产后运动对盆底功能障碍和腹直肌分离的影响：一项系统评价和荟萃分析。
Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis: a systematic review and meta-analysis.
作者信息
Beamish Nicole F, Davenport Margie H, Ali Muhammad Usman, Gervais Matthew J, Sjwed Talia Noel, Bains Gyanjot, Sivak Allison, Deering Rita E, Ruchat Stephanie-May
机构信息
School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada.
Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.
出版信息
Br J Sports Med. 2025 Mar 31;59(8):562-575. doi: 10.1136/bjsports-2024-108619.
OBJECTIVE
To examine the effect of exercise during the first year postpartum on pelvic floor disorders and diastasis recti abdominis.
DESIGN
Systematic review with random effects meta-analysis.
DATA SOURCES
MEDLINE, EMBASE, CINAHL, SPORTDiscuss, Evidence-Based Medicine Reviews (Ovid), Scopus, Web of Science and ClinicalTrials.gov were searched until 12 January 2024.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Studies of all designs (except case studies) and languages were included if they contained information on the Population (individuals in the first year postpartum), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise alone ('exercise-only') or in combination with other intervention (eg, biofeedback; 'exercise+co-intervention')), Comparator (no exercise or different exercise measures) and Outcome (symptom severity and risk of urinary incontinence, anal incontinence, pelvic organ prolapse, diastasis recti abdominis and sexual function).
RESULTS
65 studies (n=21 334 participants) from 24 countries were included. 'Moderate' certainty of evidence revealed that pelvic floor muscle training reduced the odds of urinary incontinence by 37% (seven randomised controlled trials (RCTs), n=1930; OR 0.63, 95% CI 0.41 to 0.97, I 72%) and pelvic organ prolapse by 56% (one RCT, n=123; OR 0.44, 95% CI 0.21 to 0.91) compared with control groups. 'Low' certainty of evidence showed a greater reduction in inter-rectus distance measured at rest and during a head lift following abdominal muscle training compared with no exercise. Evidence on the effect of exercise on the risk of anal incontinence and diastasis recti abdominis, as well as the severity of anal incontinence, urinary incontinence, pelvic organ prolapse and sexual function, is limited.
CONCLUSION
Evidence supports the effectiveness of postpartum pelvic floor muscle training in reducing the odds of urinary incontinence and pelvic organ prolapse and postpartum abdominal exercise training in reducing inter-rectus distance.
PROSPERO REGISTRATION NUMBER
CRD42022359282.
目的
探讨产后第一年运动对盆底功能障碍和腹直肌分离的影响。
设计
随机效应荟萃分析的系统评价。
数据来源
检索MEDLINE、EMBASE、CINAHL、SPORTDiscuss、循证医学评论（Ovid）、Scopus、科学网和ClinicalTrials.gov，检索截至2024年1月12日。
研究选择的纳入标准
所有设计（病例研究除外）和语言的研究，只要包含以下信息即可纳入：研究对象（产后第一年的个体）、干预措施（单独运动（“仅运动”）或与其他干预措施（如生物反馈；“运动+联合干预”）的频率、强度、持续时间、运动量或类型的主观或客观测量）、对照（不运动或不同的运动测量）和结局（症状严重程度以及尿失禁、肛门失禁、盆腔器官脱垂、腹直肌分离和性功能障碍的风险）。
结果
纳入了来自24个国家的65项研究（n=21334名参与者）。“中等”证据确定性表明，与对照组相比，盆底肌训练使尿失禁几率降低了37%（7项随机对照试验（RCT），n=1930；OR 0.63，95%CI 0.41至0.97，I² 72%），盆腔器官脱垂几率降低了56%（1项RCT，n=123；OR 0.44，95%CI 0.21至0.91）。“低”证据确定性表明，与不运动相比，腹肌训练后静息和抬头时测量的腹直肌间距减小幅度更大。关于运动对肛门失禁和腹直肌分离风险以及肛门失禁、尿失禁、盆腔器官脱垂和性功能障碍严重程度影响的证据有限。
结论
证据支持产后盆底肌训练在降低尿失禁和盆腔器官脱垂几率方面的有效性，以及产后腹部运动训练在减小腹直肌间距方面的有效性。
PROSPERO注册号：CRD42022359282。
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