Journal Article

Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis

Tian, Jin-hui, Gao, Cai-yun, Xun, Yang-qin, Ding, Guo-wu, Yang, Ke-hu, Shan, Hou-qian, Ge, Long, Han, Xue, Zuo, Li-qian, Pan, Bei, Chen, Ya-jing

2018

Overview

Introduction Current international guidelines recommend aerobic, resistance, and combined exercises for the management of type 2 diabetes mellitus (T2DM). In our study, we conducted a network meta-analysis to assess the comparative impact of different exercise training modalities on glycemic control, cardiovascular risk factors, and weight loss in patients with T2DM. Methods We searched five electronic databases to identify randomized controlled trials (RCTs) that compared the differences between different exercise training modalities for patients with T2DM. The risk of bias in the included RCTs was evaluated according to the Cochrane tool. Network meta-analysis was performed to calculate mean difference the ratio of the mean and absolute risk differences. Data were analyzed using R-3.4.0. Results A total of 37 studies with 2208 patients with T2DM were included in our study. Both supervised aerobic and supervised resistance exercises showed a significant reduction in HbA1c compared to no exercise (0.30% lower, 0.30% lower, respectively), however, there was a less reduction when compared to combined exercise (0.17% higher, 0.23% higher). Supervised aerobic also presented more significant improvement than no exercise in fasting plasma glucose (9.38 mg/dl lower), total cholesterol (20.24 mg/dl lower), triacylglycerol (19.34 mg/dl lower), and low-density lipoprotein cholesterol (11.88 mg/dl lower). Supervised resistance showed more benefit than no exercise in improving systolic blood pressure (3.90 mmHg lower]) and total cholesterol (22.08 mg/dl lower]. In addition, supervised aerobic exercise was more powerful in improving HbA1c and weight loss than unsupervised aerobic (HbA1c: 0.60% lower; weight loss: 5.02 kg lower) and unsupervised resistance (HbA1c: 0.53% lower) exercises. Conclusion Compared with either supervised aerobic or supervised resistance exercise alone, combined exercise showed more pronounced improvement in HbA1c levels; however, there was a less marked improvement in some cardiovascular risk factors. In terms of weight loss, there were no significant differences among the combined, supervised aerobic, and supervised resistance exercises. Trial registration Our study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42017067518 .

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aerobics / Aged / Behavioral Sciences / blood glucose / Blood Glucose - metabolism / Blood Pressure / Cardiovascular risk factors / Care and treatment / Cholesterol / Cholesterol, LDL - blood / Clinical Nutrition / Comparative analysis / data analysis / Development and progression / Diabetes / Diabetes Mellitus, Type 2 - blood / Diabetes Mellitus, Type 2 - therapy / Disease management / Exercise / Exercise Therapy - methods / Exercise training / Female / Fitness training programs / Frequentist network meta-analysis / Glucose / Glycated Hemoglobin - metabolism / Glycemic control / Health Promotion and Disease Prevention / Humans / Lipids - blood / low density lipoprotein cholesterol / Male / Medicine / Medicine & Public Health / Meta-analysis / Metabolism / Middle Aged / patients / Physical fitness / protocols / Quality of life / randomized clinical trials / Resistance Training / Review / risk factors / Strength training / Studies / Systematic review / systolic blood pressure / triacylglycerols / Type 2 diabetes / Type 2 diabetes mellitus / Weight Loss / Yang, Cindy