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Abstract
We sought to meta-analyze the effects of different modes of exercise training on measures of glucose control and other risk factors for complications of diabetes. The 27 qualifying studies were controlled trials providing, for each measure, 4-18 estimates for the effect of aerobic training, 2-7 for resistance training, and 1-5 for combined training, with 1,003 type 2 diabetic patients (age 55 +/- 7 years [mean +/- between-study SD]) over 5-104 weeks. The meta-analytic mixed model included main-effect covariates to control for between-study differences in disease severity, sex, total training time, training intensity, and dietary cointervention (13 studies). To interpret magnitudes, effects were standardized after meta-analysis using composite baseline between-subject SD. Differences among the effects of aerobic, resistance, and combined training on HbA(1c) (A1C) were trivial; for training lasting >/=12 weeks, the overall effect was a small beneficial reduction (A1C 0.8 +/- 0.3% [mean +/- 90% confidence limit]). There were generally small to moderate benefits for other measures of glucose control. For other risk factors, there were either small benefits or effects were trivial or unclear, although combined training was generally superior to aerobic and resistance training. Effects of covariates were generally trivial or unclear, but there were small additional benefits of exercise on glucose control with increased disease severity. All forms of exercise training produce small benefits in the main measure of glucose control: A1C. The effects are similar to those of dietary, drug, and insulin treatments. The clinical importance of combining these treatments needs further research.
Highlights
All forms of exercise training produce small benefits in the main measure of glucose control: A1C
Diabetes is a group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both
Physical activity or structured exercise training used alone or in combination with diet, insulin injections, or oral hypoglycemic drugs are the foundations of therapy for type 2 diabetes [3,4]
Summary
Descriptive statistics Six of the 27 publications included in the meta-analysis (Table 1) provided two outcomes (via multiple groups, men and women, 3- and 6-month durations of training, or aerobic and combined training), giving 4 –18 estimates for the effect of aerobic training, 2–7 for resistance training, and 1–5 for combined aerobicresistance training (Table 2; e.g., there were 4 estimates for the effect of aerobic training on systolic blood pressure and 18 for its effect on A1C). Aerobic and combined exercise had clear small or moderate effects on blood pressure, while the effects of resistance exercise were unclear. Moderating effects of study characteristics The effects of initial mean value of A1C and fasting glucose show that there was a small additional benefit of exercise for patients with increased disease severity, whereas the effects on blood lipids were either trivial or unclear. There was a large benefit for male relative to female subjects for insulin sensitivity, but the uncertainty allows for this effect to be trivial through moderate; the other effects of sex were mainly unclear, and all are consistent with trivial or small differences. Higher exercise intensity had a moderately harmful effect on one measure of glucose control; otherwise, the effects were unclear, trivial, or small and beneficial. The unexplained differences between studies represented by the random effect were generally negligible or small, showing that the meta-analytic model adequately accounted for the between-study variation in effects of exercise
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