Efficacy Of APP-assisted Structured Exercise In Intervention Of Type 2 Diabetes

Background:In the early stage of type 2 diabetes mellitus(T2DM),vascular and nerve damage already exists,however,some patients have no obvious symptoms in the early or even the whole course of the disease,only showing rapid decline in physical strength and weakened anti-fatigue ability.Therefore,reduced exercise capacity may play an important role in the incidence of type 2 diabetes.At present,it has been confirmed that the decline of cardiopulmonary endurance and muscle strength increases the risk of diabetes.However,cardiopulmonary exercise test and iso-tachometer muscle strength test,as the gold standard for evaluation,have high requirements on hardware,personnel and environment,and are not easy to promote clinically.The step test and the bare hand muscle endurance test have the advantages of low cost and easy operation as the evaluation means of basic athletic ability.However,the relationship between representative measures(heart rate and muscle resistance)and type 2 diabetes is not completely clear.Exercise is an important way of integrated management of type 2 diabetes,and its intervention effect depends on the intensity,type and compliance of exercise.Compared with low-intensity exercise,moderate-to-high-intensity exercise can not only significantly improve metabolic indexes such as blood glucose and HbA1c,but also significantly reduce cardiovascular risk and all-cause mortality.A large number of studies have also confirmed that structured exercise(mainly consisting of aerobic and resistance training)can provide more health benefits for people with type 2 diabetes than a single type of exercise;In addition,compared with traditional exercise intervention,although telephone follow-up can improve patients’ exercise self-efficacy and improve patients’ HbA1c,the compliance is still at a low level compared with nutrition and drugs.Therefore,the poor overall effect of exercise intervention for type 2 diabetes may be related to the lack of quantification of exercise intensity,single type of exercise,and lack of exercise monitoring.With the development of mobile information technology,APP-assisted movement structuring and visualization may be an important way to solve these problems.Reasonable exercise prescription is the foundation.Quantification,visualization and monitoring of exercise prescription using simple exercise ability indicators such as heart rate and muscle endurance combined with apps and wearable devices can realize the transformation and application of type 2 diabetes-related physical fitness indicators in exercise intervention,and establish exercise assessment,intervention and evaluation system for type 2 diabetes,which is of great significance for the prevention and treatment of type 2 diabetes.During exercise,skeletal muscle is the largest energy metabolizer and endocrine organ,and the improvement of its function plays a key role in blood glucose regulation of type 2 diabetes.Muscle endurance is an important index of skeletal muscle function.Exploring the mechanism of exercise on muscle endurance may provide a new molecular target for the treatment of type 2 diabetes.It is generally believed that the improvement of muscle endurance by exercise is related to the regulation of muscle glycogen in skeletal muscle.Adenosine 5 ’-Monophosphate-Activated Protein Kinase(AMPK)is a regulator of the body’s energy homeostasis.Exercise and skeletal muscle glycogen can affect its activity,thereby regulating the body’s glucose metabolism.Adenosine 5 ’-MonophosphateActivated Protein Kinase β2(AMPKβ2)is an important regulatory subunit of AMPK,and its unique glycogen domain is an important structural and functional basis in the process of glucose metabolism.Our previous animal experiments have shown that muscle glycogen concentration is negatively correlated with the nuclear translocation of AMPKβ2,and low muscle glycogen concentration promotes the nuclear translocation of AMPKβ2.In the case of low muscle glycogen level in type 2 diabetes model,whether exercise intervention can reverse the nuclear translocation of AMPKβ2 and achieve the purpose of regulating muscle glycogen is still unclear.Based on this,the purpose of this study was to determine the interaction between exercise ability indexes such as resting heart rate,step test recovery for 1 minute,heart rate and muscle endurance and type 2 diabetes.At the same time,through the transformation of the above exercise ability indicators,the exercise prescription was quantified,and the remote exercise monitoring was implemented by wearable devices and Apps to observe the improvement effect of APP-assisted structured exercise on muscle endurance and clinical indicators.To further explore the mechanism of AMPKβ2 as a regulatory protein in improving the muscle endurance of type 2 diabetes mellitus through exercise.Objectives:To clarify the interaction between exercise ability and type 2 diabetes mellitus,and explore the effect of APP-assisted structured exercise intervention and the mechanism of exercise improving muscle endurance in type 2 diabetes mellitus.Methods:426 participants meeting the inclusion criteria were divided into type 2 diabetes group(n=151)and non-diabetes group(n=275).All subjects used intelligent software to collect general information and exercise ability test,including quiet heart rate,step test recovery 1-minute heart rate,upper limb muscle endurance,lower limb and core muscle endurance.Test data were collected to analyze the relationship between healthy physical fitness and diabetes risk.In addition,after adjusting for height,age,weight and BMI,nondiabetic patients and type 2 diabetic patients were compared by sex to analyze the influence of type 2 diabetes on exercise ability of different genders.In the APP-assisted exercise intervention study,70 patients with type 2 diabetes who met the atretic criteria were randomly divided into two groups,including the conventional control group(referred to as control group,n=35)and the APP-assisted structured exercise group(referred to as remote group,n=35).Both groups maintained their original medication regimen during the study period and were supported with online nutrition and formal diabetes education courses using intelligent software.The control group was given paper exercise prescription,and the remote group was uniformly sent exercise video prescription via APP by doctors.In addition,the APP-assisted exercise intervention plan also included online exercise answering once a week,and the exercise methods were mainly at home.Subjects could implement a structured exercise plan based on video guidance and heart rate monitoring,and the total effective exercise target duration was≥150 minutes/week.After 12 weeks,TCM syndrome scores before and after intervention were recorded in the two groups and their changes were compared.As well as the relevant indexes of exercise ability(resting heart rate,heart rate after 1 minute recovery from step test,lower limb muscle endurance and core muscle endurance),body fat percentage,biochemical indexes(fasting blood glucose,insulin,C-peptide,lipid profile)and insulin resistance index(Homeostasis Model Assessment-Insulin)before and after the two intervention modes Resistance,HOMA2-IR)and exercise duration were compared and analyzed.In the animal experiment,45 SPF SD rats were randomly divided into two groups:normal group(n=15)and model group(n=30).The normal group was given ordinary diet.The model group was given a high-fat and high-sugar diet,and after 4 weeks of feeding,Streptozotocin(Streptozotocin,STZ)was injected to create the model.The blood glucose of the rats was measured 48 hours later,and the random blood glucose was>16.7mmol/l,indicating that the model was successful.The 6 rats that did not meet the blood glucose standard were excluded.Finally,the model group(n=24)was then included in the preintervention group(n=12)and the intervention group(n=12).After three days of adaptive swimming in the exercise intervention group,swimming intervention was carried out for 4 weeks(5 days a week,30 minutes each time,carrying 12%body weight).Fasting insulin(FINS)and Fasting Plasma Glucose(FPG)were measured before and after the intervention.Muscle tissue was collected for the determination of muscle glycogen,and AMPKβ2 protein in skeletal muscle cells was detected by Western blot.Results:426 subjects,26 of whom fell off(25 fell off because they did not complete the test,and 1 dropped out of the study).A total of 400 participants(141 in the type 2 diabetes group and 259 in the non-diabetes group)were included in the analysis,and multivariate regression analysis showed that Gender(OR=4.907,95%CI:2.105-11.437),age(OR=1.093,95%CI:1.054-1.134),BMI(OR=1.258,95%CI:1.133-1.397),and family history(OR=8.005,95%CI:3.846-16.66).Lower limb muscle endurance(OR=-0.977,95%CI:0.961-0.933)and core muscle endurance(OR=0.959,95%CI:0.925-0.995)are risk factors for the development of type 2 diabetes.After adjusting for age,height,weight,BMI,etc.,the resting heart rate and the heart rate after 1 minute of step test recovery in type 2 diabetes group were significantly higher than those in non-diabetes group(P<0.05),and the lower limb muscle endurance was significantly lower than that in non-diabetes group(P<0.05).The upper limb,lower limb and core muscle endurance of type 2 diabetic men were lower than those of non-diabetic group(P<0.05).There was no significant difference in the upper and lower limb and core muscle endurance between the two groups(P>0.05).During the exercise intervention,5 cases(n=30)fell off in the control group and 4 cases(n=31)in the remote group.There was no significant difference between the control group and the remote group at baseline.Compared with the control group,the HbA1c,fasting blood glucose,HOMA2-IR,body fat percentage and TCM syndrome score in the remote group after intervention were significantly reduced(P<0.05),and the improvement in the remote group was better than that in the control group(P<0.05).Compared with before intervention,the lower limb muscle endurance of the remote group was improved after intervention,and compared with the control group,there was statistical significance(P<0.05).The proportion of people in the remote group who recorded average weekly exercise duration≥80%was 48.38%,which was much lower than that in the control group(83.33%),and the self-reported exercise achievement rate was statistically different from that in the remote group(72.42%)(P<0.01).After modeling,6 rats in the model group(n=24)whose blood glucose was not up to the standard were excluded,and the success rate of modeling type 2 diabetes mellitus was 80%.Among them,14 rats in the normal group were included in the data analysis before exercise intervention(n=12),exercise intervention group(n=10,2 died of water inhalation)and normal group(1 died of bite injury).After modeling,random blood glucose and fasting blood glucose in the model group were higher than those in the normal group(P<0.01),muscle glycogen and fasting insulin were significantly lower than those in the normal group(P<0.01),total protein AMPKβ2 expression in skeletal muscle cells of the model group was not different,and the expression of AMPKβ2 in nuclear protein was significantly higher than that in the normal group.Compared with before exercise intervention,after 4 weeks of exercise intervention,body weight and muscle glycogen increased significantly(P<0.01),fasting blood glucose and fasting insulin had no significant changes,the expression of total protein AMPKβ2 in skeletal muscle cells had no difference,and the expression of AMPKβ2 in nuclear protein was significantly lower than that before exercise intervention(P<0.05).Conclusion:(1)Decreased core and lower limb muscle endurance is an independent risk factor for type 2 diabetes;(2)APP-assisted structured exercise significantly improved lower limb muscle endurance and cardiac autonomic function;(3)Exercise can regulate muscle glycogen by regulating AMPKβ2 translocation in skeletal muscle cells of type 2 diabetic rats,thereby improving muscle endurance;(4)After baseline adjustment,the heart rate of patients with type 2 diabetes increased for 1 minute after resting heart rate and step test resumed,while the muscle endurance of lower extremity and core muscle of males decreased,and there were gender differences in the impact of diabetes on muscle endurance.(5)Remote structured exercise can significantly improve the TCM syndrome score of type 2 diabetes patients,effectively reduce the level of HbA1c and body fat percentage,increase the level of highdensity lipoprotein,improve fasting blood glucose and insulin resistance,and the efficacy is better than that of the control group;(6)Patients with type 2 diabetes cannot distinguish between daily activities and physical exercise,and APP-assisted structured exercise can improve exercise efficiency and may indirectly improve patients’ motor cognition.