Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain.
ProEd Communications Inc., Cleveland, OH.
Menopause. 2017 Dec;24(12):1404-1413. doi: 10.1097/GME.0000000000000936.
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effect of programmed exercise for at least 12 weeks, in postmenopausal women on insulin sensitivity-related outcomes (ISROs), including fasting insulin, C-peptide, insulin growth factor (IGF-1) and IGF-binding protein (IGFBP-3), Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), and anthropometric variables.
Searches were conducted in PubMed-Medline, Embase, Scopus, Web of Science, and Cochrane Library from inception through May 3, 2016, for studies published in all languages. Extracted data included characteristics of the study design, study participants, intervention, and outcome measures. Types of exercise were classified into "mid-term exercise intervention" (MTEI, 3-4 months exercise duration) and a "long-term exercise intervention" (LTEI, 6-12 months exercise duration). Risk of bias in RCTs was evaluated with the Cochrane tool. We used random-effects models for meta-analyses. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Seven RCTS (n = 580) evaluating the effects of programmed exercise on ISROs were included. In three RCTs, MTEI significantly lowered insulin levels (mean difference [MD] -6.50 pmol/L, 95% confidence interval [CI] -11.19, -1.82, P = 0.006) and HOMA-IR values (MD -0.18, 95% CI -0.34, -0.03, P = 0.02) when compared with controls. LTEI had no significant effect on insulin levels (P = 0.19) or HOMA-IR values (P = 0.68) in four and three RCTs, respectively. There were no significant differences between exercise intervention versus controls in circulating IGF-1, glucose, triglycerides with both MTEI and LTEI, and in IGFBP-3 with LTEI. There were significant reductions in body mass index (BMI, kg/m) (MD -1.48, 95% CI -2.48, -0.48, P = 0.004) and in body fat percentage (MD -2.99, 95% CI -4.85, -1.14, P = 0.01) after MTEI; and in waist circumference after both MTEI (MD -1.87, 95% CI -3.02, -0.72, P = 0.001) and LTEI (MD -3.74, 95% CI -6.68, -0.79). Heterogeneity of effects among studies was moderate to low.
Exercising for 3 to 4 months significantly lowered insulin levels and HOMA-IR values, BMI waist circumference, and percentage body fat mass; exercising for 6 to 12 months lowered waist circumference in postmenopausal women.
我们对评估至少 12 周程序化运动对绝经后妇女胰岛素敏感性相关结局（ISRO）的影响的随机对照试验（RCT）进行了系统评价和荟萃分析，ISRO 包括空腹胰岛素、C 肽、胰岛素生长因子（IGF-1）和 IGF 结合蛋白（IGFBP-3）、稳态模型评估-胰岛素抵抗（HOMA-IR）和人体测量学变量。
从 1975 年 1 月到 2016 年 5 月 3 日，我们在 PubMed-Medline、Embase、Scopus、Web of Science 和 Cochrane Library 中以所有语言检索了研究文献，以评估至少 12 周的程序化运动对绝经后妇女胰岛素敏感性相关结局（ISRO）的影响，包括空腹胰岛素、C 肽、胰岛素生长因子（IGF-1）和 IGF 结合蛋白（IGFBP-3）、稳态模型评估-胰岛素抵抗（HOMA-IR）和人体测量学变量。提取的数据包括研究设计、研究参与者、干预措施和结局测量的特征。运动类型分为“中期运动干预（MTEI，3-4 个月运动时间）”和“长期运动干预（LTEI，6-12 个月运动时间）”。使用 Cochrane 工具评估 RCT 的偏倚风险。我们使用随机效应模型进行荟萃分析。我们遵循系统评价和荟萃分析的首选报告项目指南。
共纳入了 7 项 RCT（n=580），评估了程序化运动对 ISRO 的影响。在 3 项 RCT 中，与对照组相比，MTEI 显著降低了胰岛素水平（平均差值[MD] -6.50 pmol/L，95%置信区间[CI] -11.19，-1.82，P=0.006）和 HOMA-IR 值（MD -0.18，95% CI -0.34，-0.03，P=0.02）。在 4 项和 3 项 RCT 中，LTEI 对胰岛素水平（P=0.19）或 HOMA-IR 值（P=0.68）均无显著影响。MTEI 和 LTEI 对 IGF-1、葡萄糖、甘油三酯的循环水平以及 IGFBP-3 与对照组相比均无显著差异。MTEI 后 BMI（kg/m）显著降低（MD -1.48，95% CI -2.48，-0.48，P=0.004）和体脂肪百分比（MD -2.99，95% CI -4.85，-1.14，P=0.01）显著降低；MTEI 和 LTEI 后腰围均显著降低（MD -1.87，95% CI -3.02，-0.72，P=0.001）和 MD -3.74，95% CI -6.68，-0.79）。研究间效应的异质性为中等到低。
运动 3 至 4 个月可显著降低胰岛素水平和 HOMA-IR 值、BMI、腰围和体脂肪百分比；运动 6 至 12 个月可降低绝经后妇女的腰围。
