Sigal Ronald J, Kenny Glen P, Boulé Normand G, Wells George A, Prud'homme Denis, Fortier Michelle, Reid Robert D, Tulloch Heather, Coyle Douglas, Phillips Penny, Jennings Alison, Jaffey James
University of Ottawa, Clinical Epidemiology Program, Ottawa Health Research Institute, and Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Ann Intern Med. 2007 Sep 18;147(6):357-69. doi: 10.7326/0003-4819-147-6-200709180-00005.
Previous trials have evaluated the effects of aerobic training alone and of resistance training alone on glycemic control in type 2 diabetes, as assessed by hemoglobin A1c values. However, none could assess incremental effects of combined aerobic and resistance training compared with either type of exercise alone.
To determine the effects of aerobic training alone, resistance training alone, and combined exercise training on hemoglobin A1c values in patients with type 2 diabetes.
Randomized, controlled trial.
8 community-based facilities.
251 adults age 39 to 70 years with type 2 diabetes. A negative result on a stress test or clearance by a cardiologist, and adherence to exercise during a 4-week run-in period, were required before randomization.
Aerobic training, resistance training, or both types of exercise (combined exercise training). A sedentary control group was included. Exercise training was performed 3 times weekly for 22 weeks (weeks 5 to 26 of the study).
The primary outcome was the change in hemoglobin A1c value at 6 months. Secondary outcomes were changes in body composition, plasma lipid values, and blood pressure.
The absolute change in the hemoglobin A1c value in the combined exercise training group compared with the control group was -0.51 percentage point (95% CI, -0.87 to -0.14) in the aerobic training group and -0.38 percentage point (CI, -0.72 to -0.22) in the resistance training group. Combined exercise training resulted in an additional change in the hemoglobin A1c value of -0.46 percentage point (CI, -0.83 to -0.09) compared with aerobic training alone and -0.59 percentage point (CI, -0.95 to -0.23) compared with resistance training alone. Changes in blood pressure and lipid values did not statistically significantly differ among groups. Adverse events were more common in the exercise groups.
The generalizability of the results to patients who are less adherent to exercise programs is uncertain. The participants were not blinded, and the total duration of exercise was greater in the combined exercise training group than in the aerobic and resistance training groups.
Either aerobic or resistance training alone improves glycemic control in type 2 diabetes, but the improvements are greatest with combined aerobic and resistance training. ClinicalTrials.gov registration number: NCT00195884.
以往的试验评估了单纯有氧训练和单纯抗阻训练对2型糖尿病患者血糖控制的影响，评估指标为糖化血红蛋白值。然而，尚无试验能够评估有氧训练与抗阻训练相结合相对于单独一种训练方式的额外效果。
确定单纯有氧训练、单纯抗阻训练以及联合运动训练对患有2型糖尿病患者糖化血红蛋白值的影响。
随机对照试验。
8个社区设施。
251名年龄在39至70岁之间的2型糖尿病成年患者。随机分组前要求应激试验结果为阴性或经心脏病专家批准，并且在为期4周的导入期内坚持运动。
有氧训练、抗阻训练或两种训练方式结合（联合运动训练）。纳入一个久坐不动的对照组。运动训练每周进行3次，共22周（研究的第5至26周）。
主要结局是6个月时糖化血红蛋白值的变化。次要结局是身体成分、血脂值和血压的变化。
联合运动训练组与对照组相比，糖化血红蛋白值的绝对变化在有氧训练组为-0.51个百分点（95%可信区间，-0.87至-0.14），在抗阻训练组为-0.38个百分点（可信区间，-0.72至-0.22）。与单纯有氧训练相比，联合运动训练使糖化血红蛋白值额外变化-0.46个百分点（可信区间，-0.83至-0.09）；与单纯抗阻训练相比，额外变化-0.59个百分点（可信区间，-0.95至-0.23）。各组间血压和血脂值的变化在统计学上无显著差异。不良事件在运动组中更为常见。
结果对于运动计划依从性较差的患者的普遍适用性尚不确定。参与者未设盲，且联合运动训练组的运动总时长比有氧训练组和抗阻训练组更长。
单纯有氧训练或抗阻训练均可改善2型糖尿病患者的血糖控制，但有氧训练与抗阻训练相结合时改善效果最佳。ClinicalTrials.gov注册号：NCT00195884。
