糖尿病患者的最佳运动组合模式

Optimal exercise combinations for patients with diabetes

目的:运动是血糖管理的关键措施,可以改善血脂、血压,降低糖化血红蛋白水平,提高胰岛素敏感性,这对维持血糖稳态具有重要意义。本研究旨在探讨糖尿病患者的最优运动组合,为糖尿病患者提供科学有效的个性化运动指导。方法:收集2020年1月至2021年12月在中南大学湘雅三医院进行健康体检的3867名糖尿病患者。通过问卷调查获得人口学信息、生活习惯和精神状态;空腹血液样本检测血脂和空腹血糖水平;测量身高、体重、腰围、臀围和血压。分类变量用χ2检验;连续变量用Kruskal-Wallis检验;运动行为(运动频率、持续时间、运动强度)、运动年限、饮食习惯、降糖药物治疗与空腹血糖的关系采用多元线性回归分析。运动行为与各指标相关性采用旭日玫瑰图分析;运动行为与最佳预期效果的关系用极热图显示。结果:除低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)(P=0.681)外,不同运动习惯组的其他指标差异均有统计学意义(均P<0.01);糖尿病患者每周进行5次以上中高强度运动,每次持续30 min以上,体重指数、血脂、血糖和血压水平更达标;每周1~2次低强度运动需要30至60 min或更长时间的运动才能达到预期的效果。多元线性回归分析显示:运动频率(β=−0.208,95%CI−0.356~−0.059,P=0.006)、持续时间(β=−0.227,95%CI−0.387~−0.066,P=0.006)、运动强度(β=−0.110,95%CI−0.218~−0.002,P=0.046)、饮食习惯(β=0.462,95%CI 0.295~0.556,P<0.001)和降糖药物治疗(β=−0.520,95%CI−0.720~−0.312,P<0.001)与空腹血糖相关。结论:每周大于5次,每次30 min以上的中高强度运动是糖尿病患者的有效运动模式。低运动强度下,为达到预期效果,应增加运动频率或与较长的运动时间相结合。随着运动强度的增加,低运动频率与运动时间延长的关系减弱。

Objective:Exercise is a key way to control the blood glucose,which can improve blood lipids and blood pressure,reduce glycated hemoglobin levels,and increase insulin sensitivity.It is of great significance for maintaining blood glucose homeostasis.This study aims to explore the optimal exercise combinations suitable for diabetic patients,and to provide scientific and effective personalized exercise guidance for diabetic patients.Methods:The physical examination data and questionnaire results of were collected from the Third Xiangya Hospital of Central South University.The study was involved in 3867 diabetes from January,2020 to December,2021.The basic information and living habits were obtained through questionnaires.The fasting blood samples were collected to measure the levels of total cholesterol(TCh),triglyceride,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),and fasting blood glucose.Physical measurements included height,weight,waistline,hipline,and blood pressure.Categorical variables were tested using chi-square tests,and continuous variables were tested using non-parametric Kruskal-Wallis test.Multiple linear regression model was used to analyze the relationship between exercise behaviors(frequency,duration,and intensity),years of exercise,diet habits,medicine,and fasting blood glucose.The relationship between different exercise behaviors and various indexes(BMI,blood pressure,blood lipids,blood glucose)was analyzed by multiple rising sun rose plots.The polar thermal diagram showed the relationship of exercise behaviors with the best expected effect.Results:Non-parametric Kruskal-Wallis test showed that there were significant differences in other indexes except LDL-C(P=0.681)among groups with different exercise behaviors(all P<0.01).The multiple rising sun rose plots showed that diabetic patients who did moderate to high intensity exercise more than 5 times a week for more than 30 min each time had a healthier BMI,blood lipid levels,blood glucose levels,and blood pressure.Polar thermal diagram showed that low-intensity exercise once or twice a week requires 30 to 60 min or more of exercise to achieve the desired results.Multiple linear regression analysis showed that frequency(β=−0.208,95%CI−0.356 to−0.059,P=0.006),duration(β=−0.227,95%CI−0.387 to−0.066,P=0.006),intensity of exercise(β=−0.110,95%CI−0.218 to−0.002,P=0.046),diet habits(β=0.462,95%CI 0.295 to 0.556,P<0.001)and medicine(β=−0.520,95%CI−0.720 to−0.312,P<0.001)were correlated with fasting blood glucose.Conclusion:Moderate to high intensity exercise for more than 30 min and 5 times a week is the most beneficial combination for diabetes.Low exercise intensity should be combined with higher exercise frequency and longer exercise time to achieve the desired effect.With the increase of exercise intensity,the relationship between low exercise frequency and long exercise time is weakened.