体力活动打断久坐对血糖、胰岛素和三酰甘油水平的影响：系统评价和荟萃分析。

BACKGROUND: Physical activity (PA) breaks in sitting time might attenuate metabolic markers relevant to the prevention of type 2 diabetes. OBJECTIVES: The primary aim of this paper was to systematically review and meta-analyse trials that compared the effects of breaking up prolonged sitting with bouts of PA throughout the day (INT) versus continuous sitting (SIT) on glucose, insulin and triacylglycerol (TAG) measures. A second aim was to compare the effects of INT versus continuous exercise (EX) on glucose, insulin and TAG measures. METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Eligibility criteria consisted of trials comparing INT vs. SIT or INT vs. one bout of EX before or after sitting, in participants aged 18 or above, who were classified as either metabolically healthy or impaired, but not with other major health conditions such as chronic obstructive pulmonary disease or peripheral arterial disease. RESULTS: A total of 42 studies were included in the overall review, whereas a total of 37 studies were included in the meta-analysis. There was a standardised mean difference (SMD) of - 0.54 (95% CI - 0.70, - 0.37, p = 0.00001) in favour of INT compared to SIT for glucose. With respect to insulin, there was an SMD of - 0.56 (95% CI - 0.74, - 0.38, p = 0.00001) in favour of INT. For TAG, there was an SMD of - 0.26 (95% CI - 0.44, - 0.09, p = 0.002) in favour of INT. Body mass index (BMI) was associated with glucose responses (β = - 0.05, 95% CI - 0.09, - 0.01, p = 0.01), and insulin (β = - 0.05, 95% CI - 0.10, - 0.006, p = 0.03), but not TAG (β = 0.02, 95% CI - 0.02, 0.06, p = 0.37). When energy expenditure was matched, there was an SMD of - 0.26 (95% CI - 0.50, - 0.02, p = 0.03) in favour of INT for glucose, but no statistically significant SMDs for insulin, i.e. 0.35 (95% CI - 0.37, 1.07, p = 0.35), or TAG i.e. 0.08 (95% CI - 0.22, 0.37, p = 0.62). It is worth noting that there was possible publication bias for TAG outcomes when PA breaks were compared with sitting. CONCLUSION: The use of PA breaks during sitting moderately attenuated post-prandial glucose, insulin, and TAG, with greater glycaemic attenuation in people with higher BMI. There was a statistically significant small advantage for PA breaks over continuous exercise for attenuating glucose measures when exercise protocols were energy matched, but no statistically significant differences for insulin and TAG. PROSPERO Registration: CRD42017080982. PROSPERO REGISTRATION: CRD42017080982.

背景：体力活动（PA）打破久坐时间可能会减轻与预防 2 型糖尿病相关的代谢标志物。

目的：本文的主要目的是系统地回顾和荟萃分析比较全天打破长时间久坐与连续久坐（SIT）与连续运动（EX）相比，对葡萄糖、胰岛素和三酰甘油（TAG）指标影响的试验。第二个目的是比较 INT 与连续运动（EX）对葡萄糖、胰岛素和 TAG 测量值的影响。

方法：综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）建议。纳入标准包括比较 INT 与 SIT 或 INT 与坐前或坐后一次 EX 的试验，参与者年龄在 18 岁或以上，分为代谢健康或受损，但不伴有其他重大健康状况，如慢性阻塞性肺疾病或外周动脉疾病。

结果：共有 42 项研究被纳入全面综述，而共有 37 项研究被纳入荟萃分析。与 SIT 相比，INT 有利于葡萄糖的标准平均差异（SMD）为-0.54（95%置信区间-0.70，-0.37，p=0.00001）。关于胰岛素，INT 的 SMD 为-0.56（95%置信区间-0.74，-0.38，p=0.00001）。对于 TAG，INT 的 SMD 为-0.26（95%置信区间-0.44，-0.09，p=0.002）。体重指数（BMI）与葡萄糖反应相关（β=-0.05，95%置信区间-0.09，-0.01，p=0.01），与胰岛素相关（β=-0.05，95%置信区间-0.10，-0.006，p=0.03），但与 TAG 无关（β=0.02，95%置信区间-0.02，0.06，p=0.37）。当能量消耗相匹配时，INT 有利于葡萄糖的 SMD 为-0.26（95%置信区间-0.50，-0.02，p=0.03），但胰岛素的 SMD 无统计学意义，即 0.35（95%置信区间-0.37，1.07，p=0.35），或 TAG 即 0.08（95%置信区间-0.22，0.37，p=0.62）。值得注意的是，当将 PA 打破与坐姿进行比较时，TAG 结果存在可能的发表偏倚。

结论：在久坐期间使用 PA 打破可以适度减轻餐后葡萄糖、胰岛素和 TAG，BMI 较高的人血糖降低更为明显。当运动方案能量匹配时，PA 打破对降低葡萄糖指标有统计学上显著的小优势，但对胰岛素和 TAG 没有统计学上的显著差异。PROSPERO 注册：CRD42017080982。