第二類型糖尿病人之身體活動建議量初探

A Preliminary Study of Recommendations for Physical Activity for Patients with Type 2 Diabetes

10.6288/TJPH2011-30-01-08

徐錦興(Chin-Hsing Hsu)；曹德弘(Te-Hsung Tsao)；張蕙雯(Hui-Wen Chang)

身體活動 ； 糖化血色素 ； 走路時間 ； 劑量反應關係 ； physical activity ； glycated hemoglobin ； walking time ； dose-response relationship

台灣公共衛生雜誌

30卷1期（2011 / 02 / 15）

72 - 81

繁體中文

目標：本研究目的在探討糖尿病人身體活動量與病情控制的關係，並運用劑量反應關係解釋研究結果，以提供糖尿病照護上對身體活動的建議量。方法：研究採橫斷性調查設計，初期招募220名糖尿病人為預備受試對象。研究工具為國際身體活動量表；以12個月為期，對所有受試對象進行身體活動量前後調查。在確認一年間維持同一生活型態的前提下，選擇210位為正式受試對象，再依糖化血色素控制情形分為控制良好與控制不良組。身體活動資料並與生理及血液生化檢測值進行羅吉斯迴歸分析。結果：不同生活型態的糖尿病人在血糖與糖化血色素控制上，其劑量反應關係圖形皆呈“反J”曲線，顯示中度與高度身體活動之糖尿病人的病情控制顯著優於低度身體活動者。糖化血色素控制良好組平均每天步行時間為37分鐘、控制不良組為28分鐘；其勝算比值為1.26。結論：建議糖尿病人可用「走路」為提高身體活動量的主要模式，頻率為每週6天、每天至少37分鐘，在病情控制上較易得到顯著成效。

Objectives: The aims of this study were to investigate the association between physical activity and the status of diabetes mellitus control and to provide recommendations for physical activity for patients with type 2 diabetes. Methods: In this cross-sectional study, 220 patients were recruited in the initial phase. The International Physical Activity Questionnaire was used to determine the level of physical activity for each subject. The study was carried out over 12 months with a pretest/posttest design to determine if patients still maintained the same lifestyle; 210 patients met this criterion. These subjects were then divided into two groups based on their glycated hemoglobin (HbA1c) control: an HbA1c under-control group and an out-of-control group. Logistic regression analysis was used to estimate relationships among subjects' physical activity, physiological measures, and blood biochemical parameters on the posttest. Results: The results indicated that there was an inverse-J shape relationship between lifestyle and blood glucose/HbA1c. This demonstrated that moderate/vigorous physical activity might play an important role in the treatment of type 2 diabetes. The average duration of walking time/per day was 37 min in the HbA1c under-control group, while only 28 minutes in the HbA1c out-of-control group; the odds ratio was 1.26. Conclusions: We suggest that an appropriate physical activity for patients with type 2 diabetes is walking, 6 days/week, at least 37 min per day. This produced significant effects in HbA1c control.

1. Liou, Y.M.,Jwo, J.C.,Yao, K.G.,Chiang, L.C.,Huang, L.H.(2008).Selection of appropriate Chinese terms to represent intensity and types of physical activity terms for use in the Taiwan version of IPAQ.J Nurs Res,16,252-63.
   連結：
2. 林佑真、溫啟邦、衛沛文(2007)。台灣地區成年人之休閒運動行為與健康行為、健康狀況、健康相關生活品質之關係探討。台灣衛誌，26，218-28。
   連結：
3. 行政院衛生署：九十七年主要死因統計。台北：行政院衛生署，2009。Department of Health, Executive Yuan, R.O.C.(Taiwan). Leading Causes of Death Statistics,2008. Taipei: Department of Health, Executive Yuan,R.O.C. (Taiwan), 2009.
4. American Diabetes Association. Check your blood glucose. Available at: http://www.diabetes.org/livingwith-diabetes/treatment-and-care/blood-glucosecontrol/checking-your-blood-glucose.html/. Accessed August 15, 2010.
5. Araiza, P.,Hewes, H.,Gashetewa, C.,Vella, C.A.,Burge, M.R.(2006).Efficacy of a pedometer-based physical activity program on parameters of diabetes control in type 2 diabetes mellitus.Metabolism,55,1382-7.
6. Bacardi-Gascon, M.,Rosales, G.P.,Jimenez-Cruz, A.(2005).A diabetes intervention program of physical activity carried out at primary care settings in Mexico.Diabetes Res Clin Pract,68,135-40.
7. Bauman, A.,Bull, F.,Chey, T.(2009).The International Prevalence Study on Physical Activity: results from 20 countries.Int J Behav Nutr Phys Act,6,1-12.
8. Brown, W.J.,Burton, N.W.,Rowan, P.J.(2007).Updating the evidence on physical activity and health in women.Am J Prev Med,33,404-11.
9. Colberg, S.R.(2006).The impact of exercise on insulin action in type 2 diabetes mellitus: relationship to prevention and control.Insulin,1,85-98.
10. Di Loreto, C.,Fanelli, C.,Lucudu, P.(2005).Make your diabetic patients walk: long-term impact of different amounts of physical activity on type 2 diabetes.Diabetes Care,28,1295-302.
11. Eckel, R.H.,Kahn, R.,Robertson, R.M.,Rizza, R.A.(2006).Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes Association and the American Heart Association.Circulation,113,2943-46.
12. Fritz, T.,Wändell, P.,Aberg, H.,Engfeldt, P.(2006).Walking for exercise-does three times per week influence risk factors in type 2 diabetes?.Diabetes Res Clin Pract,71,21-7.
13. Jeon, C.Y.,Lokken, R.P.,Hu, F.B.,van Dam, R.M.(2007).Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review.Diabetes Care,30,744-52.
14. Krousel-Wood, M.A.,Berger, L.,Jiang, X.,Blonde, L.,Myers, L.,Webber, L.(2008).Does home-based exercise improve body mass index in patients with type 2 diabetes: results of a feasibility trial.Diabetes Res Clin Pract,79,230-6.
15. Matvienko, O.A.,Hoehns, J.D.(2009).A lifestyle intervention study in patients with diabetes or impaired glucose tolerance: translation of a research intervention into practice.J Am Board Fam Med,22,535-43.
16. Nagasawa, J.,Sato, Y.,Ishiko, T.(1990).Effect of training and detraining on in vivo insulin sensitivity.Int J Sports Med,11,1107-10.
17. Sato, Y.(2000).Diabetes and life-styles: role of physical exercise for primary prevention.Br J Nutr,84,S187-90.
18. Sato, Y.,Nagasaki, M.,Kubota, M.,Yno, T.,nakai, N.(2007).Clinical aspects of physical exercise for diabetes/metabolic syndrome.Diabetes Res Clin Pract,77,S87-91.
19. Shenoy, S.R.,Guglani, R.,Sandhu, J.S.(2010).Effectiveness of an aerobic walking program using heart rate monitor and pedometer on the parameters of diabetes control in Asian Indians with type 2 diabetes.Prim Care Diabetes,4,41-5.
20. Smith, T.C.,Wingard, D.L.,Besa, Smith,Kritz-Silverstein, D.,Barrett-Connor, E.(2007).Walking decreased risk of cardiovascular disease mortality in older adults with diabetes.J Clin Epidemiol,60,309-17.
21. Swartz, A.M.,Strath, S.J.,Bassett, D.R.(2003).Increasing daily walking improves glucose tolerance in overweight women.Prev Med,37,356-62.
22. Trenell, M.I.,Hollingsworth, K.G.,Lim, E.L.,Taylor, R.(2008).Increased daily walking improves lipid oxidation without changes in mitochondrial function in type 2 diabetes.Diabetes Care,31,1644-9.
23. Tudor-Locke, C.,Bassett, D.R.,Swartz, A.M.(2004).A preliminary study of one year of pedometer self-monitoring.Ann Behav Med,28,158-62.
24. Tudor-Locke, C.,Bassett, DR Jr.(2004).How many steps/day are enough? Preliminary pedometer indices for public health.Sports Med,34,1-8.
25. Tudor-Locke, C.,Myers, A.M.,Bell, R.C.,Harris, S.B.,Rodger, N.W.(2002).Preliminary outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type 2 diabetes.Patient Educ Couns,47,23-8.
26. Tudor-Locke, C.,Washington, T.L.,Hart, T.L.(2009).Expected values for steps/day in special populations.Prev Med,49,3-11.
27. Tudor-Locke, C.E.,Bell, R.C.,Myers, A.M.,Harris, S.B.,Rodger, N.W.(2002).Pedometer-determined ambulatory activity in individuals with type 2 diabetes.Diabetes Res Clin Pract,55,191-9.
28. Tuomilehto, J.,Lindström, J.,Eriksson, J.G.(2001).Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.N Engl J Med,344,1343-50.
29. Waryasz, G.R.,McDermott, A.Y.(2010).Exercise prescription and the patient with type 2 diabetes: a clinical approach to optimizing patient outcomes.J Am Acad Nurse Pract,22,217-27.
30. Young, J.C.(1995).Exercise prescription for individuals with metabolic disorders: practical considerations.Sports Med,19,43-54.
31. 黃獻樑、陳晶瑩、陳慶餘(2007)。老人運動處方之實務探討。台灣家庭醫學研究，5，1-16。
32. 劉影梅(2004)。台北=Taipei，國立台灣大學護理研究所=Department of Nursing, National Taiwan University。

1. 曹德弘、徐錦興(2011)。身體活動與體重管理。運動與健康研究，1(1)，1-13。
2. 鄭綺,紀玫如,李書芬(2015)。運用跨理論模式探討認知行為教育課程介入對第二型糖尿病患者運動階段、運動自我效能及血糖控制之影響。新臺北護理期刊，17(1)，21-31。