Coenen Pieter, Parry Sharon, Willenberg Lisa, Shi Joyce W, Romero Lorena, Blackwood Diana M, Healy Genevieve N, Dunstan David W, Straker Leon M
Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands; School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
Gait Posture. 2017 Oct;58:310-318. doi: 10.1016/j.gaitpost.2017.08.024. Epub 2017 Aug 24.
While prolonged standing has shown to be detrimentally associated with musculoskeletal symptoms, exposure limits and underlying mechanisms are not well understood. We systematically reviewed evidence from laboratory studies on musculoskeletal symptom development during prolonged (≥20min) uninterrupted standing, quantified acute dose-response associations and described underlying mechanisms. Peer-reviewed articles were systematically searched for. Data from included articles were tabulated, and dose-response associations were statistically pooled. A linear interpolation of pooled dose-response associations was performed to estimate the duration of prolonged standing associated with musculoskeletal symptoms with a clinically relevant intensity of ≥9 (out of 100). We included 26 articles (from 25 studies with 591 participants), of which the majority examined associations of prolonged standing with low back and lower extremity symptoms. Evidence on other (e.g., upper limb) symptoms was limited and inconsistent. Pooled dose-response associations showed that clinically relevant levels of low back symptoms were reached after 71min of prolonged standing, with this shortened to 42min in those considered pain developers. Regarding standing-related low back symptoms, consistent evidence was found for postural mechanisms (i.e., trunk flexion and lumbar curvature), but not for mechanisms of muscle fatigue and/or variation in movement. Blood pooling was the most consistently reported mechanism for standing-related lower extremity symptoms. Evidence suggests a detrimental association of prolonged standing with low back and lower extremity symptoms. To avoid musculoskeletal symptoms (without having a-priori knowledge on whether someone will develop symptoms or not), dose-response evidence from this study suggests a recommendation to refrain from standing for prolonged periods >40min. Interventions should also focus on underlying pain mechanisms.
虽然长期站立已被证明与肌肉骨骼症状存在有害关联，但暴露限值和潜在机制尚未得到充分理解。我们系统回顾了关于长时间（≥20分钟）不间断站立期间肌肉骨骼症状发展的实验室研究证据，量化了急性剂量反应关联，并描述了潜在机制。我们系统检索了同行评审的文章。将纳入文章的数据制成表格，并对剂量反应关联进行统计汇总。对汇总的剂量反应关联进行线性插值，以估计与强度≥9（满分100）的具有临床相关性的肌肉骨骼症状相关的长期站立持续时间。我们纳入了26篇文章（来自25项研究，共591名参与者），其中大多数研究了长期站立与腰背部和下肢症状的关联。关于其他（如上肢）症状的证据有限且不一致。汇总的剂量反应关联表明，长期站立71分钟后会出现具有临床相关性的腰背部症状水平，在那些被认为会出现疼痛的人中，这一时长缩短至42分钟。关于与站立相关的腰背部症状，在姿势机制（即躯干屈曲和腰椎曲度）方面发现了一致的证据，但在肌肉疲劳和/或运动变化机制方面未发现一致证据。血液淤积是与站立相关的下肢症状最常被报道的机制。有证据表明长期站立与腰背部和下肢症状存在有害关联。为避免肌肉骨骼症状（在事先不知道某人是否会出现症状的情况下），本研究的剂量反应证据建议避免长时间站立超过40分钟。干预措施也应关注潜在的疼痛机制。
