A Systematic Evaluation And Empirical Study On The Effect Of Exercise Intervention In Elderly Patients With Type 2 Diabetes Mellitus

Objective:The existing programs and efficacy of exercise intervention in elderly patients were systematically evaluated. To understand the situations of physical exercise in elderly patients with type 2 diabetes, initially investigate the physical exercise intervention modalities suitable for elderly patients with type 2 diabetes and explore the effects and differences of various physical exercise intervention modalities in elderly patients with type 2 diabetes, with the purposes of establishing physical exercise prescriptions suitable for elderly patients, improving the quality of life of elderly patients and the physique of the elderly patients, and providing effective physical exercise intervention modalities for the rehabilitation and treatment of elderly patients with type 2 diabetes.Methods:(1) Systematic reviewLiterature retriew:Through searching Chinese and foreign databases of CNKI, Chongqing VIP Chinese science and technology journals, Wanfang Data, PubMed and the Cochrane Library for the literatures on the subject of physical exercise interventions in elderly patients with type 2 diabetes in terms of randomized controlled trials, the searching results had been screened for including the literatures fulfilling the criteria and reviewing for meta-analysis. The main outcome measures were analyzed using RevMan5.1.4 software. Discrete variable data used relative risk ratio (RR), continuous variable data used deviation (mean difference, MD) as evaluation index. The results with 95% confidence interval (95% CI) expressed the results.(2) Empirical research①Survey content:Basic situation investigation. Movement survey included ecercise record, rating of perceived exertion (RPE), pace and heart rate. Health status indicators included, blood glucose[fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hBG), glycosylated hemoglobin(HbAlc)], blood lipid[trigycerride(TG), total cholesterol(TC), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), blood pressure [systolic blood pressure(SBP), diastolic blood pressure(DBP)], body composition[body mass index (BMI), body fat percentage, muscle mass, body fat and muscle of trunk and limbs] and adverse reactions related to exercise.②Group and exercise prescription formulation:Through investigating the current situations of 1740 elderly patients who presented to the hospital for the first time and fulfilled WHO diagnostic criteria of type 2 diabetes. The different physical exercise habits were grouped according to the criteria of Chinese diabetes guidelines, egular exercise group, sometimes exercise group, less exercise group. Comprehensive evaluation of 685 olderly patients with type 2 diabetes mellitus regular exercise group included the RPE 9-12, health indicators refer to the "China type 2 guidelines on prevention of diabetes (2013)", compliance rate, and adverse reactions related with sports, the selection of health good health in elderly patients, making walking exercise prescription according to age, prescriptions included the pace, time and frequency.③Exercise mode and exercise intervention:the elderly patients in less exercise group including 281 cases aged 60～69 years and 151 cases aged 70-years accepted with exercise intervention. The elderly patients were divided into three groups by simple randomization method, and compared three intervention models, team intervention model, family members’ accompanying intervention model and routine outpatient intervention model,1 month.251 patients aged 60～69 years old were randomly grouped in 7.5h/w moderate walking,7.5h/w taijiquan,7.5h/w square dance.123 patients aged 70-years old were randomly divided into 3 groups accompanied by family members, respectively given mild walking 10h/w, mild walking 15h/w, mild walking exercise 8h/w+ resistance exercise 2h/w, for a period of lyear. The relationship of compared different exercise prescription and health related indicators in elderly patients.④Statistical analysis methods:The statistical description of the data used statistical software SPSS 17.0 and SAS9.3 statistical software, qualitative data%, compared with the x2 test; quantitative data with (X+S), the results of different groups were compared using t test and One-Way ANOVA, or 2 (multiple) nonparametric test of independent samples between the two two groups. Multiple comparisons used LSD-t test significant difference method, the uneven variance used non-parametric test (Kruskal-Wallisx2 test). The multivariate analysis used Logistic regression. Hierarchical Linear Models(HLMs) were used to observe the blood glucose after adjustment for age, gender, marital status, educational level, family income per month later, with the interactive effect of time variation within the group and between groups, P<0.05 considered statistically significant difference.Results:(1)System evaluation:Totally 42 literatures of randomized controlled trials had been included into this systemic review. Exercise prescription factors mainly include the exercise intensity, time and frequency, but age-related exercise prescription for senile patients and compliance rate were not reported, only 6 literatures reported adverse reactions associated with exercise. The evaluation index of exercise intervention mainly concentrated in blood glucose, body weight, but the changes about the percentage of body fat and muscle mass were rarely reported.30 literatures reported the data of outcome indexes meta-analysis required. The results showed that on the basis of routine nursing, physical exercise interventions was useful in reducing glycated hemoglobin (MD:-1.20,95%CI:-1.58～-0.82, P< 0.05), fasting blood glucose (MD:-0.78,95%CI:-1.01～-0.55, P< 0.05),2 hours postprandial blood glucose (MD:-1.56,95%CI:-2.28～-0.83, P< 0.05), body mass index (MD:-1.61,95%CI:-2.20～ 1.03, P< 0.05) levels in elderly patients with diabetes.(2)Impact of exercise on health related indicators:In 1740 elderly patients,685 patients had regular physical exercise (accounting for 39.37%),468 patients occasionally had or did not had exercise (26.90%), and 587 patients had exercise from time to time (33.73%). Univariate analysis showed that age (x2=17.22), marital status (x2=5.92), and degree of education (x2=30.71) had statistically significant effects on exercise habits (P<0.05). Multifactor analysis showed that age had an effect on exercise habit (P<0.05). The attainment rate of BMI, FPG,2hBG, HbAlc, TG, TC, HDL-C, LDL-C in regular exercise group were higher than that in less exercise group,x2 were 110.90、39.63、41.19、28.89、157.80、25.94、120.46、182.02、 110.90 respectively, with the statistically significant differences. The group with regular exercise had higher proportions (%) of muscles in body weight than the group with occasional or no exercise, while the group with regular exercise had lower body mass index and body fat percentage (%) with statistically significant differences. The group with regular exercise had better blood glucose and blood lipids profile than the group with occasional or no exercise, with statistically significant difference (P<0.05). However, there was no difference in blood pressure.(3)Exercise prescription:Elderly patients were stratified according to the rating scale of perceived exertion, and good subjective and objective indexes had gathered in RPE Grade 9-10 with weekly exercise≥10h and in RPE Grade11-12 with weekly exercise 5-10h, which accordingly corresponded to Plan 1 (elderly patients≥70 years with mild exercise intensity and the pace rate of 60-80m/min) and Plan 2 (elderly patients aged 60-69 years with moderate exercise intensity and the pace rate of 100-120m/min).(4)Compliance of intervention models:Compared with the modality of accompanying family members’ participations and the modality of routine outpatient, the modality of group participation with the volunteer as the team leader had better compliance (both P<0.05). The rate of compliance of 3 modalities were 90.16%,92.00,55.00%(elderly patients≥70 years, x2=25.28, P<0.001) and 95.45%,91.51,80.46%(elderly patients 60-69 years,x2=11.17, P<0.01).(5)Effect of 3 kinds of erercise prescription on patients aged 70～years old (10h/w walking, 15h/w walking,8h/w walking+2h/w resistance):For the patients aged≥ 70 years, three exercise intervention modalities can improve blood glucose, blood lipids, blood pressure (all P<0.05); however, the attainment rate BMI of 15h/week mild walking had the best result (39.02%, x2=8.36, P=0.02). The patients in 15h/w walking group had more influence on the reduction of muscle volume and higher incidence rates of back, knee and ankle pains than the other two modalities. The modality of 8h/week mild aerobic exercise+2h/week resistance training had better influence on the muscle volume than the modality of 15h/week mild walking (all P<0.05).(6)Effect of 3 kinds of erercise prescription on patients aged 60-69 years old (7.5h/w walking, 7.5h/w taijiquan,7.5h/w square dance):all the three exercise interventions can improve blood glucose, blood lipids, blood pressure, body composition (all P<0.05). The attainment rate BMI of walking group had the best result (38.55%, x2=7.51, P=0.02), the lowest attainment rate of TC (27.96%, x2=7.43, P=0.02), and the attainment rate FPG of taijiquan group had the best result (95.70%, x2=25.41, P<0.05). The group with walking and the group with taijiquan had better improvement in DBP than the group with square dance. The muscle volumes of the bodies and extremities of the elderly patients in the group with taijiquan and the group with square dance increased. The group with square dance has larger increase of body muscle volumes than the group with taijiquan, and the group taijiquan larger than the group with walking. The group with taijiquan had larger increase of muscle volumes of lower extremities than the group with square dance with the statistically significant differences (all P<0.05).Conclusion:(1)Exercise helps to improve the health status of elderly patients with type 2 diabetes. Clinical curative effect indicators included blood glucose, blood lipid, blood pressure and the measurement of body composition that can better response to exercise influence on muscle mass, fat mass, and has important significance on body weight regulation.(2)The patient compliance should be considered for exercise prescription of elderly patients with Type 2 diabetes mellitus. This research used the investigation of the elderly patients with regular exercise habit and better health status to extract the exercise prescription. The movement prescription should include intensity, time and frequency. Exercise intervention for elderly patients with type 2 diabetes who had no habit of exercise choose the exercise program according to the age and the actual situation.(3)For the exercise interventions, the modality of group participation with the volunteer as the team leader and the modality of accompanying family members can improve the compliance of the patients.(4)For the elderly patients, the decrease of muscle volumes and incidence of back, knee and ankle pains were caused by over-exercise and should arise the researchers’ attentions. The exercise modality of taijiquan or square dance has better improvement in qualities of life and body compositions than the exercise modality of simply walking.