高强度间歇训练对2型糖尿病患者运动干预的效果：基于《WHO关于身体活动和久坐行为的指南》和WHO-FICs

doi:10.3969/j.issn.1006-9771.2022.06.004

Abstract

Abstract:

Objective To evaluate the effects of high intensity interval training (HIIT) on patients with type 2 diabetes mellitus (T2DM). Methods From May to October, 2021, twelve patients with T2DM were recruited with internet. An HIIT exercise intervention based on WHO Guidelines on Physical Activity and Sedentary Behaviour and World Health Organization Family of International Classifications (WHO-FICs) was constructed. They received aerobic combined with resistance training in a multi-combination HIIT using whole-body exercise, 30 to 35 minutes a time, three times a week, for eight weeks. Before and after intervention, their blood glucose levels, lipid levels, pancreatic fat content and body composition were measured. Results One cased was dropped. After intervention, the fasting glucose, 2-hour postprandial glucose, hemoglobin A1c, fasting serum insulin, insulin resistance index, serum total cholesterol, serum triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, pancreatic fat content, body weight, body mass index, and body fat percentage improved (t > 2.258, P < 0.05). Conclusion HIIT exercise intervention based on the Guidelines and WHO-FICs could improve the related functions of patients with T2DM, such as blood glucose levels, blood lipid levels, pancreatic fat content and body composition, and reduce the consumption of hypoglycemic drugs.

Key words: type 2 diabetes mellitus, high intensity interval training, glucose and lipid metabolism, pancreas

CLC Number:

R587.1

FENG Chen,YAO Jiaming,ZHOU Guojin,LI Muyao,WANG Li,WANG Mei. Effects of high intensity interval training on patients with type 2 diabetes mellitus using WHO Guidelines on Physical Activity and Sedentary Behaviour and WHO-FICs[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(6): 646-652.

Figures/Tables 3

References 40

[1]	LI Y, TENG D, SHI X, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study[J]. BMJ, 2020, 369: m997.
[2]	龙丹凤, 徐志伟, 王小芳, 等. 2型糖尿病并发症流行病学调查及危险因素[J]. 医学信息, 2020, 33(21): 3.
	LONG D F, XU Z W, WANG X F, et al. Epidemiological investigation and risk factors of type 2 diabetes complications[J]. Med Inform, 2020, 33(21): 3.
[3]	HOU X, LU J, WENG J, et al. Impact of waist circumference and body mass index on risk of cardiometabolic disorder and cardiovascular disease in Chinese adults: a national diabetes and metabolic disorders survey[J]. PLoS One, 2013, 8(3): e57319. doi: 10.1371/journal.pone.0057319
[4]	GERBER P A, RUTTER G A. The role of oxidative stress and hypoxia in pancreatic beta-cell dysfunction in diabetes mellitus[J]. Antioxid Redox Signal, 2017, 26(10): 501-518. doi: 10.1089/ars.2016.6755
[5]	邱卓英, 李伦, 陈迪, 等. 基于世界卫生组织国际健康分类家族康复指南研究:理论架构和方法体系[J]. 中国康复理论与实践, 2020, 26(2): 125-135.
	QIU Z Y, LI L, CHEN D, et al. Research on rehabilitation guidelines using World Health Organization Family International Classifications: framework and approaches[J]. Chin J Rehabil Theory Pract, 2020, 26(2): 125-135.
[6]	刘静, 邱芬, 邱卓英, 等. 世界卫生组织身体活动政策和指南的架构与核心内容研究[J]. 中国康复理论与实践, 2021, 27(12): 1402-1411.
	LIU J, QIU F, QIU Z Y, et al. Framework and core content of World Health Organization policy and guidelines of physical activity[J]. Chin J Rehabil Theory Pract, 2021, 27(12): 1402-1411.
[7]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4): 315-409.
	Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 ed)[J]. Chin J Diabetes Mellitus, 2021, 13(4): 315-409.
[8]	PAN B, GE L, XUN Y Q, et al. Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis[J]. Int J Behav Nutr Phys, 2018, 15(1): 72. doi: 10.1186/s12966-018-0703-3
[9]	SABAG A, WAY K L, KEATING S E, et al. Exercise and ectopic fat in type 2 diabetes: a systematic review and meta-analysis[J]. Diabetes Metab, 2017, 43(3): 195-210. doi: 10.1016/j.diabet.2016.12.006
[10]	刘瑞东, 曹春梅, 刘建秀, 等. 高强度间歇训练的应用及其适应机制[J]. 体育科学, 2017, 37(7): 73-82.
	LIU R D, CAO C M, LIU J X, et al. Application of high-intensity interval training and its adaption mechanism[J]. Chin Sport Sci, 2017, 37(7): 73-82.
[11]	MARTINEZ N, KILPATRICK M W, SALOMON K, et al. Affective and enjoyment responses to high-intensity interval training in overweight-to-obese and insufficiently active adults[J]. J Sport Exercise Psychol, 2015, 37(2): 138-149. doi: 10.1123/jsep.2014-0212
[12]	杨剑, 吴媛, 田石榴. 中老年2型糖尿病有氧运动干预的Meta分析[J]. 沈阳体育学院学报, 2020, 39(1): 68-79.
	YANG J, WU Y, TIAN S L. Meta-analysis of aerobic exercise intervention in middle-aged and elderly patients with type 2 diabetes mellitus[J]. J Shenyang Sport Univ, 2020, 39(1): 68-79.
[13]	MIYAMOTO-MIKAMI E, SATO K, KURIHARA T, et al. Endurance training-induced increase in circulating irisin levels is associated with reduction of abdominal visceral fat in middle-aged and older adults[J]. PLoS One, 2015, 10: e0120354. doi: 10.1371/journal.pone.0120354
[14]	闫增印, 闫平平, 秦春莉, 等. 连续性及高强度间歇运动对2型糖尿病血糖调控影响的研究进展[J]. 中国全科医学, 2021, 24(12): 1575-1580. doi: 10.12114/j.issn.1007-9572.2021.00.135
	YAN Z Y, YAN P P, QIN C L, et al. New advances in the effect of continuous and high-intensity interval trainings on blood glucose regulation in type 2 diabetes[J]. Chin Gen Pract, 2021, 24(12): 1575-1580. doi: 10.12114/j.issn.1007-9572.2021.00.135
[15]	MACHADO A F, BAKER J S, FIGUEIRA JUNIOR A J, et al. High-intensity interval training using whole-body exercises: training recommendations and methodological overview[J]. Clin Physiol Funct Imaging, 2019, 39(6): 378-383. doi: 10.1111/cpf.12433
[16]	LAURENS C, MORO C. Intramyocellular fat storage in metabolic diseases[J]. Horm Mol Biol Clin Investig, 2016, 26(1): 43-52.
[17]	FUKUI H, HORI M, FUKUDA Y, et al. Evaluation of fatty pancreas by proton density fat fraction using 3-T magnetic resonance imaging and its association with pancreatic cancer[J]. Eur J Radiol, 2019, 118: 25-31. doi: 10.1016/j.ejrad.2019.06.024
[18]	SIMPSON S H, LIN M, EURICH D T. Medication adherence affects risk of new diabetes complications: a cohort study[J]. Ann Pharmacother, 2016, 50(9): 741-746. doi: 10.1177/1060028016653609
[19]	TREMBLAY M S, AUBERT S, BARNES J D, et al. Sedentary Behavior Research Network (SBRN): terminology consensus project process and outcome[J]. Tint J Behav Nutr Phy, 2017, 14(1): 75.
[20]	廖涌. 中国糖尿病的流行病学现状及展望[J]. 重庆医科大学学报, 2015, 40(7): 1042-1045.
	LIAO Y. Epidemiology and research advances in diabetes mellitus in China[J]. J Chongqing Med Univ, 2015, 40(7): 1042-1045.
[21]	首健, 陈佩杰, 肖卫华. 不同运动方式对骨骼肌胰岛素抵抗的影响机制[J]. 中国糖尿病杂志, 2018, 26(8): 697-701.
	SHOU J, CHEN P J, XIAO W H. Effect of different exercise mode on insulin resistance inskeletal muscle and its mechanism[J]. Chin J Diabetes, 2018, 26(8): 697-701.
[22]	SYLOW L, TOKARZ V L, RICHTER E A, et al. The many actions of insulin in skeletal muscle, the paramount tissue determining glycemia[J]. Cell Metab, 2021, 33(4): 758-780.
[23]	SYLOW L, KLEINERT M, RICHTER E A, et al. Exercise-stimulated glucose uptake: regulation and implications for glycaemic control[J]. Nat Rev Endocrinol, 2017, 13(3): 133-148.
[24]	WINDING K M, MUNCH G W, IEPSEN U W, 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: 10.1111/dom.13198
[25]	STØA E M, MELING S, NYHUS L K, 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.
[26]	LI Y, ZHAO L, YU D, et al. The prevalence and risk factors of dyslipidemia in different diabetic progression stages among middle-aged and elderly populations in China[J]. PLoS One, 2018, 13(10): e0205709. doi: 10.1371/journal.pone.0205709
[27]	刘览, 吴雪霁, 利耀辉, 等. 血脂异常与高血压对糖尿病患病的交互作用[J]. 中国慢性病预防与控制, 2021, 29(5): 356-360.
	LIU L, WU X J, LI Y H, et al. Interaction of dyslipidemia and hypertension on morbidity of diabetes[J]. Chin J Prev Contr Chron Dis, 2021, 29(5): 356-360.
[28]	陈影, 张爽, 余珍, 等. 运动对2型糖尿病患者血脂影响的网状Meta分析[J]. 中国康复理论与实践, 2019, 25(7): 849-858.
	CHEN Y, ZHANG S, YU Z, et al. Effect of exercise on blood lipid for patients with type 2 diabetes: a network meta-analysis[J]. Chin J Rehabil Theory Pract, 2019, 25(7): 849-858.
[29]	DAMBHA-MILLER H, DAY A J, STRELITZ J, et al. Behaviour change, weight loss and remission of type 2 diabetes: a community-based prospective cohort study[J]. Diabetic Med, 2020, 37(4): 681-688. doi: 10.1111/dme.14122
[30]	CRABTREE D R, CHAMBERS E S, HARDWICK R M, et al. The effects of high-intensity exercise on neural responses to images of food[J]. Am J Clin Nutr, 2014, 99(2): 258-267. doi: 10.3945/ajcn.113.071381
[31]	韩奇, 刘佳易, 安楠, 等. 高强度间歇运动与中等强度持续运动对2型糖尿病患者血糖控制和心血管风险因子干预效果对比的Meta分析[J]. 中国运动医学杂志, 2021, 40(10): 822-830.
	HAN Q, LIU J Y, AN N, et al. Meta-analysis of effects of high-intensity intermittent exercise and moderate-intensity continuous exercise on blood glucose control and cardiovascular risk factor intervention in patients with type 2 diabetes mellitus[J]. Chin J Sports Med, 2021, 40(10): 822-830.
[32]	TERADA T, BOULÉ N G, FORHAN M, et al. Cardiometabolic risk factors in type 2 diabetes with high fat and low muscle mass: at baseline and in response to exercise[J]. Obesity, 2017, 25(5): 881-891. doi: 10.1002/oby.21808
[33]	DI MEO S, IOSSA S, VENDITTI P. Improvement of obesity-linked skeletal muscle insulin resistance by strength and endurance training[J]. J Endocrinol, 2017, 234(3): 159-181.
[34]	TUSHUIZEN M E, BUNCK M C, POUWELS P J, et al. Pancreatic fat content and beta-cell function in men with and without type 2 diabetes[J]. Diabetes Care, 2007, 30(11): 2916-2921. doi: 10.2337/dc07-0326
[35]	BEGOVATZ P, KOLIAKI C, WEBER K, et al. Pancreatic adipose tissue infiltration, parenchymal steatosis and beta cell function in humans[J]. Diabetologia, 2015, 58(7): 1646-1655. doi: 10.1007/s00125-015-3544-5
[36]	LU T, WANG Y, DOU T, et al. Pancreatic fat content is associated with β-cell function and insulin resistance in Chinese type 2 diabetes subjects[J]. Endocr J, 2019, 66(3): 265-270. doi: 10.1507/endocrj.EJ18-0436
[37]	GASMI A, NOOR S, MENZEL A, et al. Obesity and insulin resistance: associations with chronic inflammation, genetic and epigenetic factors[J]. Curr Med Chem, 2021, 28(4): 800-826. doi: 10.2174/0929867327666200824112056
[38]	YOKOO T, SERAI S D, PIRASTEH A, et al. Linearity, bias, and precision of hepatic proton density fat fraction measurements by using MR imaging: a meta-analysis[J]. Radiology, 2018, 286(2): 486-498. doi: 10.1148/radiol.2017170550
[39]	朱显贵, 石旅畅, 张海峰. 不同强度运动对脂解激素的影响及在减肥机制中的作用研究进展[J]. 中国运动医学杂志, 2020, 39(8): 569-576.
	ZHU X G, SHI L C, ZHANG H F. Review on the effects of different intensities of exercise on lipolytic hormones and its effect on weight-losing mechanism[J]. Chin J Sports Med, 2020, 39(8): 569-576.
[40]	BAJER B, VLCEK M, GALUSOVA A, et al. Exercise associated hormonal signals as powerful determinants of an effective fat mass loss[J]. Endocr Regul, 2015, 49(3): 151-163. doi: 10.4149/endo_2015_03_151

WHO-FICs	类别		内容
ICD-11	疾病诊断	05内分泌、营养或代谢疾病：内分泌疾病：糖尿病	纳入确诊为T2DM (5A11)的患者。此外,由于不适合参与高强度运动,排除伴有不稳定性糖尿病(5A24)、糖尿病性低血糖伴昏迷(5A21.1)等严重并发症的患者
ICHI β2	身体活动干预	有氧运动	身体大肌群参与的持续性、节律性的运动,如跳跃、跑步等运动
ICHI β2	身体活动干预	发展肌肉的活动	针对特定肌群的负荷训练,如哑铃、弹力带等器械性运动
ICF	身体活动效果	身体功能和身体结构	b430血液系统功能：血糖、血脂相关指标,b530体重维持功能：身体成分指标,s550胰的结构：胰腺脂肪含量
		活动和参与	d240控制应激和其他心理需求(d2400承担责任、d2401控制应激、d2402应付危险、d2408其他特指的控制应激和其他心理需求、d2409控制应激和其他心理需求,未特指),d750非正式社会关系(d750与朋友的非正式关系、d7501与邻居的非正式关系、d7502与熟人的非正式关系、d7503与同住者的非正式关系、d7504与同伴的非正式关系、d7508其他特指的非正式社会关系、d7509非正式社会关系,未特指),d760家庭人际关系(d7600父母-子女关系、d7601子女父母关系、d7602亲属关系、d7603大家族关系、d7608其他特指的家庭关系、d7609家庭关系,未特指),d9201运动,d9205社会活动

阶段		训练时长/min	训练强度
适应阶段(1~2周)	准备活动	5	20%~40%HRmax、RPE 9~12级
适应阶段(1~2周)	HITT干预	20	40%~60%HRmax、RPE 11~15级
强化阶段(3~8周)	准备活动	10	30%~60%HRmax、RPE 12~15级
强化阶段(3~8周)	HITT干预	20	70%~90%HRmax、RPE 16~19级

指标	干预前	干预后	t值	P值
FPG/mmol·L^-1	7.71±1.29	6.12±0.75	4.886	0.001
2hPG/mmol·L^-1	18.60±5.94	14.21±3.84	5.795	< 0.001
HbA1c/%	7.46±1.17	6.46±0.72	2.258	0.048
Ins/mmol·L^-1	12.62±6.44	11.52±6.12	4.790	0.001
HOMA-IR	2.22±1.03	1.95±0.98	6.170	0.001
TC/mmol·L^-1	5.11±1.25	4.44±1.02	3.465	0.006
TG/mmol·L^-1	1.53±0.69	1.10±0.64	4.533	0.001
HDL-C/mmol·L^-1	1.19±0.38	1.44±0.35	-5.394	< 0.001
LDL-C/mmol·L^-1	2.90±0.87	2.37±0.81	4.681	< 0.001
PFF/%	6.83±2.14	6.21±1.95	6.976	< 0.001
体质量/kg	65.43±16.14	62.49±15.94	5.501	< 0.001
BMI/kg·m^-2	24.49±3.85	23.35±3.78	3.058	0.012
体脂率/%	29.67±3.98	28.67±3.88	18.540	< 0.001
瘦体质量/kg	45.66±10.70	46.10±10.78	-1.662	0.128

Effects of high intensity interval training on patients with type 2 diabetes mellitus using WHO Guidelines on Physical Activity and Sedentary Behaviour and WHO-FICs

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 3

References 40

Related Articles 15

Metrics

Comments

Recommended 0

[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.
[2]	CHEN Bing-lin, GUO Jia-bao. Effects of High Intensity Interval Training on Type 2 Diabetes Mellitus: A Meta-analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(3): 353-362.
[3]	MENG Qing, CHEN Wei, ZHANG Ming, GAO Min. Effect of Aerobic and Resistance Exercise for Patients with Type 2 Diabetes Mellitus [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(12): 1465-1470.
[4]	LIU Shu-fen, QUAN Jian-dong, ZHANG Lu, ZHAO Xiao-yi, CHEN Li-xia, LI Wen-hui. Association between Cardiorespiratory Fitness and Types of Physical Activity in Physically Active Patients with Type 2 Diabetes Mellitus [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(12): 1471-1474.
[5]	ZHU Xiang-yang;WANG Liang-liang;ZHOU Yong;et al.. Cognitive Impairment after Type 2 Diabetes Mellitus (review) [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2011, 17(5): 404-407.
[6]	SUN Zhi;MA Li;HAN Hai-rong.. Effect of Acupuncture on Resistin and Adiponectin and its Gene Expression in Type 2 Diabetic Rats [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2010, 16(6): 523-534.
[7]	YUAN Ai-hong;LIU Zhi-cheng;WEI Qun-li;et al. Effect of Acupuncture on Leptin Receptor Gene Expression in Arcuate Nucleus of Type 2 Diabetes Mellitus Rats [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2009, 15(03): 211-213.
[8]	TIAN Guo-qing. Cognitive Dysfunction after Type 2 Diabetes Mellitus (review) [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2009, 15(03): 242-245.
[9]	LI Mei-xin;ZHANG Tong. Type 2 Diabetes Mellitus and Cognitive Impairment (review) [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2009, 15(02): 155-157.
[10]	ZONG Can-hua;TIAN Li-mei. Effect of Lycium Barbarum Polysaccharide on Insulin Resistance and Gene Expression of Adiponection in Type 2 Diabetes Mellitus Rats [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2008, 14(06): 531-532.
[11]	SUN Lian-qing;LIANG Xiao-chun;. Clinical Study on Relationship between Syndrome Differentiation of Traditional Chinese Medicine and Nerve Conduction Velocity in 172 Patients with Diabetic Peripheral Neuropathy [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2008, 14(02): 166-168.
[12]	ZHANG Tao;LIU Hong-bin;GONG Wei-ru;et al. Relativity between Duration of Type 2 Diabetes Mellitus and Pathological Changes of Coronary Heart Disease [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2008, 14(02): 173-174.
[13]	GUO Hua-zhen;MENG Shen;YUN Xiao-ping;et al. Thermography in Arterial Lesions of Lower Limbs after Type 2 Diabetes Mellitus [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2008, 14(01): 75-76.
[14]	LIUXiao-nan;HUO Ting-ting;WANG Wei-zhong;et al. Effect of ischemic preconditioning on apoptosis of transplanted pancreas cells in rats [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2005, 11(08): 618-620.
[15]	LIU Xiao-Nan;HUO Ting-Ting;WANG Wei-Zhong;et al. Protection of ischemic preconditioning in the posterior limbs of donor' pancreas graft without involvement adenosine in rat [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2005, 11(07): 553-554.