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Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis.
Int J Behav Nutr Phys Act 2018; 15(1):72IJ

Abstract

INTRODUCTION

Current 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.

METHODS

We 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.

RESULTS

A 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.

CONCLUSION

Compared 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 REGISTRATION

Our study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42017067518 .

Authors+Show Affiliations

Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000, China.Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000, China. The First Clinical Medical College, Lanzhou University, Lanzhou, 730000, China. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Dong gang West Road, Chengguan District, Lanzhou City, Gansu province, China.Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000, China. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Dong gang West Road, Chengguan District, Lanzhou City, Gansu province, China.Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000, China.Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000, China.Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000, China.Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000, China.Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000, China.Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Dong gang West Road, Chengguan District, Lanzhou City, Gansu province, China.Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, 730000, China.Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Dong gang West Road, Chengguan District, Lanzhou City, Gansu province, China. tjh996@163.com.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

30045740

Citation

Pan, Bei, et al. "Exercise Training Modalities in Patients With Type 2 Diabetes Mellitus: a Systematic Review and Network Meta-analysis." The International Journal of Behavioral Nutrition and Physical Activity, vol. 15, no. 1, 2018, p. 72.
Pan B, Ge L, Xun YQ, et al. Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Int J Behav Nutr Phys Act. 2018;15(1):72.
Pan, B., Ge, L., Xun, Y. Q., Chen, Y. J., Gao, C. Y., Han, X., ... Tian, J. H. (2018). Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. The International Journal of Behavioral Nutrition and Physical Activity, 15(1), p. 72. doi:10.1186/s12966-018-0703-3.
Pan B, et al. Exercise Training Modalities in Patients With Type 2 Diabetes Mellitus: a Systematic Review and Network Meta-analysis. Int J Behav Nutr Phys Act. 2018 07 25;15(1):72. PubMed PMID: 30045740.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. AU - Pan,Bei, AU - Ge,Long, AU - Xun,Yang-Qin, AU - Chen,Ya-Jing, AU - Gao,Cai-Yun, AU - Han,Xue, AU - Zuo,Li-Qian, AU - Shan,Hou-Qian, AU - Yang,Ke-Hu, AU - Ding,Guo-Wu, AU - Tian,Jin-Hui, Y1 - 2018/07/25/ PY - 2018/01/22/received PY - 2018/07/17/accepted PY - 2018/7/27/entrez PY - 2018/7/27/pubmed PY - 2018/7/27/medline KW - Cardiovascular risk factors KW - Exercise training KW - Frequentist network meta-analysis KW - Glycemic control KW - Type 2 diabetes mellitus KW - Weight loss SP - 72 EP - 72 JF - The international journal of behavioral nutrition and physical activity JO - Int J Behav Nutr Phys Act VL - 15 IS - 1 N2 - INTRODUCTION: Current 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. METHODS: We 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. RESULTS: A 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. CONCLUSION: Compared 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 REGISTRATION: Our study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42017067518 . SN - 1479-5868 UR - https://www.unboundmedicine.com/medline/citation/30045740/Exercise_training_modalities_in_patients_with_type_2_diabetes_mellitus:_a_systematic_review_and_network_meta_analysis_ L2 - https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-018-0703-3 DB - PRIME DP - Unbound Medicine ER -