Wang Y, Yuan X D, Dai X, Li F, Ji H, Lou Q Q
The College of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, China Department of Health Education, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China.
Department of Health Education, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China.
Zhonghua Nei Ke Za Zhi. 2021 Jan 1;60(1):22-28. doi: 10.3760/cma.j.cn112138-20200430-00441.
To investigate the effect of a 2-year resistance and aerobic training on reducing the risk of cardiovascular disease in patients with prediabetes. A total of 248 patients with prediabetes were enrolled from Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from January to April 2014, and Danyang People's Hospital and The First Affiliated Hospital of Guangxi Medical University from May to December 2014.Based on random number table method, the patients were divided into 3 groups: the resistance training group (RT group, 82 cases), the aerobic training group (AT group, 83 cases) and control group (83 cases). Participants in the RT group and the AT group underwent a total of 24 months of exercise training. Changes in indicators (blood glucose,blood lipid, etc.) at baseline and the end of 12 and 24 months among the groups were compared. After intervention, glycosylated hemoglobin (HbA1c), low density lipoprotein cholesterol (LDL-C), blood pressure and homeostasis model 2 insulin resistance index (HOMA2-IR) in the RT and AT groups tended to decrease, and the steady state model 2 β cell function index (HOMA2-β) tended to increase. At the end of 24 months, HbA1c [5.80 (5.43, 6.20) %, 5.70 (5.50, 6.00)% vs. 6.20 (5.70, 6.60) %, all ≤ 0.01], LDL-C [3.07 (2.69, 3.58) mmol/L, 2.97 (2.62, 3.95) mmol/L vs. 3.21(2.54, 3.78) mmol/L, all 0.05] and HOMA2-IR [0.96 (0.82, 1.47), 1.20 (0.99, 1.43) vs. 1.34 (1.09, 1.51), all 0.05] were significantly decreased in the RT and AT groups than in the control group. In addition, HOMA2-β [84.50 (60.55, 107.33), 93.00 (78.60, 119.75) vs. 53.40 (37.70, 80.40), all = 0.001] was significantly increased in the AT and RT groups compared with that in the control group. There were no significant differences in triglyceride (TG) and high-density lipoproteincholesterol (HDL-C) levels between the training groups and the control group (all 0.05). After adjusting for age, sex and blood pressure, the cardiovascular risk of prediabetes was significantly reduced in RT ( =0.017) and AT groups ( =0.018). The Cox regression analyses showed that both the resistance training (HR=0.419, 95 =0.415-0.942, 0.037) and the aerobic training (=0.310, 95=0.447-0.866, 0.026) were protective factors for cardiovascular disease in prediabetic patients after adjustment of age, sex, statins, body mass index and waist-to-hip ratio, which reduced the risks of cardiovascular disease in prediabetic patients by 58.1% and 69.0%, respectively. Two years of aerobic and resistance training interventions have obvious advantages on glycemic and insulin resistance control in prediabetes patients. The resistance training can reduce the risk of cardiovascular disease, and it is, thus, recommended for prediabetic patients without obvious exercise contraindications.
探讨为期2年的抗阻训练和有氧训练对降低糖尿病前期患者心血管疾病风险的作用。2014年1月至4月从南京中医药大学附属中西医结合医院、2014年5月至12月从丹阳市人民医院和广西医科大学第一附属医院共纳入248例糖尿病前期患者。采用随机数字表法将患者分为3组：抗阻训练组（RT组，82例）、有氧训练组（AT组，83例）和对照组（83例）。RT组和AT组的参与者共进行24个月的运动训练。比较各组基线及12个月和24个月末指标（血糖、血脂等）的变化。干预后，RT组和AT组的糖化血红蛋白（HbA1c）、低密度脂蛋白胆固醇（LDL-C）、血压和稳态模型2胰岛素抵抗指数（HOMA2-IR）呈下降趋势，稳态模型2β细胞功能指数（HOMA2-β）呈上升趋势。24个月末，RT组和AT组的HbA_{1c}[5.80(5.43,6.20)%，5.70(5.50,6.00)% vs. 6.20(5.70,6.60)%，均P≤0.01]、LDL-C[3.07(2.69,3.58)mmol/L，2.97(2.62,3.95)mmol/L vs. 3.21(2.54,3.78)mmol/L，均P<0.05]和HOMA2-IR[0.96(0.82,1.47)，1.20(0.99,1.43) vs. 1.34(1.09,1.51)，均P<0.05]较对照组均显著降低。此外，与对照组相比，RT组和AT组的HOMA2-β[84.50(60.55,107.33)，93.00(78.60,119.75) vs. 53.40(37.70,80.40)，均P = 0.001]显著升高。训练组与对照组的甘油三酯（TG）和高密度脂蛋白胆固醇（HDL-C）水平比较，差异均无统计学意义（均P>0.05）。校正年龄、性别和血压后，RT组（P = 0.017）和AT组（P = 0.018）糖尿病前期患者的心血管疾病风险显著降低。Cox回归分析显示，校正年龄、性别、他汀类药物、体重指数和腰臀比后，抗阻训练（HR = 0.419，95%CI = 0.415 - 0.942，P = 0.037）和有氧训练（HR = 0.310，95%CI = 0.447 - 0.866，P = 0.026）均为糖尿病前期患者心血管疾病的保护因素，分别使糖尿病前期患者心血管疾病风险降低58.1%和69.0%。为期2年的有氧训练和抗阻训练干预对糖尿病前期患者的血糖和胰岛素抵抗控制具有明显优势。抗阻训练可降低心血管疾病风险，因此，推荐给无明显运动禁忌证的糖尿病前期患者。
