Page 49 - 2022-19-中国全科医学

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often lacks of individualization and precision. FATmax is a precise and individualized exercise intensity determined on the basis of
individual fat oxidation rate. Objective To compare the effects of aerobic exercise and combined aerobic and resistance exercise at
FATmax intensity on improving the microcirculation in obese college students，and to explore the mechanism of action by analyzing
the changes in nitric oxide（NO），endogenous NO synthase（eNOS），endothelin-1（ET-1） and endothelial growth factor（VEGF）.
Methods In March，2021，Sixty-six obese college students were recruited from Hubei University for Nationalities，and equally
randomized into sex-matched three groups with different 10-week interventions：aerobic exercise group（performing aerobic
exercise at the FATmax intensity，4 times a week，60 minutes each time），combined aerobic and resistance exercise group〔performing
combined aerobic and resistance exercise at FATmax intensity，4 times a week，60 minutes each time（40 minutes for aerobic
exercise and 20 minutes for resistance exercise）〕，and control group（maintaining their normal living habits）. Body weight，
body fat percentage，BMI，microvascular reactivity，transcutaneous oxygen pressure（TcPO 2 ），muscle oxygen saturation
（SmO 2 ），NO，eNOS，ET-1，VEGF and HOMA-IR were tested on March 18 and June 2，2021，respectively. Results
The intervention modality and duration had significant interactive effects on body weight，BMI and body fat percentage of three
groups（P<0.05）. In particular，the average body weight，BMI and body fat percentage decreased significantly in both aerobic
exercise group and combined aerobic and resistance exercise group after the intervention（P<0.05）. What's more，the average
post-intervention levels of the above-mentioned three indicators in the two groups were significantly lower than those of the control
group（P<0.05）. The intervention modality and duration had significant interactive effects on microvascular reactivity，TcPO 2 and
SmO 2 of three groups（P<0.05）. In particular，the average microvascular reactivity，TcPO 2 and SmO 2 increased significantly in
both aerobic exercise group and combined aerobic and resistance exercise group after the intervention（P<0.05）. In addition，the
average post-intervention levels of the average microvascular reactivity and TcPO 2 in the two groups were significantly higher than
those of the control group（P<0.05）. The intervention modality and duration produced obvious interactive effects on NO，eNOS，
VEGF and HOMA-IR of three groups（P<0.05）. In particular，the average NO，eNOS，and VEGF increased significantly and
HOMA-IR decreased significantly in both aerobic exercise group and combined aerobic and resistance exercise group after the
intervention（P<0.05）. Moreover，these two groups showed higher average post-intervention levels of NO and lower average post-
intervention level of HOMA-IR than the control group（P<0.05）. Conclusion Both 10-week aerobic exercise and combined
aerobic and resistance exercise at FATmax intensity could reduce body weight，body fat percentage，BMI and HOMA-IR in obese
college students，and the latter may be more effective in improving microvascular reactivity and HOMA-IR. These two modalities of
exercise improved microcirculation may be by improving the levels of NO，ET-1，VEGF and other factors.
【Key words】 Obesity；Obesity management；Aerobic exercise；Resistance exercise；Maximum fat oxidation
intensity；Microcirculation function

微循环功能障碍可致糖脂代谢紊乱、胰岛素抵抗增 肥胖人群微循环功能尚不明确。此外，对于 FATmax 强
强、外周血管阻力增加，进而导致肥胖的发生，且易诱 度运动影响肥胖人群微循环功能的生物学机制也有待于
发动脉粥样硬化、2 型糖尿病、高血压、非酒精性脂肪 明确。微血管反应性指不同刺激下（如血流阻断、局部
肝等慢性代谢性疾病 ［1-3］ 。随着肥胖程度的加剧，微 组织加热）微血管血流灌注的变化能力，该指标在临床
循环障碍将进一步加重。研究表明，肥胖患者体内微血 已被广泛应用于微循环功能的评价 ［10-11］ 。经皮氧分压
管稀疏和内皮细胞舒张能力明显下降 ［4］ ，且微血管功 （TcPO 2 ）是毛细血管通过皮肤弥散出来的氧气含量，
能障碍程度与肥胖程度呈正相关 ［5］ 。因此，改善肥胖 可用于皮肤血流灌注量和微循环功能的评价 ［10］ 。肌氧
大学生微循环功能有着重要的意义。研究表明，有氧运 饱和度（SmO 2 ）是反映肌肉需氧 - 供氧平衡及肌肉代
动 ［6-7］ 、抗阻运动 ［8］ 等不同运动方式均具有较好的减 谢的重要指标，与 TcPO 2 有着密切关系 ［11］ 。基于此，
脂与减重效果，并能改善肥胖人群微血管内皮细胞功 本研究以 FATmax 为运动强度标准制定有氧运动和有氧
能，但多数研究对于运动强度的制定采用统一的标准， 结合抗阻运动方案，探讨 10 周有氧运动和有氧结合抗
缺乏个体差异性，导致精度不够。最大脂肪氧化强度 阻运动对肥胖大学生微血管反应性、TcPO 2 、SmO 2 的影
（FATmax）是指单位时间内脂肪氧化利用最大化时所 响，并探讨运动改善微循环功能的可能机制，为改善肥
对应的运动强度，该运动强度能有效促进脂肪分解， 胖大学生微循环功能提供运动处方选择依据。
达到较好的减脂效果，同时 FATmax 是基于个体化的脂 1 对象与方法
肪氧化速率而定，为运动强度的精准化、个体化制定提 1.1 研究对象 2021 年 3 月，以湖北民族大学在校大
供了依据 ［9］ 。目前，基于 FATmax 设计的运动方案已 学生为招募对象，经过广告招募、初步体检及心电图检
在肥胖人群中广泛应用，但 FATmax 强度运动能否改善 查等，共计 66 例符合标准的肥胖大学生入选。纳入标