别老是坐着 少坐一点对糖尿病有好处


  【24drs.com】一篇新研究指出,对于第二型糖尿病患者,藉由站立和轻度强度的行走而中断久坐不动型态的「少坐一点」介入方式,在达到血糖控制和改善胰岛素敏感性方面,比结构式运动更有效。
  
  研究者指出,以站立和在屋内走动取代坐着的时间,可为第二型糖尿病患者提供有价值的运动替代方案,特别是因为肌肉虚弱与周边神经病变而有运动困难者。
  
  荷兰Maastricht大学医学中心CARIM心血管疾病学院Bernard MFM. Duvivier医师等人于11月30日的Diabetologia期刊在线发表报告指出,我们在这篇研究中观察发现,少坐一点这个方式可改善胰岛素敏感性、24小时平均血糖值、24小时血糖差异、高血糖[血糖≧10 mmol/L]持续时间、空腹三酸甘油酯值。
  
  这些数据认为,轻度活动可以比运动更能达到稳定的血糖值。
  
  研究者指出,虽然结构式运动一般被认为是糖尿病治疗与预防的一部份,但是健康者的退出率达90%,持续遵守运动处方才是最佳方式,特别是第二型糖尿病患者。
  
  Duvivier医师等人假设,对于血糖控制,每天的运动时间比运动强度更重要。
  
  这篇研究的结果符合新兴概念,藉由轻度强度运动中断久坐行为可以改善体内血糖平衡,从年轻且瘦的血糖正常者、到过重/肥胖的正常血糖以及血糖代谢不良者都适用。
  
  在他们于2015年3月至5月进行的随机交叉研究中,他们纳入患有第二型糖尿病、未使用胰岛素的13名男性与6名女性。
  
  这些研究对象平均年龄63岁,患有糖尿病的时间平均为6年,平均身体质量指数(BMI)是30.5 kg/m2—定义为肥胖。
  
  14名研究对象有服用口服降血糖药物,13人有使用降血脂药物—主要是statin类药物。筛检时,研究对象的平均空腹血浆血糖值为7.88 mmol/L、平均HbA1c为6.7%。
  
  研究对象依循三种活动处方,各持续4天。
  
  在「一直坐着」这项处方中,研究对象被限制每天只有1小时走动以及1小时站立,其它14小时都坐着;「运动」处方则是以在研究中心受监督下进行1小时的运动脚踏车活动取代1小时的坐姿时间,研究对象骑20分钟、休息5分钟,再骑20分钟;在「少坐一点」这项处方中,要求研究对象每30分钟即中断坐姿,并以负担小的走动(每天共走动2小时)以及站立(每天共站3小时)取代。
  
  研究者接受这些处方的顺序是随机的,每种处方之间间隔10天,进行他们原本的日常生活。
  
  结果显示,相同的研究对象,相较于每天坐14小时的「一直坐着」方式,「少坐一点」介入方式的24小时血糖值增量曲线下面积(iAUC)显著降低(1263 min × mmol/L vs 1974 min × mmol/L; P = .002)。
  
  当研究对象进行每天中度强度脚踏车1小时做为运动处方时的iAUC(1383 min × mmol/L; P = .499),虽然和「少坐一点」方式差不多,但是,当与坐姿(P = .001)或骑脚踏车(P = .015)比较时,「少坐一点」在降低胰岛素阻抗性(HOMA2-IR)方面更有效果。
  
  以前,研究者在久坐不动的健康者中获得类似的结果。在自由生活的条件下,即使是没有糖尿病者,以站立和轻度强度走动取代坐姿时间,在改善胰岛素敏感性方面也比每天一次中度强度运动更有效率。
  
  他们指出,这些资料认为,坐姿对胰岛素敏感性有负面影响,与能量消耗无关;一次运动可能无法完全代偿整天之其它坐姿时间的负面影响。
  
  Duvivier医师等人指出,减少久坐时间的策略通常被认为比结构式运动的要求更低,所以持续遵守的机会比较大。
  
  他们表示,目前需要的是长期研究,以确认何种强度的运动在日常生活中可行。
  
  人口基础研究认为,成年人每天有半数时间以上花在久坐活动,如看电视与使用计算机,此外,研究者指出,观察型研究发现,花在坐姿的时间与代谢异常的标记有关。
  
  资料来源:http://www.24drs.com/
  
  Native link:No Butts About It, Sitting Less Is Beneficial in Diabetes

No Butts About It, Sitting Less Is Beneficial in Diabetes

By Kristin Jenkins
Medscape Medical News

In patients with type 2 diabetes, a "Sit-Less" intervention that breaks up sedentary behavior with standing and light-intensity walking appears to be "more potent" than structured exercise at achieving glycemic control and improving insulin sensitivity, a new study indicates.

Replacing sitting time with standing and walking around the house could provide a valuable exercise alternative for patients with type 2 diabetes, particularly when muscle weakness and peripheral neuropathy make it difficult to exercise, according to the researchers.

"In this study, we observed that the Sit-Less regimen improved insulin sensitivity, mean 24-hour glucose levels, 24-hour glucose excursions, duration of hyperglycemia [blood glucose ?10 mmol/L], and fasting triacylglycerol levels," say Bernard MFM. Duvivier, MD, of the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, the Netherlands, and colleagues in a report published online November 30 in Diabetologia.

"These data suggest that more stable glucose levels can be achieved with light-intensity activity rather than with exercise."

While structured exercise is a well-recognized part of diabetes treatment and prevention, the dropout rate in healthy individuals is about 90%, the researchers point out. "Sustained compliance with exercise programs, especially by individuals with type 2 diabetes, is at best mediocre."

The duration of activity during the day — rather than the intensity — may be more important for glycemic control, Dr Duvivier and colleagues hypothesized.

"The outcome of the present study fits the emerging picture that breaking up sedentary behavior by light-intensity activities may help to improve glucose homeostasis in groups, ranging from young lean normoglycemic individuals to overweight/obese normoglycemic and dysglycemic participants."

Sitting Has Negative Effects on Insulin Sensitivity

In their randomized crossover study, which was conducted between March and May 2015, they enrolled 13 men and six women with type 2 diabetes who were not using insulin.

Mean age of the participants was 63 years, and the mean duration of disease was 6 years. Mean body mass index (BMI) was 30.5 kg/m2, which is defined as obese.

Fourteen participants were taking oral glucose-lowering medications and 13 were using lipid-lowering drugs, primarily statins.

During screening, the participants had a mean fasting plasma glucose of 7.88 mmol/L and a mean HbA1c of 6.7%.

The participants followed three activity regimens that lasted 4 days each.

In the "Sitting" regimen, participants were restricted to 1 hour a day of walking and 1 hour a day of standing. The rest of the 14-hour day was spent sitting.

The "Exercise" regimen replaced 1 hour of sitting time with supervised cycling on an exercise bike at the research center. Participants cycled in 20-minute intervals with 5 minutes of rest in between.

In the "Sit-Less" regimen, participants were asked to interrupt sitting every 30 minutes and replace it with small bouts of walking (for a total of 2 hours per day) and standing (for a total of 3 hours each day).

The order in which participants underwent the different regimens was randomized and for 10 days between each regimen, they were told to go about their normal daily routine.

Results showed that the incremental area under the curve (iAUC) for 24-hour glucose was significantly lower during the "Sit-Less" intervention than when the same participants sat for 14 hours a day as part of a sitting regimen (1263 min × mmol/L vs 1974 min × mmol/L; P = .002).

Although iAUC was similar when study participants engaged in 1 hour of moderate cycling each day as part of the exercise regimen (1383 min × mmol/L; P = .499), the Sit-Less intervention was much more effective at reducing insulin resistance (HOMA2-IR) when compared with just sitting (P = .001) or cycling (P = .015).

Previously, the researchers demonstrated similar results in healthy individuals who were sedentary. Replacing sitting time with standing and light-intensity walking in free-living conditions was also more efficient than a single daily session of moderate exercise at improving insulin sensitivity, even in the absence of diabetes.

"These data suggest that sitting has negative effects on insulin sensitivity independent of energy expenditure," they point out. One bout of exercise probably cannot fully compensate for the negative effects of sitting for the rest of the day."

Strategies to reduce sitting time are also generally considered less demanding than structured exercise, so the chances of sustained compliance are greater, Dr Duvivier and colleagues note.

What's needed now are long-term studies to determine just how much low-intensity activity "is feasible in daily life," they say.

Population-based studies suggest that adults spend more than half of their day at sedentary activities such as watching TV and sitting at a computer. In addition, observational studies point to "associations between the time spent sitting and markers of metabolic disturbance," the researchers point out.

The study was supported by Maastricht University Medical Center and the Dutch Heart Foundation and partially funded by a Kootstra Talent Fellowship from the Center for Research Innovation, Support and Policy of Maastricht University Medical Center to Dr Duvivier. The study received additional funding from Novo Nordisk BV and the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation. The consumables for continuous glucose monitoring and glucose measurements were supplied by Medtronic and Roche. Novo Nordisk BV was involved in study design and editorial assistance. The authors report no relevant financial relationships.

For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

Diabetologia. Published online November 30, 2016.

    
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