Exercise modalities for type 2 diabetes: A systematic review and network meta‐analysis of randomized trials

Abstract

Aims:We aimed to determine the effects of different exercise modalities in patients with type 2 diabetes mellitus (T2DM). Methods:We searched PubMed, Embase, and the Cochrane Library from their inception until July 2020 to identify randomised controlled trials (RCTs) on exercise in adults with T2DM. Paired reviewers independently performed study selection, data extraction, and risk of bias assessment. The certainty of the evidence was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework.Results: A total of 106 RCTs that enroled eight exercise modalities with 7438 patients were included. Six exercise modalities, except unsupervised aerobic/resistance exercise, significantly reduced glycosylated haemoglobin (HbA1c), with mean differences (MDs) ranging from 0.71 (95% confidence interval [CI]: 0.34-1.08) to 0.34 (95% CI: 0.17-0.52), low to high certainty, in comparison with no exercise. The evidence of low to moderate certainty showed that supervised aerobic/resistance exercise improved glycaemic control, body weight, blood pressure, and blood lipid profiles compared with no exercise. Flexibility exercise may be associated with glycaemic control (HbA1c: MD = 0.71, 95% CI: 0.34-1.08); fasting plasma glucose (MD = 1.48, 95% CI: 0.78-2.17), and weight loss (MD = 1.80, 95% CI: 0.85-2.75) compared with controls, but not blood pressure and lipid profiles. Balance exercise showed the largest benefit in improving total cholesterol (MD = 52.81, 95% CI: 28.47-77.16) and low certainty. We found no significant differences between exercises and the triacylglycerol (TG) level.Conclusions: Overall, our network meta-analyses support the recommendation for exercise in patients with T2DM, especially supervised exercises. Limited evidence supports the benefits of flexibility and balance exercises. The effectiveness of exercise modalities for TG reduction remains unclear.

Effects of exercise, metformin, and their combination on glucose metabolism in individuals with impaired glycemic control: A systematic review and network meta-analysis

“…They found that flexibility exercise was the most effective exercise for reducing fasting glucose (–1.48 [–2.17 to –0.78] mmol/L) and HbA1c (–0.71 [–1.08 to –0.34] %) in T2DM patients, while only 2 studies were included to support this finding. 20 However, our results on aerobic exercise, resistance exercise, and combined exercise were in line with existing meta-analyses indicating that combined exercise was superior than performing each mode alone. 18,19 Our findings regarding aerobic interval vs continuous exercise on HbA1c were also consistent with a previous pairwise meta-analysis.…”

“…We found that combined exercise (i.e., exercise training comprising several types of exercise, mainly aerobic + resistance) and aerobic interval exercise might be the most effective exercise modalities for prediabetes and T2DM, respectively. Several meta-analyses have been conducted to investigate the best exercise modality, 18–20 while the classification of exercise modality in those studies differed from ours, leading to the inconsistency of the results. For example, one recent network meta-analysis categorized exercise into eight modalities (i.e., supervised aerobic, unsupervised aerobic, anaerobic, balance, supervised resistance, unsupervised resistance, combined aerobic and resistance, and flexibility exercise).…”

“…comparing supervised versus unsupervised training or only focusing on aerobic versus resistance exercise but without specifying intensity domains) and exclusively concentrated on individuals diagnosed with T2DM. 18–20 Thus, it remains elusive as to which is the most efficient exercise modality for the population with varying degrees of impaired glycemic control (i.e., prediabetes and T2DM).…”

Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies

“…Several RCTs have investigated whether exercise interventions (up to 96 weeks), involving either aerobic or resistance training alone, or in combination, can improve markers of metabolic health in older adults with T2DM [165][166][167][168][169][170]. Overall, these studies provide evidence that in those with T2DM, both supervised aerobic and resistance training are effective for improving HbA1c and fasting blood glucose levels [171]. In a RCT of 100 adults aged ≥55 years with T2DM, the effects of three different 16-week exercise interventions (aerobic exercise, resistance exercise, or a combination of both [same intensity but half the volume of other exercise groups]) on various metabolic health markers were compared with a control group encouraged to perform low-to-moderate intensity aerobic activities (e.g., brisk walking, cycling) for 150 minutes per week [165].…”

Effect of exercise training on heath, quality of life, exercise capacity in juvenile idiopathic arthritis: a meta-analysis of randomized controlled trials

“…However, medications usually have several side effects, may be ineffective, and can further exacerbate the disease, leading to JIA joint damage or even irreversible disability [ 11 ]. Exercise is a physical activity that maintains or enhances physical health and is characterized by a variety of forms, a broad audience, few side effects, and high operability, and is widely used in various disease areas such as obesity, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, osteoporosis, cancer, and low back pain [ 12 – 16 ]. In children with JIA, the muscles around the affected joints are usually wasted, leading to low bone density and, consequently, to osteoporosis in adulthood [ 17 ].…”