (ribs opening and expiratory apnea), in conjunction with diaphragmatic breathing. During the abdominal vacuum “rib cage lift”, the inspiratory muscles contract and consequently the diaphragm rises, sucking up the pelvic viscera and fascial connections and decreasing intraabdominal pressure. This provokes a highly demanding postural training and a great help in order to raise and tone the pelvic floor muscle group and reposition the viscera. In addition, retraining the action of the respiratory system leads to a decrease in mental anxiety and sometimes which, in turn, leads to gains in self-esteem. The person feels better with themselves and with greater body awareness. Incorporate a global exercise program such as low pressure fitness to improve your posture as well as your  abdominal and pelvic floor muscles by retraining your breathing pattern.

ON WHETHER TO CLOSE THE LINEA ALBA: a new perspective on diastasis recti recovery

What are the advantages of low pressure exercises versus the crunch or curl-up? How do each of them affect the linea alba, that line of fibrous tissue that connects the right and the left abdominal muscles? Do any of these questions have a clear-cut answer?  

In this article Dr. Rial, founder of Low Pressure Fitness, offers an explanation on these issues and clarifies the evidence available so far on the effects that curl-ups have on the linea alba. She also raises new hypotheses for low pressure training as the new alternative for rehabilitation for abdominal diastasis.

Until fairly recently, traditional abdominals were staunchly defended by practitioners and researchers as the best method to restore diastasis recti.  The logic was that since the distance between the right and left abdominal muscles decreased while executing crunches, repeating this motion would help to reduce this distance. On the other hand, exercises that increased the distance between abs were discouraged, given that in the long run, they would cause the linea alba to stretch further.

Today, however, other experts have raised their voices with different perspectives, drawing from the results of their clinical practices or studies. This alternative outlook explores the notion of increased –and unwanted- pressure in the abdomen when performing traditional crunches. These new approaches are seen as both more functional and friendlier to the pelvic floor.

Indeed, today we can find different perspectives regarding the best exercise to reduce abdominal stretching. This is the case of Low Pressure Fitness, one of the major workout programs based on the hypopressive technique.


The abdominal division: linea Alba

The white line or linea alba is the vertical line that you can see down the middle of the stomach muscles. It separates the rectus abdominis into sections and gives it the famous six-pack appearance.

During pregnancy the gap between both sides of the abs increases gradually and naturally as the pregnancy progresses. The trouble is that after delivery, many women cannot find the way to recover that distance between their abs and get their figure back.

Diastasis of the abdominal rectus occurs when the gap between the abs exceeds 2.5 or 3 cm. It is not just about looks – it can also be a functional problem. Stability of the spine and pelvis can be compromised. Diastasis is generally linked to lower back and pelvic floor dysfunctions.


Clinical advances

In an article on the reaction of the linea alba during a curl-up, Lee & Hodges (2016) revealed extremely interesting data, which shed a little more light on the question of whether to narrow or stretch the linea alba. In other words, whether to open or to close the diastasis.

The study found that when the abdominal transverse muscle was pre-activated before curl-ups, the gap between the rectus muscles increased. However, distortion of the linea alba decreased. On the other hand, when the simple curl-up was carried out, with no pre-activation tension, the abdominal rectus muscle closed and in consequence, the linea alba became distorted.

This notion of distorsion of the linea alba is a completely novel concept. The greater the distorsion in the linea alba, the greater the fascial tension. Indeed, up to date, research focused mostly on the behavior of the muscles, but did not go into the behaviour of connective tissue.

It is relevant to notice the predominant role that fascial tension has in reducing and regenerating connective tissue. Fascial tension is the mechanical stretching force that affects a muscle and it´s connective tissue.

That is why although traditional crunches narrow the distance between the rectus muscles they also reduce the fascial tension of the linea alba compared to exercise with the transverse abdominal pre-activated.

It is on this same hypothesis that I suggest Low Pressure Fitness could be an optimal workout to recover from diastasis. Low Pressure exercises are the indisputable star workout today to recover from pregnancy and delivery in Spain.

My own clinical practice and the results achieved by my students using Low Pressure training reveal its effectiveness in reducing diastasis recti. However, we have no solid scientific studies to confirm such observations and practical experiences.

Abdominal vacuum and activation of postural muscle patterns are the signature features of Low Pressure exercises. It produces transversal and longitudinal contraction in the deep muscles of the core (Figure 4). This means the deep core muscles are activated, the waist shrinks and the stomach flattens out (Figure 5).



All these factors seem to produce a very similar effect to that observed by Lee & Hodges during the pre-activation of the transverse + activation of the rectus abdominis during a curl-up. It is hypothesized that though this does put strain on the linea alba, it also reduces the distance between the abdominal rectus muscles by moving the rib cage and altering the body posture through Low Pressure exercise.

The following image shows the behavior of the diastasis recti of a clinical case in her postpartum period at rest and executing a Low Pressure exercise.


At Rest

During Low Pressure exercise

The goals of after-delivery rehabilitation include recovering the waistline and functionality in the pelvic floor. Following delivery, women often suffer some type of dysfunction in the pelvic area, such as urinary incontinence, pelvic pain or pelvic organ prolapse. Clinical and rehabilitation practice is generally concerned with finding an exercise which will produce the necessary muscle tension while avoiding unwanted pressure on the pelvic floor.

The added value of Low Pressure Fitness as an alternative to traditional curl-up training is precisely that excessive pressure is avoided. In other words, it does not increase pressure on the pelvic floor. A recent study carried out in the Quirón Hospital of A Coruña (Northern Spain) found an improvement of diastasis recti in a post-partum group after ten weeks of low pressure training.

At the moment we are unable to exactly pinpoint which are the reasons why low pressure fitness can be an optimal tool for diastasis recti rehabilitation. However, we are assisting to a change of perspective on how different abdominal exercises can affect the linea alba. Low Pressure training is an active and novel approach of this change.


Author: Tamara Rial, PhD


The principal function of the pelvic floor muscles  is to give support to the internal organs. Recently, the literature has established the role of pelvic floor muscles in the stabilization of trunk muscles and postural control.


Many factors (overweight, pregnancy, age, heavylifting, and breathing disorders) can influence the progressive weakness of the pelvic floor muscles, so consequently there is not an efficient support of internal organs. Also, lumbopelvic posture can have an advere impact on the activation and co-coordination of pelvic floor muscles.

Posture and alignment are fundamental in the prevention of common pelvic floor dysfunctions in women such as like urinary incontinence or prolapse in which internal organs (e.g., uterus, bladder, rectum) fall out of place.


If you have any of these symptoms, remember they are NOT normal:


  • pressure or bulging in your vagina or rectum.
  • bulging of your abdomen during any exercise (abdominal crunch, lift weights…)
  • any of your everyday activities cause pain, leakage or pressure.


Integrate proper posture into every part of your life, even for your pelvic floor! An easy and functional strategy to prevent prolapse is to choose appropiate movements and lifestyle tips for not increasing downward pressure. Focus on practicing  a systematic program like Low Pressure Fitness to rehabilitate your posture and coordinate deep abdominal muscles for integrate new postural patterns and management of intraadbominal pressure, will lead to a direct improve of prolapse symptoms. Focus on elongation of the vertebral spine and pelvis. By relaxing the pelvis and stretching your spine, you will allow the pelvic floor to provide better support to the internal organs. In few weeks, you will notice changes in the bulging and pressure of the pelvis. Your abs will gain tone, your waistline will become slimmer, and back or pelvic pain will begin to dissapear.  Also, associated sexual dysfunction symptoms will improve over time.

South Africa´s Director Shirley Boerssen & her personal experience with hypopressives

Low Pressure Fitness is very proud to announce the new incorporation of Shirley Boerssen as the Director of South Africa for the PressureLess workout. With this great announcement, we wanted to share her own testimonial after developing a diastasis due to her second pregnancy and how she felt a massive change training hypopressives.

“I have always been intrigued by human behaviour, movement, natural healing methods and wellness. I definitely wasn’t the sporty person at school, but I did ballet, I have always loved dancing and movement and even did aerobics and callanetics as a teenager in the 90’s. After school I completed my Psychology Honors Degree, but it felt like something was missing. I completed a Personal training and Group Fitness Instructors qualification. I wanted to work more intimately with smaller groups and decided on completing a Pilates Instructors mat work qualification, enjoying the rehabilitative angle of the method. I gained a lot of experience at a physiopilates studio, working with the deskbound corporate with postural problems to clients with sports injuries. I have worked intensively with pre and post natal clients, running my own groups as well as working for PreggieBellies South Africa and training throughout both of my pregnancies. I am also a qualified holistic and sports masseuse and completed a Biomedicine course as part of a Naturopathic/Nutritional Therapy study. I have been studying and working within human behaviour, fitness and health and wellbeing for 21 years.

With my second pregnancy I developed diastasis. Applying ALL my knowledge could not rehabilitate my problem. I remembered talking to devastated clients in the past, trying to put them at ease, telling them to take it easy and at the same time I’d be worried and concerned as I could see bellies bulging with the conventional core and breathing techniques….and for the first time I understood what they felt. Still looking pregnant, even if only to myself, almost a year and half post-natal, was not fun, it was devastating. I developed digestive issues and lower back pain as my Transversus Abdominis became weaker, something was out of balance and it affected me in more than just a physical way.

I was trained in Low Pressure Fitness technique for the first time by Janet Kimmel from Vancouver, over December of 2015 and I was amazed by the quick, automatic response my body had to the technique. The results were amazing and visible within the first 2 weeks of the programme. Suddenly I had a magical moment, a realisation connecting my educational background and experience gained from each individual client up to then. I had to learn more about the technique, I had to experiment more on myself and I had to introduce this to all the woman suffering from diastasis, prolapse, urinary incontinence or those just not knowing how to safely train or retrain the core muscles, work on the postural alignments and most importantly, to prevent pelvic floor problems. In South Africa’s multicultural society, talking comfortably about the pelvic floor is not always the case and the reality is that so many woman (and men) don’t even know what the pelvic floor is and/or suffer in silence. My mission in South Africa is first of all to create awareness of pelvic floor and core health for woman, men and children/teenagers within a supportive, educational and empathetic way, within a fitness environment. Low Pressure Fitness system is an amazing platform to achieve this. Training and educating instructors and professionals in this technique changes the whole training program, rehabilitative outcome and prevention of a variety of problems. South Africa has an amazing culture of sports, fitness, a fresh awakening to health and wellbeing,more people are outdoors either running a trail or cycling, the benefits of LPF system on oxygen usage and in competitive sports is astounding and caters for a huge market in South Africa.

My approach to health and wellbeing, fitness and longevity is holistic in nature. I look at the whole person as a being connected within a mind, body and soul and LPF fits in perfectly with this approach. It affects the sympathetic nervous system, stimulate excitation and increase metabolism. One of my favourite benefits of LPF is that it empowers the clients, giving them back the power and control within their bodies.

I feel extremely privileged, humbled and bursting with excitement to represent LPF in South Africa, first country on the African continent. I know this technique will be a game changer for many women and men; to those working in the health industry and their patients and clients”

Shirley Boerssen

LPF South Africa Director

Best Health Magazine interviews Master Coach Trista Zinn “pelvic organ prolapse prevention”

Canada’s, “Best Health” Magazine is a health & wellness magazine published by Readers Digest with the aim to help Canadian women feel more confident in pursuing their own health and fitness goals.

Trista Zinn Certified Master Coach and international course instructor for Low Pressure Fitness had the pleasure of work with Anna Sharratt, contributing writer for Canada’s Best Health Magazine.

It didn’t take any convincing when it was first suggested to bring this important topic to print. To get a better understanding and personal experience with the Hypopressive technique, Anna worked closely with Trista Zinn both privately and in groups classes. She quickly realized the importance of informing readers of this technique that gives hope to women living with pelvic organ prolapse, one of the more common forms of pelvic floor dysfunction.

This article HOLDING IT TOGETHER does just that, with a gentle approach to a sensitive topic Anna Sharratt interviews her trainer Trista about her own personal success story, two other women who share their experience, pelvic health physiotherapists and an OBGYN. The final message is clear,” there is hope and it doesn’t involve surgery”.

Low Pressure Fitness present at “Rehabilitation for life”

The interest about the application of the Low Pressure Fitness in the prevention and rehabilitation of the pelvic floor dysfunctions led the School of Health of Viseu, inviting Eunice Moura, Low Pressure Fitness coach in Portugal for a lecture in the context of the 6th Congress ” Rehabilitation for life” on January 28, 2016.

“Rehabilitation in differentiated health care”  was the name chosen for the table of Eunice Moura and with a presence of a physician, a rehabilitation nurse from the Center of rehabilitation medicine in Alcoitão, and a rehabilitation nurse of the Garcia da Orta Hospital.

With an attentive and interested audience, the themes developed and clarified about Low Pressure Fitness aroused interest of some people who have shown curiosity in getting to do more training and increase knowledge of the Low Pressure Fitness technique in order to use it in their working environment to ensure better results  both in terms of the rehabilitation of the pelvic floor muscles, and globally, ensuring a better quality of life for patients. 


Midwifes at Indonesian hospitals learn Low Pressure Fitness

The R-evolution of Low Pressure Fitness has arrived to Indonesia. A series of seminars for midwifes and women´s health care about the pressureLess workout are taking place at several hospitals of the Kasih Group around the country. The first seminar “Be healthy and recover after pregnancy with Low Pressure Fitness” was a complete success of attendance. 150 Indonesian midwifes participated in the seminar presented by Harry Setiarso at the hospital Restu Kasih (RSIA).

seminar midwifes low pressure fitness

Indonesian midwifes are known as BIDAN who usually live in rural or sub urban areas where there are no doctors or hospitals. They help women delivery. Their tools are: a bucket, water, some oil, sheets, and their hands and heart full of love and kindness. It was the first time the assistants heard about the “hypopressive concept” to recover women´s pelvic floor and core muscles after pregnancy. The Director of Low Pressure Fitness Indonesia Low Pressure Fitness Indonesia also remarked the importance of proper physical condition before pregnancy, appropriate breathing techniques and exercise during pregnancy.

Pelvic floor health with Hypopressives

What if we could address pelvic floor issues with only postures and breath?

On Mar 5 & 6th, 2016, PABC hosted Trista Zinn & Tamara Rial (Phd), as instructors for “Hypopressives/Low Pressure Fitness for Pelvic Health” at the University of British Columbia (UBC).  Many who attended the course were pelvic floor rehab specialists.  Many who attended the course also had personal reasons for being there.  If our current pelvic/core rehab model is effective, why are there physios with prolapses, cystoceles and pessaries?  It seems we’re still looking for the ‘right’ answer.

The Hypopressive Theory is based on the concept that the abdominal pressures we generate with curl-ups, planks, jumping and Pilates-type strengthening are often too great for the pelvic floor.  As a consequence, we are literally pushing our organs out the bottom. The intention of the Hypopressive exercise is to generate negative pressures in the abdominal cavity to literally traction the pelvic organs upwards, enabling the pelvic floor and Transversus Abdominus to work in shortened ranges.  Low Pressure Fitness training is a global approach to the core/pelvic floor.  It is not based on strength of the pelvic floor on its own, but concentrates on the function of the pelvic floor’s intricate relationship with the core as a whole.  The other significant difference between traditional pelvic floor strengthening and the Hypopressive (low pressure) exercise is Type II muscle fiber recruitment.  The key core muscles are 70% slow twitch fibers, which increase their volume and recruitment only with sustained contraction, (unlike a Kegel which emphasizes reps/sets with resting phases – type I fiber training).

Along with serratus anterior and posterior, multifidi, the thoraco-dorsal fascia, transversus abdominus, and the pelvic floor, the real key player in these exercises is the diaphragm.  Using rib and diaphragm mobilization techniques, we free up the rib cage to enable improved lateral costal breathing.  Then, the patient is instructed through a combination of spinal stabilization cues that are sustained, aiming to pull the diaphragm’s central tendon upwards.  In the exhalation phase, relaxation and lengthening of the diaphragm occur.  At this point the patient performs a prolonged apnea, drawing the abdomen inwards and upwards, whilst maintaining the postural cues.  The exercises progress to a series of sustained poses with the apnea, some of which are capable of generating negative 20-30 mm Hg as measured in the pelvic floor.  In first attempts, the exercise is very challenging, and requires repeated cueing by the therapist.  However with repeated practice it becomes comfortable and habit-forming.

The list of conditions which will benefit from this technique include, but are not limited to: urinary incontinence, uterine/bladder prolapse, erectile dysfunction, fibroids, hemorrhoids, pelvic pain, nocturia, cervical cell dysplasia, rectus diastasis, inguinal and abdominal hernias, constipation and low back pain.  It is estimated that greater than 40% of women experience pelviperineal pathophysiology, and low back pain incidence is twice that.  Other beneficial effects include improved alignment and postural stabilization, increased lumbar mobility, increased hamstring expandability, decreased cervical and lumbar lordoses, decreased thoracic kyphosis and scoliosis correction.  Waistlines also shrink, which explains why the Europeans are keen to integrate the technique.

This is an invaluable tool which not only has the potential to generate above average results with our pelvic health patients, but also has the ability to transform our entire client population.  It is a risk free, preventative, global exercise system, which improves well-being, aesthetics and physical performance.  If spinal health is a measure of our longevity, the Hypopressive technique is a ‘game changer’.  Become an instructor – let’s generate a Canadian wide Low Pressure Fitness movement.  We will be the new kid on the block and our patients will shine.  


We would like to thank  Katharine Hasz and PACB sharing this letter with Low Pressure Fitness after attending Level 1 LPF course in Vancouver.

Katharine Hasz Physical Therapist,

currently lives in Tofino, B.C., with a home-based practice, integrating manual therapy, acupuncture, cranio-sacral and visceral techniques. LPF leve 1 trainer.

Low Pressure Fitness lands in the Vatican Hospital

On Wednesday, Feb. 10th, 2016, Mimi Rodriguez Adami delivered a Seminar on the Low Pressure Technique for instructing hypopressive exercise at the CEMI (Centro per Medicina dell’Invecchiamento) of the Policlinico Agostino Gemelli in Rome. The Policlinico Gemelli is a University Hospital, working with the Università Cattolica del Sacro Cuore (Catholic University of the Sacred Heart) to train medical personnel, perform research, study and adapt the latest methods and technology available.

The hospital has an in-house fitness center, Healthness, which is used by patients for rehabilitation and physical therapy and for external clients who want to train for fitness with specialized personnel.

The seminar was attended by over 50 persons, including physical therapists, physical education graduates specialized in adaptive exercise and physicians. After the presentation the participants were invited to participate in a brief demonstration of the basics of the technique: the posture, the breathing and an expiratory apnea. Their response was very positive and the Healthness management has decided to embrace Low Pressure Fitness and have all the physical therapists and personnel working in the gym, train to be able to teach hypopressive exercise using the Low Pressure Fitness technique to both patients and healthy clients.

Healthness management has also offered to host all future Low Pressure Fitness training workshops in Rome and promote the method locally and nationally.  Low Pressure Fitness in Rome will look forward to holding all its training workshops at the Healthness Center of the Policlinico Gemelli.

Mimi Adami, LPF Italy Director

The horrors of suffering a pelvic organ prolapse, Todays Parents interview Trista Zinn

Todays Parents is a Canadian monthly magazine for parents. This magazine addresses topics related to the health, education and behavior of children under 14 years old. Last May ,Todays Parents interviewed Canada´s Low Pressure Fitness director, Trista Zinn about the “horror of suffering a prolapse” and how to prevent or rehabilitate this condition.

Pelvic prolapse is a serious medical condition that impacts many women postpartum. The worst part of this condition is the mystery and lack of knowledge surrounding pelvic floor dysfunctions. Almost all women that have a vaginal delivery have some degree of prolapse or pelvic floor dysfunction that initially doesn´t result in any signs or symptom. Consequently, most women don´t worry about this condition or seek aditional consultation with their healthcare provider.

This was the case of Trista Zinn, Canadas Low Pressure Fitness director. She is a mother who has experienced pelvic organ prolapse. In her words to Todays Parents, “No one talked about it”, “No one told me not to work out right away or educated me about all the muscles and connective tissue that push out the equivalent of a bowling ball”. After being diagnosed with Stage 2 prolapse, from which she was told there was little non-surgical chance of recovery, she was determined to find a non-invasive and less traditional treatment.  She wanted a routine that would effectively target the pelvic floor musculature and help her condition. This is how she discovered the hypopressive technique which are popular in Spain. After two weeks of performing hypopressive breathing and poses, she went back to her healthcare provider and discovered that her stage 2 prolapse had become stage 1.

Trista traveled to Spain to become certified in Low Pressure Fitness in order to train physiotherapist and and help other women with similar conditions.