2型糖尿病患者联合运动类型及特征的范围综述

doi:10.3761/j.issn.0254-1769.2023.10.006

摘要/Abstract

摘要：

目的探索2型糖尿病患者联合运动的不同类型，明确不同联合运动方式的特征，为2型糖尿病患者提供不同联合运动方式的个性化选择。方法以Arksey等提出的范围综述框架为指导，检索中国生物医学文献数据库、中国知网、万方数据库、维普中文科技期刊数据库、PubMed、Embase、Web of Science、Cochrane Library及中国临床试验注册中心的相关研究。检索时限为建库至2022年2月26日，提取纳入文献的研究对象、样本量、监测指标等相关信息。结果纳入18篇文献，联合运动按照运动方式（相同、不同）、强度（高强度间歇、中等强度持续、混合强度和抗阻的不同强度）和顺序（双任务式、交互式和序贯式）可分为不同的联合类型，在应用于2型糖尿病患者时，联合运动不仅呈现出单一运动的特征，同时各运动类型彼此交叉。结论 3种联合类型在提高运动多样性、调整运动节奏、增强运动效果等方面有显著作用，但对于运动选择、效果评价等方面仍存在局限性，虽然能在较大程度上满足2型糖尿病患者的个性化诉求，但仍未形成规范的组合范式。因此，在联合运动中如何制订规范性操作标准、智能推荐个性化方案、识别适用人群仍需要进一步探索。

关键词: 糖尿病, 2型, 运动, 范围综述, 护理

Abstract:

Objective To explore the different application types of combined exercises in patients with type 2 diabetes，and to clarify the characteristics of different combined exercises. Methods Guided by the scoping review framework proposed by Arksey et al.，a literature search was performed in the Chinese and English literature Databases. The retrieval period was from the establishment of the database to February 26，2022，and relevant information such as research subjects，sample size and monitoring indicators of the included literature was extracted. Results A total of 18 articles were included. Combined exercises can be divided into different combined types by exercise types（same，different），intensity（high intensity intermittent，moderate-intensity continuous，mixed intensity and different intensities of resistance） and sequence（dual-task，interactive and sequential）. When applied to patients with type 2 diabetes mellitus，combined exercises not only present a single aspect of characteristics，but also intersect with each other. Conclusion The 3 combined exercises have a significant impact in terms of increasing exercise variety，adjusting exercise rhythms and enhancing exercise effects. However，there are still limitations in exercise selection and effect evaluation. Therefore，there is still a need to further explore how to develop normative operational standards，intelligently recommend personalised programmes and identify suitable populations in combined exercises.

Key words: Diabetes Mellitus, Type 2, Exercise, Scoping Review, Nursing Care

王惠, 程康耀, 朱佩敏, 吕伟波, 王燕, 刘莹萍, 杨苑聆, 马瑞. 2型糖尿病患者联合运动类型及特征的范围综述[J]. 中华护理杂志, 2023, 58(10): 1192-1198.

WANG Hui, CHENG Kangyao, ZHU Peimin, LÜ Weibo, WANG Yan, LIU Yingping, YANG Yuanling, MA Rui. Design of combined exercises in patients with type 2 diabetes mellitus in intervention studies：a scoping review[J]. Chinese Journal of Nursing, 2023, 58(10): 1192-1198.

图/表 1

参考文献 34

[1]	Li Z, Chen QQ, Yan JY, et al. Effectiveness of motivational interviewing on improving care for patients with type 2 diabetes in China:a randomized controlled trial[J]. BMC Health Serv Res, 2020, 20(1):57. DOI
[2]	Oser TK, Oser SM, Parascando JA, et al. Social media in the diabetes community:a novel way to assess psychosocial needs in people with diabetes and their caregivers[J]. Curr Diab Rep, 2020, 20(3):10. DOI
[3]	Shah SZA, Karam JA, Zeb A, et al. Movement is improvement:the therapeutic effects of exercise and general physical activity on glycemic control in patients with type 2 diabetes mellitus:a systematic review and meta-analysis of randomized controlled trials[J]. Diabetes Ther, 2021, 12(3):707-732. DOI
[4]	中华医学会糖尿病学分会, 朱大龙. 中国2型糖尿病防治指南(2020年版)[J]. 国际内分泌代谢杂志, 2021, 41(5):482-548.
	Chinese Diabetes Society, Zhu DL. Guideline for the prevention and treatment of type 2 diabetes mellitus in China(2020 edition)Chinese Diabetes Society[J]. Int J Endocrinol Metab, 2021, 41(5):482-548.
[5]	Sigal RJ, Armstrong MJ, Bacon SL, et al. Physical activity and diabetes[J]. Can J Diabetes, 2018, 42:S54-S63.
[6]	Eriksson JG. Exercise and the treatment of type 2 diabetes mellitus. An update[J]. Sports Med, 1999, 27(6):381-391. PMID
[7]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2010年版)[J]. 中国糖尿病杂志, 2012, 20(1):81-117.
	Chinese Diabetes Society. Guidelines for prevention and treatment of type 2 diabetes in China(2010 edition)[J]. Chin J Diabetes, 2012, 20(1):81-117.
[8]	Arksey H, O’Malley L. Scoping studies:towards a methodological framework[J]. Int J Soc Res Methodol, 2005, 8(1):19-32. DOI URL
[9]	Levac D, Colquhoun H, O’Brien KK. Scoping studies:advancing the methodology[J]. Implement Sci, 2010, 5(1):1-9. DOI URL
[10]	Lockwood C, dos Santos KB, Pap R. Practical guidance for knowledge synthesis:scoping review methods[J]. Asian Nurs Res(Korean Soc Nurs Sci), 2019, 13(5):287-294.
[11]	Locke SR, Bourne JE, Beauchamp MR, et al. High-intensity interval or continuous moderate exercise:a 24-week pilot trial[J]. Med Sci Sports Exerc, 2018, 50(10):2067-2075. DOI URL
[12]	Winding KM, Munch GW, Iepsen UW, et al. The effect on glycaemic control of low-volume high-intensity interval training versus endurance training in individuals with type 2 diabetes[J]. Diabetes Obes Metab, 2018, 20(5):1131-1139. DOI PMID
[13]	Støa EM, Meling S, Nyhus LK, et al. High-intensity aerobic interval training improves aerobic fitness and HbA1c among persons diagnosed with type 2 diabetes[J]. Eur J Appl Physiol, 2017, 117(3):455-467. DOI PMID
[14]	常凤. 中年2型糖尿病患者有氧运动结合原地深蹲抗阻训练方案及其干预效果研究[J]. 中国全科医学, 2018, 21(24):2980-2986. DOI
	Chang F. Intervention effect of aerobic exercise combined with situ squats resistance training program on middle-aged patients with type 2 diabetes[J]. Chin Gen Pract, 2018, 21(24):2980-2986.
[15]	Larose J, Sigal RJ, Boule NG, et al. Effect of exercise training on physical fitness in type Ⅱ diabetes mellitus[J]. Med Sci Sports Exerc, 2010, 42(8):1439-1447. DOI URL
[16]	Yang P, Swardfager W, Fernandes D, et al. Finding the optimal volume and intensity of resistance training exercise for type 2 diabetes:the FORTE Study,a randomized trial[J]. Diabetes Res Clin Pract, 2017, 130:98-107. DOI URL
[17]	AminiLari Z, Fararouei M, Amanat S, et al. The effect of 12 weeks aerobic,resistance,and combined exercises on omentin-1 levels and insulin resistance among type 2 diabetic middle-aged women[J]. Diabetes Metab J, 2017, 41(3):205-212. DOI PMID
[18]	Benham JL, Booth JE, Dunbar MJ, et al. Significant dose-response between exercise adherence and hemoglobin A1c change[J]. Med Sci Sports Exerc, 2020, 52(9):1960-1965. DOI URL
[19]	Hetherington-Rauth M, Magalhães JP, Júdice PB, et al. Vascular improvements in individuals with type 2 diabetes following a 1 year randomised controlled exercise intervention,irrespective of changes in cardiorespiratory fitness[J]. Diabetologia, 2020, 63(4):722-732. DOI PMID
[20]	Banitalebi E, Kazemi A, Faramarzi M, et al. Effects of sprint interval or combined aerobic and resistance training on myokines in overweight women with type 2 diabetes:a randomized controlled trial[J]. Life Sci, 2019, 217:101-109. DOI PMID
[21]	Bassi D, Dibai-Filho AV, Durans LH, et al. Glycemic behavior in patients with type 2 diabetes during a short period of a combined training program[J]. Motriz:Rev Educ Fis, 2018, 24(3):e0086-18.
[22]	Martins FM, de Paula Souza A, Nunes PRP, et al. High-intensity body weight training is comparable to combined training in changes in muscle mass,physical performance,inflammatory markers and metabolic health in postmenopausal women at high risk for type 2 diabetes mellitus:a randomized controlled clinical trial[J]. Exp Gerontol, 2018, 107:108-115. DOI URL
[23]	Sawada SS, Gando Y, Kawakami R, et al. Combined aerobic and resistance training,and incidence of diabetes:a retrospective cohort study in Japanese older women[J]. J Diabetes Investig, 2019, 10(4):997-1003. DOI URL
[24]	Fealy CE, Nieuwoudt S, Foucher JA, et al. Functional high-intensity exercise training ameliorates insulin resistance and cardiometabolic risk factors in type 2 diabetes[J]. Exp Physiol, 2018, 103(7):985-994. DOI PMID
[25]	何珂, 刘玲, 卞荣蓉, 等. 八段锦联合抗阻运动疗法对2型糖尿病的疗效分析[J]. 中医药导报, 2019, 25(15):85-90.
	He K, Liu L, Bian RR, et al. Clinical analysis of Baduanjin combined with resistance exercise therapy on patients with type 2 diabetes[J]. Guid J Tradit Chin Med Pharm, 2019, 25(15):85-90.
[26]	Magalhães JP, Santos DA, Correia IR, et al. Impact of combined training with different exercise intensities on inflammatory and lipid markers in type 2 diabetes:a secondary analysis from a 1-year randomized controlled trial[J]. Cardiovasc Diabetol, 2020, 19(1):1-11. DOI
[27]	Cox ER, Gajanand T, Burton NW, et al. Effect of different exercise training intensities on musculoskeletal and neuropathic pain in inactive individuals with type 2 diabetes:preliminary randomised controlled trial[J]. Diabetes Res Clin Pract, 2020, 164:108168.
[28]	赵秀君, 刘丽华, 王丽娟, 等. 有氧运动联合抗阻训练对青少年2型糖尿病病人的影响[J]. 护理研究, 2019, 33(6):1059-1061.
	Zhao XJ, Liu LH, Wang LJ, et al. Effect of aerobic exercise combined with resistance training on adolescent patients with type 2 diabetes[J]. Chin Nurs Res, 2019, 33(6):1059-1061.
[29]	Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes:a position statement of the American Diabetes Association[J]. Diabetes Care, 2016, 39(11):2065-2079. PMID
[30]	王英杰, 乔然, 于彤, 等. 低负荷小强度抗阻运动对卧床老年患者肌力和心肺功能的影响[J]. 中华护理杂志, 2021, 56(11):1605-1611. DOI URL
	Wang YJ, Qiao R, Yu T, et al. Effect of resistance exercise program on muscle strength and cardiopulmonary function in elderly bedridden patients[J]. Chin J Nurs, 2021, 56(11):1605-1611. DOI URL
[31]	赵小燕, 黄秀秀, 万巧琴. 运动结合认知训练在轻度认知障碍和阿尔茨海默病患者中应用的整合性综述[J]. 中华护理教育, 2021, 18(12):1098-1105.
	Zhao XY, Huang XX, Wan QQ. The effects of exercise combined with cognitive training in people with mild cognitive impairment and Alzheimer’s disease:an integrated review[J]. Chin J Nurs Educ, 2021, 18(12):1098-1105.
[32]	王丹文, 陈璇, 徐桂华. 太极拳联合八段锦对社区2型糖尿病患者血糖及生存质量的影响[J]. 护理学杂志, 2016, 31(15):37-39,42.
	Wang DW, Chen X, Xu GH. Effect of Tai Chi combined with Ba Duan Jin on blood glucose and quality of life for community type 2 diabetic patients[J]. J Nurs Sci, 2016, 31(15):37-39,42.
[33]	毛荣华, 孙立. 高强度间歇训练联合八段锦在冠心病合并糖尿病病人中的应用[J]. 全科护理, 2021, 19(2):218-221.
	Mao RH, Sun L. Application of high-intensity interval training combined with Baduanjin in patients with coronary heart disease complicated with diabetes mellitus[J]. Chin Gen Pract Nurs, 2021, 19(2):218-221.
[34]	冯苏文, 赵春艳, 许方蕾. 糖尿病患者运动管理评价指标的研究进展[J]. 中华护理杂志, 2021, 56(11):1741-1746. DOI URL
	Feng SW, Zhao CY, Xu FL. Research progress of exercise management evaluation index in diabetic patients[J]. Chin J Nurs, 2021, 56(11):1741-1746. DOI URL