تأثير تمرينات هوازي بر سيستم اتونوم قلبي در مردان ميانسال مبتلا به ديابت نوع دوم: مطالعه فراتحليلي

The Effect of Aerobic Exercise on Cardiac Autonomic System in Middle-Aged Men with Type 2 Diabetes: A Meta-Analysis Study

ﺳﺎﺑﻘﻪ و ﻫﺪف: اﺧﺘﻼل ﻋﻤﻠﮑﺮد ﺳﯿﺴﺘﻢ اﺗﻮﻧﻮم ﻗﻠﺒﯽ در اﻓﺮاد ﻣﺒﺘﻼ ﺑﻪ دﯾﺎﺑﺖ ﻧﻮع دوم در ﺻﻮرت ﻋﺪم ﮐﻨﺘﺮل ﻣﯽﺗﻮاﻧﺪ ﻣﻨﺠﺮ ﺑﻪ ﻧﻮروﭘﺎﺗﯽ دﯾﺎﺑﺘﯽ ﮔﺮدد. ﻫﺪف از اﯾﻦ ﭘﮋوﻫﺶ، ﻣﻄﺎﻟﻌﻪ و ﺑﺮرﺳﯽ ﻓﺮاﺗﺤﻠﯿﻠﯽ ﺗﺄﺛﯿﺮ ﺗﻤﺮﯾﻨﺎت ﻫﻮازي ﺑﺮ ﺳﯿﺴﺘﻢ اﺗﻮﻧﻮم ﻗﻠﺒﯽ در ﻣﺮدان ﻣﯿﺎﻧﺴﺎل ﻣﺒﺘﻼ ﺑﻪ دﯾﺎﺑﺖ ﻧﻮع دوم ﺑﻮد. ﻣﻮاد و روﺷﻬﺎ: ﺑﺎ ﺟﺴﺘﺠﻮ در ﭘﺎﯾﮕﺎهﻫﺎي ﻋﻠﻤﯽ ScienceDirect ،Web of Science ،Pubmed و Magiran ﺗﻌﺪاد 256 ﻣﻘﺎﻟﻪ ﻣﺮﺗﺒﻂ در اﯾﻦ زﻣﯿﻨﻪ اﻧﺘﺨﺎب ﮔﺮدﯾﺪﻧﺪ. در ﻧﻬﺎﯾﺖ ﺑﺎ ﻣﺪﻧﻈﺮ ﻗﺮار دادن ﻣﻌﯿﺎرﻫﺎي ورود ﺑﻪ ﭘﮋوﻫﺶ ﺗﻌﺪاد 11 ﻣﻘﺎﻟﻪ ﺟﻬﺖ ﺑﺮرﺳﯽ و ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﺑﻌﺪ از اﻋﺘﺒﺎرﺳﻨﺠﯽ ﺑﺎ اﺳﺘﻔﺎده از ﻣﻘﯿﺎس PEDro اﻧﺘﺨﺎب ﺷﺪﻧﺪ. ﺟﻬﺖ اﺳﺘﺨﺮاج داده از ﻫﺮ ﻣﻘﺎﻟﻪ از روش PICOS اﺳﺘﻔﺎده ﺷﺪ. ﺳﭙﺲ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮماﻓﺰار ﻓﺮاﺗﺤﻠﯿﻠﯽ Comprehensive Meta Analysis V3.exe و ﺑﺎ اﺳﺘﻔﺎده از روش ﻣﻘﺎﯾﺴﻪ ﮔﺮوﻫﯽ در ﻣﻄﺎﻟﻌﺎت ﺑﺎ ﻣﺪلﻫﺎي اﺛﺮات ﺗﺼﺎدﻓﯽ و ﺛﺎﺑﺖ اﻧﺪازه اﺛﺮ ﻫﺮﯾﮏ از ﻣﻄﺎﻟﻌﺎت ﻣﻮرد ﺗﺤﻠﯿﻞ ﻗﺮار ﮔﺮﻓﺖ. ﯾﺎﻓﺘﻪﻫﺎ: ﺷﺮﮐﺖ ﻣﻨﻈﻢ در ﺑﺮﻧﺎﻣﻪﻫﺎي ﺗﻤﺮﯾﻨﺎت ﻫﻮازي در ﻣﺮدان ﻣﯿﺎﻧﺴﺎل ﻣﺒﺘﻼ ﺑﻪ دﯾﺎﺑﺖ ﻧﻮع دوم ﺳﺒﺐ اﺛﺮات ﻣﻌﻨﯽدار ﺑﺮ ﺷﺎﺧﺺ زﻣﺎن ﻣﺤﻮر p=0/004) SDNN ؛ اﻧﺪازه ﺗﺎﺛﯿﺮ = 0/33( و ﺷﺎﺧﺺ ﻓﺮﮐﺎﻧﺲ ﻣﺤﻮر p=0/017) HF ؛ اﻧﺪازه ﺗﺎﺛﯿﺮ = 0/23( ﻣﯽﮔﺮدد. ﻫﻤﭽﻨﯿﻦ اﯾﻦ ﺗﻤﺮﯾﻨﺎت ﺑﺎ وﺟﻮد ﺗﻐﯿﯿﺮات ﻣﺸﻬﻮدي در ﺷﺎﺧﺺﻫﺎي زﻣﺎن ﻣﺤﻮر p=0/069) rMSSD ؛ اﻧﺪازه ﺗﺎﺛﯿﺮ = 0/50( و ﻓﺮﮐﺎﻧﺲ ﻣﺤﻮر LF )0/184=p ؛ اﻧﺪازه ﺗﺎﺛﯿﺮ = 0/47( ﺗﺎﺛﯿﺮ ﻣﻌﻨﯽداري را ﻧﺸﺎن ﻧﺪاد. ﻧﺘﯿﺠﻪﮔﯿﺮي: ﺷﺮﮐﺖ ﻣﻨﻈﻢ در ﻓﻌﺎﻟﯿﺖ ورزﺷﯽ ﻫﻮازي ﺑﺎ ﺷﺪت ﻣﺘﻮﺳﻂ در ﻣﺮدان ﻣﯿﺎﻧﺴﺎل ﻣﺒﺘﻼ ﺑﻪ دﯾﺎﺑﺖ ﻧﻮع دوم ﻣﯽﺗﻮاﻧﺪ ﺗﺎ ﺣﺪودي از اﺛﺮات اﯾﻦ ﺑﯿﻤﺎري ﺑﺮ ﻋﻤﻠﮑﺮد ﺳﯿﺴﺘﻢ اﺗﻮﻧﻮم ﻗﻠﺒﯽ ﺟﻠﻮﮔﯿﺮي ﺑﻪ ﻋﻤﻞ آورد. ﻟﺬا ﺑﻪ ﺑﯿﻤﺎران دﯾﺎﺑﺘﯽ ﻣﺮد ﻣﯿﺎﻧﺴﺎل ﺗﻮﺻﯿﻪ ﻣﯽﮔﺮدد، ﺷﺮﮐﺖ در ﻓﻌﺎﻟﯿﺖ ورزﺷﯽ را ﺑﻪ ﻋﻨﻮان ﯾﮑﯽ از ﻣﺪاﺧﻼت درﻣﺎﻧﯽ ﺧﻮد ﻣﺪﻧﻈﺮ ﻗﺮار دﻫﻨﺪ.

Background and Purpose: Cardiac autonomic system dysfunction in type 2 diabetic patients can lead to diabetic neuropathy. The purpose of this study was to investigate the meta-analysis of the effect of aerobic exercise on cardiac autonomic system in middle-aged men with type 2 diabetes. Methodology: A total of 256 related articles were selected by searching in the Pubmed, Web of Science, ScienceDirect and Magiran databases. Finally, considering the inclusion criteria, 11 articles were selected for evaluation and analysis after validation using PEDro scale. PICOS method was used to extract data from each article. Then, they were analyzed using Comprehensive Meta Analysis V3.exe software with group comparisons method and random and fixed effects size models of each study. Results: Regular participation in aerobic training programs in middle-aged men with type 2 diabetes had significant effects on SDNN as time domain index (p = 0.004; effect size = 0.33) and HF as frequency domain index (P = 0.017; effect size = 0.23). Also, these exercises had an insignificant effect on the rMSSD as time domain index (p = 0.096; effect size = 0.50) and LF as frequency domain index (p = 0.184; effect size = 0.47). Conclusion: Regular participation in moderate intensity aerobic exercise in middle-aged men with type 2 diabetes can partially prevent the effects of this disease on cardiac autonomic system function. Therefore, it is recommended for middle-aged diabetic patients to consider exercise as one of their therapeutic modalities