Stewart Kerry J
Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
JAMA. 2002 Oct 2;288(13):1622-31. doi: 10.1001/jama.288.13.1622.
The coexistence of type 2 diabetes and hypertension is especially damaging to cardiovascular health. Most trials of exercise training for these conditions have focused on glycemic control and blood pressure reduction. Less is known about the effects of exercise on the cardiovascular consequences of diabetes and hypertension. This article reviews the available evidence and plausible mechanisms by which exercise training may improve the cardiovascular health of persons with type 2 diabetes and hypertension and provides practical guidelines for exercise prescription. A MEDLINE search was performed for January 1985 to June 2002. Bibliographies from relevant articles, professional society clinical practice guidelines, and books were also reviewed. Because few large, randomized trials exist on these topics, meta-analyses, smaller trials, nonrandomized trials, and animal studies were also considered. Data quality was determined by publication in peer-reviewed journals or professional society literature. Type 2 diabetes and hypertension result in abnormalities in central and peripheral parameters of cardiovascular structure and function. Evidence for an exercise training benefit is strongest for improvements in endothelial vasodilator function and left ventricular diastolic function. The data for exercise training's improvement of arterial stiffness and system inflammation and reduction of left ventricular mass are less robust. However, this assertion is based more on a lack of randomized controlled trials rather than data to the contrary. Exercise training also reduces total and abdominal fat. These changes in body composition mediate improvements in insulin sensitivity and blood pressure and may improve endothelial vasodilator function. The current evidence, albeit not fully confirmed in randomized trials, suggests that the benefits of exercise training go beyond the recognized benefits of glycemic control and blood pressure reduction.
2型糖尿病与高血压并存对心血管健康的损害尤为严重。针对这些病症的大多数运动训练试验都集中在血糖控制和血压降低方面。关于运动对糖尿病和高血压心血管后果的影响，人们了解得较少。本文综述了现有证据以及运动训练可能改善2型糖尿病和高血压患者心血管健康的合理机制，并提供了运动处方的实用指南。对1985年1月至2002年6月进行了MEDLINE检索。还查阅了相关文章的参考文献、专业学会临床实践指南和书籍。由于关于这些主题的大型随机试验较少，因此也考虑了荟萃分析、较小规模的试验、非随机试验和动物研究。数据质量由同行评审期刊或专业学会文献中的发表情况决定。2型糖尿病和高血压会导致心血管结构和功能的中枢和外周参数异常。运动训练对内皮血管舒张功能和左心室舒张功能改善的益处证据最为充分。运动训练改善动脉僵硬度和全身炎症以及减轻左心室质量的数据则不太确凿。然而，这一论断更多是基于缺乏随机对照试验，而非相反的数据。运动训练还能减少全身和腹部脂肪。身体成分的这些变化介导了胰岛素敏感性和血压的改善，并可能改善内皮血管舒张功能。目前的证据虽然在随机试验中尚未得到充分证实，但表明运动训练的益处超出了公认的血糖控制和血压降低的益处。
