2型糖尿病相关的身体活动与健康政策和指南研究

doi:10.3969/j.issn.1006-9771.2025.08.002

摘要/Abstract

摘要：

目的分析世界卫生组织(WHO)、欧盟、美国、加拿大、澳大利亚和中国等国际组织和国家关于2型糖尿病(T2DM)的身体活动和健康相关政策和指南。

方法采用内容分析和比较研究的方法，对国际和国家层面的身体活动相关政策和指南进行比较研究。

结果国际组织和国家均将身体活动作为防控T2DM和提高人群健康水平的重要措施。WHO提出明确的全球性目标和监测指标，美国、加拿大和澳大利亚将社区干预、医保激励和结构化运动方案紧密结合，中国则将全民健身与公共卫生服务融合。国际上T2DM相关运动干预指南强调每周> 150 min中等强度有氧运动并结合抗阻训练。

结论国际和国家层面关于T2DM的身体活动与健康政策的目标在于提升身体活动参与率、改善人群健康状况、有效降低T2DM等慢性疾病的发病率和死亡率。与T2DM相关的指南强调采用多学科合作模式，以提高指南的实践可操作性和实施效果以及健康相关身体活动的可持续性。未来发展重点将是根据个体的需求建立针对T2DM的个体化身体活动方案，构建融合身体活动、社区健康、慢性疾病管理和数字技术的综合健康相关服务体系。

关键词: 2型糖尿病, 身体活动, 健康相关政策, 健康管理

Abstract:

Objective To analyze the physical activity and health-related policies and guidelines for type 2 diabetes mellitus (T2DM) issued by international organizations and countries, including World Health Organization (WHO), European Union, the United States, Canada, Australia and China.

Methods A content analysis and a comparative study were conducted to examine physical activity-related policies and guidelines at international and national levels.

Results International organizations and countries all recognized physical activity as a key measure for preventing and controlling T2DM and improving population health. WHO established clear global targets and monitoring indicators. The United States, Canada and Australia closely integrated community interventions, healthcare incentives and structured exercise programs, while China combined national fitness initiatives with public health services. International T2DM-related exercise guidelines recommended > 150 minutes of moderate-intensity aerobic exercise per week combined with resistance training.

Conclusion At both international and national levels, T2DM-related physical activity and health policies aim to increase participation in physical activity, improve population health, and effectively reduce the incidence and mortality of chronic diseases such as T2DM. Guidelines emphasize a multidisciplinary collaboration model to enhance practical applicability, implementation effectiveness and the sustainability of health-related physical activity. Future development priorities will include establishing personalized physical activity programs for T2DM based on individual needs, and building an integrated health-related service system that combines physical activity, community health, chronic disease management and digital technologies.

Key words: type 2 diabetes, physical activity, health-related policy, health management

中图分类号:

R587.1

王梅, 朱文平. 2型糖尿病相关的身体活动与健康政策和指南研究[J]. 《中国康复理论与实践》, 2025, 31(8): 876-882.

WANG Mei, ZHU Wenping. Physical activity and health policies and guidelines related to type 2 diabetes[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 876-882.

图/表 2

表1

国际和国家层面T2DM相关的健康政策和技术指南的框架和内容分析"

要素	WHO	欧盟	美国	加拿大	澳大利亚	中国
政策框架	《全球身体活动行动计划2018-2030：更多运动，更健康的世界》《HEARTS D: 2型糖尿病的诊断和管理》《WHO身体活动与久坐行为指南》	《到2030年欧盟防治糖尿病行动蓝图》《欧盟非传染性疾病倡议：指导文件》《2024年欧盟促进健康的体育活动》	国家糖尿病预防计划；《改善群体护理与促进健康：2023年糖尿病护理标准》	《加拿大糖尿病框架》《加拿大18~64岁成人及65岁及以上老年人24小时运动指南：融合身体活动、久坐行为与睡眠》《预防慢性病战略计划(2013-2016年)》	《澳大利亚国家糖尿病战略(2021-2030年)》《国家预防健康战略》《全体澳大利亚人身体活动与锻炼指南》《国家慢性疾病战略框架》	《“健康中国2030”规划纲要》《中国糖尿病防治指南》(2024版)、全民健身计划(2021-2025年)
目标人群	高风险人群(肥胖、高血压等)；久坐人群和T2DM患者；社区及初级卫生保健覆盖人群；全年龄段人群	高风险人群(肥胖、代谢综合征)；T2DM患者(全生命周期管理)；慢性疾病患者；医疗系统从业人员	糖尿病前期人群(HbA1c 5.7%~6.4%)；T2DM患者(社区及临床管理)；少数族裔/低收入群体(精准干预)	高风险人群(原住民、低收入群体)；T2DM患者；儿童及青少年	高风险人群(≥ 45岁、肥胖等)；T2DM患者；偏远地区居民	高风险人群(> 40岁、肥胖等)；T2DM患者(基层卫生服务覆盖)；城乡重点人群(健康扶贫)
主要干预措施	社区健康教育；结构化身体活动(每周150 min，中等强度)；药物可及性(基本药物清单)	结构化糖尿病教育；运动处方；开发数字健康工具	生活方式干预；医疗保险覆盖；数字健康工具；身体活动	社区糖尿病预防计划；运动处方；健康干预	国家糖尿病服务计划；生活方式计划；远程医疗	国家基本公共卫生服务；中医特色干预；社区健身设施全覆盖
支持机制	国家慢性病防控多部门协调机制；全球糖尿病知识共享平台；初级卫生保健能力建设	欧盟基金支持；德国法定医保报销；跨区域医疗数据共享	联邦资金支持；雇主参与；电子健康记录整合	省级卫生部门资金支持；电子健康记录；社区健康中心网络	联邦资助；My Health Record系统整合；全科医生激励计划	中央财政专项(慢性疾病防控)；分级诊疗制度；医保支付改革
绩效评估	糖尿病发病率/死亡率监测；身体活动达标率；药物覆盖率	糖尿病并发症率；疾病管理计划参与率；身体活动达标率；慢性疾病指标改善	糖尿病预防计划参与者的体质量减轻5%达标率;年度糖尿病筛查率；社区健康评估	糖尿病发病率；运动指南依从率；原住民健康差距指标	国家糖尿病服务计划服务覆盖率；HbA1c达标率；预防计划参与率	糖尿病患者规范管理率；全民健身参与率；县域血糖检测覆盖率
跨部门协同	联合联合国儿童基金会、世界银行推动政策落地；与食品行业合作(减盐减糖倡议)；城市健康倡议；体育、交通、城市规划部门协作；学校/职场健康计划	欧盟委员会协调；体育、卫生、教育部门联动；工作场所健康促进；食品行业监管	卫生与公众服务部统筹疾病控制与预防中心、联邦医疗保险和医疗补助服务中心、国立卫生研究院；公私合作；地方卫生部门与社区组织联动	联邦-省-地区卫生合作；与非营利组织合作；食品政策联盟	联邦与州政府联合拨款；与研究机构合作；食品行业监管	国家卫健委牵头多部门协作；体医融合试点；健康城市建设

表1

表2

T2DM相关的身体活动与健康指南或专家共识分析"

指南/机构	人群(P)	干预(I)	对照(C)	结局(O)	备注/特殊考虑
ADA (2023)	成年T2DM患者	每周≥150 min中强度有氧运动+每周2~3次抗阻训练	常规治疗	HbA1c水平、心血管风险、胰岛素敏感性	强调减少久坐；有并发症的患者需调整运动处方
英国国家健康和护理研究所	高危糖尿病人群	社区和学校层面普及运动及健康教育，每天多次活动，减少久坐	常规健康教育	糖尿病发病率、身体质量指数变化、生活质量评分	提倡全人群健康信息传播；重视文化适配
加拿大糖尿病框架(2022)	成年T2DM患者	每周≥ 150 min中强度有氧运动，每周2~3次抗阻训练；结合饮食干预	常规治疗	HbA1c水平、体质量变化、血压变化	强调生活方式综合干预
国家老年医学中心等(2024)	成年T2DM患者	定制运动处方，每周3~5 d，150 min中等强度的有氧运动时间	常规治疗	跌倒风险、认知功能、肌少症预防效果	包含体能评估、并发症管理、营养指导和数字健康等76条推荐意见
美国运动医学会指南(2022)	T2DM患者	有氧+抗阻训练，强调每周4~5 d运动、逐渐加量	常规或较低运动量	HbA1c水平、最大摄氧量、微血管并发症风险	鼓励分散运动、餐后运动；适用于绝大多数患者
澳大利亚皇家全科医师学院指南(2014)	成年T2DM患者	结构化、有监督的有氧+抗阻训练，每周≥150 min	建议但无结构化干预(附加饮食)	HbA1c水平、腰围变化、抑郁症状改善	指出有氧运动降HbA1c可达0.73%；需关注低血糖风险
澳大利亚糖尿病与锻炼(2020)	成年T2DM患者	每天≥ 30 min中强度有氧运动，≥ 2 d天抗阻训练	常规治疗	运动依从性、HbA1c水平、低血糖事件	提醒胰岛素使用者运动中血糖监测及调整剂量
美国运动医学会运动处方专家共识(2025)	成年T2DM患者	每周≥ 150min中强度有氧运动，每周2~3次抗阻训练，同时特别强调高强度抗阻训练优势	常规治疗	肌肉量变化、基础代谢率、术后减重效果	强调运动对减重和代谢改善的重要性

表2

参考文献 19

[20]	Australian Government Department of Health. Australian National Diabetes Strategy 2021-2030[R/OL]. (2021-11-12)[2025-02-10]. https://www.health.gov.au/resources/publications/australian-national-diabetes-strategy-2021-2030?language=en.
[21]	Australian Government Department of Health. National Preventive Health Strategy[R/OL]. (2021-12-12)[2025-03-12]. https://www.health.gov.au/sites/default/files/documents/2021/12/national-preventive-health-strategy-2021-2030_1.pdf.
[22]	Australian Government Department of Health. Physical activity and exercise guidelines for all Australians[R/OL]. (2021-05-07)[2025-02-10]. https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians.
[23]	Australian Government Department of Health. National strategic framework for chronic conditions[R/OL]. (2020-03-03)[2025-02-11]. https://www.health.gov.au/resources/publications/national-strategic-framework-for-chronic-conditions?language=en.
[24]	新华社. 中共中央国务院印发«"健康中国2030"规划纲要»[EB/OL]. (2016-10-25)[2025-01-10]. https://www.gov.cn/zhengce /2016-10/25/content_5124174.htm.
[25]	中华医学会糖尿病学分会. 中国糖尿病防治指南(2024版)[J]. 中华糖尿病杂志, 2025, 17(1): 16-139.
	Chinese Diabetes Society. Guideline for the prevention and treatment of diabetes mellitus in China (2024 edition)[J]. Chin J Diabetes Mellitus, 2025, 17(1): 16-139.
[26]	国务院. 国务院关于印发全民健身计划(2021—2025年)的通知[A/OL]. (2021-08-03)[2025-01-22]. https://www.gov.cn/zhengce/content/2021-08/03/content_5629218.htm.
[27]	National Center for Biotechnology Information. The role of exercise in diabetes[EB/OL]. (2023-01-06)[2025-01-02]. https://www.ncbi.nlm.nih.gov/books/NBK549946/#:-:text=Exercise%2C%20together%20with%20medical%20nutrition,in%20blood%20pressure%2C%20improvement%20in.
[28]	国家老年医学中心,中华医学会糖尿病学分会,中国体育科学学会. 中国2型糖尿病运动治疗指南(2024版)[J]. 中国运动医学杂志, 2024, 43(6): 419-452.
	National Center for Geriatrics and Gerontology, Chinese Diabetes Society, China Sport Science Society. Guideline for exercise therapy of type 2 diabetes mellitus in China (2024 Edition)[J]. Chin J Sports Mede, 2024, 43(6): 419-452.
[29]	American College of Sports Medicine. ACSM publishes new recommendations on type 2 diabetes and exercise[EB/OL]. (2022-01-09)[2025-03-07]. https://acsm.org/exercise-recommendations-type-2-diabetes/#:-:text=%E2%80%9CExercise%20can%20play%20an%20important,%E2%80%9D.
[30]	American College of Sports Medicine. ACSM's Guidelines for exercise testing and prescription (12 Edition)[M]. Philadelphia: Wolters Kluwer, 2025.
[31]	National Institute for Health and Care Excellence. Type 2 diabetes prevention: population and community-level interventions[EB/OL]. (2011-05-10)[2025-02-11]. https://www.nice.org.uk/guidance/ph35/chapter/recommendations#:-:text=,of%20time%20spent%20being%20sedentary.
[32]	TONGA E, WORBOYS H, EVANS R A, et al. Physical activity guidelines for adults with type 2 diabetes: systematic review[J]. Diabetes Res Clin Pract, 2025, 220(1): 111982.
[33]	Royal Australian College of General Practitioners. Exercise: type 2 diabetes[EB/OL]. (2014-11-02)[2025-02-11]. https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/HANDI/Exercise-for-type-2diabetes.pdf#:-:text=Supervised%20structured%20and%20progressive%20aerobic, and%2For%20resistance%20training%20for%20150.
[34]	Diabetes Autralia. Exercise & diabetes[EB/OL]. (2020-12-11)[2025-01-22]. https://www.diabetesaustralia.com.au/living-with-diabetes/exercise/#:-:text=The%20National%20Physical%20Activity%20Guidelines,for%20Australian%20Adults%20recommend.
[1]	International Diabetes Federation. IDF Diabetes Atlas 11th edition 2025[R/OL]. (2025-01-22)[2025-03-01]. https://idf.org/about-diabetes/diabetes-facts-figures/.
[2]	World Health Organization. Urgent action needed as global diabetes cases increase four-fold over past decades[R/OL]. (2024-11-13)[2025-01-23]. https://www.who.int/news/item/13-11-2024-urgent-action-needed-as-global-diabetes-cases-increas e-four-fold-over-past-decades#:-:text=%E2%80%9CWe%20have%20seen%20an%20alarming,%E2%80%9D.
[3]	World Health Organization. Nearly 1.8 billion adults at risk of disease from not doing enough physical activity[R/OL]. (2024-06-26)[2025-01-22]. https://www.who.int/news/item /26-06 -2024-nearly-1.8-billion-adults-at-risk-of-disease-from-not-doing-enough-physical-activity#:-:text=New%20data%20show%20that%20nearly,points%20between%202010%20and%202022.
[4]	COLBERG S R, SIGAL R J, YARDLEY J E, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association[J]. Diabetes Care, 2016, 39(11): 2065-2079. pmid: 27926890
[5]	王梅, 廖婷, 陈建. 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系统综述[J]. 中国康复理论与实践, 2022, 28(11): 1288-1298. doi: 10.3969/j.issn.1006-9771.2022.11.008
	WANG M, LIAO T, CHEN J. Health benefit of three exercise-related interventions for type 2 diabetes mellitus in community: a systematic review[J]. Chin J Rehabil Theory Pract, 2022, 28(11): 1288-1298.
[6]	LOVAS S, MAHROUSEH N, BOLAJI O S, et al. Impact of policies in nutrition and physical activity on diabetes and its risk factors in the 28 member states of the European Union[J]. Nutrients, 2021, 13(10): 3439.
[7]	World Health Organization. New WHO report highlights progress and challenges in improving physical activity levels across the European Union[R/OL]. (2024-11-07)[2025-02-23]. https://www.who.int/europe/news/item/07-11-2024-new-who-report-highlights-progress-and-challenges-in-improving-physical-activity-levels-across-the-european-union#:-:text=Despite%20 the%20increase%20in%20policy,be%20met%20in%20most%20countries.
[8]	World Health Organization. Global action plan on physical activity 2018-2030: more active people for a healthier world[R]. Geneva: World Health Organization, 2018.
[9]	World Health Organization. WHO guidelines on physical activity and sedentary behaviour[R]. Geneva: World Health Organization, 2020.
[10]	World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020[R]. Geneva: World Health Organization, 2013.
[11]	World Health Organization.HEARTS D: diagnosis and management of type 2 diabetes [S]. Geneva: World Health Organization, 2020.
[12]	International Diabetes Federation Europe. Blueprint for action on diabetes in the European Union by 2030[R/OL]. (2020-02-01)[2025-02-13]. https://idf.org/europe/media/uploads/sites/2/2023/05/MMD-BLUEPRINT-FOR-ACTION-ON-DIABETES.pdf.
[13]	European Commission. EU non-communicable diseases (NCDs) initiative: guidance document[R/OL]. (2022-06-20)[2025-03-12]. https://health.ec.europa.eu/publications/eu-non-communicable-diseases-ncds-initiative-guidance-document_en.
[14]	World Health Organization. Health-enhancing physical activity in the European Union, 2024[R]. Copenhagen: World Health Organization Regional Office for Europe, 2024.
[15]	National Diabetes Prevention Program. What is the national DPP?[EB/OL]. (2024-05-15)[2025-02-11]. https://www.cdc.gov/diabetes-prevention/programs/what-is-the-national-dpp.html.
[16]	ELSAYED N A, ALEPPO G, ARODA V R, et al. 1. Improving care and promoting health in populations: standards of care in diabetes-2023[J]. Diabetes Care, 2022, 46(1): S8-S10.
[17]	Public Health Agency of Canada. Framework for diabetes in Canada[EB/OL]. (2022-10-20)[2025-03-10]. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/framework-diabetes-canada/framework-diabetes-canada.pdf.
[18]	ROSS R, CHAPUT J P, GIANGREGORIO L M, et al. Canadian 24-hour movement guidelines for adults aged 18-64 years and adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep[J]. Appl Physiol Nutr Metab, 2020, 45(10Suppl 2): S57-S102.
[19]	Public Health Agency of Canada. Preventing Chronic Disease Strategic Plan 2013-2016[R/OL]. (2013-03-02)[2025-03-10]. https://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-39-2013-eng.pdf.