Chinese Journal of Rehabilitation Theory and Practice ›› 2025, Vol. 31 ›› Issue (8): 876-882.doi: 10.3969/j.issn.1006-9771.2025.08.002
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Received:
2025-05-29
Published:
2025-08-25
Online:
2025-09-01
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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.
Table 1
Analysis of framework and content of the policy and technical guidelines related to T2DM at international and national levels"
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 |
Table 2
Analysis of guidelines and consensuses of physical activity and health of T2DM"
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 |
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