Nascimento S L, Pudwell J, Surita F G, Adamo K B, Smith G N
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
Int J Obes (Lond). 2014 May;38(5):626-35. doi: 10.1038/ijo.2013.183. Epub 2013 Sep 19.
For women of reproductive age, excessive gestational weight gain and/or postpartum weight retention can increase the risk of obesity. This systematic review evaluates the effectiveness of lifestyle modification control trials that utilize exercise interventions, with or without dietary intervention, on weight loss among postpartum women. A search of randomized clinical trials (RCT) was performed using the follow databases and the bibliography of candidate studies: MEDLINE, Web of Science, EMBASE, CENTRAL/Cochrane and Physiotherapy Evidence Database. English language RCT papers published up to 31 October 2012, which present changes on maternal body weight from baseline to the end of exercise intervention were included. The primary meta-analysis examined the effects of exercise interventions, with or without complementary dietary intervention, on weight loss during the postpartum period compared with usual standard of care. Five subgroup analyses were performed to examine differences in study interventions and exercise modalities: duration of intervention, quality of study methodology, supervision of exercise intervention, exercise intervention goals used and the type of dietary intervention. In total 11 studies met eligibility criteria with 769 participants, 409 under intervention and 360 in the control group. The primary meta-analysis included all 11 studies and found a mean difference (MD) on weight loss of -2.57 kg (95% CI -3.66 to -1.47). The subgroup analysis demonstrated that the most effective interventions in reducing weight in postpartum women were exercise programs with objectively defined goals, such as the use of heart rate monitors or pedometer (MD of -4.09 kg-95% CI -4.94 to -3.25, I(2)=0%) and exercise combined with intensive dietary intervention (MD of -4.34 kg-95% CI -5.15 to -3.52, I(2)=0%). Thus, there is benefit from overall lifestyle interventions on weight loss in postpartum women and exercise plus intensive diet and objective targets are the most effective intervention strategies.
对于育龄女性而言，孕期体重过度增加和/或产后体重滞留会增加肥胖风险。本系统评价评估了采用运动干预（无论有无饮食干预）的生活方式改变对照试验对产后女性体重减轻的有效性。使用以下数据库和候选研究的参考文献进行随机临床试验（RCT）检索：MEDLINE、科学网、EMBASE、CENTRAL/考克兰图书馆和物理治疗证据数据库。纳入截至2012年10月31日发表的英文RCT论文，这些论文呈现了从基线到运动干预结束时母体体重的变化。主要荟萃分析研究了与常规标准护理相比，运动干预（无论有无辅助饮食干预）对产后体重减轻的影响。进行了五项亚组分析，以研究研究干预和运动方式的差异：干预持续时间、研究方法质量、运动干预的监督、使用的运动干预目标以及饮食干预类型。共有11项研究符合纳入标准，涉及769名参与者，其中409名接受干预，360名在对照组。主要荟萃分析纳入了所有11项研究，发现体重减轻的平均差异（MD）为-2.57 kg（95%CI -3.66至-1.47）。亚组分析表明，对产后女性最有效的减肥干预措施是具有客观定义目标的运动计划，如使用心率监测器或计步器（MD为-4.09 kg，95%CI -4.94至-3.25，I²=0%）以及运动与强化饮食干预相结合（MD为-4.34 kg，95%CI -5.15至-3.52，I²=0%）。因此，整体生活方式干预对产后女性体重减轻有益，运动加强化饮食和客观目标是最有效的干预策略。
