Hypertension
Diabetes
High Cholesterol

血壓高
膽固醇
糖尿病
及運動

帶氧運動證實有效降低血壓

帶氧運動是高血壓患者優先考慮的治療,可降血壓5-7度1,2,3

亦能降低心血管疾病風險達20-30%4

1. Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA, et al. American college of sports medicine position stand: exercise and hypertension. Med Sci Sports Exerc. 2004;36:533–53.
2. Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005;46:667–75.
3. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2
4. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136:493–503.

研究高血壓患者每週只鍛練1天

研究發現每週鍛練1天已可降低高血壓患者的全因死亡率,媲美藥物治療5

5. Brown RE, Riddell MC, Macpherson AK, Canning KL, Kuk JL. The joint association of physical activity, blood-pressure control, and pharmacologic treatment of hypertension for all-cause mortality risk. Am J Hypertens. 2013;26:1005–10.

Harrison Medical

各大醫療組織高血壓患者運動建議

1. 聯合國家高血壓預防、檢測、評估和治療委員會第8報告及美國心臟協會

每次運動40分鐘6,7

2. 美國心臟協會

每星期運動150分鐘8

3. 美國運動醫學會

連續運動30-60分鐘或累積每次10分鐘並逐漸遞增9

4. 歐洲高血壓協會/歐洲心臟病學會

每日30分鐘運動10

6. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth Joint National Committee (JNC 8) JAMA. 2014;311:507–20.
7. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014;63:2960–84.
8. Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American heart association. Hypertension. 2013;61:1360–83.
9. Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA, et al. American college of sports medicine position stand: exercise and hypertension. Med Sci Sports Exerc. 2004;36:533–53.
10. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC practice guidelines for the management of arterial hypertension. Blood Press. 2014;23:3–16.

糖尿病患者與運動

患2型糖尿病應一周內至少3天,進行共150分鐘以上中度至劇烈帶氧運動,但不宜連續2天內做11

患者在專業監察下運動血糖控制更好12,13

除帶氧運動外,應至少每周進行2-3天中度至劇烈阻力訓練11

11. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147–e167.
12. Balducci S, Zanuso S, Nicolucci A, et al. : Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in type 2 diabetic subjects. A randomized controlled trial: The Italian Diabetes and Exercise Study (IDES). Arch Intern Med.
13. Gordon BA, Benson AC, Bird SR, Fraser SF: Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res Clin Pract 2009;83(2):157–75

運動時糖尿病患者須注意

研究證實不須注射胰島素或服食藥物糖尿病患者運動時甚少血糖低。注射胰島素或服食糖尿藥運動時,建議根據個人情況補充碳水化合物,以免運動期間或之後出現低血糖反應14,15,16,17

Harrison Medical

總結眾多文獻帶氧運動和阻力訓練均可改善血糖控制、自身胰島素反應及脂肪氧化和儲存18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36

高膽固醇及運動

運動顯著降低死亡風險 (37)

研究以高膽固醇患者1,005,791人,跟進了18.1年。 受訪期間,運動組死亡率減少12-59%37

另一研究持續10年,服用降膽固醇藥加帶氧運動相比只服藥物可顯著降低死亡風險,而帶氧運動屬必需38

好膽固醇、三酸甘油酯、PCSK9膽固醇酵素

薈萃研究分析通過25個隨機對照,得出結論只做中等至強度帶氧運動而不服藥或戒口,好膽固醇(HDL-C)已會增加2.53 mg /dL39

研究亦廣泛證實運動可以降低三酸甘油酯濃度40,41,42

另一研究發現志願者經過3個月運動後,近期熱門的PCSK9水平和壞膽固醇都顯著下降,因此得出結論,每日運動與降低PCSK9水平有重大關係43

通過多個薈萃分析總結血脂高患者,運動對身體健康產生積極作用44

11. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147–e167.
12. Balducci S, Zanuso S, Nicolucci A, et al. : Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in type 2 diabetic subjects. A randomized controlled trial: The Italian Diabetes and Exercise Study (IDES). Arch Intern Med. In press
13. Gordon BA, Benson AC, Bird SR, Fraser SF: Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res Clin Pract 2009;83(2):157–75
14. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C: Physical activity/exercise and type 2 diabetes. Diabetes Care 2004;27(10):2518–39
15. American Diabetes Association Physical activity/exercise and diabetes. Diabetes Care2004;27(90001):S58–S62
16. Larsen JJ, Dela F, Madsbad S, Vibe-Petersen J, Galbo H: Interaction of sulfonylureas and exercise on glucose homeostasis in type 2 diabetic patients. Diabetes Care 1999;22(10):1647–54
17. Rosenstock J, Hassman DR, Madder RD, et al. : Repaglinide versus nateglinide monotherapy: a randomized, multicenter study. Diabetes Care 2004;27(6):1265–70
18. Winnick JJ, Sherman WM, Habash DL, et al. : Short-term aerobic exercise training in obese humans with type 2 diabetes mellitus improves whole-body insulin sensitivity through gains in peripheral, not hepatic insulin sensitivity. J Clin Endocrinol Metab 2008;93(3):771–8
19. Bajpeyi S, Tanner CJ, Slentz CA, et al. : Effect of exercise intensity and volume on persistence of insulin sensitivity during training cessation. J Appl Physiol 2009;106(4):1079–85
20. Evans EM, Racette SB, Peterson LR, Villareal DT, Greiwe JS, Holloszy JO: Aerobic power and insulin action improve in response to endurance exercise training in healthy 77–87 yr olds. J Appl Physiol2005;98(1):40–5
21. Galbo H, Tobin L, van Loon LJ: Responses to acute exercise in type 2 diabetes, with an emphasis on metabolism and interaction with oral hypoglycemic agents and food intake. Appl Physiol Nutr Metab2007;32(3):567–75
22. Houmard JA, Tanner CJ, Slentz CA, Duscha BD, McCartney JS, Kraus WE: Effect of the volume and intensity of exercise training on insulin sensitivity. J Appl Physiol 2004;96(1):101–639. Christ-Roberts CY, Pratipanawatr T, Pratipanawatr W, et al. : Exercise training increases glycogen synthase activity and GLUT4 expression but not insulin signaling in overweight non- diabetic and type 2 diabetic subjects. Metabolism 2004;53(9):1233–42
23. Christ-Roberts CY, Pratipanawatr T, Pratipanawatr W, et al. : Exercise training increases glycogen synthase activity and GLUT4 expression but not insulin signaling in overweight non- diabetic and type 2 diabetic subjects. Metabolism 2004;53(9):1233–42
24. Holten MK, Zacho M, Gaster M, Juel C, Wojtaszewski JF, Dela F: Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes 2004;53(2):294–305
25. O'Gorman DJ, Karlsson HK, McQuaid S, et al. : Exercise training increases insulin-stimulated glucose disposal and GLUT4 (SLC2A4) protein content in patients with type 2 diabetes. Diabetologia2006;49(12):2983–92
26. Wang Y, Simar D, Fiatarone Singh MA: Adaptations to exercise training within skeletal muscle in adults with type 2 diabetes or impaired glucose tolerance: a systematic review. Diabetes Metab Res Rev2009;25(1):13–40
27. Duncan GE, Perri MG, Theriaque DW, Hutson AD, Eckel RH, Stacpoole PW: Exercise training, without weight loss, increases insulin sensitivity and postheparin plasma lipase activity in previously sedentary adults. Diabetes Care 2003;26(3):557–62
28. Goodpaster BH, Katsiaras A, Kelley DE: Enhanced fat oxidation through physical activity is associated with improvements in insulin sensitivity in obesity. Diabetes 2003;52(9):2191–7
29. Kelley GA, Kelley KS: Effects of aerobic exercise on lipids and lipoproteins in adults with type 2 diabetes: a meta-analysis of randomized-controlled trials. Public Health 2007;121(9):643–55
30. Braun B, Sharoff C, Chipkin SR, Beaudoin F: Effects of insulin resistance on substrate utilization during exercise in overweight women. J Appl Physiol 2004;97(3):991–7
31. Cohen ND, Dunstan DW, Robinson C, Vulikh E, Zimmet PZ, Shaw JE: Improved endothelial function following a 14-month resistance exercise training program in adults with type 2 diabetes. Diabetes Res Clin Pract 2008;79(3):405–11
32. Dunstan DW, Daly RM, Owen N, et al. : High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care 2002;25(10):1729–36
33. Ibanez J, Gorostiaga EM, Alonso AM, et al. : Lower muscle strength gains in older men with type 2 diabetes after resistance training. J Diabetes Complications 2008;22(2):112–8
34. Ibanez J, Izquierdo M, Arguelles I, et al. : Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes. Diabetes Care2005;28(3):662–7
35. Ishii T, Yamakita T, Sato T, Tanaka S, Fujii S: Resistance training improves insulin sensitivity in NIDDM subjects without altering maximal oxygen uptake. Diabetes Care 1998;21(8):1353–5
36. Snowling NJ, Hopkins WG: Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 2006;29(11):2518–27
37. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE, Bauman A, Lee IM, Lancet Physical Activity Series 2 Executive Committe., Lancet Sedentary Behaviour Working Group. Lancet. 2016 Sep 24; 388(10051):1302-10.
38. Interactive effects of fitness and statin treatment on mortality risk in veterans with dyslipidaemia: a cohort study.Kokkinos PF, Faselis C, Myers J, Panagiotakos D, Doumas M Lancet. 2013 Feb 2; 381(9864):394-9.
39. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Kodama S, Tanaka S, Saito K, Shu M, Sone Y, Onitake F, Suzuki E, Shimano H, Yamamoto S, Kondo K, Ohashi Y, Yamada N, Sone H Arch Intern Med. 2007 May 28; 167(10):999-1008.
40. Kazeminasab F, Marandi M, Ghaedi K, et al. Endurance training enhances LXRα gene expression in Wistar male rats. Eur J Appl Physiol. 2013;113(9):2285–2290.
41. Ghanbari-Niaki A, Khabazian BM, Hossaini-Kakhak SA, et al. Treadmill exercise enhances ABCA1 expression in rat liver. Biochem Biophys Res Commun. 2007;361(4):841–846.
42. Kazeminasab F, Marandi M, Ghaedi K, et al. Effects of a 4-week aerobic exercise on lipid profile and expression of LXRα in rat liver. Cell J. 2017;19(1):45–49.
43. Kamani CH, Gencer B, Montecucco F, et al. Stairs instead of elevators at the workplace decreases PCSK9 levels in a healthy population. Eur J Clin Investig.2015;45(10):1017–1024.
44. Evidence for prescribing exercise as therapy in chronic disease. Pedersen BK, Saltin B Scand J Med Sci Sports. 2006 Feb; 16 Suppl 1():3-63.

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