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绝经后妇女非酒精性脂肪性肝病及其相关合并症的运动干预处方

鞠杰 王兴 张欣格 杨昌瑜 刘鹏

引用本文:
Citation:

绝经后妇女非酒精性脂肪性肝病及其相关合并症的运动干预处方

DOI: 10.12449/JCH240627
基金项目: 

国家社会科学基金项目 (22BTY076)

利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:鞠杰撰写文章并最后定稿;王兴对论文进行审阅与修改;张欣格、杨昌瑜整理文献并审阅修改图表;刘鹏指导撰写与审阅。
详细信息
    通信作者:

    刘鹏, liupeng@sus.edu.cn (ORCID: 0009-0002-3984-3366)

Exercise intervention prescription for postmenopausal women with nonalcoholic fatty liver disease and related comorbidities

Research funding: 

The National Social Science Fund of China (22BTY076)

More Information
  • 摘要: 绝经后妇女非酒精性脂肪性肝病(NAFLD)患病率显著高于绝经前妇女,甚至超过了同期男性患病率,运动干预仍是预防与治疗绝经后妇女NAFLD的有效方法。同时,该年龄段NAFLD患病妇女常合并肌少症、骨质疏松、心血管疾病以及糖尿病等慢性疾病,这要求相应运动处方应更具针对性,同时对可能的合并症进行前瞻性干预。本文在总结相关文献的基础上,对绝经后妇女NAFLD以及相关合并症的运动干预处方提出针对性建议。

     

  • 表  1  绝经后妇女NAFLD患者运动处方与干预效果

    Table  1.   Exercise prescription and intervention effects for postmenopausal women with NAFLD

    参考 文献 样本 (例) 年龄(岁) 运动 方式 运动强度 时间与频率 周期 (周) 疗效指标 干预效果 其他 干预
    16 96 145 90 96 57.2±5.9 57.9±6.5 56.7±6.4 56.4±6.3 CON AE-M AE-M AE-M 无运动干预 50% VO2peak 50% VO2peak 50% VO2peak <8 000步/天 73 min/周 136 min/周 192 min/周 24 Wt、BMI、WC、Fat%、TG、HDL、FBG、BP 运动量与健康变化存在分级剂量反应
    17 87 118 117 117 57.4±4.4 58.1±6.0 58.1±5.0 58.0±4.5 CON CR AE-MV AE-MV+CR 无运动干预 无运动干预 70%~85%HRmax 70%~85%HRmax AE-M<100 min/周 AE-M<100 min/周 45 min;5天/周 45 min;5天/周 52 Wt、BMI、WC、Fat%、LBM、体适能指标 减重效果AE-MV+CR组>CR组>AE-MV组>CON组,CR减少瘦体重最多 CR
    18 86 87 60.6±6.8 60.7±6.7 CON AE-MV 拉伸练习 60%~75%HRR 45 min/周 45 min;5天/周 52 Wt、BMI、Fat%、TG、FBG、WC 定期中等强度运动可以有效降低胰岛素和瘦素浓度
    19 9 15 12 51.0±9.0 51.0±9.0 51.0±9.0 CON AE-M AE-V 无运动干预 RPE 10~12 RPE 15~17 无运动干预 5天/周;400 kcal 5天/周;400 kcal 16 BMI、WC、Fat%、AF%、TG、HDL、FBG、BP 高强度运动对减少肥胖妇女腹部总脂肪与内脏脂肪方面更有效
    20 86 87 60.5±6.7 60.6±6.6 CON AE-M 拉伸练习 60%~75%HRR 45 min/周 45 min;5天/周 52 Wt、BMI、TG、HDL、Fat%、AF%、体适能指标 一年的中等强度运动,显著减少Fat%与AF%,同时84%的运动者心肺健康获得提升
    21 34 40 38 58.4±6.0 57.7±5.5 59.0±5.0 CON(CR) AE-M+CR AE-V+CR 无运动干预 45%~50%HRR 70%~75%HRR 无运动干预 55 min;3天/周 30 min;3天/周 20 BMI、WC、Fat%、TG、HDL、LDL、体适能指标 消耗同样能量,不同运动强度对AF%没有明显差别,但高强度运动对提高心肺健康更显著 CR
    22 13 13 12 60.0 62.0 62.0 CON R-LM R-LM 拉伸练习 70% 1RM 70% 1RM 2天/周 3组;3天/周 6组;3天/周 16 BMI、WC、Fat%、TG、HDL、WHR R-LM练习组数与改善脂质代谢、Fat%效果有关;每次3组练习足够改善肌肉力量
    23 16 16 15 55.2±4.3 54.4±5.8 54.9±4.7 CON HIIT AE-M 无运动干预 >80%VO2peak 60%~70%HRmax 无运动干预 40 min;3天/周 40~50 min;3天/周 8 BMI、ALT、Fat%、AF%、IHTG、TG 高强度间歇与持续中强度有氧运动都能降低NAFLD伴糖尿病患者的IHGT和AF%
    24 50 50 50 50 50~65 50~65 50~65 50~65 CON AE-M LCh AE-M+LCh 无运动干预 70%VO2max 无运动干预 70%VO2max 无运动干预 60 min;3~5天/周 无运动干预 60 min;3~5天/周 26 BMI、Fat%、TG、HDL、LDL、体适能指标 运动与LCh,可改变肠道菌群组成。可有效改善肝脂肪代谢与预防糖尿病 LCh
    25 21 19 54.5±8.9 56.2±7.8 CON AE-V 无运动干预 >VAT、<RCP 无运动干预 50 min;2天/周 24 BMI、WC、HDL、LDL、ALT、AST、体适能指标 24周高强度有氧运动改善了WC、HDL,提升了心肺健康
    26 16 15 16 17 52.0±1.8 55.0±1.2 52.0±1.1 53.0±1.3 CON AE-M R-M COM-M 无运动干预 60% HRR 75% 1RM AE-M:60% HRR R-M:75% 1RM 无运动干预 30 min;5天/周 30 min;5天/周 AE 15 min;5天/周 R15 min;5天/周 12 Wt、BMI、WC、TG、Fat%、AF%、HDL、LDL、体适能指标 同等强度同期运动较单纯的有氧运动与抗阻运动对减轻体重和促进心肺健康效果更好
    27 86 85 60.5±6.7 60.6±6.6 CON AE-M 拉伸练习 60%-75%HRR 45 min/周 45 min;5天/周 52 Wt、BMI、TG、HDL 血清脂蛋白水平没有显著改变,与运动强度不高有关
    注:CON,对照组;AE-M,中等强度有氧运动;AE-V,高强度有氧运动;R-M,中强度抗阻运动;R-LM,中低强度抗阻运动;COM-M,中强度同期运动;HIIT,高强度间歇训练;VO2max,最大摄氧量;1RM,最大重复次数为1;HRmax,最大心率;HRR,心率储备;RPE,自感用力度;RM,最大重复次数;VO2peak,峰值耗氧量;RCP,呼吸补偿点;VAT,换气无氧阈;CR,能量限制;LCh,低碳水饮食;Wt,体重;LBM,瘦体重;WC,腰围;Fat%,体脂率;AF%,腹脂率;FBG,空腹血糖;BP,血压;WHR,腰臀比;IHTG,肝内甘油三酯。
    下载: 导出CSV

    表  2  绝经后妇女NAFLD及相关合并症运动处方

    Table  2.   Exercise prescription recommendations for postmenopausal women with NAFLD and related comorbidities

    NAFLD 合并症 运动阶段 运动方式 运动强度 时间与频率 评价指标 注意事项
    肌少症 骨质疏松 易摔倒 初级 R-LM COM-LM 20%~50% 1RM 55%~75% HRmax 8~12次;3组;2~3天/周 >30 min;3天/周;>12周 握力、平衡能力、BMD、LBM、WC、Fat%、AF%、TG、HDL、LDL、FBG等 运动前确保无骨折或已康复;抗阻运动注意时间间隔24~48 h;循序渐进增加运动强度,谨慎使用大强度;增加本体感受能力的练习、柔韧性练习、关节力量练习;注意环境温度与安全保障;注意膳食蛋白质的摄入与补充维生素D
    中高级 及预防 R-M AE-MV、HIIT 50%~70%1RM >75% HRmax 8~12次;3组;2~3天/周 >30 min;3天/周;>12周
    2型糖尿病 初级 AE-M、COM-M R-M 55%~75% HRmax 50%~70% 1RM 40~60 min;5天/周;>12周 8~12次;3组;2~3天/周 HbA1c、WC、Fat%、AF%、TG、HDL、LDL、FBG、INS等 坚持运动最重要;根据个人情况,推荐使用高强度有氧运动,采用HIIT方法。运动过程尽量动员更多肌群,推荐HMF饮食
    中高级 及预防 AE-V、HIIT R-M >75% HRmax 50%~75% 1RM 40~60 min;>3天/周;>12周 8~12次;3组;2~3天/周
    心血管疾病 高风险 患者及初级 AE-M、COM-LM R-LM 55%~75% HRmax 20%~50% 1RM >30 min;5天/周;>12周 8~12次;3组;1~2天/周 BP、HCY、心肺健康、WC、Fat%、AF%、TG、HDL、LDL、FBG等 记录既往病史;运动负荷与运动方式应在遵循保障安全的原则下进行;运动前准备充分,逐渐增加强度;注意运动的规律性,避免长时间大强度与竞技对抗类运动;推荐地中海饮食,适当补充叶酸与辅酶Q10
    中高级 及预防 AE-MV、HIIT R-M >75% HRmax 50%~70% 1RM 45 min;3天/周;>12周 8~12次;3组;2~3天/周
    注:COM-LM,中低强度同期运动;AE-MV,中高强度有氧运动;BMD,骨密度;HMF,高单不饱和脂肪酸饮食;HbA1c,糖化血红蛋白;INS,胰岛素;HCY,同型半胱氨酸。
    下载: 导出CSV
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