2型糖尿病患者の運動療法アドヒアランスに影響する心理社会的要因

Psychosocial Factors That Influence Adherence to an Exercise Regimen in Individuals with Type 2 Diabetes

要旨

　本研究の目的は，2型糖尿病患者の運動療法におけるアドヒアランスの実態とそれに影響を及ぼす心理社会的要因を明らかにすることである．運動療法を勧められている患者を対象に，自記式質問紙調査と加速度計による身体活動の測定を行った．運動療法への合意がなかった人を除外した131名を対象に，歩数，活発な身体活動を運動療法アドヒアランスの指標とし，ステップワイズ重回帰分析により検討した．

　分析対象者の平均歩数は8,817歩/日，約3METs以上の活発な身体活動は18.7 METs×h/weekであった．運動療法アドヒアランスの高さに最も影響を及ぼしていたのは，運動の自己効力が高いことであった．

　歩数と活発な身体活動はBMIやHbA1cと関連しており，血糖コントロールを良好にするためにも，運動療法アドヒアランスを高めることが必要である．運動療法アドヒアランスを高めるためには，歩数計等を活用し，具体的な数値目標を決め，個人に応じた運動療法を検討することが重要と考える．

Abstract

　The purpose of this study is to clarify the actual situation regarding adherence to an exercise regimen in individuals with type 2 diabetes, and to examine the psychosocial factors that influence this phenomenon. A self-recording questionnaire survey and the measurement of physical activity using an accelerometer were carried out for the patients who had been recommended to participate in exercise regimen. The number of steps walked and the “active physical activity” that the patients participated in the exercise regimen were evaluated as an index of adherence to an exercise regimen by making 131 people who excluded the people who didn't agree on exercise regimen the subject and the findings were then analyzed by a stepwise multiple-regression analysis.

　The average number of steps walked, the active physical activity of about 3 METs or more that the subjects participated in the exercise regimen were as follows:8,817 steps/day, 18.7 METs×h/week, respectively. Self-efficacy for exercise was therefore found to be the factor which most greatly influenced adherence to an exercise regimen.

　The number of steps walked and the active physical activity were found to be related to BMI and HbA1c, therefore it's necessary to raise adherence to an exercise regimen in order to help patients to control their blood sugar levels. In order to raise patient adherence to exercise regimens, we utilized a pedometer, etc., while regarding specific exercise goals in regard to the amount of exercise in numerical targets, it is considered to be important to design exercise regimens according to the needs and abilities of each individual on a case by case basis.