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运动训练对绝经后女性代谢综合征危险因素的影响——随机对照试验的系统评价和荟萃分析

Effects of exercise training on metabolic syndrome risk factors in post-menopausal women - A systematic review and meta-analysis of randomised controlled trials.

作者信息

Tan Abbigail, Thomas Rebecca L, Campbell Matthew D, Prior Sarah L, Bracken Richard M, Churm Rachel

机构信息

Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea, UK.

Diabetes Research Group, Grove Building, Swansea University, Swansea, UK.

出版信息

Clin Nutr. 2023 Mar;42(3):337-351. doi: 10.1016/j.clnu.2023.01.008. Epub 2023 Jan 10.

Abstract

BACKGROUND & AIMS: Alterations in the hormonal profiles as women transition to the menopause predisposes individuals to the metabolic syndrome (MetS). In post-menopausal women, this can be exacerbated by sedentary behaviour and physical inactivity. Physical activity can convey many health benefits including improvement in MetS risk factors. However, it remains to be elucidated how differing exercise intensities and its mode of delivery can ameliorate MetS risk factors and resultant progression amongst post-menopausal women. The purpose of this systematic review and meta-analysis was to investigate the effects and efficacy of exercise training on MetS risk factors in post-menopausal women.

METHODS

Database searches using PubMed, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials were conducted from inception to December 2021 for randomised controlled studies (RCTs) investigating exercise training (>8 weeks) in at least one of the MetS risk factors in post-menopausal women. Utilising the random-effects model, appropriate standardised mean differences (SMD) or mean differences (MD) with 95% confidence interval (CI) for each MetS risk factor were used to calculate the overall effect size between the exercise and control groups. Sub-group analyses were performed for exercise intensity, modality, and duration for each risk factor. Meta-regression was performed for categorical (health status) and continuous (body mass index) covariates.

RESULTS

39 RCTs (40 studies) involving 2132 participants were identified as eligible. Overall, the meta-analysis shows that exercise training significantly improved all MetS risk factors: waist circumference (WC) [MD: -2.61 cm; 95% CI: -3.39 to -1.86 cm; p < 0.001; 21 studies]; triglycerides (TG) [SMD: -0.40 mmol/L; 95% CI: -0.71 to -0.09 mmol/L; p = 0.01; 25 studies]; high-density lipoprotein (HDL) [SMD: 0.84 mmol/L (95% CI: 0.41-1.27 mmol/L; p < 0.001; 26 studies]; fasting glucose (BG) [SMD: -0.38 mmol/L (95% CI: -0.60 to -0.16 mmol/L; p < 0.001; 20 studies]; systolic blood pressure (SBP) [MD: -5.95 mmHg (95% CI: -7.98 to -3.92 mmHg; p < 0.001; 23 studies]; and diastolic blood pressure (DBP) [MD: -4.14 mmHg (95% CI: -6.19 to -2.08 mmHg; p < 0.001; 23 studies]. Furthermore, sub-group analyses identified that moderate intensity and combined exercise training significantly improved MetS risk factors (p < 0.05) except for HDL, with combined exercise being the most effective. Long duration (≥12 weeks) training also significantly improved MetS risk factors except for TG. Meta-regression revealed no moderating effects on any MetS risk variables.

CONCLUSION

This study reinforces the importance of regular physical activity as a non-pharmacological tool in the reduction of MetS risk in post-menopausal women, with significant metabolic improvements seen in interventions spanning 8-10 weeks. Moderate intensity and combined training significantly benefitted abdominal obesity, dyslipidaemia, dysglycaemia and hypertension in post-menopausal women. Improvements in at least one MetS risk were also seen with other exercise modalities and intensities.

摘要

背景与目的

女性向更年期过渡时激素水平的变化使个体易患代谢综合征(MetS)。在绝经后女性中,久坐行为和缺乏身体活动会加剧这种情况。体育活动能带来诸多健康益处,包括改善代谢综合征风险因素。然而,不同运动强度及其实施方式如何改善绝经后女性的代谢综合征风险因素及由此导致的病情进展仍有待阐明。本系统评价和荟萃分析的目的是研究运动训练对绝经后女性代谢综合征风险因素的影响和效果。

方法

使用PubMed、Scopus、Web of Science和Cochrane对照试验中心注册库进行数据库检索,检索时间从建库至2021年12月,以查找针对绝经后女性至少一种代谢综合征风险因素进行运动训练(>8周)的随机对照研究(RCT)。采用随机效应模型,针对每个代谢综合征风险因素,使用适当的标准化均数差(SMD)或均数差(MD)及95%置信区间(CI)来计算运动组和对照组之间的总体效应大小。对每个风险因素的运动强度、方式和持续时间进行亚组分析。对分类(健康状况)和连续(体重指数)协变量进行meta回归分析。

结果

确定39项RCT(40项研究)符合纳入标准,涉及2132名参与者。总体而言,荟萃分析表明运动训练显著改善了所有代谢综合征风险因素:腰围(WC)[MD:-2.61cm;95%CI:-3.39至-1.86cm;p<0.001;21项研究];甘油三酯(TG)[SMD:-0.40mmol/L;95%CI:-0.71至-0.09mmol/L;p=0.01;25项研究];高密度脂蛋白(HDL)[SMD:0.84mmol/L(95%CI:0.41 - 1.27mmol/L;p<0.001;26项研究];空腹血糖(BG)[SMD:-0.38mmol/L(95%CI:-0.60至-0.16mmol/L;p<0.001;20项研究];收缩压(SBP)[MD:-5.95mmHg(95%CI:-7.98至-3.92mmHg;p<0.001;23项研究];舒张压(DBP)[MD:-4.14mmHg(95%CI:-6.19至-2.08mmHg;p<0.001;23项研究]。此外,亚组分析发现,中等强度和联合运动训练除HDL外显著改善了代谢综合征风险因素(p<0.05),联合运动最为有效。长时间(≥12周)训练除TG外也显著改善了代谢综合征风险因素。Meta回归分析显示对任何代谢综合征风险变量均无调节作用。

结论

本研究强化了规律体育活动作为一种非药物手段在降低绝经后女性代谢综合征风险方面的重要性,在8 - 10周的干预中可观察到显著的代谢改善。中等强度和联合训练对绝经后女性的腹部肥胖、血脂异常、血糖异常和高血压有显著益处。其他运动方式和强度也能使至少一种代谢综合征风险得到改善。

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