产后妇女体适能训练指引

PostNatalFitnessGuidelines

产后妇女体适能训练指引

AASFPFitnessSpecialist(PersonalTraining)PRENATALFITNESS

产前体适能ProposedBenefitsofExerciseDuringPregnancy

孕期训练的益处Cardiovascular心肺系统方面Increaseormaintainaerobicfitness

提高或保持有氧体适能水平Increasecardiopulmonaryreserve

提高心肺储备Possibilitytoreducetheriskofhypertension

减少高血压的危险Musculoskeletal骨骼肌肉方面Promotegoodposture促进好的身体姿态Improveand/ormaintainmusclestrengthandtone

提高和/或保持肌肉力量和线条Preventand/orhelptoreducelowbackpain

防止和/或帮助减少腰背痛Maintainorimprovepelvicfloorintegrityandrecovery

保持或促进骨盆底部肌肉的完整和恢复Hormonal荷尔蒙方面Reducetheriskofgestationaldiabetes

降低妊娠期糖尿病的危险Labour分娩方面Possiblyexperienceaneasierorshorterlabour?

有可能帮助顺产或减短分娩时间？Promotefasterrecoveryfromlabourandpregnancy加快产后恢复

Reducepostdatedeliveries减少晚于预产期的情况Reducefetaldistress降低胎儿窘迫症的发生?Biggerplacenta增大胎盘？General综合方面Preventexcessive“fatgain”

防止过量获得脂肪Improvepsychologicalaspectsofpregnancyandreducepostpartumdepression

孕妇心理方面的帮助以及减少产后心情消沉Improvesleep增进睡眠Aiddigestionandreduceconstipation

帮助消化，减少便秘Cardiovascular/RespiratoryIssues

心肺/呼吸系统相关事宜PotentialProblems&ExerciseImplications

潜在问题和训练应用(2)SOBorEIA(Exercise-inducedasthma)气促（SOB）或运动性哮喘（EIA）(3)Frequency(avoidhighintensityex;exregularly;shorterdurationandlesserintensity)频率（避免高强度运动；经常运动；减少训练时间和降低强度）Intensity(<140bpm;avoidanaerobicworkouts,exhaustiveex;monitoring;RPE<15强度（心率<140；避免无氧运动/力竭运动；进行监测；RPE<15Musculoskeletal/AnatomicalIssues

骨骼肌肉/解剖学相关事宜PotentialProblems&ExerciseImplications

潜在问题和训练应用GeneralJoint/RoundLigamentPain

主要的关节/周围的韧带疼痛Reduceimpactactivities减少冲击活动

Avoidhyperextensionofjointsduringstretching

进行拉伸时避免关节超伸(2)LowBackPain,Sciatica,Sacro-iliacJointPain腰背痛，坐骨神经痛，骶骨关节痛

LBPisusuallysecondarytoSIstrain riskfactors(hxofLBP,age,parity)

腰背痛一般是第二大导致骶骨关节（SI）拉伤的因素（有腰背痛病史，年龄，病毒）Awareposture注意身体姿态Abdominalbinder束腹带PostureAwareness

孕期身体姿态(3)PubicSymphysisPain耻骨联合疼痛Avoidimpact,deepsquatorone-leggedexercise andpositions

避免冲击运动/深蹲或单腿运动/姿势Performstabilizationexercise

进行稳定性训练Weartrochantericbelt/pelvicbinder,etc.

穿托腹带/骨盆固定带(4)Knee/FootPain膝关节/足部疼痛Footwear鞋(5)NerveCompressionSyndromes(e.g.CarpalTunnelSyndrome)

神经压迫综合症（如：腕管综合症）Nightsplints夜间夹板Gentlestretching轻微拉伸Advice建议(6)Edema/Cramps浮肿／抽筋Move活动Avoidmotionlessstandingandprolongedsitting避免长时间静止站立和坐姿Calfcramps–stretching,calcium/magnesiumbalance,hydration小腿抽筋－拉伸，钙／镁平衡，水合作用(7)RectusDiastasis(Noble,1988)怀孕引起的腹直肌分离Aweakeningoftheseamofcentralfibroustissue(lineaalba)betweentherectusabdominaecanoccurandleadtoadiastasis;maybepresentinupto30%ofpregnantwomen,generallyoccursinlasttrimester腹直肌中间肌纤维组织连接处（腹白线）拉长导致分离；30％的怀孕妇女会出现这种现象，特别是在怀孕晚期Painlessconditionthatrequiresnotreatmentunlessseparationexceedsapprox.7cm(3fingers),abdominalexerciseswouldthenrequiremodification由于没有痛感所以无需特别治疗，除非分离大于7厘米（3个手指宽度），这时需要进行一些腹部训练改善

GeneralGuidelinestoAvoidMusculoskeletalInjuries

避免骨骼肌肉损伤的一般性指引Encouragerhythmicmotionoflargemusclegroups建议进行大肌肉群参与的有节奏的活动Teachproperbodymechanicsforliftingorposture教授正确的身体活动和姿势Encouragestrengthtrainingofmajormusclegroups,emphasizeontechnique>loads建议进行大肌肉群的力量训练，重点主要放在训练技巧上，而不是负重多少Strengthenweakmuscles(e.g. )andstretchtightmuscles(e.g. )训练无力的肌肉（如：）拉伸紧张的肌肉（如：）Useappropriatesupportwhennecessary

需要的时候进行适当的支持Encourageswimmingorwateraerobics(reducestressonthejointsandaidsedema)

建议进行游泳训练或水中有氧运动（可以减少对于关节的压力和帮助减轻水肿）AvoidValsalvamaneuver避免捏鼻闭嘴呼气法Consultwithphysiotherapistandreferanywomenwithchronicachesandpains如果有慢性的周身疼痛，需要与医生沟通Nodatashowsthatexerciseincreasetheriskofinjury没有数据表明训练会增加受伤的危险Thermoregulation

体温调节PregnancyRelatedChangesthatAffectExercise

孕期身体改变对运动的影响Increaseinbasalmetabolicrate(BMR)increaseinheatproduction基础代谢率（BMR）提高

产生热量增多Fluidloss水分流失PotentialProblems&ExerciseImplications

潜在问题和训练应用ExercisePrescription

训练处方1.Medicalscreeningbeforeexercise运动前进行医务检查 History:overallhealth,obstetric(e.g.maternalage,previouslowbirthweighthistory,shortintervalbetweenbirths)&medical(?affectCV)

病史：整体健康，产科（如：母亲年龄，有无婴儿体重不足的历史，两次生产时间间隔短）和内科（？影响心肺系统（CV））Relativecontraindicationtoaerobicexerciseduringpregnancy(ACOG,2002)

孕期进行有氧运动的相对禁忌症（ACOG，2002）Severeanaemia严重贫血Unevaluatedmaternalcardiacarrhythmia

孕妇心律不齐Chronicbronchitis慢性支气管炎PoorlycontrolledtypeIDM没有得到控制的I型糖尿病（DM）Extrememorbidobesity(BMI>39)

极度病态肥胖（BMI>39）Extremeunderweight(BMI<12)

极度体重过轻（BMI<12)WarningsignstoSTOPexercise(ACOG,2002)停止运动的信号（ACOG，2002）Vaginalbleeding阴道出血Dyspnoeabeforeexertion在用力之前呼吸困难Dizziness眩晕Headache头痛Chestpain胸部疼痛Muscleweakness肌肉无力Calfpainorswelling(needtoruleoutthrombophlebitis)

小腿疼痛或水肿（排除血栓性静脉炎的可能）Pretermlabour早产Decreasedfetalmovement胎儿活动减少Amnioticfluidleakage羊水渗漏5. Exerciseprogramming训练计划Pre-pregnantlevelofphysicalfitness

孕前的身体体适能水平Reasonablegoals建立合理的训练目标 (Enjoyment,health,reducediscomfort,maximizebenefits,regulatefatgain>performance/achievements)（享受，健康，减少不适感，获益最大化，控制脂肪增加>运动表现/成绩）Typeofexercise运动类型

~Aerobicexercise-(walking,swimming,cyclingetc.,AVOIDsupine/impactex)

有氧训练-（步行，游泳，自行车等，避免仰卧/高冲击训练）

~Resistancetraining-considerrepetition/position

抗阻力训练-考虑重复次数/姿势

~Flexibility-AVOIDhyperextension

拉伸-避免超伸Intensity强度60-70%HRmaxor50–60%maxO2uptake(formostpregnantwomenwhodidnotengageinregularexercisebeforepregnancy),

HR<140bpm

最大心率的60-70%或最大摄氧量的50-60%(适用于大多数孕前不是经常进行运动的孕妇）,心率不超过140RPE12–14(somewhathard),3ptchange自觉运动强度(RPE)12-14（有些辛苦）,在3点范围内改变3–4METs3-4梅脱Adjustmentforregularexercisers对于有经常运动的孕妇做适量调整Duration训练时间ACSM–

NOrecommendationsACSM-没有给出建议Consider~考虑 Thermoregulation(environment),core temperaturerise<1.5

Cover30min

体温调节（环境），运动超过30分钟身体核心温度提高<1.5

C Energybalance能量平衡Frequency频率 30min/day30分钟/天Progression进度 Pregnancyisnotatimeforgreatlyimprovingphysicalfitness

怀孕期间不适合大幅度的提升体适能水平

Selfmonitoring自我监控 (Colourofurine;avoidfatigue;expectsomeweightgain;RPE;usecommonsense)

（尿液颜色；避免疲劳；体重增加；自觉运动强度表（RPE）；运用常识判断）RecommendationsforSportActivitiesDuringPregnancy(ACOG,1994)

孕期运动建议ActivitiestoEncourage

建议运动Walking步行Stationarycycling固定自行车Low-impactaerobics低冲击有氧运动Swimming游泳ActivitiestoDiscourage

不建议的运动Guideline

指引1.Precautions注意事项2.NutritionandWeightLoss

营养和降低体重Followgeneralweightlossguidelines根据一般降低体重的指引Mayhaveextraweightlossbyincreasedenergyoutputduetomilkproductionordecreasededema由于乳汁分泌或水肿使能量消耗增多会额外减少体重Extra300-400kcal/dayforthefirst3monthsofbreast-feeding母乳喂养首３个月每日会额外消耗300-400卡路里8-12glassesoffluid(avoidcaffeine)补充8-12杯水（避免含有咖啡因的饮料）Severecaloricrestrictionwilldecreasemilkproduction严重卡路里摄入不足会减少乳汁分泌RectusDiastasis腹直肌分离3.MusculoskeletalIssuesandExercise

骨骼肌肉相关事宜和训练3.MusculoskeletalIssuesandExercise

骨骼肌肉相关事宜和训练AbdominaldiastasisandTrAexercise腹肌分离和腹横肌训练(Sheppard,1996)BeforeTrAexercise(60mm)

腹横肌训练前(60mm)AfterTrAexercise(7mm)腹横肌训练后(7mm)15weeks周

3.MusculoskeletalIssuesandExercise

骨骼肌肉相关事宜和训练ThePelvicFloorMuscles

骨盆底部肌肉HowtoDoPelvicFloorExercise–1

如何训练骨盆底部肌肉－1Position:Startinlyingonyourback,sideorfrontandprogresslatertostanding,straddlingachairthensquatting.姿势：开始以仰卧，侧卧或俯卧，逐渐进阶到站立，跨骑在椅子上，最后到蹲举姿势Imaginethatyouaretryingtostopyourselffrompassingwindandatthesametimetryingtostopyourflowofurinemidstream;thefeelingisoneofsqueezeandlift,closinganddrawingupbothfrontandbackpassages.想象你试图憋屁同时憋尿；是夹紧和上提的感觉，关闭和上提前和后的通路Whenyouaredoingthisyoushouldnotholdyourbreath,orsqueezeyourbottomorthighstogetherbuttrytorelaxandbreathenormally做时不要憋气，不要夹紧臀部或大腿，反而要放松和自然的呼吸.HowtoDoPelvicFloorExercise–2

如何进行骨盆底部肌肉的训练－2Tocheckthefeelingofyourpelvicfloormusclesworking,trystoppingtheflowofurinenexttimeyougotothetoilet.Remember,youwon’tbeabletostopitcompletelyatfirst.Onceyouarefamiliarwiththesensationtrytopracticeitatothertimes.

在想上厕所时憋住尿，可以体会到骨盆底部肌肉收缩的感觉。记住，你在第一次时不会完全憋住。多做练习直到熟悉这种感觉下次就会好很多HowtoDoPelvicFloorExercise–3

如何进行骨盆底部肌肉的训练－3Therearetwowaystodothisexercise:有两种方式进行这个练习：ForStrengthening=Quickly,asrepeatedsqueezingandrelaxingofthemuscles.强化力量＝快速，重复收紧和放松这些肌肉ForEndurance=Slowly,sothatyousqueezethepelvicfloormusclesupslowly,holdthecontractionforaslongasyoucan(keepbreathing!)thenrelaxslowly.提高耐力＝慢速，慢些夹紧骨盆底部肌肉，尽可能保持这种收缩（保持呼吸），然后慢慢放松HowtoDoPelvicFloorExercise–4

如何训练骨盆底部肌肉-4Toprogresstheendurancecapacityofthesemusclesimaginethatyourpelvicfloorisaliftinaliftshaft.Whenyouarenotconsciouslycontractingthemuscles,itisatgroundfloor.

逐渐提高这些肌肉的耐力，想象你的骨盆底部肌肉是上升的电梯。当你不能持续收紧这些肌肉，就好像电梯下到底层一样Trytocontractalittlebitandraisethe“lift”tothefirstfloor,thenalittlemoretothesecondfloorandthentothethirdfloor.Whenyouhavesqueezedasmuchasyoucan,holditthereforaslongasyoucan……keepingbreathing!

试图收紧多一些，将电梯升高到1楼，再多一些来到2楼，然后再到三楼。尽可能多的夹紧，能保持多久就多久，不要忘记呼吸！Now,taketheliftbackslowlytothesecondfloor,thentothefirstfloorandthentoground.Goingdownismuchharderthangoingup!!

现在，慢慢将电梯下降到2楼，然后到1楼，然后到底层。向下降比向上升会感觉更困难！！HowtoDoPelvicFloorExercise–5

如何训练骨盆底部肌肉训练-5Strength:力量OnMonday,WednesdayandFriday周一，周三和周五8-12maximaleffortcontractions8-12次最大力量收缩Hold5secondseach每次保持5秒Repeat3timesaday每天重复3次Endurance:耐力OnTuesday,Thurs