产后身体活动最佳证据研究

doi:10.3969/j.issn.1006-9771.2022.07.011

Abstract

Abstract:

Objective To summarize and evaluate the best evidence for postpartum physical activity and exercise regimens.

Methods Literatures of postpartum sports and exercise programs were searched from JBI, UpToDate, Cochrane Library, International Federation of Gynecology and Obstetrics (FIGO), The Agency for Healthcare Research and Quality(AHRQ), Royal College of Obstetricians and Gynaecologists (RCOG), American Collage of Obstetricians and Gynecologists (ACOG), Registered Nurses' Association of Ontario (RNAO), World Health Organization (WHO), Fitness Australia (FA), National Institute for Health and Care Excellence (NICE), Web of Science, PubMed, CINAHL, Medlive, CNKI, and Wanfang Data, from database inception to October, 2021. Two researchers independently evaluated the literature quality according to the tool of the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE Ⅱ), A Measurement Tool to Assess Systematic Reviews (AMSTAR), and Joanna Briggs Institute Critical Appraisal Checklist.

Results A total of 15 articles were selected, including four randomized controlled trials, four systematic reviews, one cross-sectional study, one evidence summary, four guidelines, and one expert consensus. A total of 28 pieces of evidence were summarized, including the significance of postpartum physical activity and exercise, obstacle factors, assessment, exercise style, intensity and timing, and precautions.

Conclusion Knowledge of exercise after delivery is important to promote women's health and quality of life. It is recommended that the evidence be screened on a case-by-case basis and that an individualized programme of physical activity and exercise be developed.

Key words: puerpera, physical activity, exercise, evidence summary

CLC Number:

R714.6

GENG Xiaoting,LI Shuying,ZHANG Jinyan,GUO Yanwei. Research on postpartum physical activities based on the best evidence[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(7): 809-815.

Figures/Tables 5

项目	证据描述	证据等级	推荐强度
活动和锻炼的意义	1.产后运动可以提高产后妇女的整体身体素质,改善心肺功能,增强上肢及腹部的肌力耐力,促进背部和大腿的肌肉伸展,有利于控制产后体质量,防治血栓栓塞性疾病及糖尿病等,增强抵抗力^[16,28]。	1c	A
	2.适宜运动可缓解疼痛,减轻尿失禁症状,改善睡眠,提高自信,调节情绪,减少产后抑郁^{[21,23,25-26,30]}。	1a	A
	3.产后恢复孕前锻炼或建立新的锻炼习惯对于健康非常重要,产后也是妇产科医师以及其他专业人员进行健康保健生活方式宣教的最佳时机^[28]。	5b	A
活动和锻炼的障碍因素	4.疲劳、睡眠不足、忙于家务、缺乏时间、不可预测的日常活动,缺乏家人、朋友、伴侣等支持,是阻碍产后妇女运动的因素^[22]。	2b	A
活动和锻炼的障碍因素	5.缺乏专业人士关于产后体育活动和锻炼方面的建议与鼓励,医疗保健提供者也很少将运动计划纳入到产后护理计划 ^[16,22]。	1c	A
活动和锻炼的评估	6.建议产后体育活动前,应根据分娩方式进行评估,评估是否存在医疗或手术并发症,身体是否安全,是否可以恢复体力活动^[28,30]。	5b	A
	7.建议在进行高强度运动之前,进行腹部和盆底肌肉测试。可以采用盆底肌肉电生理学检查、指压试验、影像学检测、三维体态评价等进行盆底功能测试,也可以采用症状问卷进行评价 ^[27,29]。	5a	A
	8.建议在运动期间或运动后,及时评估产妇是否存在背痛、腰部疼痛、尿失禁等现象,若存在,建议放慢或降低强度水平^[27]。	5a	A
活动和锻炼的方式	9.建议进行腹部强化练习,包括腹部紧缩练习和牵引练习,以此拉动腹壁肌肉来增加腹部压力,减少腹直肌分离的发生率^[28,30]。	4a	A
	10.建议产妇每周进行中等强度有氧运动,包括体操、肌力训练、游泳、固定式自行车、舞蹈等^[26-27]。	5b	A
	11.建议产妇进行普拉提家庭锻炼,包括架桥、卷起、单腿循环、双腿闭合摇杆、单直腿伸展、双腿伸展、脊柱向前伸展、单腿踢、上下侧踢等以深呼吸为重点的全身伸展和核心力量训练^[17]。	1c	A
	12.建议无阴道并发症的产妇,产后立即进行腹部训练和盆底肌训练^[27,29-30]。	4b	A
	13.习惯从事高强度有氧运动或孕前进行过体育活动的妇女,建议在孕期及产后可继续从事这些活动^[26]。	5b	A
	14.普拉提、低强度有氧运动和肌肉强化活动,对产妇来说方便可行^[17,24]。	1c	B
	15.集体锻炼形式优于个人锻炼形式,此方式能够提高产后锻炼的动机、运动量和自我效能^[23]。	1a	A
	16.稳定训练能改善骨盆疼痛患者的功能,建议作为产后腰部疼痛产妇的一线治疗选择^[19]。	1c	A
	17.建议产后前4周进行呼吸功能训练、肌力训练,产后3~8周进行行走、游泳(一旦出血停止)、腹部和盆底运动、低冲击有氧运动、低强度水上有氧运动(一旦出血停止)等^[27]。	5a	B
	18.建议产后8~12周增加运动强度和重量练习,强化产后核心力量、腹部和盆底锻炼^[27]。	5a	A
	19.建议产后16周评估产妇盆底肌肉和核心控制能力,无产前或产后并发症可恢复孕前活动^[27]。	5a	A
活动和锻炼的强度与时间	20.根据产妇的健康水平定制个性化运动强度,建议使用Borg量表(6~20分)进行监测,运动强度应控制在12~14分的中等强度^[16]。	1c	B
	21.建议产后立即开始盆底运动(Kegel运动),可每日2~3次,每次10~15 min^[28-29]。	5a	A
	22.建议产妇每周锻炼4~5次,每次锻炼持续时间30~40 min^[23]。	1a	A
	23.建议产后4~6周,每周进行至少150 min中等强度有氧运动^[26,29]。	5a	A
注意事项	24.建议正在哺乳的产妇锻炼前应排空乳汁,以免乳房肿胀。运动之前补充充足水分^[27,29]。	4b	A
	25.建议避免单次过长时间锻炼,以免造成产妇额外的疲劳和压力^[23]。	1a	A
	26.建议鼓励产妇穿着宽松、舒适的服装,佩戴具有支持性良好的运动内衣^[27]。	5a	A
	27.建议通过提升产妇健康知识水平和健康素养,调动产妇参加体育锻炼的积极性,进而提高产后体力活动水平^[18]。	1c	A
	28.建议采取饮食与运动相结合,进行自我监测,是产妇减轻体质量最有效的方法^[20]。	1b	B

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纳入文献	年份	文献类型	文献主题	来源
Zourladani等^[16]	2015	随机对照试验	体育锻炼对产后康复的影响	CINAHL
Ashrafinia等^[17]	2015	随机对照试验	普拉提运动对产妇产后疲劳的影响	CINAHL
Abdollahi等^[18]	2017	随机对照试验	基于健康素养策略的教育计划对产妇身体康复的影响	CINAHL
Wang等^[19]	2021	随机对照试验	产后腰盆疼痛训练的康复计划	UpToDate
Lim等^[20]	2015	系统评价	产后妇女减肥的有效策略	PubMed
Carter等^[21]	2019	系统评价	基于运动的干预措施预防或治疗产后抑郁症	CINAHL
Rebekah等^[22]	2021	系统评价	产后妇女的运动障碍	CINAHL
姜霞等^[23]	2021	系统评价	运动锻炼对产妇抑郁干预效果的 Meta分析	万方
Wolpern等^[24]	2021	横断面研究	初产妇产后早期的体力活动	PubMed
Eustis等^[25]	2019	证据总结	孕期和产后瑜伽和体力活动对产妇康复的干预作用	CINAHL
Piercy 等^[26]	2018	指南	美国体育活动指南	PubMed
FA^[27]	2013	指南	孕期运动和产后运动	FA
ACOG^[28]	2021	指南	孕期和产后的体育活动和锻炼	ACOG
中华预防医学会妇女保健分会^[29]	2021	指南	产后保健服务指南	万方
Lee等^[30]	2021	专家共识	亚太地区关于孕期和产后身体活动和运动的共识	UpToDate

指南	各领域标准化得分/%						≥ 60%领域数	≥ 30%领域数	推荐级别
指南	范围和目的	参与人员	严谨性	清晰性	适用性	编辑独立性	≥ 60%领域数	≥ 30%领域数	推荐级别
Piercy等^[26]	100	72.2	67.7	88.8	64.5	100	6	6	A
FA^[27]	100	61.1	67	86.1	52	79.1	5	6	B
ACOG^[28]	94.4	69.4	61.4	83.3	50	58.3	4	6	B
中华预防医学会妇女保健分会^[29]	83.3	75	69.7	83.3	66.6	87.5	6	6	A

Research on postpartum physical activities based on the best evidence

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评价条目	Zourladani等^[16]	Ashrafinia等^[17]	Abdollahi等^[18]	Wang等^[19]
1是否对研究对象真正采用了随机分组的方法	是	不清楚	否	是
2是否做到了分配隐藏	是	是	是	是
3组间基线是否具有可比性	是	是	是	是
4是否对研究对象实施了盲法	否	否	是	否
5是否对干预者实施了盲法	否	否	否	否
6是否对结果测评者实施了盲法	否	否	否	是
7除了要验证的干预措施外,各组接受的其他措施是否相同	是	是	是	是
8随访是否完整,如不完整,是否采取措施处理失访	是	是	是	是
9是否将所有随机分配的研究对象纳入结果分析	是	是	是	是
10是否采用相同的方式对各组研究对象的结局指标进行测评	是	是	是	是
11结局指标的测评方法是否可信	是	是	是	是
12资料分析方法是否恰当	是	是	是	是
13研究设计是否合理?在实施研究和资料分析过程中是否有不同于准RCT之处	是	是	不清楚	是

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