Wallberg-Henriksson H, Rincon J, Zierath J R
Department of Clinical Physiology, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
Sports Med. 1998 Jan;25(1):25-35. doi: 10.2165/00007256-199825010-00003.
The incidence of non-insulin-dependent diabetes mellitus (NIDDM) has increased worldwide during the last decades, despite the development of effective drug therapy and improved clinical diagnoses. NIDDM is one of the major causes of disability and death due to the complications accompanying this disease. For the well-being of the patient, and from a public healthcare perspective, the development of effective intervention strategies is essential in order to reduce the incidence of NIDDM and its resulting complications. For the patient, and for society at large, early intervention programmes are beneficial, especially from a cost-benefit perspective. Physical activity exerts pronounced effects on substrate utilisation and insulin sensitivity, which in turn potentially lowers blood glucose and lipid levels. Exercise training also improves many other physiological and metabolic abnormalities that are associated with NIDDM such as lowering body fat, reducing blood pressure and normalising dyslipoproteinaemia. Clearly, regular physical activity plays an important role in the prevention and treatment of NIDDM. Since physical activity has been shown in prospective studies to protect against the development of NIDDM, physical training programmes suitable for individuals at risk for NIDDM should be incorporated into the medical care system to a greater extent. One general determinant in a strategy to develop a preventive programme for NIDDM is to establish a testing programme which includes VO2max determinations for individuals who are at risk of developing NIDDM. Before initiating regular physical training for people with NIDDM, a complete physical examination aimed at identifying any long term complications of diabetes is recommended. All individuals above the age of 35 years should perform an exercise stress test before engaging in an exercise programme which includes moderate to vigorously intense exercise. The stress test will identify individuals with previously undiagnosed ischaemic heart disease and abnormal blood pressure responses. It is important to diagnose proliferative retinopathy, microalbuminuria, peripheral and/or autonomic neuropathy in patients with NIDDM before they participate in an exercise programme. If any diabetic complications are present, the exercise protocol should be modified accordingly. The exercise programme should consist of moderate intensity aerobic exercise. Resistance training and high intensity exercises should only be performed by individuals without proliferative retinopathy or hypertension. Once enrolled in the exercise programme, the patient must be educated with regard to proper footwear and daily foot inspections. Fluid intake is of great importance when exercising for prolonged periods or in warm and humid environments. With the proper motivation and medical supervision, people with NIDDM can enjoy regular physical exercise as a means of enhancing metabolic control and improving insulin sensitivity.
在过去几十年间，尽管有了有效的药物治疗和改进的临床诊断方法，非胰岛素依赖型糖尿病（NIDDM）在全球范围内的发病率仍有所上升。NIDDM是导致残疾和死亡的主要原因之一，因为该疾病会引发各种并发症。为了患者的健康，以及从公共医疗保健的角度来看，制定有效的干预策略对于降低NIDDM的发病率及其引发的并发症至关重要。对于患者以及整个社会而言，早期干预计划是有益的，特别是从成本效益的角度来看。体育活动对底物利用和胰岛素敏感性有显著影响，进而有可能降低血糖和血脂水平。运动训练还能改善许多与NIDDM相关的其他生理和代谢异常情况，如降低体脂、降低血压以及使血脂异常恢复正常。显然，规律的体育活动在NIDDM的预防和治疗中起着重要作用。由于前瞻性研究表明体育活动可预防NIDDM的发生，适合NIDDM高危个体的体育训练计划应在更大程度上纳入医疗保健系统。制定NIDDM预防计划策略的一个总体决定因素是建立一个检测计划，其中包括对有患NIDDM风险的个体进行最大摄氧量测定。在开始对NIDDM患者进行规律的体育训练之前，建议进行全面的身体检查，以确定糖尿病的任何长期并发症。所有35岁以上的个体在参加包括中度至剧烈运动的锻炼计划之前，都应进行运动压力测试。该压力测试将识别出先前未被诊断出患有缺血性心脏病和血压反应异常的个体。在NIDDM患者参加运动计划之前，诊断增殖性视网膜病变、微量白蛋白尿、周围神经病变和/或自主神经病变非常重要。如果存在任何糖尿病并发症，运动方案应相应调整。运动计划应包括中等强度的有氧运动。只有没有增殖性视网膜病变或高血压的个体才能进行抗阻训练和高强度运动。一旦参加运动计划，患者必须接受关于合适鞋类和每日足部检查的教育。在长时间运动或在温暖潮湿的环境中运动时，液体摄入非常重要。在适当的激励和医疗监督下，NIDDM患者可以将规律的体育锻炼作为增强代谢控制和提高胰岛素敏感性的一种方式。
