探討瑜珈對糖尿病患者之血糖與血脂成效之整合分析

The Effects of Yoga on Glycemia and Lipidemia Control in Patients with Diabetes: Meta-Analysis

10.6386/CGN.201909_30(3).0004

張曉雲(Hsiao-Yun Chang)；劉芊葳(Chien-Wei Liu)；林昕璇(Hsin-Hsuan Lin)；曾麗娥(Li-O Tzeng)；劉美鳳(Mei-Feng Liu)

瑜珈 ； 糖尿病 ； 整合分析 ； yoga ； diabetes ； meta-analysis

長庚護理

30卷3期（2019 / 09 / 01）

318 - 332

繁體中文

背景：糖尿病為國人十大死因之一，其造成的後遺症不容忽視，是目前急需要自我控制改善的慢性疾病。瑜珈運動可以調節身體機能、達到身心平衡，陸續有學者探討瑜珈對於糖尿病病人執行瑜珈的成效，但國內文獻中鮮少提供具體實證性結論。目的：本研究經由文獻整合分析探討瑜珈對於糖尿病病人血糖與血脂控制之成效。方法：搜尋七個中英文資料庫，使用關鍵字瑜珈（yoga）和糖尿病（diabetes）進行搜尋，時間自2008年1月至2018年6月，依納入與排除條件篩選文章，以modified Jadad quality scale評值文獻品質，並使用RevMan 5.3.5軟體進行統合分析。結果：最後納入12篇文獻符合篩選標準，實驗組有691位執行瑜珈運動；控制組502位執行一般衛教或伸展運動。分析結果顯示瑜珈實驗組在空腹血糖-FPG（p ＜ .001; EF：4.16）、糖化血色素-HbA1c（p ＜ .001; EF：5.21）、高密度脂蛋白-HDL（p ＜ .01; EF：2.50）與低密度脂蛋白-LDL（p ＜ .004; EF：2.90）皆比控制組有顯著成效，顯示持續性的瑜珈課程對於血糖與血脂的控制有顯著性效果。結論：糖尿病病人平時規律的服藥控制，倘若再加上瑜珈輔助治療，對於血糖與血脂控制皆有顯著性改善。

Background: Diabetes and its complications are among one of the top 10 causes of death in Taiwan. It is a chronic disease that requires a self-management for improvement. Yoga exercise can regulate body functions in order to balance between body and mind. Some scholars have explored the effectiveness of performing yoga for diabetic patients. However, conclusive evidence is limited in Taiwan. Purposes: This study synthesized the effects of yoga on glycaemia and lipidemia in patients with diabetes. Methods: The systematic review and meta-analysis was undertaken to search seven Chinese and English databases with the following keywords: yoga and diabetes from Jan 2008 to Jun 2018. The articles were selected by inclusive and exclusive criteria and appraise the quality of the study by modified Jadad quality scale. The RevMan 5.3.5 software was used to perform the meta-analysis. Results: A total of 12 eligible study was included, including 691 patients in experimental group with yoga exercises and 502 people in control group with regular health education and/or stretching exercises. The findings indicated that yoga exercise has significantly improved effects on FPG (p ＜ .001; EF: 4.16), HbA1c (p ＜ .001; EF: 5.21), HDL (p ＜ .01; EF: 2.50), and LDL (p ＜ .004; EF: 2.90). Conclusion: Patients with diabetes with regular medications in addition to yoga as complementary therapy have a significantly better control of blood sugar and blood lipid.

1. 林欣慈、胡夢鯨(2017)。中高齡瑜珈教學指標建構與應用。運動休閒管理學報，14(3)，1-22。
   連結：
2. 林俐伶、林秋菊(2016)。糖尿病整合照護之概論。護理雜誌，63(5)，115-120。
   連結：
3. 陳怡靜、饒見維(2016)。從「非二分性覺知」析論瑜珈中「身、心、息」的互動關係。中華體育季刊，30(1)，57-63。
   連結：
4. 黃秋玲、黃佳進、張耿維、戴研光(2018)。彈力帶低阻力訓練對第二型糖尿病病患功能性體適能、血糖及血脂之影響。醫學與健康期刊，7(1)，29-39。
   連結：
5. 黃喬欣、林碧珠、Yeh, M. C.、張媚、李碧霞(2017)。糖尿病病人自我照護行為及相關因素研究。護理雜誌，64(1)，61-69。
   連結：
6. 黃惠美、林小玲、廖媛美、戴秀好、明金蓮(2018)。以系統性文獻回顧與整合分析探討瑜珈對更年期相關症狀之成效。台灣公共衛生雜誌，37(3)，324-339。
   連結：
7. 趙明玲、陳威廷、汪素敏(2018)。老年糖尿病人自我效能、社會支持與自我照顧行為相關之探討。台灣健康照顧研究學刊，18，1-12。
   連結：
8. American Diabetes Association(2014).Standards of medical care in diabetes-2014.Diabetes Care,37(1, Suppl.),S14-S80.
9. Beena, R. K.,Sreekumaran, E.(2013).Yogic practice and diabetes mellitus in geriatric patients.International Journal of Yoga,6(1),47-54.
10. Carter, K. S.,Carter, R.(2016).Breath-based meditation: A mechanism to restore the physiological and cognitive reserves for optimal human performance.World J Clin Cases,4(4),99-102.
11. Cui, J.,Yan, J.,Yan, L.,Pan, L.,Le, J.,Guo, Y.(2017).Effects of yoga in adults with type 2 diabetes mellitus: A meta analysis.Journal of Diabetes Investigation,8(2),201-209.
12. Dasappa, H.,Fathima, F. N.,Prabhakar, R.(2016).Effectiveness of yoga program in the management of diabetes using community health workers in the urban slums of Bangalore city: A non-randomized controlled trial.Journal of Family Medicine and Primary Care,5(3),619-624.
13. Fan, J. T.,Chen, K. M.(2011).Using silver yoga exercises to promote physical and mental health of elders with dementia in long-term care facilities.International Psychogeriatrics,23(8),1222-1230.
14. Harinath, K.,Malhotra, A. S.,Pal, K.,Prasad, R.,Kumar, R.,Kain, T.,Sawhney, R. C.(2004).Effects of hatha yoga and omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion.Journal of Alternative and Complementary Medicine,10(2),261-268.
15. Hegde, S. V.,Adhikari, P.,Kotian, S.,Pinto, V. J.,D'Souza, S.,D'Souza, V.(2011).Effect of 3-month yoga on oxidative stress in type 2 diabetes with or without complications: A controlled clinical trial.Diabetes Care,34(10),2208-2210.
16. Hegde, S. V.,Adhikari, P.,Shetty, S.,Manjrekar, P.,D'Souza, V.(2013).Effect of communitybased yoga intervention on oxidative stress and glycemic parameters in prediabetes: A randomized controlled trial.Complementary Therapies in Medicine,21(6),571-576.
17. Hordern, M. D.,Dunstan, D. W.,Prins, J. B.,Baker, M. K.,Singh, M. A.,Coombes, J. S.(2012).Exercise prescription for patients with type 2 diabetes and pre-diabetes: A position statement from Exercise and Sport Science Australia.Journal of Science and Medicine in Sport,15(1),25-31.
18. Innes, K. E.,Selfe, T. K.(2016).Yoga for adults with type 2 diabetes: A systematic review of controlled trials.Journal of Diabetes Research,2016,6979370.
19. Jadad, A. R.,Moore, R. A.,Carroll, D.,Jenkinson, C.,Reynolds, D. J.,Gavaghan, D. J.,McQuay, H. J.(1996).Assessing the quality of reports of randomized clinical trials: Is blinding necessary?.Controlled Clinical Trials,17(1),1-12.
20. Jyotsna, V. P.,Joshi, A.,Ambekar, S.,Kumar, N.,Dhawan, A.,Sreenivas, V.(2012).Comprehensive yogic breathing program improves quality of life in patients with diabetes.Indian Journal of Endocrinology and Metabolism,16(3),423-428.
21. Keerthi, G. S.,Pal, P.,Pal, G. K.,Sahoo, J. P.,Sridhar, M. G.,Balachander, J.(2017).Effect of 12 Weeks of Yoga Therapy on Quality of Life and Indian Diabetes Risk Score in Normotensive Indian Young Adult Prediabetics and Diabetics: Randomized Control Trial.J Clin Diagn Res,11(9),Cc10-cc14.
22. Kumar, V.,Jagannathan, A.,Philip, M.,Thulasi, A.,Angadi, P.,Raghuram, N.(2016).Role of yoga for patients with type II diabetes mellitus: A systematic review and meta-analysis.Complementary Therapies in Medicine,25,104-112.
23. Oremus, M.,Wolfson, C.,Perrault, A.,Demers, L.,Momoli, F.,Moride, Y.(2001).Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer's disease drug trials.Dementia and Geriatric Cognitive Disorders,12(3),232-236.
24. Riley, K. E.,Park, C. L.(2015).How does yoga reduce stress? A systematic review of mechanisms of change and guide to future inquiry.Health Psychology Review,9(3),379-396.
25. Shen, Y. W.,Zhang, X. M.,Lv, M.,Chen, L.,Qin, T. J.,Wang, F.,Yang, J.(2015).Utility of gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian damage in premenopausal women with breast cancer: A systematic review and meta-analysis.OncoTargets and Therapy,8,3349-3359.
26. Singh, A. N.(2006).Role of yoga therapies in psychosomatic disorders.International Congress Series,1287,91-96.
27. Singh, G.,Kumar, A.(2011).Relationship among HbA1c and lipid profile in Punajbi type 2 diabetic population.Journal of Exercise Science and Physiotherapy,7(2),99-102.
28. Singh, S.,Kyizom, T.,Singh, K. P.,Tandon, O. P.,Madhu, S. V.(2008).Influence of pranayamas and yoga-asanas on serum insulin, blood glucose and lipid profile in type 2 diabetes.Indian Journal of Clinical Biochemistry,23(4),365-368.
29. Sreedevi, A.,Unnikrishnan, A. G.,Karimassery, S. R.,Deepak, K. S.(2017).The effect of yoga and peer support interventions on the quality of life of women with diabetes: Results of a randomized controlled trial.IndianJjournal of Endocrinology and Metabolism,21(4),524-530.
30. Thind, H.,Lantini, R.,Balletto, B. L.,Donahue, M. L.,Salmoirago-Blotcher, E.,Bock, B. C.,Scott-Sheldon, L. A. J.(2017).The effects of yoga among adults with type 2 diabetes: A systematic review and meta-analysis.Preventive Medicine,105,116-126.
31. Vaishali, K.,Kumar, K. V.,Adhikari, P.,UnniKrishnan, B.(2012).Effects of yogabased program on glycosylated hemoglobin level serum lipid profile in community dwelling elderly subjects with chronic type 2 diabetes mellitus-A randomized controlled trial.Physical & Occupational Therapy in Geriatrics,30(1),22-30.
32. Wood, C.(1993).Mood change and perceptions of vitality: A comparison of the effects of relaxation, visualization and yoga.Journal of the Royal Society of Medicine,86(5),254-258.
33. Yang, K.,Bernardo, L. M.,Sereika, S. M.,Conroy, M. B.,Balk, J.,Burke, L. E.(2011).Utilization of 3-month yoga program for adults at high risk for type 2 diabetes: A pilot study.Evidence-Based Complementary and Alternative Medicine: eCAM,2011,257891.
34. 社團法人中華民國糖尿病學會(2018)。糖尿病臨床照護指引。臺北市=Taipei City:糖尿病學會=Diabetes Society, Taiwan, ROC.。
35. 陳桂敏、洪瑄曼(2006)。探索瑜珈的身心治療效益。長期照護雜誌，10(2)，190-202。
36. 詹紹華、蔡明燕、邱智鈴、林為森(2018)。糖尿病共同照護於第二型糖尿病病人健康促進行為與糖化血色素控制之成效。澄清醫護管理雜誌，14(2)，50-57。
37. 劉文琪、劉雪娥(2018)。瑜珈運動對孕婦下背疼痛指數、生活品質之影響。運動健康休閒學報，9，30-40。
38. 衛生福利部(2018，6 月15 日) 106 年國人死因統計結果 2019，5 月24 日取自https://www.mohw.gov.tw/cp-3795-41794-1.html[Ministry of Health and Welfare (2018, June 15). 2017 Statistics of Causes of Death. Retrieved May 24, 2019 from https://www.mohw.gov.tw/cp-3795-41794-1.html]
39. 衛生福利部國民健康署(2017，1 月9 日)．世界糖尿病日由來與國內宣導響應．2018，6 月15 日取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1090&pid=6426[ Health Promotion Administration, Taiwan, ROC. (2017, January 9). World Diabetes Day originated and domestically advertised. Retrieved June 15, 2018 from https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1090&pid=6426
40. 糖尿病醫療品質資訊(2018)．認識糖尿病．取自http://www1.nhi.gov.tw/mqinfo/Content.aspx?List=1&Type=DM [Diabetes medical quality information, Taiwan, ROC. (2018). Understanding diabetes. Retrieved from http://www1.nhi.gov.tw/mqinfo/Content.aspx?List=1&Type=DM
41. 譚建民(2011)。2011 年美國糖尿病協會（ADA）糖尿病診療標準指引摘要。台灣醫界，54(3)，14-22。