以行為改變策略促進運動對糖尿病危險因子的影響

Abstract

研究背景與目的：已有文獻指出增加活動量、改變生活型態可延緩或預防第2型糖尿病的發生，然而運動為一耗時、費力且需自發性的活動。本研究的目的是比較一般的運動提倡，與以行為改變策略促進運動的介入，對具第2型糖尿病危險因子者的影響。 研究方法：共有108名22~70歲，平日無規律運動且具糖尿病危險因子之受試者完成三個月前後的兩次測試。受試者被以隨機分配的方式分至一般運動提倡組（控制組），與以行為改變策略促進運動組（介入組）。控制組受試者（54人）皆可獲得介紹正確飲食與有效運動方法之衛教單張。介入組受試者（54人）則在測試後接受會談，研究者以健康信念模式與跨理論模式為基礎，說服受試者進行其個人化之運動計畫。所有受試者皆在第一次評估的三個月後，進行第二次評估。觀測因子為運動行為、運動自我效能、糖尿病危險因子與胰島素阻抗指數。 結果：具有顯著組別效應（p < 0.05）的參數有規律運動者的比例（控制組18%，介入組51%）、每日能量消耗（控制組減少0.4%，介入組增加0.3%）、柔軟度（控制組增加1.0%，介入組增加8.9%）、心肺耐力（控制組增加3.9%，介入組增加11.2%）、身體質量指數（控制組減少0.3%，介入組減少1.8%）與運動自我效能（控制組增加12%，介入組增加44%）。其它參數則無顯著的組別效應。 結論：三個月以行為改變策略促進運動的介入，能較一般的運動提倡有效減少具糖尿病危險因子者的身體質量指數，增加其規律運動的比例、每日能量消耗、柔軟度、心肺適能與運動自我效能。至於對糖尿病其他危險因子與胰島素阻抗的影響，可能仍須更長時間的觀察。

Background and purpose: Recent studies indicate that changes in the lifestyle with increased physical activity can prevent type 2 diabetes in high-risk subjects. However, many individuals drop out from structured exercise programs even before any health benefits can be seen. The purpose of this study was to investigate the effects of changing exercise behavior on diabetic risk factors. Methods: A total of 108 subjects (age range from 22 to 70 years old) who have had at least one risk factor of type 2 diabetes were randomized into control or intervention group. Subjects in the control group received general information about the proper diet and exercise, while subjects in the intervention group were interviewed providing an individualized exercise program and follow-ups based on Health Belief Model and Transtheoretical Model to promote their exercise behaviors. All the subjects received assessment of exercise behavior, exercise self-efficacy, physical fitness, diabetic risk factors, and insulin resistance at baseline and three months after. Result: Significant differences (p < 0.05) between groups were found in the percentage of regular exerciser (control: 18%; intervention: 51%), daily energy expenditure (control: 0.4% decrease; intervention: 0.3% increase), flexibility (control: 1.0% increase; intervention: 8.9% increase), cardiorespiratory endurance (control: 3.9% increase; intervention: 11.2% increase), body mass index (control: 0.3% decrease; intervention: 1.8% decrease) and exercise self-efficacy (control: 12% increase; intervention: 44% increase). No beneficial effects on insulin resistance were noted. Conclusions: This randomized controlled study demonstrates that 3-month individualized exercise program enhanced by behavior change strategies can decrease body mass index, and improve daily energy expenditure, flexibility, cardiorespiratory endurance, and exercise self-efficacy in persons who had at least one of the diabetic risk factors.