The effect of strength and endurance training on insulin sensitivity and fat distribution in human immunodeficiency virus-infected patients with lipodystrophy
The effect of strength and endurance training on insulin sensitivity and fat distribution in human immunodeficiency virus-infected patients with lipodystrophy
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DOI：
10.1210/jc.2007-2733
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发表时间：
2008-10-01
影响因子：
5.8
通讯作者：
Pedersen, B. K.
中科院分区：
文献类型：
--
作者：
Lindegaard, B.;Hansen, T.;Pedersen, B. K.
背景：脂肪重新分布、胰岛素抵抗和低度炎症是 HIV 感染者脂肪营养不良的特征。目前，尚无有效的方法来联合治疗脂肪重新分布和胰岛素抵抗。 目的：我们的目的是评估力量和耐力训练对 HIV 感染脂肪营养不良患者胰岛素敏感性和脂肪分布的影响。 受试者和方法：20 名久坐的脂肪营养不良 HIV 感染男性被随机分配接受监督力量或耐力训练，每周 3 次，持续 16 周。主要终点是改善外周胰岛素敏感性（正常血糖-高胰岛素钳夹结合同位素示踪剂输注）和身体脂肪成分（双能 X 射线吸收测定扫描）。次要终点包括空腹血脂和炎症标志物。 结果：耐力训练（55.7 +/- 11 至 63.0 +/- 11 μmol 葡萄糖/kg 瘦体重中心点分钟，P = 0.02）和力量训练（49.0 +/- 12 至 57.8 +/- 18 μmol 葡萄糖/kg 瘦体重中心点分钟，P = 0.005），无论训练方式如何（P = 0.24）。仅力量训练可使总去脂体重增加 2.1 公斤 [95% 置信区间 (CI)，0.8-3.3]，总脂肪减少 3.3 公斤（95% CI，-4.6 至 -2.0），躯干脂肪减少 2.5 公斤（95% CI，-3.5 至 -1.5），四肢脂肪减少 0.75 公斤（95% CI，-1.1 至 -0.4）。力量训练比耐力训练更能显着降低总脂肪量和肢体脂肪量（P < 0.05）。耐力训练降低了总胆固醇、低密度脂蛋白胆固醇、游离脂肪酸、高敏C反应蛋白、IL-6、IL-18和TNF-α，并增加了高密度脂蛋白胆固醇，而力量训练则降低了甘油三酯、游离脂肪酸和IL-18，并增加了高密度脂蛋白胆固醇（所有测量结果P<0.05）。结论：这项研究表明，力量训练和耐力训练都可以提高外周胰岛素敏感性，而只有力量训练才能提高外周胰岛素敏感性。减少患有脂肪营养不良的艾滋病毒感染患者的全身脂肪。
Context: Fat redistribution, insulin resistance, and low-grade inflammation characterize HIV-infected patients with lipodystrophy. Currently, no effective therapies exist for the combined treatment of fat redistribution and insulin resistance.Objective: Our objective was to evaluate the effects of strength and endurance training on insulin sensitivity and fat distribution in HIV-infected patients with lipodystrophy.Subjects and Methods: Twenty sedentary HIV-infected men with lipodystrophy were randomly assigned to supervised strength or endurance training three times a week for 16 wk. The primary endpoints were improved peripheral insulin sensitivity (euglycemic-hyperinsulinemic clamp combined with isotope-tracer infusion) and body fat composition (dual-energy x-ay absorptiometry scan). Secondary endpoints included fasting lipids and inflammatory markers.Results: Insulin-mediated glucose uptake increased with both endurance training (55.7 +/- 11 to 63.0 +/- 11 mu mol glucose/kg lean mass center dot min, P = 0.02) and strength training (49.0 +/- 12 to 57.8 +/- 18 mu mol glucose/kg lean mass center dot min, P = 0.005), irrespective of training modality (P = 0.24). Only strength training increased total lean mass 2.1 kg [95% confidence interval (CI), 0.8-3.3], decreased total fat 3.3 kg (95% CI, -4.6 to -2.0), trunk fat 2.5 kg (95% CI, -3.5 to -1.5), and limb fat 0.75 kg (95% CI, -1.1 to -0.4). Strength training significantly decreased total and limb fat mass to a larger extent than endurance training (P < 0.05). Endurance training reduced total cholesterol, low-density lipoprotein cholesterol, free fatty acids, high-sensitivity C-reactive protein, IL-6, IL-18, and TNF-alpha and increased high-density lipoprotein cholesterol, whereas strength training decreased triglycerides, free fatty acids, and IL-18 and increased high-density lipoprotein cholesterol (P < 0.05 for all measurements).Conclusion: This study demonstrates that both strength and endurance training improve peripheral insulin sensitivity, whereas only strength training reduces total body fat in HIV-infected patients with lipodystrophy.