| 161 | 0 | 233 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 探讨基于健康行动过程取向(health action process approach, HAPA)理论的有氧运动干预方案在糖尿病肾病(diabetic nephropathy, DN)患者中的应用效果。方法 采用便利抽样法，选取2023年1月—2024年6月南京中医药大学附属医院收治的DN住院患者为研究对象，基于随机数字表法将其分为对照组和干预组，对照组实施常规护理，干预组在对照组的基础上实施为期3个月的基于HAPA理论的有氧运动干预方案。比较2组患者干预前后的生化指标、运动自我效能量表、自评抑郁量表、糖尿病生活质量得分。结果 最终93例患者完成研究，其中对照组47例、干预组46例。干预后，干预组患者空腹血糖、餐后2 h血糖、糖化血红蛋白、肾小球滤过率、尿微量白蛋白各项指标优于对照组，差异有统计学意义(P<0.05);运动自我效能得分高于对照组，差异有统计学意义(P<0.05);糖尿病生活质量总得分及各维度得分均低于对照组，差异有统计学意义(P<0.05);2组患者抑郁水平差异无统计学意义(P>0.05)。结论 基于HAPA理论的有氧运动方案有助于DN患者血糖控制、延缓肾功能下降，提高其运动自我效能和生活质量水平。
Abstract：Objective To investigate the application effect of aerobic exercise intervention program based on the health action process approach(HAPA) theory in diabetic nephropathy(DN) patients. Methods Using a convenience sampling method, inpatients with DN admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2023 to June 2024 were selected as the study subject, and were divided into a control group and an intervention group based on a random number table. The control group received routine care, while the intervention group received a 3-month aerobic exercise intervention program based on HAPA theory in addition to the routine care. The biochemical indicators, scores of exercise self-efficacy scale(ESS), self-rating depression scale, and diabetes scale of quality of life(DSQL)between 2 groups were compared before and after the intervention.Results A total of 93 patients completed this study, including 47 in the control group and 46 in the intervention group. After intervention, fasting blood glucose(FBG), 2-hour post-meal blood glucose(2 hPG), glycosylated hemoglobin(HbA1c), glomerular filtration rate(GFR), and urinary microalbuminuria of the intervention group were better than those of the control group with statistically significant differences(P<0.05),and the score of ESS was higher than that of the control group with statistically significant differences(P<0.05).The total score of DSQL and the scores of each dimension was lower than those of the control group, and the differences were statistically significant(P<0.05), while there was no significant difference in depression levels between 2 groups(P>0.05). Conclusion The aerobic exercise program based on the HAPA theory is feasible and helpful in regulating blood sugar, slowing down the decline of renal function, and improving self-efficacy and quality of life in DN patients.
[1] THE LANCET.Diabetes:a defining disease of the 21st century[J].Lancet,2023,401(10394):2087.
[2] GILBERT R E.The endothelium in diabetic nephropathy[J].Current Atherosclerosis Reports,2014,16(5):410.
[3] 谢薇，尚进，赵占正.网络互动平台的延伸护理服务在早期糖尿病肾病患者中的应用及效果观察[J].护士进修杂志，2020,35(8):759-762.XIE W,SHANG J,ZHAO Z Z.Application and effect observation of extended nursing service of network interactive platform in patients with early diabetic nephropathy[J].Journal of Nurses Training,2020,35(8):759-762.
[4] 中华医学会肾脏病学分会专家组.糖尿病肾脏疾病临床诊疗中国指南[J].中华肾脏病杂志，2021,37(3):255-304.Expert Group of the Nephrology Branch of the Chinese Medical Association.Chinese guidelines for diagnosis and treatment of diabetic kidney disease[J].Chinese Journal of Nephrology,2021,37(3):255-304.
[5] American Diabetes Association Professional Practice Committee.5.facilitating positive health behaviors and well-being to improve health outcomes:standards of care in diabetes-2024[J].Diabetes Care,2024,47(Suppl 1):S77-S110.
[6] CAI Z X,YANG Y,ZHANG J J.Effects of physical activity on the progression of diabetic nephropathy:a meta-analysis[J].Bioscience Reports,2021,41(1):BSR20203624.
[7] FORMIGARI G P,DÁTILO M N,VAREDA B,et al.Renal protection induced by physical exercise may be mediated by the irisin/AMPK axis in diabetic nephropathy[J].Scientific Reports,2022,12:9062.
[8] SCHWARZER R,LIPPKE S,LUSZCZYNSKA A.Mechanisms of health behavior change in persons with chronic illness or disability:the Health Action Process Approach (HAPA)[J].Rehabilitation Psychology,2011,56(3):161-170.
[9] 姜世敏，方锦颖.糖尿病肾病多学科诊治与管理专家共识[J].中国临床医生杂志，2020,48(5):522-527.JIANG S M,FANG J Y.Expert consensus on multidisciplinary diagnosis,treatment and management of diabetic nephropathy[J].Chinese Journal for Clinicians,2020,48(5):522-527.
[10] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版)(上)[J].中国实用内科杂志，2021,41(8):668-695.Diabetes Branch of Chinese Medical Association.Guideline for the prevention and treatment of type 2 diabetes mellitus in China(2020 edition)(Part 1)[J].Chinese Journal of Practical Internal Medicine,2021,41(8):668-695.
[11] 孙振球.医学统计学[M].北京：人民卫生出版社，2007:333-341.SUN Z Q.Medical statistics[M].Beijing:People 's Health Press,2007:333-341.
[12] 陈心茹，赵立，瞿建铃，等.基于健康行动过程取向理论的护理干预在2型糖尿病患者中的应用效果[J].当代护士(上旬刊),2025,32(12):36-40.CHEN X R,ZHAO L,QU J L,et al.Application effect of nursing intervention based on health action process approach theory in patients with type 2 diabetes [J].Contemporary Nurse (Early Edition),2025,32(12):36-40.
[13] RESNICK B,JENKINS L S.Testing the reliability and validity of the self-efficacy for exercise scale[J].Nursing Research,2000,49(3):154-159.
[14] LEE L L,PERNG S J,HO C C,et al.A preliminary reliability and validity study of the Chinese version of the self-efficacy for exercise scale for older adults[J].International Journal of Nursing Studies,2009,46(2):230-238.
[15] 王征宇，迟玉芬.抑郁自评量表(SDS)[J].上海精神医学，1984(2):71-72.WANG Z Y,CHI Y F.Self-rating depression scale (SDS)[J].Shanghai Archives of Psychiatry,1984(2):71-72.
[16] 段泉泉，胜利.焦虑及抑郁自评量表的临床效度[J].中国心理卫生杂志，2012,26(9):676-679.DUAN Q Q,SHENG L.Differential validity of SAS and SDS among psychiatric non-psychotic outpatients and their partners[J].Chinese Mental Health Journal,2012,26(9):676-679.
[17] 廖志红，周凤琼，梁奕铨.生存质量是评价糖尿病治疗的重要指标[J].中国糖尿病杂志，2000,8(5):304-305.LIAO Z H,ZHOU F Q,LIANG Y Q.Quality of life is an important index to evaluate the treatment of diabetes[J].Chinese Journal of Diabetes,2000,8(5):304-305.
[18] MALLAMACI F,PISANO A,TRIPEPI G.Physical activity in chronic kidney disease and the EXerCise introduction to enhance trial[J].Nephrology,Dialysis,Transplantation,2020,35(Suppl 2):ii18-ii22.
[19] LI R Y,GUO L.Exercise in diabetic nephropathy:protective effects and molecular mechanism[J].International Journal of Molecular Sciences,2024,25(7):3605.
[20] LAZAREVIC G,ANTIC S,VLAHOVIC P,et al.Effects of aerobic exercise on microalbuminuria and enzymuria in type 2 diabetic patients[J].Renal Failure,2007,29(2):199-205.
[21] LI S M,YUAN S P,ZHANG J T,et al.The effect of periodic resistance training on obese patients with type 2 diabetic nephropathy[J].Scientific Reports,2024,14:2761.
[22] 邹元美，白雪，杨斌，等.基于HAPA模型的护理干预在维持性血液透析患者运动康复中的应用[J].湖北科技学院学报(医学版),2024,38(5):431-433,438.ZOU Y M,BAI X,YANG B,et al.Application of nursing intervention based on HAPA model in the exercise rehabilitation of maintenance hemodialysis patients[J].Journal of Hubei University of Science and Technology (Medical Sciences),2024,38(5):431-433,438.
[23] HELOU N,TALHOUEDEC D,ZUMSTEIN-SHAHA M,et al.A multidisciplinary approach for improving quality of life and self-management in diabetic kidney disease:a crossover study[J].Journal of Clinical Medicine,2020,9(7):2160.
[24] THIPSAWAT S.Early detection of diabetic nephropathy in patient with type 2 diabetes mellitus:a review of the literature[J].Diabetes & Vascular Disease Research,2021,18(6):14791641211058856.
[25] YARIBEYGI H,BUTLER A E,SAHEBKAR A.Aerobic exercise can modulate the underlying mechanisms involved in the development of diabetic complications[J].Journal of Cellular Physiology,2019,234(8):12508-12515.
[26] 郑丽丽，叶佩芝.运动自我效能感在糖尿病患者血糖管理积极度与生活质量中的中介效应[J].护士进修杂志，2024,39(8):795-798,804.ZHENG L L,YE P Z.Mediating effect of exercise self-efficacy on blood glucose management enthusiasm and quality of life in patients with diabetics[J].Journal of Nurses Training,2024,39(8):795-798,804.
[27] 王婷，鞠梅，王琳，等.中老年2型糖尿病病人运动自我效能现状及影响因素[J].护理研究，2024,38(15):2641-2647.WANG T,JU M,WANG L,et al.Analysis of exercise self-efficacy in middle-aged and elderly type 2 diabetes patients[J].Chinese Nursing Research,2024,38(15):2641-2647.
[28] CASHMORE B A,COOPER T E,EVANGELIDIS N M,et al.Education programmes for people with chronic kidney disease and diabetes[J].Cochrane Database of Systematic Reviews,2024,8(8):CD007374.
[29] 黎明，杨海川，马轶坡，等.营养指导联合HAPA模式个性化抗阻运动对维持性血液透析肌少症患者营养指标及生存质量改善作用[J].解放军医药杂志，2022,34(10):62-67.LI M,YANG H C,MA Y P,et al.Nutritional guidance combined with personalized resistance exercise based on the HAPA model improves quality of survival and serum nutritional parameters in patients with sarcopenia undergoing MHD[J].Medical & Pharmaceutical Journal of Chinese PLA,2022,34(10):62-67.
[30] NG C L,TAI E S,GOH S Y,et al.Health status of older adults with type 2 diabetes mellitus after aerobic or resistance training:a randomised trial[J].Health and Quality of Life Outcomes,2011,9:59.
基本信息:
DOI：10.16821/j.cnki.hsjx.2026.06.009
中图分类号:R473.5
引用信息:
[1]崔淼,王俊,陈雯雯,等.基于健康行动过程取向理论的有氧运动干预在糖尿病肾病患者中的应用研究[J].护士进修杂志,2026,41(06):619-625.DOI:10.16821/j.cnki.hsjx.2026.06.009.
基金信息:
江苏省中医药管理局项目(编号：ZT202206)
2026-03-28
2026-03-28