Stewart Kerry J
Division of Cardiology, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
Cardiol Clin. 2004 Nov;22(4):569-86. doi: 10.1016/j.ccl.2004.06.007.
Exercise training is an essential component in the medical management of patients who have type 2 diabetes and hypertension. Regular exercise improves the cardiovascular health of individuals who have these conditions through multiple mechanisms (Fig. 1). These mechanisms include improvements in endothelial vasodilator function,left ventricular diastolic function, arterial stiffness.systematic inflammation, and reducing left ventricular mass. Exercise training also reduces total and abdominal fat, which mediate improvements in insulin sensitivity and blood pressure, and possibly, endothelial function. Persons who are in a prediabetic stage or those who have the metabolic syndrome may be able to prevent or delay the progression to overt diabetes by adopting a healthier lifestyle, of which increasing habitual levels of physical activity isa vital component. Most persons who have diabetes and hypertension or are at risk for these conditions should be able to initiate an exercise program safely after appropriate medical screen-ing and the establishment of an individualized exercise prescription. Despite the increasing amount of evidence that shows the benefits of exercise training, this modality of prevention and treatment continues to be underused. Although patients' lack of knowledge of the benefits of exercise or lack of motivation contributes to this underuse, a lack of clear and specific guidelines from health care professionals also is an important factor. Clinicians need to educate patients about the benefits of exercise for managing their type 2 diabetes and assist in formulating specific advice for increasing physical activity. Specific instructions should be given to patients, rather than general advice, such as "you should exercise more often." Many cardiac re-habilitation and clinical exercise programs can accommodate patients who have type 2 diabetes and hypertension. Such programs can establish individualized exercise prescriptions and provide an environment that is conducive for "lifestyle change" that underlies long-term compliance to exercise and risk factor modification.
运动训练是2型糖尿病和高血压患者医疗管理的重要组成部分。规律运动通过多种机制改善患有这些疾病的个体的心血管健康（图1）。这些机制包括改善内皮血管舒张功能、左心室舒张功能、动脉僵硬度、全身炎症反应以及减轻左心室质量。运动训练还能减少全身和腹部脂肪，从而改善胰岛素敏感性和血压，可能还会改善内皮功能。处于糖尿病前期或患有代谢综合征的人可以通过采取更健康的生活方式来预防或延缓向显性糖尿病的进展，其中增加日常身体活动水平是至关重要的一部分。大多数患有糖尿病和高血压或有患这些疾病风险的人在经过适当的医学筛查并制定个性化运动处方后，应该能够安全地开始运动计划。尽管越来越多的证据表明运动训练有益，但这种预防和治疗方式仍未得到充分利用。虽然患者对运动益处的了解不足或缺乏动力导致了这种未充分利用的情况，但医疗保健专业人员缺乏明确和具体的指导方针也是一个重要因素。临床医生需要教育患者运动对管理2型糖尿病的益处，并协助制定增加身体活动的具体建议。应该给患者具体的指导，而不是一般性的建议，比如“你应该更经常地运动”。许多心脏康复和临床运动项目可以接纳2型糖尿病和高血压患者。这样的项目可以制定个性化运动处方，并提供一个有利于实现“生活方式改变”的环境，而这种改变是长期坚持运动和改变危险因素的基础。
