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, I2 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. Data are available on reasonable request.

中文翻译：

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产后运动对盆底疾病和腹直肌分离的影响：系统评价和荟萃分析


目的 探讨产后第1年运动对盆底疾病和腹直肌分离的影响。设计 系统评价与随机效应荟萃分析。数据来源：MEDLINE、EMBASE、CINAHL、SPORTDiscuss、Evidence-Based Medicine Reviews （Ovid）、Scopus、Web of Science 和 ClinicalTrials.gov 检索截止到 2024 年 1 月 12 日。选择研究的资格标准 所有设计（案例研究除外）和语言的研究都包含有关人群（产后第一年的个体）、干预（单独（“仅运动”）或与其他干预（例如，生物反馈;“运动+共同干预”）、对照（不运动或不同的运动措施）和结果（尿失禁、肛门失禁、盆腔器官脱垂、腹直肌分离和性功能的症状严重程度和风险）。结果 共纳入来自 24 个国家的 65 项研究 （n=21 334 名受试者）。“中等”证据表明，盆底肌肉训练使尿失禁的几率降低了 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 56%（一项 RCT，n=123;OR 0.44,95% CI 0.21 至 0.91）。“低”质量证据表明，与不运动相比，在休息时和腹部肌肉训练后抬头时测得的腹直肌间距减少幅度更大。 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严重程度的影响的证据有限。结论 有证据支持产后盆底肌肉训练降低尿失禁和盆腔器官脱垂几率和产后腹部运动训练减少腹直肌间距的有效性。PROSPERO 注册号 CRD42022359282。数据可应合理要求提供。