临床和运动专业人士对产后身体活动预筛查及参与产后身体活动禁忌症意见的国际德尔菲研究

International Delphi study of clinical and exercise professionals' opinion of physical activity prescreening and contraindications for participating in postpartum physical activity.

作者信息

Davenport Margie H, Christopher Shefali, Deering Rita E, Prevett Christina, Dufour Sinead, Forte Milena, Beamish Nicole, Adamo Kristi, Bo Kari, Brockwell Emma, Brunet-Pagé Émilie, Chari Radha, De Vivo Marlize, Fleming Karen, Hassan Amal, Hayman Melanie, Lane Kirstin N, Mottola Michelle F, Neil-Sztramko Sarah E, Santos-Rocha Rita A, Szumilewicz Anna, Ruchat Stephanie-May

机构信息

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

Doctor of Physical Therapy Program, Department of Rehabilitation Sciences, Tufts University, Medford, Washington, USA.

出版信息

Br J Sports Med. 2025 Mar 31;59(8):527-538. doi: 10.1136/bjsports-2024-109104.

DOI:10.1136/bjsports-2024-109104

PMID:40054885

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12013588/

Abstract

OBJECTIVE

To establish expert consensus on prescreening and contraindications to moderate-to-vigorous intensity physical activity (MVPA) during the first year postpartum.

METHODS

A Delphi survey of clinical and exercise professionals working with postpartum women and people was conducted until consensus was reached (≥75% agreement). Round I consisted of questions about relative and absolute contraindications to MVPA. Rounds II and III included additional questions based on the thematic coding of open-ended responses from the previous rounds. The results were used to develop a postpartum MVPA preparticipation screening tool.

RESULTS

120 participants completed round I, 105 completed round II and 95 completed round III. Consensus was reached in 46/49 (94%) statements. Twenty-four relative contraindications to MVPA were identified: (loss of consciousness; neurological symptoms; kidney disease; calf pain or swelling suggestive of deep vein thrombosis; severe abdominal pain; vaginal bleeding not associated with menses; postpartum cardiomyopathy; caesarean section with symptoms that worsen with MVPA; unstable hypertension; eating disorder; malnutrition; anaemia; excessive fatigue; fractures or other significant musculoskeletal injuries; haemodynamic instability; breathing difficulties; acute systemic infection accompanied by fever, body aches, or swollen lymph glands; the new onset of chest pain, discomfort, and other angina-like symptoms with exertion; dizziness or lightheadedness during MVPA; new symptoms of heart disease, stroke; and other medical or physical conditions that may affect the ability to be physically active. Key biopsychosocial barriers to MVPA were identified.

CONCLUSION

This Delphi study recommends relative contraindications to MVPA for the first year postpartum that were incorporated into a postpartum MVPA pre-participation screening tool the Get Active Questionnaire for Postpartum.

摘要

目的

就产后第一年进行中等到高强度身体活动（MVPA）的预筛查及禁忌证达成专家共识。

方法

对从事产后女性相关工作的临床和运动专业人员进行了德尔菲调查，直至达成共识（≥75%的一致意见）。第一轮包括关于MVPA相对和绝对禁忌证的问题。第二轮和第三轮则根据前一轮开放式回答的主题编码纳入了其他问题。研究结果用于开发产后MVPA参与前筛查工具。

结果

120名参与者完成了第一轮，105名完成了第二轮，95名完成了第三轮。在49条陈述中有46条（94%）达成了共识。确定了24条MVPA的相对禁忌证：（意识丧失；神经系统症状；肾脏疾病；提示深静脉血栓形成的小腿疼痛或肿胀；严重腹痛；与月经无关的阴道出血；产后心肌病；剖宫产且MVPA会使症状加重；不稳定的高血压；饮食失调；营养不良；贫血；过度疲劳；骨折或其他严重的肌肉骨骼损伤；血液动力学不稳定；呼吸困难；伴有发热、身体疼痛或淋巴结肿大的急性全身感染；运动时新发胸痛、不适及其他心绞痛样症状；MVPA期间头晕或眩晕；心脏病、中风的新症状；以及其他可能影响身体活动能力的医学或身体状况。确定了MVPA的关键生物心理社会障碍。