产后妇女体适能训练指引.ppt

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

3、底部肌肉的完整和恢复,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

4、盘？,General综合方面 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 ex re

5、gularly; 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 15,Musculoskeletal / Anatomical Issues骨骼肌肉/解剖学相关事宜,Pregnancy Related Changes that Affect exercise 孕期相关变化会对运动产生的

6、影响 Increased levels in oestrogen may be present in up to 30% of pregnant women, generally occurs in last trimester 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 Painless condition that requires no treatment unless separation exceeds approx. 7cm (3 fingers), abdominal exercises would then require

7、modification 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,General Guidelines to Avoid Musculoskeletal Injuries避免骨骼肌肉损伤的一般性指引,Encourage rhythmic motion of large muscle groups 建议进行大肌肉群参与的有节奏的活动 Teach proper body mechanics for lifting or posture 教授正确的身体活动和姿势 Encourage strength training of major musc

8、le groups, emphasize on technique 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

9、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 Exerc

10、ise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 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 Hi

11、story : overall health, obstetric (e.g. maternal age, previous low birth weight history, short interval between births) 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,Activit

12、ies to Encourage建议运动,Walking 步行 Stationary 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

13、for falls/ trauma) 高危险的运动（增加摔倒/外伤的危险） Gymnastics 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

14、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 exercising 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 precauti

15、ons regarding musculoskeletal risks 在骨骼肌肉方面的危险同产前注意事项 Avoid 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 dec

16、reased 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 for 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. Musculoskeleta

17、l Issues and Exercise 骨骼肌肉相关事宜和训练,3. Musculoskeletal Issues and 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 pelv

18、ic floor exercises within 24 hours after delivery 产后24小时内进行骨盆底部肌肉的训练 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

19、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 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

20、底部肌肉1,Position : Start in lying on your back, side or front and progress 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 f

21、eeling is one of squeeze and lift, closing and drawing up both front and back 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 P

22、elvic Floor Exercise 2如何进行骨盆底部肌肉的训练2,To check the feeling of your pelvic floor 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

23、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 Floor 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 squeez

24、e the pelvic floor muscles up slowly, hold the contraction for as long as you can (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 i

25、n a lift shaft. When you are not consciously contracting the muscles, it is at ground 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 s

26、queezed as much as you can, hold it there for as long as you can keeping breathing! 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

27、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 Monday, 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 Reapeat重复,How to