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THE EFFICACY OF EXERCISE INTENSITY AND TIME ON STRESS HYPERGLYCEMIA IN PATIENTS AFTER PANCREATICODUODENECTOMY
Qiuju Tian², Minjing Wang^*2, Mingxia Chen², Xueyang Li², Xiaoping Fang^1
1pancreas center, The first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu, China; ²Nanjing Medical University, Nanjing, China

Background
Stress hyperglycemia (SHG) is a state of insulin resistance, impaired glucose tolerance or hyperglycemia resulting from acute and severe illness, trauma and perioperative stress. Although exercise has been confirmed the efficacy of reducing inflammatory reaction and IR, there is little study quantitatively exploring the relationship between exercise intensity and time and SHG after PD.
Objective：
The aim of this study was to investigate the quantitative relationship between exercise intensity and time and SHG after PD, in order to provide clinical nurses with predictive nursing and form an appropriate exercise prescription to maintain SHG.
Methods：
Patients matched inclusion and exclusion standard undergoing PD in pancreas center in the university hospital between March 2016 and February 2017 were prospectively included in current study. Patients were randomly divided into 4 groups corresponding to related exercise program when meeting the condition of mobilization on the third day after PD. Blanked control group five was set up without exercise intervention where both the intensity and time were 0, and the cases were from the first part of this study. Demographic data, other information related to SHG, peripheral BG at 6, 11, 17, 21 o'clock during postoperative 7 days, fasting blood glucose (FBG) on postoperative day (POD) 1, 3 and 7, postoperative complication and postoperative length of hospital stay (LOS) were collected. The efficacy of exercise intensity and time on glycemic lability index (GLI)，FBG and peripheral BG, complication and postoperative LOS were compared.
Results:
There were five groups, including low intensity-15 minutes, low intensity-30 minutes, moderate intensity-15 minutes, moderate intensity-30 minutes and blank group. The values of GLI in each group were 8.35±4.86，5.67±2.52，3.23±1.82，3.35.±2.25, 8.02 ± 6.59 (mmol/L)2/(h*d). There was significance difference in the main effect of exercise intensity on GLI (F=11.091, P=0.001), There was significance difference in GLI between moderate intensity-15 minutes and blank group (P < 0.05).
Conclusion:
Exercise intensity played the role of the main effect on GLI considering the efficacy of exercise intensity and time on SHG. Exercise with moderate intensity-15 minutes was the best program of all for reducing the glycemic variability in patients after PD without increasing the rate of postoperative complication, which deserved to be popularized in clinic.
Keywords：
exercise time; exercise intensity; stress hyperglycemia; pancreaticoduodenec- tomy; glycemic variability

The single-factor multivariate ANOVA for GLI, FBG and BG from the 3rd to 7th day after surgery

Intensity	Time (min)	n	GLI(mmol/L)2/(h*d)	FBGPOD7( mmol/L)	BGAVE(mmol/L)
Low	15	23	8.35 ± 4.86	6.74 ± 1.68	9.03 ± 1.47
	30	21	5.67 ± 2.52	6.34 ± 0.84	8.61 ± 1.05
Moderate	15	22	3.23 ± 1.82	6.24 ± 1.34	8.08 ± 1.16
	30	21	3.35 ± 2.25	6.61 ± 1.00	8.77 ± 1.09
Control group		23	8.02 ± 6.59	7.36 ± 1.06	9.95 ± 2.12
F	Intensity		11.091	0.365	1.210
	Time		2.921	0.013	0.215
	Intensity×Time		1.104	0.847	0.603
P	Intensity		0.001	0.547	0.274
	Time		0.090	0.911	0.644
	Intensity×Time		0.296	0.360	0.439

FBGPOD7: fasting blood gulcose on postoperative day 7 BGAVE: the average blood glucose from the 3rd day to 7th day after PD


The comparison of postoperative complications and postoperative LOS

Intensity	Time (min)	n	complications(with)	complications(without)	Postoperative LOS
low	15	23	11	12	20.48 ± 15.95
	30	21	13	8	16.86 ± 6.79
moderate	15	22	12	10	13.45 ± 3.80
	30	21	14	7	17.00 ± 6.09
Control group		23	11	12	15.13 ± 8.67
F&χ2			1.374		1.759

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