久坐行为间断干预对血糖、胰岛素和血脂影响的系统综述与Meta分析

Systematic Review and Meta-analysis on Effects of Sedentary Behavior with Intermittent Intervention on Glycemia, Insulin and Lipidemia

目的:久坐行为间断干预备受关注,其间断方式因涉及因素多(间断频率、间断时长及强度)而呈现多样化。从间断前静坐时长、间断时长以及间断时身体活动强度的角度综述久坐行为间断干预对血糖、胰岛素和血脂的影响幵进行Meta分析,为久坐间断干预制定提供参考依据。方法:在Pubmed、Google学术、CNKI检索截止2017年11月的英文和中文的原始研究文献。筛选久坐行为间断干预对糖脂代谢影响的研究,结局指标至少包括一项有关血糖、胰岛素和血脂的指标。由一名作者按照拟定方案对纳入的研究进行数据提取,幵进行质量评分,再由另一名作者进行复核;对符合纳入标准的文献进行系统综述,幵根据文献可提取数据的情况进行Meta分析。结果:共29项研究符合纳入标准,Meta分析了其中18项探讨久坐过程中每20 min进行2 min(2/20 min,9项)和每30 min进行100 s^5 min(100 s-5/30 min,9项)身体活动间断干预对糖脂代谢影响的研究,对其它久坐间断方式和结局指标的研究进行了综述。结果显示,2/20 min和100s-5/30 min的低强度和中高强度步行间断干预均可降低身体活动不足的超重/肥胖者餐后血糖和胰岛素的曲线下面积(AUC)/曲线下面积增加值(iAUC),对2型糖尿病或血糖调节受损的中老年人中效果更显著;而对于身体活动不足的正常体重健康人只有中高强度步行间断干预可降低餐后血糖的AUC/i AUC;幵且这种间断方式可降低次日甘油三酯的AUC/i AUC。其它类型的久坐行为间断方式研究较少,不能得出一致的结论。结论:久坐行为间断干预对血糖、胰岛素和血脂的效应依间断方式各要素(间断频率、间断时长、间断强度)以及受试者健康状况的不同而不同。短暂频繁的低强度身体活动间断干预(如2/20 min,3-5/30 min)即可改善身体活动不足的超重/肥胖者餐后血糖和胰岛素应答,在中老年人群和血糖异常者中效果更好;对于身体活动不足的正常体重健康者可能需要更高强度的身体活动(如MVPA)间断干预以改善血糖、胰岛素和甘油三酯;对甘油三酯的效应可能具有滞后性。然而,短暂频繁的间断干预实际应用性较低,今后需要对可接受性较高的久坐行为间断干预方式(较低的间断频率、较短的间断时长)进行更多的探讨。

Objective:Aa to break the sedentary behavior and reduce health risks associated with sedentary behavior,sedentary behavior with intermittent intervention has got much attention,the related factors(frequency,duration and intensity)tend to diversified.This paper,based on duration of sedentary before break,break time and physical activity intensity during break,makes systematic review and meta-analysis on effects of sedentary behavior with intermittent intervention on glycemia,insulin and lipidemia,and provides a reference for the development of sedentary behavior guidelines.Method:The original research literature in English and Chinese are searched in Pubmed,Google scholar,and CNKI as of November 2017.Screening studies on the effects of sedentary behavior with intermittent intervention on glycolipid metabolism included at least one indicator of glycemia,insulin and lipidemia.Data were extracted from the included studies by one author in accordance with the proposed programme,and quality scores were given and reviewed by another author.The literature that meets the inclusion criteria was systematically reviewed and Meta analysis was carried out based on the data available from the literature.Result:A total of 29 studies included in the standard,in the process of 18 exploration sedentary,the meta-analysis of every 20 min for 2 min break(2/20 min,9),and every 30 min for 100 s-5 min break(100 s-5/30 min,9)of physical activity with intermittent intervention on glucolipid metabolism is made,for the the other break of sedentary behavior and outcome indicators research are reviewed.The result shows that 2/20 5/30 min min and 100 s-low intensity and middle-high walking intensity intermittent interventions can reduce the lack of physical activity of overweight/obese postprandial blood glucose and insulin area under curve(AUC)/added value of the area under the curve(iAUC),for type 2 diabetes or blood sugar regulation damaged of the middle-aged and old people is more effective.For normal weight healthy people with insufficient physical activity,only moderate and high intensity walking intermittent intervention can reduce postprandial blood glucose AUC/iAUC.Moreover,the AUC/iAUC of the next day triglycerides can be reduced by this intermittent method.There are few studies on other types of sedentary behavior with intermittent and no consistent conclusions can be drawn.Conclusion:The effect of sedentary behavior with intermittent interventions on glycemia,insulin and lipidemia is different with the intermittent modes(frequency,duration,intensity)as well as the health of the subjects.Short frequent interminttent with low intensity physical activity(such as 2/20 min,3-2/20 min)can improve the physical activity of overweight/obese postprandial blood glucose and insulin response,better in middle-aged and old people and abnormal blood sugar.Healthy people with normal weight who are physically inactive may need more intensive physical activity(such as MVPA)intermittent interventions to improve blood sugar,insulin and triglycerides.The effect on triglycerides may be delayed.Short frequent intermittent intervention in practical applications,however,is low.In the future,we need to explore more acceptable ways(frequency,the shorter duration)to intervene in sedentary behavior.