1、Post Natal Fitness Guidelines产后妇女体适能训练指引,AASFP Fitness Specialist (Personal Training),,Presented by :,PRENATAL FITNESS产前体适能,Introduction胎儿和子宫介绍,Proposed Benefits of Exercise During Pregnancy孕期训练的益处,Cardiovascular心肺系统方面Increase or maintain aerobic fitness 提高或保持有氧体适能水平Increase cardiopulmonary reserve
2、提高心肺储备Possibility to reduce the risk of hypertension 减少高血压的危险Musculoskeletal骨骼肌肉方面Promote good posture 促进好的身体姿态Improve and/or maintain muscle strength and tone 提高和/或保持肌肉力量和线条Prevent and/or help to reduce low back pain 防止和/或帮助减少腰背痛Maintain or improve pelvic floor integrity and recovery 保持或促进骨盆底部肌肉的完整
3、和恢复,Hormonal荷尔蒙方面Reduce the risk of gestational diabetes 降低妊娠期糖尿病的危险Labour分娩方面Possibly experience an easier or shorter labour? 有可能帮助顺产或减短分娩时间？Promote faster recovery from labour and pregnancy加快产后恢复 Reduce post date deliveries 减少晚于预产期的情况Reduce fetal distress降低胎儿窘迫症的发生? Bigger placenta增大胎盘？,General综合方
4、面Prevent excessive “fat gain” 防止过量获得脂肪Improve psychological aspects of pregnancy and reduce postpartum depression 孕妇心理方面的帮助以及减少产后心情消沉Improve sleep增进睡眠Aid digestion and reduce constipation 帮助消化，减少便秘,Cardiovascular / Respiratory Issues心肺/呼吸系统相关事宜,Pregnancy Related Cardiovascular & respiratory changes
5、that affect exercise孕期心肺/呼吸系统的变化对于运动的影响Increase in blood volume 40-50%血流量提高40-50% Increase in HR (20%), SV(10%), CO (30-50%)(Wolfe et al, 1989) 心率提高20%，心缩排血量（SV）提高10%，心输出量（CO）提高30-50% Because of increase uterine vasculature and uteroplacental circulation Decrease in systemic vascular resistance (5-1
6、0mmHg) 由于子宫脉管系统和胎盘血流的原因循环系统血管阻力减少（5-10mmHg）The above establish a circulatory reserve to provide nutrients and O2 to mother and foetus.以上可以增进循环储备以提供母亲和胎儿的营养和氧气,Increase in O2 uptake in baseline consumption (Wang & Apgar, 1998) 增加基础氧的摄入量Increase in resting O2 requirement and increase in work of breath
7、ing (because of enlarged uterus on the diaphragm) reduce O2 availability for performance of aerobic exercise during pregnancy 静态氧气需求量增加，运动时呼吸加快（因为增大的子宫对横膈膜影响） 孕期进行有氧运动时对于氧气的利用会减少During exercise, greater increase in respiratory rate & O2 consumption, to meet greater O2 demand 运动时，呼吸频率和氧耗量会显著增加，以满足身体对
8、更多氧气的需要,Potential Problems & Exercise Implications潜在问题和训练应用,Implications : 应用：(1) Exercise Positioning训练姿势Supine position : decrease in CO (20%) 仰卧姿势：CO减少20% CO optimal in side-lying position 最理想姿势是侧卧,(2) SOB or EIA (Exercise-induced asthma) 气促（SOB）或运动性哮喘（ EIA ）(3)Frequency (avoid high intensity ex;
9、 ex regularly; shorter duration and lesser intensity) 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 ( 140 bpm; avoid anaerobic workouts, exhaustive ex; monitoring; RPE 15 强度（心率 140；避免无氧运动/力竭运动；进行监测；RPE 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Strengthen weak muscles (e.g.) and stretch tight muscles (e.g.)训练无力的
10、肌肉（如：） 拉伸紧张的肌肉（如：）Use appropriate support when necessary 需要的时候进行适当的支持,Encourage swimming or water aerobics (reduce stress on the joints and aids edema) 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）Avoid Valsalva maneuver 避免捏鼻闭嘴呼气法Consult with physiotherapist and refer any women with chronic aches and pains 如果
11、有慢性的周身疼痛，需要与医生沟通No data shows that exercise increase the risk of injury 没有数据表明训练会增加受伤的危险,Thermoregulation体温调节,Pregnancy Related Changes that Affect Exercise孕期身体改变对运动的影响,Increase in basal metabolic rate (BMR) increase in heat production基础代谢率（BMR）提高产生热量增多Fluid loss水分流失,Potential Problems & Exercise Im
12、plications潜在问题和训练应用,Exercise increases heat dissipation sweating 运动增加热量散发流汗Dehydration may cause cramps, uterine irritability, preterm labour during late pregnancy 脱水可能引起抽筋，子宫敏感性，妊娠晚期早产Decrease in foetus heat dissipation ? congenital problems 胎儿散热降低 ？ 先天性问题Wear appropriate clothing 选择合适的服装Water exer
13、cise may be more tolerable for longer than land exercise 水中训练时间可以长于陆上训练Stay well-hydrated before, during and after exercise; drink one glass every 15 min 训练前，中，后都要补充水分；每15分钟喝一杯水DO NOT exercise with a fever 发烧时不能运动,Exercise Prescription训练处方,1.Medical screening before exercise 运动前进行医务检查History : overa
14、ll health, obstetric (e.g. maternal age, previous low birth weight history, short interval between births) & medical (? affect CV) 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）,Absolute contraindication to aerobic exercise during pregnancy (ACOG, 2002) 孕期进行有氧运动的绝对禁忌症（ACOG，2002）Haemodynami
15、cally significant heart disease 显著血液动力障碍严重心脏病Restrictive lung disease限制型肺病Incompetent cervix子宫颈口松弛症Multiple gestation at risk for premature labour 多次怀孕有早产的危险Persistent second and third trimester bleeding 在中期妊娠和晚期妊娠持续流血Placenta praevia after 26 weeks gestation 怀孕26周后胎盘前置Premature labour during the cu
16、rrent pregnancy 怀孕时早产Ruptured membranes胎衣破裂Pregnancy induced hypertension 孕妇有高血压,Relative contraindication to aerobic exercise during pregnancy (ACOG, 2002) 孕期进行有氧运动的相对禁忌症（ACOG，2002）Severe anaemia严重贫血Unevaluated maternal cardiac arrhythmia 孕妇心律不齐Chronic bronchitis慢性支气管炎Poorly controlled type I DM 没有
17、得到控制的I型糖尿病（DM）Extreme morbid obesity (BMI39) 极度病态肥胖（ BMI39）Extreme underweight (BMI12) 极度体重过轻（BMI20/day)酗烟（20支/天）,Warning signs to STOP exercise (ACOG, 2002 ) 停止运动的信号（ACOG， 2002）Vaginal bleeding 阴道出血Dyspnoea before exertion在用力之前呼吸困难Dizziness眩晕Headache头痛Chest pain胸部疼痛Muscle weakness肌肉无力Calf pain or s
18、welling (need to rule out thrombophlebitis) 小腿疼痛或水肿（排除血栓性静脉炎的可能）Preterm labour早产Decreased fetal movement 胎儿活动减少Amniotic fluid leakage 羊水渗漏,5.Exercise programming训练计划Pre-pregnant level of physical fitness 孕前的身体体适能水平Reasonable goals建立合理的训练目标(Enjoyment, health, reduce discomfort, maximize benefits, reg
19、ulate fat gain 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）Type of exercise运动类型 Aerobic exercise - (walking, swimming, cycling etc., AVOID supine/ impact ex) 有氧训练-（步行，游泳，自行车等，避免仰卧/高冲击训练） Resistance training - consider repetition/ position 抗阻力训练-考虑重复次数/姿势 Flexibility - AVOID hyperexte
20、nsion 拉伸-避免超伸,Intensity强度60 - 70% HR max or 50 60% max O2 uptake (for most pregnant women who did not engage in regular exercise before pregnancy), HR 140 bpm 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140RPE 12 14 (somewhat hard), 3 pt change自觉运动强度(RPE)12-14（有些辛苦）,在3点范围内改变3 4 METs 3-4梅脱Adj
21、ustment for regular exercisers 对于有经常运动的孕妇做适量调整Duration训练时间ACSM NO recommendationsACSM-没有给出建议Consider 考虑Thermoregulation (environment), core temperature rise 1.5C over 30 min 体温调节（环境），运动超过30分钟身体核心温度提高1.5C Energy balance 能量平衡,Frequency频率30 min / day 30分钟/天Progression进度Pregnancy is not a time for great
22、ly improving physical fitness 怀孕期间不适合大幅度的提升体适能水平 Self monitoring自我监控(Colour of urine; avoid fatigue; expect some weight gain; RPE; use common sense) （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）,Recommendations for Sport Activities During Pregnancy (ACOG, 1994)孕期运动建议,Activities to Encourage建议运动,Walking 步行Sta
23、tionary cycling 固定自行车Low-impact aerobics 低冲击有氧运动Swimming 游泳,Activities to Discourage不建议的运动,Contact sports (increased risk of abdominal trauma) 有身体碰撞的运动（增加腹部外伤危险）Hockey (field and ice)曲棍球（野外和冰上）Boxing拳击Football橄榄球Soccer足球High-risk sports (increased potential for falls/ trauma) 高危险的运动（增加摔倒/外伤的危险）Gymna
24、stics Horseback riding体操、马术Skating溜冰Skiing (snow and water) 滑雪和滑水Hang gliding滑翔Vigorous racquet sports剧烈球类运动Weight lifting举重Scuba diving 潜水,Guideline指引,1. Precautions 注意事项,Avoid moderately strenuous activities if there is vaginal bleeding or soreness of episiotomy如果阴道出血或由于外阴切开术疼痛，要避免进行中等强度的训练Stop ex
25、ercising if vaginal bleeding increases or bright red blood appears如果阴道出血增加或出现鲜红色血液要停止运动Avoid water sports if persistent discharge and unhealed episiotomy; typical recommendation 4 weeks.如果持续流血和外阴切开术没有痊愈要避免水中运动，一般建议周Use all pre-pregnancy precautions regarding musculoskeletal risks在骨骼肌肉方面的危险同产前注意事项Avo
26、id fatigue and dehydration避免疲劳和脱水Gradual progression of exercise 运动循序渐进,2. Nutrition and Weight Loss 营养和降低体重,Follow general weight loss guidelines根据一般降低体重的指引May have extra weight loss by increased energy output due to milk production or decreased edema 由于乳汁分泌或水肿使能量消耗增多会额外减少体重Extra 300-400 kcal/day f
27、or the first 3 months of breast-feeding母乳喂养首个月每日会额外消耗300-400卡路里8-12 glasses of fluid (avoid caffeine)补充8-12 杯水（避免含有咖啡因的饮料）Severe caloric restriction will decrease milk production 严重卡路里摄入不足会减少乳汁分泌,Rectus Diastasis 腹直肌分离,3. Musculoskeletal Issues and Exercise 骨骼肌肉相关事宜和训练,3. Musculoskeletal Issues and
28、Exercise 骨骼肌肉相关事宜和训练,Abdominal diastasis and TrA exercise 腹肌分离和腹横肌训练(Sheppard, 1996),Before TrA exercise(60mm) 腹横肌训练前(60mm),After TrA exercise(7mm)腹横肌训练后(7mm),15 weeks周 ,3. Musculoskeletal Issues and Exercise 骨骼肌肉相关事宜和训练,Perform pelvic floor exercises within 24 hours after delivery产后24小时内进行骨盆底部肌肉的训练
29、The pelvic floor is a sling of muscles that support the intestines, uterus, bowel, and bladder. They are very important in closing the bladder and bowel openings, hence preventing unwanted leakages.骨盆底部肌肉是可以支持肠，子宫，大肠和膀胱的肌肉。它们对于合拢膀胱和大肠开口非常重要，可以预防不自觉漏出排泄物During a vaginal delivery they are stretched by
30、 the passage of the baby through the birth canal. Episiotomy or tearing results in further damage to these muscles.在生产时由于胎儿经过阴道会使肌肉拉伸。外阴切开术或肌肉撕裂在将来会对这些产生破坏作用,The Pelvic Floor Muscles骨盆底部肌肉,How to Do Pelvic Floor Exercise 1如何训练骨盆底部肌肉1,Position : Start in lying on your back, side or front and progress
31、 later to standing, straddling a chair then squatting.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Imagine that you are trying to stop yourself from passing wind and at the same time trying to stop your flow of urine mid stream; the feeling is one of squeeze and lift, closing and drawing up both front and b
32、ack passages. 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When you are doing this you should not hold your breath, or squeeze your bottom or thighs together but try to relax and breathe normally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.,How to Do Pelvic Floor Exercise 2如何进行骨盆底部肌肉的训练2,To check the feeling of your pelvic flo
33、or muscles working, try stopping the flow of urine next time you go to the toilet. Remember, you wont be able to stop it completely at first. Once you are familiar with the sensation try to practice it at other times.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,How to Do Pelvic Flo
34、or Exercise 3如何进行骨盆底部肌肉的训练3,There are two ways to do this exercise :有两种方式进行这个练习：For Strengthening = Quickly, as repeated squeezing and relaxing of the muscles.强化力量快速，重复收紧和放松这些肌肉For Endurance = Slowly, so that you squeeze the pelvic floor muscles up slowly, hold the contraction for as long as you can
35、 (keep breathing!) then relax slowly. 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,How to Do Pelvic Floor Exercise 4如何训练骨盆底部肌肉-4,To progress the endurance capacity of these muscles imagine that your pelvic floor is a lift in a lift shaft. When you are not consciously contracting the muscles, it is at gr
36、ound floor. 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Try to contract a little bit and raise the “lift” to the first floor, then a little more to the second floor and then to the third floor. When you have squeezed as much as you can, hold it there for as long as you can keeping breathing
37、! 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, take the lift back slowly to the second floor, then to the first floor and then to ground. Going down is much harder than going up! 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！,How to Do Pelvic Floor Exercise 5如何训练骨盆底部肌肉训练-5,Strength:力量On M
38、onday, Wednesday and Friday周一，周三和周五8-12 maximal effort contractions 8-12次最大力量收缩Hold 5 seconds each每次保持5秒Repeat 3 times a day每天重复3次Endurance:耐力On Tuesday, Thursday and Saturday周二，周四和周六Lift and hold as long as possible尽可能上提并且保持Rest 5 seconds between each每次之间休息5秒Repeat 4 times重复4次Rest 2 minutes休息2分钟Rea
39、peat重复,How to Do Pelvic Floor Exercise 6如何训练骨盆底部肌肉-6,If you feel in the early days that you may leak on any effort, e.g., when you cough or sneeze or lift anything heavy, squeeze and lift your pelvic floor first to brace it and prevent any leakage. Do not get into the habit of going to the toilet just in case this makes the pelvic floor lazy! 如果早上你发现稍用力就会失禁，比如当你咳嗽或打喷嚏或提起重物，这时要夹紧和提起骨盆底部肌肉来停止和避免失禁。不要养成一失禁就去厕所的习惯，这样会使你的骨盆底部肌肉无力！,
