Research And Application Of The Associations Between Physical Activity And Type 2 Diabetes Mellitus

Type 2 diabetes mellitus(T2DM)is a major public health problem that currently threatens the health of Chinese people.Lifestyle intervention is essential in T2DM prevention and health management for individuals at a high risk and patients with T2DM.Increasing physical activity is an important means of lifestyle intervention,which can improve glycemic control and cardiovascular risk factors,prevent or delay the onset and development of T2DM and its complications.Unstructured low-intensity physical activity based on housework is an important component of daily total physical activity.Investigating the association between household physical activity and T2DM will be conducive to the development of control strategies for T2DM and improving the recognition of Chinese people on exercise promoting health.The interactions of physical activity and T2DM risk factors influence the intervention effect,and deepening the understanding of these interactions can improve the accuracy and effectiveness of intervention strategies.On-site supervision is conducive to improving patient compliance with exercise interventions and promoting the establishment of early behavioral habits,while it is limited in the field of population health management in China.The T2DM risk assessment can provide an important intervention window and play a role in the evaluation of intervention effects.A variety of risk score models have been developed abroad.However,these models may not be applicable in China due to population differences.So it is necessary to establish appropriate T2DM risk assessment tools based on the characteristics of Chinese population.In addition,developed countries in Europe and the United States have developed several T2DM health management systems.However,foreign management models may not be applicable to the Chinese population due to the tremendous differences in medical institution settings and resource allocation,and the lack of awareness and ability of patients' self-health management.Therefore,it is necessary to establish risk assessment,population exercise intervention and health management methods and techniques for individuals at a high risk and patients with T2DM in China.Based on the demands,in this thesis,the studies on the associations of physical activity with T2DM and their application are made as follows:1.Study on the association between household physical activity and T2DM among Chinese malesWe analyzed the association between the time(hours/day)spent on housework and T2DM among 13,862 Chinese urban males in a cross-sectional study.The results suggested that household physical activity might contribute to long-term glycemic control:compared to those who did not do housework,the T2DM odds ratio(OR)was 0.80 and 0.60 for those who spent>0 to 2 hours/day and>2 hours/day on housework,respectively(P<0.001).The inverse association of household physical activity with T2DM was persistent and varied in subgroup analyses based on different risk factors.It is necessary to increasing the unstructured physical activity level as an important component for the future T2DM prevention strategy.2.Study on the associations between physical activity and T2DM risk factorsHypertension and dyslipidemia are both the most important risk factors and the most common complications of T2DM.We reviewed the beneficial effects and mechanisms of aerobic exercise on hypertension.Meanwhile,we examined the association between physical activity and dyslipidemia in a large sample study,and we also investigated the interactions between smoking,drinking obesity,and exercise.It was found that smoking deteriorated triglycerides(TG)and high-density lipoprotein cholesterol(HDL-C);alcohol consumption was harmful to total cholesterol and TG,but had a protective effect on HDL-C;exercise was beneficial for blood lipids and might relieve the negative influences of smoking and drinking on blood lipids.In addition,we also found that physical inactivity and obesity contributed to the development of dyslipidemia,and there was an additive effect.The above results indicated that physical activity played a different role in individuals with different T2DM risk factors,which provides data support for the development of personalized T2DM intervention and management strategies.3.Effectiveness of remotely supervised exercise intervention in patients with T2DMWe proposed a remotely supervised exercise intervention method based on wearable monitoring equipment.The effectiveness of the method was verified by a 12-week randomized controlled trial among 40 sedentary patients with T2DM.All subjects were randomly assigned to a supervised exercise group and a control group.The subjects in the supervised exercise group received a remotely supervised exercise intervention combined with health education and consultation service;those in the control group only received health education and consultation service.It was found that the remotely supervised exercise intervention not only improved glycemic control,but also significantly improved body composition,blood pressure,blood lipids and aerobic capacity.This provides a practical basis for the exercise intervention system based on cloud technology and mobile terminals.4.Development and validation of an overall risk score model for T2DMA T2DM risk score model was established in Chinese population based on logistic regression method.Participants included 26,600 men and 9,600 women,and were respectively divided into derivation and validation cohorts.Multivariate logistic regression analysis was used to select and weigh variables in the derivation cohorts.The validity of the model was tested by the area under the receiver operating characteristic curve in the validation cohort.The results showed that the performance of the current model was superior to the Finnish Diabetes Risk Score model.This study provides theoretical and technical support for the hierarchical stratification approach in the exercise intervention system for T2DM.5.Development and pilot application of an exercise intervention system for T2DMIn view of the current situation and demands of T2DM health management in China,we designed a T2DM exercise intervention and health management service model for general hospitals.Based on the methods developed above and combined with information technologies such as cloud computing,we established an exercise intervention system,and demonstrated it in the exercise intervention clinic of Chinese PLA General Hospital.We comprehensively detect and evaluate the overall health status and risk factors of individuals,formulate an effective and accessible intervention program,provide continuous follow-up supervision services,evaluate the intervention effect,and realize closed-loop intervention management.The ultimate goal of the system is to empower patients with T2DM toward the self-management of their disease.