身体活动干预2型糖尿病患者的健康效益：系统综述的系统综述

doi:10.3969/j.issn.1006-9771.2025.05.008

摘要/Abstract

摘要：

目的系统评价身体活动对2型糖尿病(T2DM)患者血糖控制以及相关健康结局的证据。
方法根据PRISMA指南，检索Medline、Embase、Cochrane Library等数据库，获得2017年至2024年的系统综述和Meta分析。由2名研究人员独立进行数据提取，采用AMSTAR2评估纳入文献的方法学质量。对最终纳入的系统综述进行系统综述。
结果共纳入8篇系统综述，其中6篇为高质量，2篇为低质量。多种形式的身体活动干预(有氧运动、抗阻训练、联合训练、高强度间歇训练)均能显著降低T2DM患者糖化血红蛋白水平，改善心肺适能，降低心血管风险因素(如体质量、血压、血脂)，减少糖尿病相关并发症的风险与死亡率。联合训练和较高强度的运动方案可能更有效；专业监督下的运动干预效果更优。
结论规律且多模式的身体活动能改善T2DM患者血糖控制，降低相关心血管代谢风险因素。建议推广个别化、多元化、剂量充足(鼓励更高总量)、强度适宜(鼓励更高强度)、多模式结合、专业监督与自我管理相结合的运动策略。

关键词: 2型糖尿病, 身体活动, 血糖控制, 并发症, 系统综述

Abstract:

Objective To evaluate the evidence about impact of physical activity (PA) on glycemic control and related health outcomes in patients with type 2 diabetes mellitus (T2DM).
Methods Adhering to PRISMA guideline, systematic reviews and meta-analyses published between 2017 and 2024 were retrieved from the databases such as Medline, Embase and Cochrane Library. Two researchers independently extracted data and assessed the quality using AMSTAR2. The included systematic reviews were systematically reviewed.
Results Eight systematic reviews were included, with six rated as high quality and two as low quality. Various forms of PA interventions, such as aerobic exercise, resistance training, combined training and high-intensity interval training, might significantly reduce glycated hemoglobin, enhance cardiorespiratory fitness, lower cardiovascular risk factors (such as body mass, blood pressure and blood lipids), and decrease the risk of diabetes-related complications and mortality in T2DM patients. Combined training and high-intensity training seemed to be better. Professionally supervised PA was more effective.
Conclusions Regular and multimodal PA is effective on glycemic control, and cardiovascular and metabolic risk factors in T2DM patients. It is advocated an individualized, diversified, adequately dosed (encouraging higher total doses), intensity-appropriate (promoting higher intensity), combined-mode and supervision-integrated PA strategies.

Key words: type 2 diabetes, physical activity, glycemic control, complications, systematic review

中图分类号:

R587.1

王梅, 朱文平. 身体活动干预2型糖尿病患者的健康效益：系统综述的系统综述[J]. 《中国康复理论与实践》, 2025, 31(5): 553-560.

WANG Mei, ZHU Wenping. Health benefits of physical activity in patients with type 2 diabetes: a systematic review of systematic reviews[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(5): 553-560.

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纳入文献基本特征"

纳入文献	国家	样本特征	干预类型	干预方案	比较	结局
Maudet-Coulomb等^[12](2024)	法国	纳入研究：7项样本量：n = 2096 平均年龄：62.6岁健康状况：T2DM、高血压、血脂异常、冠心病或代谢综合征	身体活动：AE(如步行、游泳、有氧操等) 动机/自我效能干预：身体活动动机小组会议，心理学小组会议(促进个人对身体活动的信念和态度) 饮食干预：健康饮食和训练	频率：每次60~90 min，每周1~3次强度：低~中等时间：8~48周模式：全程监督+部分监督	与非运动对照组比较	身体健康血糖控制改善体质量下降心理健康行走、运动和障碍自我效能感提高健康行为久坐时间减少健康饮食行为增加
Gallardo-Gómez等^[13](2024)	西班牙	纳入研究：126项样本量：n = 6718 年龄：39~73岁健康状况：T2DM	身体活动：步行、AE	频率：每次20~60 min，每周2~6次强度：低~中等时间：6~34周模式：有监督	不同身体活动剂量比较	身体健康血糖控制改善体质量下降心理健康未提及健康行为未提及
Grace等^[14](2017)	澳大利亚	纳入研究：27项样本量：n = 1372 年龄：> 18岁健康状况：T2DM	身体活动：AE，如固定自行车、椭圆机等	频率：每次15~75 min，每周2~5次强度：低~剧烈时间：4~52周模式：未提及	与非运动对照组比较	身体健康 HbA1c降低血清胰岛素降低体质量降低 CRF改善心理健康未提及健康行为未提及
De Mello等^[15](2022)	巴西	纳入研究：20项样本量：n = 738 年龄：43~69岁健康状况：T2DM	身体活动：HIIT (骑行、跑步、步行)； MICT	频率：每次20~60 min，每周2~6次强度：中等~剧烈时间：4~16周模式：有监督	不同干预强度比较	身体健康 CRF提高血糖控制改善心血管疾病和糖尿病引起的并发症发生率和死亡率降低心理健康未提及健康行为未提及
Igarashi等^[16](2021)	日本	纳入研究：48项样本量：n = 2395 年龄：52~70岁健康状况：T2DM	身体活动：散步、慢跑或滑雪、气功、太极球、跑步机、椭圆机、划船机等	频率：每次20~60 min，每周2~5次强度：低~剧烈时间：12~39周模式：未提及	不同干预方式比较	身体健康血糖控制改善心理健康未提及健康行为久坐行为减少
Jansson等^[17](2022)	澳大利亚	纳入研究：20项样本量：n = 1489 年龄：55~85岁健康状况：T2DM	身体活动：RT，如卷腹、卧推、哑铃、滑轮、划船等	频率：每次10~30 min，每周4~12次强度：低~剧烈时间：8~48周模式：有监督+部分监督	不同干预方式比较	身体健康血糖控制改善肌力改善心理健康未提及健康行为未提及
王梅等^[18](2022)	中国	纳入研究：10项样本量： n = 24715 年龄：55~85岁健康状况：T2DM	身体活动：AE(跑步)、RT(卷腹、卧推、肩推、蹬腿等)；CT 身体活动+饮食干预	频率：每次10~30 min，每周3~5次强度：低~剧烈时间：20~48周模式：有监督+无监督	不同干预方式比较	身体健康体质量、血压和多项生活质量指标改善血糖控制改善微血管并发症减少，冠心病绝对风险降低心理健康抑郁改善活力增加健康行为身体活动参与度提高
Pan等^[19](2018)	中国	纳入研究：37项样本量：n = 2208 年龄：55~72岁健康状况：T2DM	身体活动：AE、RT、CT	频率：每次25~60 min，每周2~5次强度：低~剧烈时间：4~24周模式：监督+无监督+部分监督	不同干预方式比较不同身体活动模式比较	身体健康 HbA1c降低体质量降低收缩压降低总胆固醇降低心理健康未提及健康行为未提及

表3

参考文献 26

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纳入文献	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	总体质量
Maudet-Coulomb等^[12](2024)	√	√	√	√	√	√	√	√	√	√	-	√	√	√	√	√	高
Gallardo-Gómez等^[13](2024)	√	√	√	√	√	√	√	√	√	√	√	√	√	√	√	√	高
Grace等^[14](2017)	√	√	√	√	√	√	√	√	√	√		√	√	√	√	√	低
De Mello等^[15](2022)	√	√	√	√	√	√	√	√	√	√		√	√	√	√	√	低
Igarashi等^[16](2021)	√	√	√	√	√	√	√	√	√	√	√	√	√	√	√	√	高
Jansson等^[17](2022)	√	√	√	√	√	√	√	√	√	√	√	√	√	√	√	√	高
王梅等^[18](2022)	√	√	√	√	√	√	√	√	√	√	-	√	√	√	√	√	高
Pan等^[19](2018)	√	√	√	√	√	√	√	√	√	√	√	√	√	√	√	√	高