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運動改善糖尿病和高血壓:特別注意這些安全事項

運動改善糖尿病和高血壓:特別注意這些安全事項

許多慢性疾病患者可能認為,為了避免身體勞累,應該多休息,減少活動。然而,這種觀念不盡正確。適度的運動對於脂肪肝、糖尿病、高血壓等代謝疾病患者有顯著的益處。

適量運動能改善糖尿病和高血壓

對糖尿病患者:規律運動可以提高胰島素敏感度,並促使肌肉細胞更有效地吸收血糖,幫助血糖控制。對其他代謝疾病指標,例如降低壞膽固醇和血酯的水平也有幫助。此外,運動能讓我們消耗熱量和維持肌肉量,有助減重或保持理想體重。

對高血壓患者:規律運動可以降低血壓,研究證明收縮壓(上壓)和舒張壓(下壓)分別平均降低11和8mmHg[1]。運動還有助於改善血管彈性,降低周邊血管阻力,幫助控制血壓。

運動前:評估心臟病風險和藥物影響

由於代謝疾病患者的心臟病風險較高,我們建議優先檢查心血管,盡可能排除運動中引發心臟病的危機[2]。同時,也該詢問醫生服用藥物對運動的影響和配合的方法。若病情較為複雜,建議在具備復健專業知識的運動教練指導下運動,確保安全。

糖尿病患者運動:留意併發症和低血糖

糖尿病患者往往伴隨其他健康問題,常見的有關節疼痛、足部麻痺,以及視力不佳。運動時需要視乎情況,特別護理這些併發症,例如避免高衝擊性的運動(如跳躍、短跑衝刺),也盡量不要在低光環境下運動,並該穿著合腳、透氣、防滑的運動鞋,防止跌倒受傷。

同時,糖尿病患者的血糖控制機能較弱,且可能正服用胰島素或降血糖藥物,所以必須監察血糖狀況。若血糖指數高於14mmol/L或低於4mmol/L,則不宜運動。運動時也可能因血糖消耗過快,導致低血糖,出現頭暈、手抖、冒冷汗等症狀,建議隨身攜帶葡萄糖或運動飲料,適當時補充水份和糖份。

高血壓患者運動:避免閉氣和調整強度

高血壓患者則要保持運動過程中血壓平穩,尤其在進行阻力訓練(「舉重」)時,應避免閉氣發力,以免發生「努責現象」(Valsalva manoeuvre)[3],引起血壓急劇升降。同時,若運動前的靜態血壓愈高,則運動強度要愈低,例如保持運動時在最大心跳率的40%-60%,避免過度負荷。

糖尿病和高血壓患者運動頻率可與常人無異,但強度較低

若果病情並不嚴重或複雜,糖尿病和高血壓患者的運動頻率和一般人士沒有差別,都是建議每周最少150分鐘中強度帶氧運動,輔以最少2天阻力訓練。同時,為了降低受傷風險或觸發急性病症,尤其剛開始規律運動時,強度不要過高。

一般而言,帶氧運動達到最高心跳率或攝氧量的五至六成(大約是運動過程中可以輕鬆說話的程度),已經適合從前未有運動習慣的人士;在「舉重」阻力運動時,可控制在40-60% 1RM(即最大可舉起重量的40%-60%),並保持 8-15 次的重複次數、1至3組,以訓練大肌肉群為主。如果病況控制得宜,各項代謝指標例如空腹血糖、血壓均呈現平穩健康的趨勢,才逐步考慮提升強度,得到更佳的運動效率。相反,病況或代謝指標較差的患者,則須經醫生或專業的運動治療師評估,設計合適的運動方案了。

校閱:黃煒燊教授
日期:2025年2月12日

註釋:
[1] Hagberg JM, Park JJ, Brown MD. The role of exercise training in the treatment of hypertension: an update. Sports Med. 2000;30(3):193-206. doi:10.2165/00007256-200030030-00004
[2] 例如接受心血管壓力測試、心電圖、心臟超聲波等檢查,以及排除瓣膜性心臟病(Valvular Disease)、慢性心臟衰竭(Chronic Heart Failure, CHF)和冠狀動脈疾病(Coronary Artery Disease, CAD)的風險。
[3] 努責現象是指人在用力時,屏住呼吸並增加腹內壓的情況。這種現象會導致短暫的血壓上升,隨後可能引起血壓驟降,甚至頭暈或昏厥。

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