別老是坐著 少坐一點對糖尿病有好處


  【24drs.com】一篇新研究指出,對於第二型糖尿病患者,藉由站立和輕度強度的行走而中斷久坐不動型態的「少坐一點」介入方式,在達到血糖控制和改善胰島素敏感性方面,比結構式運動更有效。
  
  研究者指出,以站立和在屋內走動取代坐著的時間,可為第二型糖尿病患者提供有價值的運動替代方案,特別是因為肌肉虛弱與周邊神經病變而有運動困難者。
  
  荷蘭Maastricht大學醫學中心CARIM心血管疾病學院Bernard MFM. Duvivier醫師等人於11月30日的Diabetologia期刊線上發表報告指出,我們在這篇研究中觀察發現,少坐一點這個方式可改善胰島素敏感性、24小時平均血糖值、24小時血糖差異、高血糖[血糖≧10 mmol/L]持續時間、空腹三酸甘油酯值。
  
  這些數據認為,輕度活動可以比運動更能達到穩定的血糖值。
  
  研究者指出,雖然結構式運動一般被認為是糖尿病治療與預防的一部份,但是健康者的退出率達90%,持續遵守運動處方才是最佳方式,特別是第二型糖尿病患者。
  
  Duvivier醫師等人假設,對於血糖控制,每天的運動時間比運動強度更重要。
  
  這篇研究的結果符合新興概念,藉由輕度強度運動中斷久坐行為可以改善體內血糖平衡,從年輕且瘦的血糖正常者、到過重/肥胖的正常血糖以及血糖代謝不良者都適用。
  
  在他們於2015年3月至5月進行的隨機交叉研究中,他們納入患有第二型糖尿病、未使用胰島素的13名男性與6名女性。
  
  這些研究對象平均年齡63歲,患有糖尿病的時間平均為6年,平均身體質量指數(BMI)是30.5 kg/m2—定義為肥胖。
  
  14名研究對象有服用口服降血糖藥物,13人有使用降血脂藥物—主要是statin類藥物。篩檢時,研究對象的平均空腹血漿血糖值為7.88 mmol/L、平均HbA1c為6.7%。
  
  研究對象依循三種活動處方,各持續4天。
  
  在「一直坐著」這項處方中,研究對象被限制每天只有1小時走動以及1小時站立,其他14小時都坐著;「運動」處方則是以在研究中心受監督下進行1小時的運動腳踏車活動取代1小時的坐姿時間,研究對象騎20分鐘、休息5分鐘,再騎20分鐘;在「少坐一點」這項處方中,要求研究對象每30分鐘即中斷坐姿,並以負擔小的走動(每天共走動2小時)以及站立(每天共站3小時)取代。
  
  研究者接受這些處方的順序是隨機的,每種處方之間間隔10天,進行他們原本的日常生活。
  
  結果顯示,相同的研究對象,相較於每天坐14小時的「一直坐著」方式,「少坐一點」介入方式的24小時血糖值增量曲線下面積(iAUC)顯著降低(1263 min × mmol/L vs 1974 min × mmol/L; P = .002)。
  
  當研究對象進行每天中度強度腳踏車1小時做為運動處方時的iAUC(1383 min × mmol/L; P = .499),雖然和「少坐一點」方式差不多,但是,當與坐姿(P = .001)或騎腳踏車(P = .015)比較時,「少坐一點」在降低胰島素阻抗性(HOMA2-IR)方面更有效果。
  
  以前,研究者在久坐不動的健康者中獲得類似的結果。在自由生活的條件下,即使是沒有糖尿病者,以站立和輕度強度走動取代坐姿時間,在改善胰島素敏感性方面也比每天一次中度強度運動更有效率。
  
  他們指出,這些資料認為,坐姿對胰島素敏感性有負面影響,與能量消耗無關;一次運動可能無法完全代償整天之其他坐姿時間的負面影響。
  
  Duvivier醫師等人指出,減少久坐時間的策略通常被認為比結構式運動的要求更低,所以持續遵守的機會比較大。
  
  他們表示,目前需要的是長期研究,以確認何種強度的運動在日常生活中可行。
  
  人口基礎研究認為,成年人每天有半數時間以上花在久坐活動,如看電視與使用電腦,此外,研究者指出,觀察型研究發現,花在坐姿的時間與代謝異常的標記有關。
  
  資料來源: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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