Association of traditional Chinese exercises with glycemic responses in people with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials

Abstract

BackgroundThere is increasing evidence showing the health benefits of various forms of traditional Chinese exercises (TCEs) on the glycemic profile in people with type 2 diabetes. However, relatively little is known about the combined clinical effectiveness of these traditional exercises. This study was designed to perform a systematic review and meta-analysis of the overall effect of 3 common TCEs (Tai Ji Quan, Qigong, Ba Duan Jin) on glycemic control in adults with type 2 diabetes.MethodsWe conducted an extensive database search in Cochrane Library, EMBASE, PubMed, Web of Science, EBSCO, and China National Knowledge Infrastructure on randomized controlled trials published between April 1967 and September 2017 that compared any of the 3 TCEs with a control or comparison group on glycemic control. Data extraction was performed by 2 independent reviewers. Study quality was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions, which assessed the risk of bias, including sequence generation, allocation concealment, blinding, completeness of outcome data, and selective outcome reporting. The resulting quality of the reviewed studies was characterized in 3 grades representing the level of bias: low, unclear, and high. All analyses were performed using random effects models and heterogeneity was quantified. We a priori specified changes in biomarkers of hemoglobin A1c (in percentage) and fasting blood glucose (mmol/L) as the main outcomes and triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein-cholesterol, 2-h plasma glucose, and fasting plasma glucose as secondary outcomes.ResultsA total of 39 randomized, controlled trials (Tai Ji Quan = 11; Qigong = 6; Ba Duan Jin = 22) with 2917 type 2 diabetic patients (aged 41–80 years) were identified. Compared with a control or comparison group, pooled meta-analyses of TCEs showed a significant decrease in hemoglobin A1c (mean difference (MD) = −0.67%; 95% confidence interval (CI): −0.86% to −0.48%; p < 0.00001) and fasting blood glucose (MD = −0.66 mmol/L; 95%CI: −0.95 to −0.37 mmol/L; p < 0.0001). The observed effect was more pronounced for interventions that were medium range in duration (i.e., >3–<12 months). TCE interventions also showed improvements in the secondary outcome measures. A high risk of bias was observed in the areas of blinding (i.e., study participants and personnel, and outcome assessment).ConclusionAmong patients with type 2 diabetes, TCEs were associated with significantly lower hemoglobin A1c and fasting blood glucose. Further studies to better understand the dose and duration of exposure to TCEs are warranted.

Characteristic of Clinical Studies on Baduanjin during 2000–2019: A Comprehensive Review

“…Baduanjin is a low-intensity aerobic exercise, which is characterized by a slow coordinated posture combined with musculoskeletal stretching movements, meditation minds, and breathing techniques. Several recent research studies have shown that practicing Baduanjin can relieve musculoskeletal pain [ 17 – 19 ], adjust blood pressure, glucose, and lipid [ 4 , 8 , 20 ], enhance cardiopulmonary function [ 7 , 21 ], and improve sleep quality by relaxing the mental state and regulating breathing [ 22 , 23 ].…”

“…To date, a growing number of clinical studies have demonstrated the safety and health benefits from Baduanjin intervention [ 2 , 3 ]. Several systematic reviews have examined the evidence provided by Baduanjin in randomized controlled trials or nonrandomized clinical trials for various specific diseases and health conditions, such as diabetes mellitus [ 4 – 6 ], chronic obstructive pulmonary disease (COPD) [ 7 ], and cardiovascular disease [ 8 , 9 ]. It is particularly worth noting the coronavirus disease 2019 (COVID-19) that broke out in Wuhan, China; some of the discharged patients in 2019 novel coronavirus (2019-nCoV) still have clinical manifestations such as fatigue, anorexia, and emotional abnormalities, with varying degrees of impaired lung function, changes in interstitial pneumonia, and the possibility of pulmonary fibrosis.…”

Mechanism of increased risk of insulin resistance in aging skeletal muscle

“…In addition, there are nonpharmacological treatments, such as exercise, that can prevent and treat insulin resistance in aging skeletal muscle. Studies have shown that exercise can increase skeletal muscle mass and improve skeletal muscle insulin sensitivity [36,65,88]. Exercise can also enhance mitochondrial oxidative capacity, enhance skeletal muscle autophagy and antioxidant capacity, reduce oxidative stress and inflammation levels [36,74], and improve skeletal muscle insulin resistance.…”

Whole-body vibration exercise for low back pain

“…Regardless of the amount of data available for the quantitative analyses and data summary, the overall quality of the evidence for each outcome will be assessed. The Grading of Recommendations Assessment, Development, and Evaluation approach [ 35 ] will be used to assess the overall quality of the evidence by employing the adopted version of the criteria advocated by the Cochrane Back Review Group. [ 36 ] The factors that may decrease the quality of the evidence are the study design and risk of bias, inconsistency of the results, indirectness (not generalizable), imprecision (sparse data), and others (e.g., reporting bias).…”