步行对2型糖尿病患者血糖控制及其他心血管危险因素的影响：一项荟萃分析
Impact of walking on glycemic control and other cardiovascular risk factors in type 2 diabetes: a meta-analysis.
作者信息
Qiu Shanhu, Cai Xue, Schumann Uwe, Velders Martina, Sun Zilin, Steinacker Jürgen Michael
机构信息
Division of Sports and Rehabilitation Medicine, Department of Medicine II, Ulm University, Ulm, Germany; Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, Nanjing, P. R. China.
Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, Nanjing, P. R. China.
出版信息
PLoS One. 2014 Oct 17;9(10):e109767. doi: 10.1371/journal.pone.0109767. eCollection 2014.
BACKGROUND
Walking is the most popular and most preferred exercise among type 2 diabetes patients, yet compelling evidence regarding its beneficial effects on cardiovascular risk factors is still lacking. The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the association between walking and glycemic control and other cardiovascular risk factors in type 2 diabetes patients.
METHODS
Three databases were searched up to August 2014. English-language RCTs were eligible for inclusion if they had assessed the walking effects (duration ≥8 weeks) on glycemic control or other cardiovascular risk factors among type 2 diabetes patients. Data were pooled using a random-effects model. Subgroup analyses based on supervision status and meta-regression analyses of variables regarding characteristics of participants and walking were performed to investigate their association with glycemic control.
RESULTS
Eighteen studies involving 20 RCTs (866 participants) were included. Walking significantly decreased glycosylated haemoglobin A1c (HbA1c) by 0.50% (95% confidence intervals [CI]: -0.78% to -0.21%). Supervised walking was associated with a pronounced decrease in HbA1c (WMD -0.58%, 95% CI: -0.93% to -0.23%), whereas non-supervised walking was not. Further subgroup analysis suggested non-supervised walking using motivational strategies is also effective in decreasing HbA1c (WMD -0.53%, 95% CI: -1.05% to -0.02%). Effects of covariates on HbA1c change were generally unclear. For other cardiovascular risk factors, walking significantly reduced body mass index (BMI) and lowered diastolic blood pressure (DBP), but non-significantly lowered systolic blood pressure (SBP), or changed high-density or low-density lipoprotein cholesterol levels.
CONCLUSIONS
This meta-analysis supports that walking decreases HbA1c among type 2 diabetes patients. Supervision or the use of motivational strategies should be suggested when prescribed walking to ensure optimal glycemic control. Walking also reduces BMI and lowers DBP, however, it remains insufficient regarding the association of walking with lowered SBP or improved lipoprotein profiles.
TRIAL REGISTRATION
PROSPERO CRD42014009515.
背景
步行是2型糖尿病患者中最受欢迎且最常选择的运动方式，但关于其对心血管危险因素有益影响的有力证据仍然不足。这项随机对照试验（RCT）的荟萃分析旨在评估2型糖尿病患者中步行与血糖控制及其他心血管危险因素之间的关联。
方法
检索了截至2014年8月的三个数据库。如果英文RCT评估了步行（持续时间≥8周）对2型糖尿病患者血糖控制或其他心血管危险因素的影响，则符合纳入标准。使用随机效应模型汇总数据。基于监督状态进行亚组分析，并对参与者特征和步行相关变量进行meta回归分析，以研究它们与血糖控制的关联。
结果
纳入了18项研究，涉及20项RCT（866名参与者）。步行显著降低糖化血红蛋白A1c（HbA1c）0.50%（95%置信区间[CI]：-0.78%至-0.21%）。有监督的步行与HbA1c显著降低相关（加权均数差 -0.58%，95%CI：-0.93%至-0.23%），而无监督的步行则不然。进一步的亚组分析表明，使用激励策略的无监督步行在降低HbA1c方面也有效（加权均数差 -0.53%，95%CI：-1.05%至-0.02%）。协变量对HbA1c变化的影响通常不明确。对于其他心血管危险因素，步行显著降低体重指数（BMI）并降低舒张压（DBP），但收缩压（SBP）降低不显著，或高密度或低密度脂蛋白胆固醇水平无变化。
结论
这项荟萃分析支持步行可降低2型糖尿病患者的HbA1c。在开具步行处方时，应建议进行监督或使用激励策略以确保最佳血糖控制。步行还可降低BMI并降低DBP，然而，步行与降低SBP或改善脂蛋白谱之间的关联仍不充分。
试验注册
PROSPERO CRD42014009515。
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