Schwaab Bernhard, Kafsack Friderike, Markmann Edith, Schütt Morten
Curschmann Klinik, Rehabilitation Clinic for Cardiology, Angiology and Diabetes, Timmendorfer Strand.
Diabetologische Schwerpunktpraxis, Lübeck, Germany.
Cardiovasc Endocrinol Metab. 2020 Feb 21;9(1):3-8. doi: 10.1097/XCE.0000000000000188. eCollection 2020 Mar.
In patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM), physical activity is strongly advised as nonpharmacological therapy. In general, a moderate aerobic exercise intensity is recommended. It was also proposed, however, that greater intensities tend to yield even greater benefits in HbA1c. Hence, the most appropriate exercise intensity seems not to be established yet. We compared the effect of moderate (aerobic) and vigorous (anaerobic) activity on postprandial plasma glucose.
In 10 consecutive patients (63 ± 12 years, BMI 28.3 ± 2.6 kg/m, fasting plasma glucose 6.1 ± 1.2 mmol/l), 2-hour plasma glucose was ≥11.1 mmol/l in the oral glucose tolerance test at rest (OGTT-0). Cardiopulmonary exercise test (CPX) was performed until a respiratory exchange ratio (RER) ≥1.20, beeing anaerobic (CPX-1), followed by OGTT-1. A steady-state CPX of 30-minute duration was performed targeting an RER between 0.90 and 0.95, being aerobic (CPX-2), followed by OGTT-2.
In CPX-1, maximum exercise intensity (maxIntensity) averaged at 99 ± 30 Watt and peak oxygen consumption (VO) reached 15.9 ± 2.8 ml/min/kg. In CPX-2, aerobic intensity averaged at 29 ± 9 Watt, representing 31% of maxIntensity and 61% of VO. After aerobic exercise, 2-hour plasma glucose was significantly reduced to an average of 9.4 ± 2.3 mmol/l ( < 0.05). Anaerobic exercise did not reduce 2-hour plasma glucose as compared to OGTT-0 (12.6 ± 2.2 vs 12.6 ± 3.9 mmol/l).
Aerobic exercise intensity was very low in our patients with CHD and T2DM. Postprandial plasma glucose was reduced only by aerobic exercise. Larger studies on the optimal exercise intensity are needed in this patient cohort.
对于冠心病（CHD）和2型糖尿病（T2DM）患者，强烈建议将体育活动作为非药物治疗方法。一般而言，推荐中等强度的有氧运动。然而，也有人提出，更高强度的运动往往能在糖化血红蛋白（HbA1c）方面带来更大益处。因此，最合适的运动强度似乎尚未确定。我们比较了中等强度（有氧运动）和高强度（无氧运动）活动对餐后血糖的影响。
连续纳入10例患者（年龄63±12岁，体重指数28.3±2.6kg/m²，空腹血糖6.1±1.2mmol/L），静息状态下口服葡萄糖耐量试验（OGTT-0）中2小时血糖≥11.1mmol/L。进行心肺运动试验（CPX）直至呼吸交换率（RER）≥1.20，即无氧运动（CPX-1），随后进行OGTT-1。进行持续30分钟的稳态CPX，目标RER在0.90至0.95之间，即有氧运动（CPX-2），随后进行OGTT-2。
在CPX-1中，最大运动强度（maxIntensity）平均为99±30瓦，峰值耗氧量（VO）达到15.9±2.8毫升/分钟/千克。在CPX-2中，有氧运动强度平均为29±9瓦，占最大运动强度的31%，峰值耗氧量的61%。有氧运动后，2小时血糖显著降低至平均9.4±2.3mmol/L（P<0.05）。与OGTT-0相比，无氧运动未降低2小时血糖（12.6±2.2对12.6±3.9mmol/L）。
在我们的冠心病和2型糖尿病患者中，有氧运动强度非常低。仅有氧运动可降低餐后血糖。该患者群体需要进行更多关于最佳运动强度的研究。
