抗阻运动对糖尿病前期伴轻度高血压人群血压的影响

Effect of resistance exercise on blood pressure of people with mild hypertension in prediabetes

摘要:

目的 研究不同运动方式对社区糖尿病前期（IGR）人群血压的控制效果。方法 于2015 年6 ~ 8 月在桂林的3 个社区卫生服务中心长期管理的社区居民中筛选出符合标准的IGR 合并轻度高血压人群83 人，随机分为3 组，经过1 年的干预和随访，最终收集到67 人的完整数据：抗阻运动组22 人、有氧运动组23 人、对照组22 人。干预期间，对照组保持原有的生活方式，抗阻和有氧运动组分别进行相应的运动干预，约50 min/ 次，以集体形式隔天训练。对干预后3、6、12 个月抽血查空腹血糖、空腹胰岛素和糖化血红蛋白（HbA1c），测血压，计算胰岛素抵抗指数（HOMA-IR）。结果 ①不同时间点之间的HbA1c、HOMA-IR、收缩压（SBP）、舒张压（DBP）比较，差异有统计学意义（F =22.415、9.289、32.689 和6.713，均P =0.000）；3 组间的HbA1c、HOMA-IR、SBP、DBP 比较， 差异有统计学意义（F =16.525、4.241、26.436 和4.653，P =0.000、0.044、0.000 和0.013），干预后抗阻运动组和有氧运动组的HbA1c、HOMA-IR、SBP、DBP 低于对照组；3 组的HbA1c、HOMA-IR、SBP、DBP 变化趋势差异有统计学意义（F =19.134、4.782、22.520 和6.792，均P =0.000），干预期间，对照组各指标总体呈上升趋势，两运动组各指标总体呈下降趋势，虽然两运动组不同时段各指标比较差异无统计学意义（P >0.05），但抗阻运动组的HbA1c、HOMAIR的下降幅度大于有氧运动组，且SBP、DBP 下降幅度小于有氧运动组。②干预3 个月时，有氧和抗阻运动组的HbA1c、HOMA-IR、DBP 均低于干预前，有氧运动组SBP 低于干预前；干预6 个月时，有氧和抗阻运动组的HbA1c、SBP、DBP 均低于干预前，抗阻运动组HOMA-IR 低于干预前；干预12 个时，有氧和抗阻运动组的HbA1c、HOMA-IR、SBP、DBP 均低于干预前，对照组HbA1c、SBP 高于干预前，均差异有统计学意义（P <0.05）。结论 抗阻和有氧运动均能安全有效地改善社区IGR 合并轻度高血压人群的HbA1c、血压、HOMA-IR，值得推广。

Abstract:

Objective To study the effect of different exercise methods on blood pressure (BP) control in community people with prediabetes. Methods In the period from June to August 2015, the people who suffered from prediabetes with mild hypertension (n = 83) were selected from the community residents who had been managed by three community health service centers in Guilin. The volunteers were randomly divided into 3 groups. After a year of intervention and follow-up, 67 people were eventually collected with 22 in the resistance exercise group, 23 in the aerobic exercise group and 22 in the control group. During the intervention period, the control group maintained the original way of life; the resistance and aerobic exercise groups were given the corresponding exercise intervention, about 50 min each time, once every other day. In 3, 6 and 12 months after intervention, fasting blood glucose, fasting insulin, glycosylated hemoglobin (HbA1c), BP and insulin resistance index (HOMA-IR) were measured. Results HbA1c, HOMA-IR, SBP and DBP at different time points were significantly different (F = 22.415, 9.289, 32.689 and 6.713 respectively; P = 0.000). HbA1c, HOMA-IR, SBP and DBP were significantly different among the three groups (F = 16.525, 4.241, 26.436 and 4.653; P = 0.000, 0.044, 0.000 and 0.013). After intervention, HbA1c, HOMA-IR, SBP and DBP of the resistance exercise group and the aerobic exercise group were lower than those of the control group; the change trends of HbA1c, HOMA-IR, SBP and DBP were significantly different (F = 19.134, 4.782, 22.520 and 6.792; P = 0.000). During the intervention period, although the differences were not statistically significant between the two exercise groups when the index values of different time periods were compared (P > 0.05), the decline ranges of HbA1c and HOMA-IR in the resistance exercise group were greater than those in the aerobic exercise group, SBP and DBP of the aerobic exercise group decreased more obviously than those of the resistance exercise group. After 3 months, HbA1c, HOMA-IR and DBP of the aerobic group and the resistance group were lower than those before intervention; SBP of the aerobic group was lower than that before intervention. After intervention for 6 months, HbA1c, SBP and DBP of the aerobic group and the resistance group were lower than those before intervention; HOMA-IR of the resistance group was lower than that before intervention. After 12-month intervention, HbA1c, HOMA-IR, SBP and DBP of the aerobic group and the resistance group were lower than those before intervention, HbA1c and SBP of the control group increased, there were significant differences (P < 0.05). Conclusions Both resistance and aerobic exercises could improve the glycosylated hemoglobin, blood pressure and insulin resistance of the community residents with both prediabetes and mild hypertension. The two kinds of sports should be popularized and applied.