社区环境下2型糖尿病三种运动相关干预模式健康效益的系统综述

doi:10.3969/j.issn.1006-9771.2022.11.008

Abstract

Abstract:

Objective To construct the categories and framework of research on health effects of three exercise-related intervention models on patients with type 2 diabetes mellitus (T2DM) based on International Classification of Functioning, Disability and Health (ICF), and systematically review their health effects in community settings.

Methods Randomized controlled trials (RCTs) about the the health outcomes of community-based chronic disease management, community-based exercise rehabilitation and community-based physical activity interventions for patients with T2DM in community setting were retrieved from databases of Web of Science, PubMed, CNKI and EBSCO, from 2012 to November, 2022, and screened and reviewed.

Results Ten RCTs from five countries were included finally, involving 24 715 participants (aged 55 to 85 years). The main sources were journals in fields of diabetes, primary care and community health, elderly health and rehabilitation, with publication dates from 2018 to 2022. For the modality of community-based chronic disease management, interventions might be performed in community health centers and community health service centers; by medical professionals, community physical therapists, registered nurses, registered dietitians, program coordinators, pharmacists and exercise coaches; for six to 18 months; including medical consultation, health education, medical visit reminders, physical activity, home visits and regular health status monitoring; mainly for treatment and health promotion. For community-based exercise rehabilitation, interventions might be performed in community senior centers and community medical centers, with exercise coaching and monitoring; by community rehabilitation workers, exercise therapists, nutritionists, and general practitioners; for three to twelve months; including exercise rehabilitation interventions, dietary interventions and health literacy interventions; mainly for treatment, rehabilitation, and health promotion. For community physical activity, interventions might be performed in community senior centers and community health centers, with activity guidance and monitoring; by community rehabilitation workers, exercise therapists, dietitians and general practitioners; involving aerobic exercise (running), resistance exercise (abdominal contraction, vertical chest press, shoulder press, leg press, leg extensions, leg curl, triceps extension, supine pulldown and seated rowing) and combined exercises, ten to 30 minutes a time, three to five times a week, moderate intensity, for five to twelve months; for prevention, treatment, rehabilitation and health promotion. Health outcomes involved in increase of cardiometabolism, improvement of high-density lipoprotein cholesterol and insulin sensitivity, decrease of glucose and glycated hemoglobin, increase of lower extremity strength; drinking behavior reducing, exercise participation increasing and more lighter diets; risk of chronic diseases reducing, progression of the diseases delaying, risk of falls and fractures reducing, and mental health and well-being improving.

Conclusion A study framework of programs and outcomes of exercise related intervention for patients with T2DM has been constructured based on ICF, involving three modalities: community-based chronic disease management, community-based exercise rehabilitation and community-based physical activity. Patients with T2DM can benefit in physical function, activity and participation, quality of life, and well-being from the exercise-related intervention in community.

Key words: type 2 diabetes mellitus, exercise, community-based rehabilitation, physical activity, systematic review

CLC Number:

R587.1

WANG Mei,LIAO Ting,CHEN Jian. Health benefit of three exercise-related interventions for type 2 diabetes mellitus in community: a systematic review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(11): 1288-1298.

Figures/Tables 4

文献	国家	样本特征	干预模式	干预属性	干预场所	干预人员	干预措施	干预时长	比较	健康结局指标
Kong等^[13](2019)	中国	平均年龄58岁样本量258 2型糖尿病且至少患病1年	社区慢病管理	健康促进	社区卫生服务中心	社区理疗师	健康系统策略：健康教育、身体活动，制定刺激策略，并进行监督和评估自我管理支持计划：目标设定、计划、执行、检查和评估决策支持记录系统设计临床信息系统	9个月	因身体问题导致的角色限制、社交功能，因情绪问题导致的任务限制和身体成分总分的生活质量评分改善	身体结构与功能糖化血红蛋白降低空腹血糖、舒张压降低腰围减小活动与参与运动次数更加频繁生活质量与福祉不太可能经常饮酒清淡饮食自我管理意识和自我监控能力增强
Alkaff等^[14](2021)	印度尼西亚	年龄(62.83±7.96)岁样本量300 2型糖尿病和高血压	社区慢病管理	治疗	社区医疗中心	医疗专业人员	每月定期举行医疗咨询会议医疗保健专业人员的同侪教育医疗就诊提醒同侪俱乐部身体活动家访定期健康状况监测(包括2型糖尿病患者每月血糖检查) 每6个月进行1次代谢控制和肾功能的实验室评估	8个月	多数代谢和肾脏参数改善 2型糖尿病患者空腹血糖降低	身体结构与功能血清甘油三酯水平改善多数代谢和肾脏参数改善空腹血糖降低活动与参与未提及生活质量与福祉未提及
Miklavcic等^[15] (2020)	加拿大	年龄65岁以上样本量132 2型糖尿病	社区慢病管理	健康促进	社区	注册护士、注册营养师、项目协调员、药剂师和运动教练	多达3次的家访每月1次的集体健康计划每月的病例会议护理协调	6个月	社区干预效果更好	身体结构与功能体质量、血压和多项生活质量指标均有改善认知功能测试改善活动与参与未提及生活质量与福祉抑郁症状改善
Sawatzky等^[16](2007)	加拿大	年龄65岁以上样本量22432 2型糖尿病	社区运动康复	健康促进	社区老年中心有活动监测	社区康复师	每周至少1 000 kCal的体力活动	3个月	活动受限、疼痛和情绪问题改善	身体结构与功能情绪健康相对增加认知问题和灵活性限制减少疼痛减少活动与参与活动限制减少生活质量与福祉获得更大的情绪幸福感
Vieira等^[17](2021)	美国	年龄60岁以上样本量29 2型糖尿病	社区运动康复	健康促进	社区老年中心有活动监测	运动治疗师和营养师	运动干预(依据奥塔戈运动计划)+饮食干预(依据美国糖尿病老年人饮食指南)、饮食干预	3个月	与饮食干预相比，运动+饮食组椅子站立测试站立次数增加与运动+饮食干预相比，饮食组腰臀比降低，肌肉质量百分比增加	身体结构与功能身体功能改善下肢力量增强血糖控制改善血糖变异性改善活动与参与未提及生活质量与福祉预防跌倒，降低受伤和虚弱风险
Wei 等^[18](2020)	中国	年龄55~85岁样本量799 2型糖尿病	社区运动康复	治疗	社区医疗中心有活动监测	全科医生	健康素养干预运动干预：步行、结构化有氧运动训练，每次30~70 min，每周3~5次，中等强度，持续6~12个月综合干预	12个月	与综合干预组相比，运动干预改善血糖控制健康素养组血糖控制优于运动组和综合组	身体结构与功能血糖改善糖化血红蛋白降低高密度脂蛋白胆固醇改善微血管并发症减少40%~60% 冠心病绝对风险降低5%~17% 活动与参与未提及生活质量与福祉未提及
Newton 等^[19] (2020)	美国	年龄55.8~61岁样本量116 2型糖尿病	社区身体活动干预	健康促进	社区有活动监测	社区卫生人员	有氧运动(跑步)、抗阻运动(卷腹、卧推、肩推、蹬腿、伸膝、勾腿、伸肘、仰卧下拉和坐姿划船)，中等强度	每周有氧运动150 min，抗阻运动20~30 min，5个月	心脏代谢显著变化	身体结构与功能最大代谢当量增加腰围减少2% 脂肪量减少活动与参与身体活动参与度提高生活质量与福祉未提及
Vidanage等^[20](2022)	斯里兰卡	年龄57~62.5岁样本量225 2型糖尿病	社区身体活动干预	健康促进	社区有活动监测	社区卫生人员	有氧运动	每天30 min，每周4~5 d，6个月	与低强度运动相比，高强度运动增加对甜味的敏感性改变甜味感觉可以更好地控制糖	身体结构与功能对甜味敏感性增加蔗糖偏好降低糖化血红蛋白降低活动与参与未提及生活质量与福祉有助于糖尿病患者更好地控制血糖
Gray等^[21](2021)	美国	年龄55岁以上样本量251 2型糖尿病	社区身体活动干预	健康促进	社区有活动监测	社区卫生人员	有氧运动、抗阻运动、联合运动中等强度	每天10~20 min，每周3次，6个月	与低强度有氧运动相比，高强度有氧运动有益于血糖改善	身体结构与功能抗阻运动改善胰岛素敏感性抗阻运动降低糖化血红蛋白有氧运动降低糖化血红蛋白活动与参与未提及生活质量与福祉未提及
Myers 等^[22](2013)	美国	平均年龄57.1岁样本量173 2型糖尿病	社区身体活动干预	健康促进	社区有活动监测	社区卫生人员	有氧运动、抗阻运动、联合运动中等强度	每天20 min，每周3次，9个月	有氧运动和联合运动有益于身体功能改善与有氧运动相比，联合运动有益于心理成分改善联合运动活力提高更大	身体结构与功能抗阻运动降低疼痛活动与参与未提及生活质量与福祉活力增加

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研究	资格标准	随机分配	分配隐藏	基线相似	被试施盲	治疗师施盲	评估者施盲	被试流失率≤ 15%	意向治疗分析	组间统计比较	报告点测量和变异量值	总分
Kong等^[13](2019)	√	√	√	√				√	√	√	√	7
Alkaff等^[14](2021)	√	√	√	√	√	√		√	√	√	√	9
Miklavcic等^[15](2020)	√	√	√	√				√	√	√	√	7
Sawatzky等^[16] (2007)	√	√	√	√			√	√	√	√	√	8
Vieira等^[17](2021)	√	√	√	√			√	√	√	√	√	8
Wei等^[18] (2020)	√	√	√	√				√	√	√	√	7
Newton^[19]等(2020)	√	√	√	√	√	√		√	√	√	√	9
Vidanage^[20]等(2022)	√	√	√	√				√	√	√	√	7
Gray等^[21](2021)	√	√	√	√			√	√	√	√	√	8
Myers等^[22](2013)	√	√	√	√				√	√	√	√	7

Health benefit of three exercise-related interventions for type 2 diabetes mellitus in community: a systematic review

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