FATmax运动对老年2型糖尿病患者糖脂代谢影响的研究

发布时间：2018-06-04 12:39

本文选题：2型糖尿病 + FATmax　；参考：《天津体育学院》2017年硕士论文

【摘要】：研究目的:随着社会的发展,人们的生活方式发生了较大的改变,这使得糖尿病的患病人数与日俱增,糖尿病不仅对患者的身体健康有着极大的危害,而且加重了家庭以及整个社会的负担。而运动作为DM患者的一项有效干预手段,它的功效已逐渐被人们所认可。但目前国内外通过运动手段来控制糖尿病患者病情的成功率并不十分理想,这已成为全球公共卫生事业的一大难题,这与运动强度的选择不当有着密不可分的关系,而Jeukendrup与Achten提出的最大脂肪氧化率(FATmax)不仅能确定科学的运动强度,而且理论上对改善脂代谢可能有着良好的效果,对于T2DM患者来说,脂代谢的改善不仅有助于糖代谢的改善,有利于控制心血管并发症的发生,而且胰岛素敏感性与血清游离脂肪酸(FFA)浓度有着高度的相关性,因此,脂代谢的改善对增加胰岛素敏感性也有一定的帮助。所以理论上,FATmax运动对改善T2DM患者的病情可能有良好的作用。本研究旨在通过实验测量出老年女性2型糖尿病(T2DM)患者的FATmax Rate,并找出FATmax Rate对应的运动强度以及运动心率,FATmax运动组以此运动强度以及运动心率执行为期三个月的运动干预,将志愿者们实验前后的数据进行对比分析,评价FATmax运动对老年女性T2DM患者糖脂代谢的影响。研究方法:研究对象为经三甲医院正式确诊的2型糖尿病女性患者34名,年龄在60-69岁,诊断标准为空腹血糖(FPG)大于7.0mmol/L,口服葡萄糖耐量试验(OGTT)或随机血糖大于11.1mmol/L,只要满足以上两个标准中的任意一个,即可被确诊为糖尿病。排除运动禁忌症,并将志愿者分为FATmax运动组以及对照组,每组各17人。1、实验前取空腹静脉血,测定瘦素、脂联素、脂蛋白脂肪酶、乙酰辅酶A脱氢酶、乙酰辅酶A脱羧酶、糖化血清蛋白、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白等指标;2、实验前测试简易糖耐量,即抽取空腹静脉血,即刻口服葡萄糖75g(溶于250-300ml水中,并在5min之内饮完),再取2h静脉血,测定空腹葡萄糖、两小时葡萄糖、空腹胰岛素、两小时胰岛素等指标;3、实验前测试身高、体重、腰围、臀围、腹部脂肪百分比,内脏脂肪等级评定、体脂百分比等身体形态以及身体成分指标;4、使用德国Ergoselect 100系列立式功率自行车、芬兰产Polar心率表进行测试,记录每一级负荷末的心率以及主观运动感觉(RPE)量表评分,根据Astrand列线图间接推测出最大摄氧量(VO2max);5、使用Cortex ML 3B气体分析仪,佩戴芬兰产RS800CX Polar遥测心率表进行递增负荷运动试验,记录被测者每一级后2min平均每15s的摄氧量以及二氧化碳呼出量,将这两种气体的数值带入到Achten[14]改良的脂肪氧化量计算公式:1.67×VO2-1.67×VCO2,最后推算出FATmax;6、将测得的FATmax Rate对应的运动心率作为靶心率,FATmax运动组以此运动强度严格执行3个月的FATmax运动锻炼,主要干预手段是以FATmax对应的心率(100±8b/min)作为靶心率进行行进间各种形式的走,并将腰腹部减脂的锻炼方法融入其中,除此之外,维持原有的生活方式,以便观察FATmax运动对其糖脂代谢的影响;7、3个月运动训练后使用同样的仪器,采用同样的测试方法再次进行各项指标的测试,对实验前后及组间的数据进行对比分析。研究结果:1.老年女性T2DM患者的FATmax Rate为0.37,FATmax Rate所对应的运动强度为37.39±7.39%VO2max,对应的运动速度为3.59±0.60km/h以及对应的运动心率为100±8次/分钟。此运动强度为老年女性T2DM患者运动处方的干预强度。2.与进行FATmax运动前比较,FATmax运动组的BMI有显著性下降(P0.01),腰臀比由干预前的0.94下降到0.92,且有显著性变化(P0.01),体脂百分比由干预前的34.4%下降至31.0%,且有显著性变化(P0.01),腹部脂肪百分比有显著性下降(P0.01),内脏脂肪等级评定下降明显(P0.01),且已属正常范围。而对照组无显著性改变(P0.05)。3.经过3个月的FATmax运动干预后,运动组的甘油三酯有明显下降趋势(P0.01),总胆固醇平均下降了0.36mmol/L(P0.01),高密度脂蛋白的水平上升显著(P0.01),低密度脂蛋白有明显降低的趋势(P0.01)。脂蛋白脂肪酶、乙酰辅酶A脱氢酶以及乙酰辅酶A脱羧酶均没有显著性变化(P0.05),瘦素有显著性下降(P0.01),脂联素升高显著(P0.01),对照组无明显变化(P0.05)。4.FATmax运动锻炼前后,运动组的空腹血糖由干预前的7.95mmol/L下降到6.99mmol/L(P0.01),餐后两小时血糖也有明显下降(P0.01),空腹胰岛素以及餐后2小时胰岛素有显著性下降(P0.01),糖化血清蛋白平均下降了30mmol/L(P0.01),胰岛素抵抗下降明显(P0.01),β细胞功能没有发生显著性改变(P0.05)。而对照组的胰岛素抵抗却有明显增加的趋势(P0.05),其余指标无显著性改变(P0.05)。研究结论:1.老年女性T2DM患者最大脂肪氧化强度所对应的运动强度为37.39±7.39%VO2max,对应的运动速度为3.59±0.60km/h以及对应的运动心率为100±8次/分钟,以此运动强度进行锻炼对于老年女性T2DM患者的糖脂代谢有良好的改善效果。2.FATmax运动可有效改善BMI、腰臀比、体脂百分比、腹部脂肪百分比以及内脏脂肪等级等危险因素,这提示FATmax运动可以降低这些危险因素的作用。此结果为T2DM的预防以及改善提供了参考的依据。3.FATmax运动可以有效改善血糖、胰岛素分泌、糖化血清蛋白以及胰岛素抵抗,这提示FATmax运动对老年女性T2DM患者的糖脂代谢功能有一定的改善效果,此结果为T2DM患者改善病情以及控制并发症提供了参考的依据。
[Abstract]:Research purposes: with the development of society, people's lifestyle has been greatly changed, which makes the number of diabetes increasing. Diabetes not only has a great harm to the health of the patients, but also aggravates the burden of the family and the whole society. And the movement is an effective intervention for DM patients. However, the success rate of controlling diabetic patients by sports means is not very ideal at home and abroad. This has become a major problem in the global public health cause, which is closely related to the improper selection of sports intensity, and the maximum fat oxidation rate proposed by Jeukendrup and Achten (FATma X) not only can determine the scientific exercise intensity, but also have a good effect on improving lipid metabolism. For T2DM patients, the improvement of lipid metabolism not only helps to improve the metabolism of sugar, but also helps to control the occurrence of cardiovascular complications, and the insulin sensitivity is highly correlated with the concentration of serum free fatty acid (FFA). Therefore, the improvement in lipid metabolism is also helpful in increasing insulin sensitivity. So FATmax exercise may have a good effect on improving the patient's condition in T2DM. This study was designed to test the FATmax Rate of elderly women with type 2 diabetes (T2DM) and to find the exercise intensity and transport of FATmax Rate. The FATmax exercise group carried out three months of exercise intervention with the exercise intensity and heart rate, and compared the data of the volunteers before and after the experiment to evaluate the effect of FATmax movement on the glucose and lipid metabolism of the elderly women with T2DM. 34 people, aged 60-69, were diagnosed as fasting blood glucose (FPG) greater than 7.0mmol/L, oral glucose tolerance test (OGTT) or random blood sugar greater than 11.1mmol/L. Diabetes was diagnosed as only one of the above two standards. Exercise taboos were excluded and volunteers were divided into FATmax exercise group and control group. 17 people,.1, were taken empty abdominal venous blood before the experiment to determine leptin, adiponectin, lipoprotein lipase, acetyl coenzyme A dehydrogenase, acetyl coenzyme A decarboxylase, glycosylated serum protein, cholesterol, triglyceride, high-density lipoprotein, low density lipoprotein, and 2. Test simple glucose tolerance before experiment, that is, to extract fasting venous blood and immediately take oral glucose 75g oral oral oral administration. Dissolve in 250-300ml water and drink in 5min), then take 2H venous blood, determine fasting glucose, two hour glucose, fasting insulin, two hour insulin and other indicators; 3, test height, weight, waist circumference, hip circumference, abdominal fat percentage, visceral fat grade assessment, body fat percentage, body form and body composition index; 4, Using the German Ergoselect 100 series vertical power bicycles, Finland produced the Polar heart rate meter, recorded the heart rate at the end of each level and the subjective motion sensation (RPE) scale, and estimated the maximum oxygen uptake (VO2max) indirectly according to the Astrand line map; 5, the Cortex ML 3B gas analyzer was used, and the RS800CX Polar telemetry heart was worn in Finland. The rate table was carried out by incremental load exercise test to record the oxygen uptake per 15s per 2min and the exhalation of carbon dioxide after each level of the subjects. The values of these two gases were brought into the formula of the improved fat oxidation of the Achten[14]: 1.67 x VO2-1.67 x VCO2, and the final calculation of FATmax; 6, the measured FATmax Rate corresponding motion heart rate as a result. The target heart rate, the FATmax exercise group carries out 3 months of FATmax exercise with the intensity of exercise. The main intervention is to take the heart rate (100 + 8b/min) corresponding to FATmax as the target rate to go in various forms, and integrate the method of reducing the fat in the waist and abdomen, in addition to maintain the original way of life in order to observe the FATmax The effect of exercise on its glucose and lipid metabolism; after 7,3 months of exercise, the same instrument was used, and the same test method was used to test each index again. The data were compared and analyzed before and after the experiment. The results of the study were as follows: the FATmax Rate of the 1. elderly women with T2DM was 0.37, and the corresponding exercise intensity of FATmax Rate was 37.39 + 7.. 39%VO2max, the corresponding movement speed was 3.59 + 0.60km/h and the corresponding motion heart rate was 100 + 8 times per minute. The exercise intensity was the intervention intensity of the exercise prescription of the elderly female T2DM patients. Compared with the FATmax exercise, the BMI of the FATmax exercise group decreased significantly (P0.01), the waist to hip ratio decreased to 0.92 from 0.94 before the intervention, and it was significant. The percentage of body fat decreased from 34.4% to 31% before intervention (P0.01), and there was a significant change (P0.01), the percentage of abdominal fat decreased significantly (P0.01), the grade of visceral fat decreased significantly (P0.01), and it was in the normal range. The control group had no significant change (P0.05).3. after 3 months of FATmax exercise, and the exercise group The triglyceride decreased significantly (P0.01), the average total cholesterol decreased by 0.36mmol/L (P0.01), the level of HDL increased significantly (P0.01), and the low density lipoprotein decreased significantly (P0.01). There were no significant changes in lipoprotein lipase, acetyl coenzyme A dehydrogenase and acetyl coenzyme A decarboxylase (P0.05), and leptin was significant. P0.01, adiponectin increased significantly (P0.01), and there was no significant change in the control group (P0.05), before and after.4.FATmax exercise, the fasting blood glucose in the exercise group decreased from 7.95mmol/L to 6.99mmol/L (P0.01), and the blood glucose decreased significantly (P0.01) at two hours after the meal (P0.01), and there was a significant decrease in the fasting insulin and 2 hours after the meal (P0.01). The glycosylated serum protein decreased by 30mmol/L (P0.01), the insulin resistance decreased significantly (P0.01), and the function of beta cells did not change significantly (P0.05), but the insulin resistance in the control group was significantly increased (P0.05), and the other indexes were not significantly changed (P0.05). The study conclusion: 1. the maximum fat oxidation intensity of the elderly women with T2DM. The corresponding exercise intensity is 37.39 + 7.39%VO2max, the corresponding movement speed is 3.59 + 0.60km/h and the corresponding motion heart rate is 100 + 8 times per minute. The exercise intensity exercise has a good improvement effect on the glycolipid metabolism of the elderly women T2DM,.2.FATmax exercise can improve the BMI, the waist to hip ratio, the percentage of body fat, the abdominal fat. The risk factors such as the percentage of fat and the grade of visceral fat suggest that FATmax exercise can reduce the role of these risk factors. This result provides a reference basis for the prevention and improvement of T2DM, which can effectively improve blood sugar, insulin secretion, glycosylated serum protein and insulin resistance, which suggests that the FATmax exercise is old to the old. The glycolipid metabolism function of female T2DM patients was improved in a year, which provided a reference basis for improving the condition and controlling the complications of T2DM patients.
【学位授予单位】：天津体育学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：G804.2

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