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

Abstract

IntroductionCurrent 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.MethodsWe 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.ResultsA 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.ConclusionCompared 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 registrationOur study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42017067518.Electronic supplementary materialThe online version of this article (10.1186/s12966-018-0703-3) contains supplementary material, which is available to authorized users.

Effectiveness of high‐intensity interval training combined with resistance training versus continuous moderate‐intensity training combined with resistance training in patients with type 2 diabetes: A one‐year randomized controlled trial

“…Thus, there is no information on the long‐term effects of an intervention using an HIIT protocol in type 2 diabetes . It is well established that a combination of aerobic exercise and resistance training (RT) is more beneficial than either alternative alone for improving glycaemic control . However, previous trials have not analysed the effectiveness of HIIT combined with RT concening health‐related variables.…”

“…[10][11][12][13][14][15][16] It is well established that a combination of aerobic exercise and resistance training (RT) is more beneficial than either alternative alone for improving glycaemic control. 7,17,18 However, previous trials have not analysed the effectiveness of HIIT combined with RT concening health-related variables. Therefore, the purpose of this one-year randomized controlled trial was to investigate the effects of HIIT or MCT combined with RT on glycaemic control, body composition, cardiorespiratory fitness (CRF) and enjoyment of physical activity in patients with type 2 diabetes.…”

Identification of 17 mRNAs and a miRNA as an integrated prognostic signature for lung squamous cell carcinoma

“…The statistical heterogeneity of different studies was assessed by Cochran's Q statistic and I 2 statistics, which were quantitative measures of consistency across studies. When the p value of Q test ≥ 0.10 and I 2 < 31%, the heterogeneity was considered low and, when the p < 0.10 and I 2 > 56%, the heterogeneity was considered high . In addition, when the heterogeneity was low across different studies, a fixed model was applied; in other cases, a random model was used to pool the data.…”

Trends in Shared Decision-Making Studies From 2009 to 2018: A Bibliometric Analysis

“…However, most published key papers are included in the WoS database, and moreover, the WoS is the most commonly used database in bibliometrics analysis (9,10). Secondly, all datasets were identified using computer software or tool, such as VOSviewer, CiteSpace, and WoS, rather than being selected and collected manually, and manual selection and collection of datasets is required for systematic reviews or overviews (36)(37)(38)(39)(40); therefore, these datasets may be subject to bias (e.g., irrelevant studies may be included), although this would not affect the trends identified and conclusions of the present study. Finally, data generated from studies published in the current year (2019) were not included in our analysis as the dataset for this year is incomplete.…”