柔術醫師：懷孕可不可以運動？ (by 林杏青復健科總醫師)
你多少聽過老一輩常說孕婦不可以搬重物、不可以爬樓梯、不要過度活動、要好好休息。如果我跟你說懷孕的過程中做運動其實是很好的，肯定會被長輩罵。
我們可以理解以前醫療與科學不發達的年代，對於懷孕這件事有些習俗、直覺上的看法，但其實孕婦運動不只可以控制懷孕時以及產後體重，更可以預防懷孕引起的糖尿病、預防子癲前症、下背痛、尿失禁、產後憂鬱等等。今天復健科住院醫師整合了一些研究文獻來告訴妳孕婦如何安全又健康的運動。
什麼！？為什麼是復健科醫師不是婦產科醫師？
其實都有喔！！
婦產科醫師負責診斷和處理懷孕、疾病、生理上的問題，再由復健科醫師依照診斷的結果給予運動上的建議。
在所有醫師當中，復健科醫師被賦予開立運動處方的責任，並且和物理治療師、運動教練、運動防護師一起努力達成更好的運動安全與品質。
復健科醫師同時也處理懷孕時可能遇到的肌肉骨骼相關問題，例如腕隧道症候群、下背痛、生產導致的腰薦關節疾病、懷孕引起的扁平足和疼痛、預防代謝疾病的發生等等。
什麼樣的孕婦不適合運動？
大部分的孕婦是適合運動的，而且我們也很鼓勵運動，但如果妳有以下情形，就比較不適合直接去運動，必須先經過婦產科醫師和相關科別醫師的評估：
1. 嚴重貧血
2. 未經醫師判斷許可的心律不整
3. 慢性支氣管炎
4. 控制不好的第一型糖尿病
5. 極度肥胖 (懷孕前 BMI>40)
6. 極度瘦小
7. 平常幾乎完全沒有運動
8. 最近懷孕時有胎兒生長受限的狀況
9. 控制不良的高血壓
10. 骨骼問題 (例如骨折、肢體變形或骨質疏鬆)
11. 控制不良的癲癇問題
12. 控制不良的甲狀腺機能亢進
13. 抽菸抽很兇
但如果有以下狀況，就絕對不適合懷孕時期做運動：
1. 症狀明顯的心臟問題
2. 限制性肺病(常常由胸廓變形或神經肌肉問題引起)
3. 子宮頸閉鎖不全
4. 可能早產的多胞胎
5. 懷孕二十六週後的前置胎盤
6. 羊膜囊破裂(破水)
7. 子癲前症、懷孕引起的高血壓
8. 第二到第三孕期持續出血
好，假如妳沒有以上問題，是個好棒棒的健康孕婦，那就可以放心去運動囉～
或許妳會問：
「那懷孕時該做什麼樣的運動呢？要做到什麼程度呢？」
懷孕時期運動建議
我們可以參考美國運動醫學會對孕婦的運動建議：
| 有氧 | 阻力訓練 | 柔軟度 | |
|---|---|---|---|
| 頻率 | 3~5天以上/週 | 2~3天/週 | 2~3天以上/週 |
| 強度 | 中等強度； 如果原本有高強度運動習慣的話可以增強 | 8~12 RM，直到中等程度疲倦 | 伸展到輕微不舒服 |
| 時間 | 中等強度的話每天 30 分鐘，一週累積150分鐘。 高強度的話一週累積75分鐘。 | 初學者做一組就好，進階者做2~3組。 | 10~30秒 |
| 種類 | 健行、游泳都不錯 | 重量訓練機器、自由重量、利用自身體重都可以。 例如壺鈴、胸推 | 靜態、動態伸展、主動、被動伸展皆可 |
中等強度的意思大概就像是做家事、爬樓梯的感覺；高等強度大概就像騎腳踏車騎快一點的感覺。
但事實上目前還未有一個絕對的指標說孕婦應該一週運動幾天、一天幾次、一次多久。但原則上建議依照心肺能力來做選擇：
假如妳的懷孕前 BMI 值小於 25 的話可以參考以下表格：
| 年齡 | 心肺狀況 | 運動目標 (每分鐘心跳數) |
|---|---|---|
| <20 | 140~155 下/分鐘 | |
| 20~29 | 差 (最弱的四分之一) | 129~144 下/分鐘 |
| 中等 | 135~150 下/分鐘 | |
| 優 (最好的四分之一) | 145~160 下/分鐘 | |
| 30~39 | 差 (最弱的四分之一) | 128~144 下/分鐘 |
| 中等 | 130~145 下/分鐘 | |
| 優 (最好的四分之一) | 140~156 下/分鐘 |
假如妳的懷孕前 BMI 值大於等於 25 的話，無論任何年紀盡量不要太拼，20~29歲每分鐘心跳不要超過 102~124 下；30~39歲每分鐘心跳不要超過 101~120 下。
另外建議運動前至少要有 10 到 15 分鐘的暖身，運動後也要正確的收操。
假如妳以前沒有運動習慣，那我們建議每個禮拜先不用運動超過三次，每次 15 分鐘，慢慢增加時間與強度。
如果妳本來就有運動習慣，甚至是一位運動好手，只要維持原本的節奏就行了。
孕婦運動時要考量的事
1. 懷孕超過十六週後，應該要避免仰臥做心肺運動，因為可能會造成靜脈循環不良以及增加心臟負擔。
2. 避免在溼熱的環境運動，記得多補充水分。
3. 懷孕時記得要維持良好的體重，體重增加太多或太少都不好。
4. 懷孕時不建議接觸性運動，容易引起外傷、跌倒影響母體及胎兒的安全，例如足球、籃球、冰上曲棍球、騎馬、滑雪、潛水、上海拔兩千五百公尺以上的高山，這些都不適合。
英國健保局搜尋網站特別建議不要玩柔道和自由搏擊…..這算是英式幽默嗎？XDDDD
5. 相對來說瑜珈、跑步、某些類型的舞蹈是較適合的運動。
6. 避免閉氣(增加腹壓)、長時間的向心收縮運動和久站。
孕婦運動時要注意的事項
假如妳運動時有以下情形，請馬上停止運動，並且儘速和醫生討論：
1. 發現陰道出血或破水
2. 在力竭之前就喘不過氣
3. 頭暈，尤其是快要暈倒或頭痛
4. 胸痛
5. 肌肉無力
6. 小腿疼痛或腫脹
7. 胎兒活動減少
8. 出現早產陣痛(過早出現子宮頸擴張或變薄)
那生完小孩後呢？
假如妳是自然產，安全的建議是 4 到 6 週後可以從低強度的運動慢慢開始。
假如妳是剖腹產，那建議讓傷口有足夠的癒合時間， 8 到 10 週後再開始慢慢運動。
不過這兩項僅是文獻上的建議，實際上依照婦產科醫師與復健科醫師的指示來做會比較好。
產後運動有助於促進健康，以及恢復良好的體態。
最後祝大家懷孕愉快！！！
合作撰寫：
好痛痛復健科、骨科、物理治療、運動訓練搜尋器
參考資料：
ACSM(美國運動醫學會指引)第十版 P162-167
NHS Choice (英國國民健康服務網站)
鼓勵未懷孕前就開始運動會更好
沒錯～隨時讓身體保持健康的狀態是很重要的
醫師您好，有兩個問題想請教：
1. 前文中數次提到的BMI值應是指懷孕前嗎？因為懷孕時體重、BMI都會大幅增加，故有此推測。
2. 過去醫界文獻大多仍以BMI為指標，但教練界已發現相同BMI可能肌肉、體脂天差地遠，所以我們教練通常不優先考慮BMI。因此想請問的是：BMI以外的醫療文獻、準則等等是否仍很稀少，只能憑經驗by case處理？
您好～這真的是一個很棒的問題，確實 BMI 難以代表一個人的身體狀況。
我們已把這個問題轉給林醫師，請他回覆您。謝謝～
1.這邊提到的BMI是懷孕前
2.您對BMI的顧慮是對的，但是醫學上很多時候的指引，仍然是用BMI。並不是因為不夠進步，而是因為其他做法不是準確度也常常有問題（例如皮摺厚度），就是普遍實施太困難（MRI很貴，且需要測的人能仰躺且靜止一段時間配合，如果全身上下要全掃也是大工程，有些人甚至要麻醉才做得到）。因此，如果要收集一個應用在大多數人的大數據，訂出可以給大多數人參考且有信度效度的東西，還是BMI最實用。當然，我們必須知道指引只是一種參考，不照指引做的醫師如果有明確合理的理由和考量，需要尊重臨床判斷。每個人都是不同的（也是目前沒辦法只照google或電腦看病的原因），如您所說，case by case。
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