运动结合健康教育对社区中老年高血压患者疗效的研究
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摘要
目的1.评价运动干预结合健康教育对社区中老年高血压患者临床指标(收缩压、舒张压、空腹血糖、餐后2小时血糖、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、体质指数、腰臀比)及心理状态的影响效果,为高血压病的有效干预提供依据。2.探讨干预前后各项指标的变化对血压水平改变的影响。3.评估运动干预结合健康教育对社区中老年高血压患者高血压病相关知识的认知、态度及行为的影响,以提高人群对高血压病的知晓率和认知率。4.探讨个人的知识、认知、态度对运动干预效果的影响。
方法采取整群抽样的方法从天津市南开区王顶堤社区抽取3个经济卫生条件相近的小区(淦江东里小区、堡山北里小区、园荫里小区),结合基线资料、1999年世界卫生组织推荐的高血压诊断标准、本次研究的纳入标准和排除标准、从中选取160例愿意参与本研究的中老年高血压患者作为研究样本,随机分为试验组和对照组,对照组不给予任何干预措施,试验组给予每周3次为期6个月的强化运动干预及每月2次的高血压相关知识健康教育。考虑伦理学问题干预结束后在对照组开展高血压健康知识讲座。干预前后采用一般情况量表、焦虑自评量表(SAS)、高血压知识态度行为量表对受试者进行问卷调查,并测量患者血压、血糖、血脂、体质指数、腰臀比、高血压相关知识的KAB评分及心理量分。比较两组患者干预前后临床指标值、心理状态及干预前后知识、态度、行为的改变,并分析影响运动干预效果的因素。采用SPSS17.0统计软件对资料进行统计学分析,统计方法包括t检验、卡方检验、Wilcoxon秩和检验、Kruskal-Wallis秩和检验、重复测量方差分析、双变量关联性分析及多元线性回归分析。
结果1.干预组与对照组研究对象在年龄、性别、民族、职业、文化程度、收入水平、构成比上没有统计学差异(P>0.05),基线干预组与对照组一般人口学特征均衡可比。
2.干预前干预组与对照组研究对象收缩压、舒张压、体质指数、腰臀比、空腹血糖、餐后2小时血糖、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白之间的差异没有统计学意义(P>0.05),基线干预组与对照组临床指标值均衡可比。
3.干预组与对照组干预前后收缩压、舒张压、空腹血糖、餐后2小时血糖、胆固醇、甘油三酯、心理评分的变化有显著性差异(P<0.05),干预组与对照组干预前后体质指数、腰臀比、低密度脂蛋白、高密度脂蛋白的变化差异没有统计学意义(P>0.05)。
4.干预前后干预组与对照组高血压病相关知识得分差值的比较,可见将两组干预前后KAB得分差值进行t检验差异有统计学意义(P<0.05)。两组患者K、A、B得分的重复测量方差分析结果显示,患者的KAB得分除了B得分外,不同的干预方法存在组间差别(均P<0.05)；干预前后的得分有差别(均P<0.05)；干预前后与处理存在交互作用(均P<0.05)。将所收集的问卷进行Wilcoxon秩和检验、Kruskal-Wallis秩和检验,比较影响因素与干预前后得分差值的关系,不同年龄、性别、民族、职业、文化程度、收入水平对高血压知识的掌握和认知均没有明显区别,差异无统计学意义(均P>0.05)。
5.干预前后高血压知识总分的变化与干预前后收缩压、空腹血糖、餐后2小时血糖、甘油三酯的变化存在明显正相关性(rs>0,P<0.05),与干预前后心理评分的变化存在明显负相关(rs<0,P<0.05)。
6.多元线性逐步回归分析发现,干预组与对照组患者收缩压干预前后的差值与干预前后的体质指数、腰臀比、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、空腹血糖、餐后2小时血糖、KAB得分、心理评分的差值均有关,逐步回归方程有统计学意义(F=3.233,P=0.001)。舒张压干预前后的差值与干预前后的体质指数、腰臀比、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、空腹血糖、餐后2小时血糖、KAB得分、心理评分的差值均有关,逐步回归方程有统计学意义(F=3.154,P=0.001)。
结论1.运动干预有助于提高高血压患者的临床疗效,有效地降低高血压患者的收缩压、舒张压、空腹血糖、餐后2小时血糖、胆固醇及甘油三酯,从而降低与心血管相关的危险指标,改善代谢水平。而长达6个月的运动干预对于降低高血压患者的低密度脂蛋白和提高高血压患者的高密度脂蛋白效果不显著。
2.运动干预与社区干预中最常见的方法——健康教育相结合,可提高运动干预组研究对象的依从性,容易使运动干预的效果发挥到最大,并有效提高患者对高血压病相关知识的认知水平。
3.提高高血压患者对高血压病相关知识的得分,有助于降血压、降血糖、降血酯,并改善高血压患者的心理状况,提高治疗疾病的信心。
4.干预前后高血压患者收缩压、舒张压的降低受患者的体质指数、腰臀比、胆固醇、甘油三酯、空腹血糖、餐后2小时血糖、KAB得分、心理评分的变化的影响。
Objective:1.To evaluate the effects of exercise intervention combined with health education on clinical indicators (including:systolic blood pressure, diastolic blood pressure, fasting plasma glucose, two-hour postprandial plasma glucose, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, BMI, WHR.) and psychological state of the community middle-aged and elderly hypertension patients,in order to provide a basis for effective interventions in hypertensive patients.2.To explore the effects of changes in the indicators on blood pressure changes before and after intervention.3.To assess the effects of the intervention on hypertension-related knowledge, awaress, attitude and behaveiors in middle-aged and elderly hypertension patients.
Methods:Three communities of the similar economic condition were selected by cluster sampling from Wangdingdi community of Nankai District in Tianjin,according to the baseline data of physical eaxamination. Diagnostic criteria for hypertension recommended by the World Health Organization in 1999 was adopted.160 hypertension patients who were willing to participate in this study were chosen as the subjects. They were randomly divided into experimental group and control group.The control group was not given any intervention and the experimental group was given intensive exercise intervention three times per week for six months. At the same time the experimental group was asked to take part in the hypertension-related health education two times per month. Considering the ethical issue, the control group was given lectures about knowledge of hypertension after the program. Before and after the intervention, the general situation and the psychological states of of the hypertension patients were investigated by a questionnaires survey of hypertension-r elated knowledge scale. Blood pressure, blood glucose, blood lipids, weight and height, waist-hip ratio, hypertension-related knowledge score and psychological score were measured. The changes of all the indices, the psychological score and hypertens ion-related knowledge score after six months'exercise intervention were ana lyzed with SPSS17.0 statistical software,including t test, chi-square test,repeated measure ment analysis of variance, Wilcoxon rank test and Kruskal-Wallis rank test, bivariate correlation analysis, multiple linear stepwise regressions.
Results:1.There were no statistically differences between intervention group subjects and control group subjects in constituent ratios of age, gender, nationality, occupation, education level, income level (all P>0.05) at baseline.
2.There were no statistically differences between intervention group subjects and control group subjects in systolic blood pressure, diastolic blood pressure, BMI, WHR,fasting plasma glucose, two-hour postprandial plasma glucose, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein before the invertention (all P>0.05)
3.The changes compared before and after intervention there were statistically differences between intervention group subjects and control group subjects in systolic blood pressure, diastolic blood pressure, fasting plasma glueose, two-hour postprandial plasma glucose, total cholesterol, triglyceride,psychological score (all P <0.05). The changes compared before and after intervention there were no statistically difference between intervention group subjects and control group subjects in BMI, WHR high-density lipoprotein, low-density lipoprotein (all P>0.05)
4.There was statistically difference between intervention group subjects and control group subjects in the scores of hypertension knowledge by t test (P< 0.05).From the multiple linear stepwise regression analysis,except for the behavior scores, statistical differences existed in the knowledge scores and the attitude scores between groups of different intervention (all P<0.05). Statistical differences existed in the knowledge scores and the attitude scores between groups before and after intervention (all P<0.05), furthermore,there was an interaction effect between intervention and time (all P<0.05).According to Wilcoxon rank test and Kruskal-Wallis rank test analysis, it was found that no statistically significant changes happened in hypertension-related knowledge of age, gender, nationality occupation, education level, income level (all P>0.05)
5.There were significant positive correlations between the changes in total score of hypertension knowledge and the changes in systolic blood pressure, fasting glucose, two-hour postprandial plasma glucose, triglyceride before and after the intervention (all rs>0,P<0.05).There were significant negative correlations between the changes in total score of hypertension knowledge and the changes in psychological score (all rs<0,P<0.05)
6.According to the multiple linear stepwise regression, the difference of the systolic blood pressure before and after the intervention was related to the differences of BMI,WHR,total cholesterol,triglyceride,high-density lipoprotein,low-density lipo protein,fasting plasma glueose,two-hour postprandial plasma glucose,hypertension-related knowledge score, psychological score before and after the intervention respectively. Stepwise regression equation was statistically significant (F=3.233, P=0.001).The difference of the diastolic blood pressure before and after the intervention was related to the differences of BMI,WHR, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, fasting plasma glueose, two-hour postprandial plasma glucose, hypertension-related knowledge score, psychological score before and after the intervention respectively. Stepwise regression equation was statistically significant (F=3.154, P=0.001)
Conclusion:1.Exercise intervention can be helpful to improve the clinical effects of treatment of hypertensives. It is of effectiveness in reducing the levels of systolic blood pressure, diastolic blood pressure, fasting plasma glucose, two-hour postprandial plasma glucose, total cholesterol, triglyceride. But they were not found that the levels of low-density lipoprotein and increasing high-density lipoprotein have decreased in 6 months'intervention.
2.The combination of exercise intervention and health education can improve the compliance of the subjects to participate in it. And it can make the effects much better and the hypertension-related knowledge improved.
3.Increase of patients' hypertension-related knowledge level can be helpful to lower the levels of systolic blood pressure, diastolic blood pressure, fasting plasma glucose, two-hour postprandial plasma glucose, total cholesterol, triglyceride, etc. It also can improve the psychological status of hypertension and enhance the confidence in treatment of hypertension.
4.The changes in BMI, WHR, total cholesterol, triglyceride fasting plasma glucose, two-hour postprandial plasma glucose, hypertension-related knowledge score, psychological score before and after the intervention can reduce systolic blood pressure and diastolic blood pressure levels.
方法采取整群抽样的方法从天津市南开区王顶堤社区抽取3个经济卫生条件相近的小区(淦江东里小区、堡山北里小区、园荫里小区),结合基线资料、1999年世界卫生组织推荐的高血压诊断标准、本次研究的纳入标准和排除标准、从中选取160例愿意参与本研究的中老年高血压患者作为研究样本,随机分为试验组和对照组,对照组不给予任何干预措施,试验组给予每周3次为期6个月的强化运动干预及每月2次的高血压相关知识健康教育。考虑伦理学问题干预结束后在对照组开展高血压健康知识讲座。干预前后采用一般情况量表、焦虑自评量表(SAS)、高血压知识态度行为量表对受试者进行问卷调查,并测量患者血压、血糖、血脂、体质指数、腰臀比、高血压相关知识的KAB评分及心理量分。比较两组患者干预前后临床指标值、心理状态及干预前后知识、态度、行为的改变,并分析影响运动干预效果的因素。采用SPSS17.0统计软件对资料进行统计学分析,统计方法包括t检验、卡方检验、Wilcoxon秩和检验、Kruskal-Wallis秩和检验、重复测量方差分析、双变量关联性分析及多元线性回归分析。
结果1.干预组与对照组研究对象在年龄、性别、民族、职业、文化程度、收入水平、构成比上没有统计学差异(P>0.05),基线干预组与对照组一般人口学特征均衡可比。
2.干预前干预组与对照组研究对象收缩压、舒张压、体质指数、腰臀比、空腹血糖、餐后2小时血糖、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白之间的差异没有统计学意义(P>0.05),基线干预组与对照组临床指标值均衡可比。
3.干预组与对照组干预前后收缩压、舒张压、空腹血糖、餐后2小时血糖、胆固醇、甘油三酯、心理评分的变化有显著性差异(P<0.05),干预组与对照组干预前后体质指数、腰臀比、低密度脂蛋白、高密度脂蛋白的变化差异没有统计学意义(P>0.05)。
4.干预前后干预组与对照组高血压病相关知识得分差值的比较,可见将两组干预前后KAB得分差值进行t检验差异有统计学意义(P<0.05)。两组患者K、A、B得分的重复测量方差分析结果显示,患者的KAB得分除了B得分外,不同的干预方法存在组间差别(均P<0.05)；干预前后的得分有差别(均P<0.05)；干预前后与处理存在交互作用(均P<0.05)。将所收集的问卷进行Wilcoxon秩和检验、Kruskal-Wallis秩和检验,比较影响因素与干预前后得分差值的关系,不同年龄、性别、民族、职业、文化程度、收入水平对高血压知识的掌握和认知均没有明显区别,差异无统计学意义(均P>0.05)。
5.干预前后高血压知识总分的变化与干预前后收缩压、空腹血糖、餐后2小时血糖、甘油三酯的变化存在明显正相关性(rs>0,P<0.05),与干预前后心理评分的变化存在明显负相关(rs<0,P<0.05)。
6.多元线性逐步回归分析发现,干预组与对照组患者收缩压干预前后的差值与干预前后的体质指数、腰臀比、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、空腹血糖、餐后2小时血糖、KAB得分、心理评分的差值均有关,逐步回归方程有统计学意义(F=3.233,P=0.001)。舒张压干预前后的差值与干预前后的体质指数、腰臀比、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、空腹血糖、餐后2小时血糖、KAB得分、心理评分的差值均有关,逐步回归方程有统计学意义(F=3.154,P=0.001)。
结论1.运动干预有助于提高高血压患者的临床疗效,有效地降低高血压患者的收缩压、舒张压、空腹血糖、餐后2小时血糖、胆固醇及甘油三酯,从而降低与心血管相关的危险指标,改善代谢水平。而长达6个月的运动干预对于降低高血压患者的低密度脂蛋白和提高高血压患者的高密度脂蛋白效果不显著。
2.运动干预与社区干预中最常见的方法——健康教育相结合,可提高运动干预组研究对象的依从性,容易使运动干预的效果发挥到最大,并有效提高患者对高血压病相关知识的认知水平。
3.提高高血压患者对高血压病相关知识的得分,有助于降血压、降血糖、降血酯,并改善高血压患者的心理状况,提高治疗疾病的信心。
4.干预前后高血压患者收缩压、舒张压的降低受患者的体质指数、腰臀比、胆固醇、甘油三酯、空腹血糖、餐后2小时血糖、KAB得分、心理评分的变化的影响。
Objective:1.To evaluate the effects of exercise intervention combined with health education on clinical indicators (including:systolic blood pressure, diastolic blood pressure, fasting plasma glucose, two-hour postprandial plasma glucose, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, BMI, WHR.) and psychological state of the community middle-aged and elderly hypertension patients,in order to provide a basis for effective interventions in hypertensive patients.2.To explore the effects of changes in the indicators on blood pressure changes before and after intervention.3.To assess the effects of the intervention on hypertension-related knowledge, awaress, attitude and behaveiors in middle-aged and elderly hypertension patients.
Methods:Three communities of the similar economic condition were selected by cluster sampling from Wangdingdi community of Nankai District in Tianjin,according to the baseline data of physical eaxamination. Diagnostic criteria for hypertension recommended by the World Health Organization in 1999 was adopted.160 hypertension patients who were willing to participate in this study were chosen as the subjects. They were randomly divided into experimental group and control group.The control group was not given any intervention and the experimental group was given intensive exercise intervention three times per week for six months. At the same time the experimental group was asked to take part in the hypertension-related health education two times per month. Considering the ethical issue, the control group was given lectures about knowledge of hypertension after the program. Before and after the intervention, the general situation and the psychological states of of the hypertension patients were investigated by a questionnaires survey of hypertension-r elated knowledge scale. Blood pressure, blood glucose, blood lipids, weight and height, waist-hip ratio, hypertension-related knowledge score and psychological score were measured. The changes of all the indices, the psychological score and hypertens ion-related knowledge score after six months'exercise intervention were ana lyzed with SPSS17.0 statistical software,including t test, chi-square test,repeated measure ment analysis of variance, Wilcoxon rank test and Kruskal-Wallis rank test, bivariate correlation analysis, multiple linear stepwise regressions.
Results:1.There were no statistically differences between intervention group subjects and control group subjects in constituent ratios of age, gender, nationality, occupation, education level, income level (all P>0.05) at baseline.
2.There were no statistically differences between intervention group subjects and control group subjects in systolic blood pressure, diastolic blood pressure, BMI, WHR,fasting plasma glucose, two-hour postprandial plasma glucose, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein before the invertention (all P>0.05)
3.The changes compared before and after intervention there were statistically differences between intervention group subjects and control group subjects in systolic blood pressure, diastolic blood pressure, fasting plasma glueose, two-hour postprandial plasma glucose, total cholesterol, triglyceride,psychological score (all P <0.05). The changes compared before and after intervention there were no statistically difference between intervention group subjects and control group subjects in BMI, WHR high-density lipoprotein, low-density lipoprotein (all P>0.05)
4.There was statistically difference between intervention group subjects and control group subjects in the scores of hypertension knowledge by t test (P< 0.05).From the multiple linear stepwise regression analysis,except for the behavior scores, statistical differences existed in the knowledge scores and the attitude scores between groups of different intervention (all P<0.05). Statistical differences existed in the knowledge scores and the attitude scores between groups before and after intervention (all P<0.05), furthermore,there was an interaction effect between intervention and time (all P<0.05).According to Wilcoxon rank test and Kruskal-Wallis rank test analysis, it was found that no statistically significant changes happened in hypertension-related knowledge of age, gender, nationality occupation, education level, income level (all P>0.05)
5.There were significant positive correlations between the changes in total score of hypertension knowledge and the changes in systolic blood pressure, fasting glucose, two-hour postprandial plasma glucose, triglyceride before and after the intervention (all rs>0,P<0.05).There were significant negative correlations between the changes in total score of hypertension knowledge and the changes in psychological score (all rs<0,P<0.05)
6.According to the multiple linear stepwise regression, the difference of the systolic blood pressure before and after the intervention was related to the differences of BMI,WHR,total cholesterol,triglyceride,high-density lipoprotein,low-density lipo protein,fasting plasma glueose,two-hour postprandial plasma glucose,hypertension-related knowledge score, psychological score before and after the intervention respectively. Stepwise regression equation was statistically significant (F=3.233, P=0.001).The difference of the diastolic blood pressure before and after the intervention was related to the differences of BMI,WHR, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, fasting plasma glueose, two-hour postprandial plasma glucose, hypertension-related knowledge score, psychological score before and after the intervention respectively. Stepwise regression equation was statistically significant (F=3.154, P=0.001)
Conclusion:1.Exercise intervention can be helpful to improve the clinical effects of treatment of hypertensives. It is of effectiveness in reducing the levels of systolic blood pressure, diastolic blood pressure, fasting plasma glucose, two-hour postprandial plasma glucose, total cholesterol, triglyceride. But they were not found that the levels of low-density lipoprotein and increasing high-density lipoprotein have decreased in 6 months'intervention.
2.The combination of exercise intervention and health education can improve the compliance of the subjects to participate in it. And it can make the effects much better and the hypertension-related knowledge improved.
3.Increase of patients' hypertension-related knowledge level can be helpful to lower the levels of systolic blood pressure, diastolic blood pressure, fasting plasma glucose, two-hour postprandial plasma glucose, total cholesterol, triglyceride, etc. It also can improve the psychological status of hypertension and enhance the confidence in treatment of hypertension.
4.The changes in BMI, WHR, total cholesterol, triglyceride fasting plasma glucose, two-hour postprandial plasma glucose, hypertension-related knowledge score, psychological score before and after the intervention can reduce systolic blood pressure and diastolic blood pressure levels.
引文
[1]Chobanian,A.V,G.L.Bakris,H.R.Blaek,et al. and the National High Blood Pressure Edueation Program Coordinating Committee:the Seventh Report of the Joint National Committee on Prevention,Deteetion,Evaluation,and Treatment of High Blood Pressure.The JNC 7 Report Hypertens.2003,42:1206-1252.
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