《中国康复理论与实践》

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (11): 1288-1298.doi: 10.3969/j.issn.1006-9771.2022.11.008

• 循证研究 • 上一篇    下一篇

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

王梅1(),廖婷2,陈建1   

  1. 1.武汉体育学院运动医学院，湖北武汉市 430079
    2.武汉体育学院水中康复与健身研究中心，湖北武汉市 430079
  • 收稿日期:2022-11-15 修回日期:2022-11-15 出版日期:2022-11-25 发布日期:2022-12-20
  • 通讯作者: 王梅 E-mail:wangmeipku@qq.com
  • 作者简介:王梅(1975-)，女，汉族，湖北武汉市人，博士，副教授，主要研究方向：运动康复、康复体育和适应性体育、社区身体活动与社区运动康复。
  • 基金资助:
    1. 武汉体育学院中青年科研团队项目(2021.05);2. 湖北省高等学校优秀中青年科技创新团队计划项目(T2022036)

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

WANG Mei1(),LIAO Ting2,CHEN Jian1   

  1. 1. School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei 430079, China
    2. Wuhan Sports University Aquatic Therapy & Fitness Research Center, Wuhan, Hubei 430079, China
  • Received:2022-11-15 Revised:2022-11-15 Published:2022-11-25 Online:2022-12-20
  • Contact: WANG Mei E-mail:wangmeipku@qq.com
  • Supported by:
    Wuhan Sports University Youth Scholar Research Team(2021.05);Hubei Excellent Youth Scientific and Technological Innovation Team of Colleges(T2022036)

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摘要：

目的 基于世界卫生组织《国际功能、残疾和健康分类》(ICF)构建社区环境下2型糖尿病三种运动相关干预模式健康效益的范畴及研究架构，系统综述社区环境下2型糖尿病患者3种运动相关干预模式、干预方案及其健康效益。

方法 检索Web of Science、PubMed、中国知网和EBSCO，筛选2012年至2022年11月公开发表的2型糖尿病患者在社区环境下，接受社区慢病管理、社区运动康复、社区身体活动干预及其健康结局的随机对照试验，进行系统综述。

结果 纳入文献10篇，分别来自5个国家，24 715例参与者(55~85岁)，主要来源于糖尿病研究、初级保健与社区健康、老年人健康和康复等相关领域期刊，发表时间集中在2018年至2022年。在社区慢病管理模式下，干预场所主要集中于社区医疗中心、社区卫生服务中心；干预人员一般包括社区卫生人员、社区理疗师、注册护士、注册营养师、项目协调员、药剂师和运动教练等；干预时长6~18个月；干预措施涉及医疗咨询、健康教育、医疗就诊提醒、身体活动、家访、定期健康状况监测；干预属性主要是治疗和健康促进。在社区运动康复模式下，干预场所主要集中于社区老年中心和社区医疗中心，且均提供活动监测；干预人员一般包括社区康复师、运动治疗师、营养师、全科医生；干预时长3~12个月；干预措施集中于运动康复干预、饮食干预和健康素养干预；运动康复干预主要目标是治疗、康复和健康促进。在社区身体活动干预模式下，干预场所主要集中于社区老年中心和社区医疗中心，均提供活动监测；干预人员一般包括社区康复师、运动治疗师、营养师、全科医生；干预措施集中于运动干预，活动方式主要涉及有氧运动(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)和联合运动，每次10~30 min，每周3~5次，中等强度，持续5~12个月；干预目标是预防、治疗、康复和健康促进。健康结局主要涉及提高心脏代谢，改善高密度脂蛋白胆固醇和胰岛素敏感性，降低血糖、糖化血红蛋白水平，增强下肢力量；减少饮酒行为，提高运动参与度且饮食更加清淡；减少慢性并发症风险，延缓疾病进展，降低跌倒和骨折风险，改善心理健康和幸福感。

结论 基于ICF构建了2型糖尿病患者在社区慢病管理、社区运动康复、社区身体活动干预三种干预模式下，运动相关干预方案和干预结局的研究架构。2型糖尿病患者在三种运动相关干预模式下，不仅改善身体功能，还改善活动和参与水平、提升生活质量与福祉。

关键词: 2型糖尿病, 运动, 社区康复, 身体活动, 系统综述

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

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