Gill Jason M R, Cooper Ashley R
Institute of Diet, Exercise and Lifestyle, Faculty of Biomedical and Life Sciences, University of Glasgow, Glasgow, UK.
Sports Med. 2008;38(10):807-24. doi: 10.2165/00007256-200838100-00002.
The worldwide prevalence of type 2 diabetes mellitus is increasing at a rapid rate, predominantly because of changes in environmental factors interacting with individual genetic susceptibility to the disease. Data from 20 longitudinal cohort studies present a consistent picture indicating that regular physical activity substantially reduces risk of type 2 diabetes. Adjustment for differences in body mass index between active and inactive groups attenuates the magnitude of risk reduction, but even after adjustment, a high level of physical activity is associated with a 20-30% reduction in diabetes risk. The data indicate that protection from diabetes can be conferred by a range of activities of moderate or vigorous intensity, and that regular light-intensity activity may also be sufficient, although the data for this are less consistent. The risk reduction associated with increased physical activity appears to be greatest in those at increased baseline risk of the disease, such as the obese, those with a positive family history and those with impaired glucose regulation. Data from six large-scale diabetes prevention intervention trials in adults with impaired glucose tolerance or at high risk of cardiovascular disease indicate that increasing moderate physical activity by approximately 150 minutes per week reduces risk of progression to diabetes, with this effect being greater if accompanied by weight loss. However, this level of activity did not prevent all diabetes, with 2-13% of participants per annum who underwent lifestyle intervention still developing the disease. Thus, while 150 minutes per week of moderate activity confers benefits, higher levels of activity may be necessary to maximize diabetes risk reduction in those at high baseline risk of the disease. In contrast, those at low baseline risk of type 2 diabetes, e.g. people with a very low body mass index and no family history of diabetes, will remain at low risk of developing diabetes whether they are active or not. Thus, the amount of physical activity required to confer low risk of diabetes differs according to an individual's level of baseline risk. Consequently, a 'one size fits all' mass-population strategy may not provide the most appropriate approach when designing physical activity guidelines for the prevention of type 2 diabetes. Producing tailored guidelines with the specific aim of reducing risk of diabetes in high-risk populations may provide an alternative approach.
2型糖尿病在全球的患病率正迅速上升，主要原因是环境因素的变化与个体对该疾病的遗传易感性相互作用。来自20项纵向队列研究的数据呈现出一致的情况，表明规律的体育活动能大幅降低2型糖尿病的风险。对活跃组和不活跃组之间体重指数差异进行调整后，风险降低的幅度有所减弱，但即使调整后，高水平的体育活动仍与糖尿病风险降低20%-30%相关。数据表明，一系列中等强度或高强度的活动都能提供预防糖尿病的保护作用，而且规律的低强度活动可能也足够，尽管这方面的数据不太一致。与增加体育活动相关的风险降低在疾病基线风险增加的人群中似乎最为显著，比如肥胖者、有家族病史者以及血糖调节受损者。来自六项针对糖耐量受损或心血管疾病高危成年人的大规模糖尿病预防干预试验的数据表明，每周增加约150分钟的中等强度体育活动可降低进展为糖尿病的风险，如果同时伴有体重减轻，这种效果会更明显。然而，这种活动水平并不能预防所有糖尿病，每年接受生活方式干预的参与者中有2%-13%仍会患上这种疾病。因此，虽然每周150分钟的中等强度活动有益，但对于疾病基线风险高的人群，可能需要更高水平的活动才能最大程度降低糖尿病风险。相比之下，2型糖尿病基线风险低的人群，比如体重指数非常低且无糖尿病家族史的人，无论是否活跃，患糖尿病的风险都很低。因此，降低糖尿病低风险所需的体育活动量因个体的基线风险水平而异。因此，在设计预防2型糖尿病的体育活动指南时，“一刀切”的大众策略可能不是最合适的方法。制定针对高危人群降低糖尿病风险这一特定目标的个性化指南可能提供另一种方法。
