School of Kinesiology and Health Science, Muscle Health Research Centre, Physical Activity and Chronic Disease Unit, York University, 4700 Keele Street, Toronto, ON, Canada.
Appl Physiol Nutr Metab. 2011 Jul;36 Suppl 1:S154-89. doi: 10.1139/h11-063.
Physical activity (PA) is one of the most powerful treatment options for persons with prediabetes or diabetes. However, some elevation in risk occurs with increased PA, at least initially, and certain precautions need to be made to lower these risks, particularly if these persons are unaccustomed to exercise. We conducted a standardized search of all adverse events associated with increased PA in persons with prediabetes or diabetes (type 1 or type 2) and provided evidence-based guidelines on PA screening in these apparently high-risk individuals. A systematic literature review was performed of all studies reporting on adverse events in persons with prediabetes or diabetes. Studies included were from all designs (retrospective and prospective including randomized controlled trials) and were assessed according to evaluation criteria adapted by a consensus panel. A total of 47 studies, involving >8000 individuals, were deemed eligible. A number of these studies identified a range of mild to severe acute risks with exercise (musculoskeletal injury, hypoglycemia, foot ulceration, proliferative retinopathy, hypotension, sudden death) but the overall prevalence was low. Based on several randomized controlled trials and prospective studies in which prescribed exercise was performed at a wide range of intensities, it appears that increased PA is a relatively safe procedure with no evidence of a loss of life. Based on our assessment of the available literature, we provide a new PA risk algorithm for persons with prediabetes and diabetes and comment on the role of the patient, the qualified exercise professional, and the patient's physician in the risk screening process.
身体活动（PA）是治疗糖尿病前期或糖尿病患者的最有效治疗方法之一。然而，随着身体活动的增加，至少在最初阶段，风险会有所上升，因此需要采取某些预防措施来降低这些风险，特别是对于那些不习惯于运动的患者。我们对所有与糖尿病前期或糖尿病（1 型或 2 型）患者身体活动增加相关的不良事件进行了标准化搜索，并为这些高危人群提供了基于证据的身体活动筛查指南。对所有报告糖尿病前期或糖尿病患者不良事件的研究进行了系统的文献回顾。纳入的研究设计包括回顾性和前瞻性研究（包括随机对照试验），并根据共识小组改编的评估标准进行了评估。共有 47 项研究，涉及>8000 名患者，被认为符合条件。其中一些研究确定了一系列与运动相关的轻度至重度急性风险（肌肉骨骼损伤、低血糖、足部溃疡、增殖性视网膜病变、低血压、猝死），但总体发生率较低。基于几项随机对照试验和前瞻性研究，在这些研究中，以广泛的强度进行规定的运动，似乎增加身体活动是一种相对安全的方法，没有生命损失的证据。根据我们对现有文献的评估，我们为糖尿病前期和糖尿病患者提供了新的身体活动风险算法，并对患者、合格的运动专业人员以及患者的医生在风险筛查过程中的作用进行了评论。
