Abstract P345: Physical Activity and Cardiorespiratory Fitness Among Adolescents With Type 1 and Type 2 Diabetes: A Systemic Review and Meta-Analysis

Abstract

Background: Physical activity (PA) is a cornerstone in the management of pediatric diabetes, due in part to a dose-response effect on cardiorespiratory fitness (CRF). The extent to which PA and CRF is impaired in children and adolescents with diabetes remains unclear. Hypothesis: We hypothesized that PA and CRF would be lower in children and adolescents with type 1 (T1D) and (T2D) compared to controls. Design and Methods: To test this hypothesis we conducted a systematic review of observational studies in MEDLINE, Embase, the Cochrane Library, and CINAHL from 2000 to April 2022. Cross sectional studies that reported PA and/or CRF for children and adolescents (0-21 years) with T1D, T2D and controls without diabetes were included in the analysis. We excluded studies in adults and those that did not differentiate diabetes type. The main outcomes of interest were objective or subjective measures of PA and direct or indirect measures of CRF. Co-variates extracted from each manuscript included body mass index, sex, measures of socio-economic status, age and ethnicity. A modified risk of bias tool was used to assess the methodological quality of each study. (Prospero registration: CRD42022329303). We used an inverse variance weighted meta-analysis to estimate effect size and precision effects. A random effects model was used. Results: Of 7857 citations retrieved, we included 42 studies with T1D (n=4027 with T1D, n=9699 controls) and 14 studies with T2D (n=581 with T2D, n=1008 controls). 26 and 2 studies included direct and indirect measures of cardiorespiratory fitness respectively. 14 and 26 studies include objective and subjective measures of PA respectively. The standardized mean difference (SMD) was PA [-0.28; 95% CI: -0.46, -0.10; I 2 = 89%] and CRF [-0.30; 95% CI: -0.66, 0.06; I 2 = 92%] were lower children and adolescents with for T1D compared to controls. The SMD for PA [-0.61; 95% CI: -0.98, -0.24; I 2 = 89%] and CRF [-1.20; 95% CI: -1.73, -0.67; I 2 = 91%] were also lower for children and adolescents with T2D compared to controls. The majority of studies were considered a high risk of bias. Conclusions: Children and adolescents with T1D display modestly lower daily PA and CRF compared to controls. Deficits in PA and CRF are more profound among children and adolescents with T2D.