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Published in: Acta Diabetologica 5/2016

01-10-2016 | Original Article

Effect of aerobic exercise intensity on glycemic control in type 2 diabetes: a meta-analysis of head-to-head randomized trials

Authors: Yilina Liubaoerjijin, Tasuku Terada, Kevin Fletcher, Normand G. Boulé

Published in: Acta Diabetologica | Issue 5/2016

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Abstract

Aims

To conduct a meta-analysis of head-to-head trials comparing aerobic exercise training of different intensities on glycemic control in type 2 diabetes.

Methods

Databases, including MEDLINE and EMBASE, were searched up to January 2016. Randomized trials of at least 12 weeks in duration that compared two exercise interventions of different intensities were identified. Two reviewers independently extracted data from eligible trials. Using fixed effect model, weighted mean differences (WMD) between different exercise intensities were calculated for changes in glycated hemoglobin (HbA1c) and secondary outcomes, such as fasting glucose and fasting insulin.

Results

Eight studies with a total of 235 participants were eligible. The exercise interventions lasted from 12 weeks to 6 months. The prescribed exercise intensities varied among studies. Four studies utilized vigorous exercise intensities for short durations by performing interval training. Overall, higher-intensity exercise resulted in a greater reduction in HbA1c compared to lower-intensity exercise (WMD = −0.22 %; 95 % confidence interval [−0.38, −0.06]; or −2.4 mmol/mol [−4.15, −0.66], I 2 = 0). Adherence to exercise and proportion of dropouts did not differ within trials. No adverse events were reported in these small trials with selected inclusion criteria.

Conclusions

Although our meta-analysis had a limited sample size, increasing exercise intensity safely accentuated reductions in HbA1c in some people with type 2 diabetes. Different approaches have been used to increase exercise intensity (i.e., some used interval training, whereas others used higher-intensity continuous exercise). However, at this time, it is unclear which form, if any, leads to the most favorable results.
Appendix
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Literature
1.
go back to reference Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ (2001) Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. J Am Med Assoc: JAMA 286:1218–1227CrossRef Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ (2001) Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. J Am Med Assoc: JAMA 286:1218–1227CrossRef
2.
go back to reference Umpierre D, Ribeiro PA, Kramer CK et al (2011) Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA, J Am Med Assoc 305:1790–1799CrossRef Umpierre D, Ribeiro PA, Kramer CK et al (2011) Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA, J Am Med Assoc 305:1790–1799CrossRef
3.
go back to reference Thomas DE, Elliott EJ, Naughton GA (2006) Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev 3:CD002968PubMed Thomas DE, Elliott EJ, Naughton GA (2006) Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev 3:CD002968PubMed
4.
go back to reference Colberg SR, Albright AL, Blissmer BJ et al (2010) Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exerc 42:2282–2303CrossRefPubMed Colberg SR, Albright AL, Blissmer BJ et al (2010) Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exerc 42:2282–2303CrossRefPubMed
5.
go back to reference Canadian Diabetes Association Clinical Practice Guidelines Expert C, Sigal RJ, Armstrong MJ, Colby P et al (2013) Physical activity and diabetes. Can J Diabetes 37(1):S40–S44 Canadian Diabetes Association Clinical Practice Guidelines Expert C, Sigal RJ, Armstrong MJ, Colby P et al (2013) Physical activity and diabetes. Can J Diabetes 37(1):S40–S44
6.
go back to reference Yang Z, Scott CA, Mao C, Tang J, Farmer AJ (2014) Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med 44:487–499CrossRefPubMed Yang Z, Scott CA, Mao C, Tang J, Farmer AJ (2014) Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med 44:487–499CrossRefPubMed
7.
go back to reference Schwingshackl L, Missbach B, Dias S, Konig J, Hoffmann G (2014) Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis. Diabetologia 57:1789–1797CrossRefPubMed Schwingshackl L, Missbach B, Dias S, Konig J, Hoffmann G (2014) Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis. Diabetologia 57:1789–1797CrossRefPubMed
8.
go back to reference Thompson W (2013) Now trending: worldwide survey of fitness trends for 2014. ACSM’S Health Fit J 17:10–20 Thompson W (2013) Now trending: worldwide survey of fitness trends for 2014. ACSM’S Health Fit J 17:10–20
9.
go back to reference Weston KS, Wisloff U, Coombes JS (2014) High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med 48:1227–1234CrossRefPubMed Weston KS, Wisloff U, Coombes JS (2014) High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med 48:1227–1234CrossRefPubMed
10.
go back to reference Boulé NG, Kenny GP, Haddad E, Wells GA, Sigal RJ (2003) Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus. Diabetologia 46:1071–1081CrossRefPubMed Boulé NG, Kenny GP, Haddad E, Wells GA, Sigal RJ (2003) Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus. Diabetologia 46:1071–1081CrossRefPubMed
11.
go back to reference Umpierre D, Ribeiro PA, Schaan BD, Ribeiro JP (2013) Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia 56:242–251CrossRefPubMed Umpierre D, Ribeiro PA, Schaan BD, Ribeiro JP (2013) Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia 56:242–251CrossRefPubMed
12.
go back to reference Garber CE, Blissmer B, Deschenes MR et al (2011) American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43:1334–1359CrossRefPubMed Garber CE, Blissmer B, Deschenes MR et al (2011) American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43:1334–1359CrossRefPubMed
13.
go back to reference The Cochrane Collaboration (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. In: Higgins JPT, Green S (eds). http://handbook.cochrane.org. Accessed 28 Oct 2015 The Cochrane Collaboration (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. In: Higgins JPT, Green S (eds). http://​handbook.​cochrane.​org. Accessed 28 Oct 2015
14.
go back to reference Chao M, Liang F, Wang Z, Wang L, Ouyang G, Wang XD (2015) Effects of aerobic exercises in different intensities to the physiological indicators of type 2 diabetes patients. Chin J Rehabil Med 30:883–887 Chao M, Liang F, Wang Z, Wang L, Ouyang G, Wang XD (2015) Effects of aerobic exercises in different intensities to the physiological indicators of type 2 diabetes patients. Chin J Rehabil Med 30:883–887
15.
go back to reference Sgadari A, Broccatelli M, De Bellonia S, Bernabei R (2014) Hi-intensity interval training vs. constant load training: the effects on body composition and endothelial function in patients with type 2 diabetes mellitus. Med Sci Sports Exerc 46:166 Sgadari A, Broccatelli M, De Bellonia S, Bernabei R (2014) Hi-intensity interval training vs. constant load training: the effects on body composition and endothelial function in patients with type 2 diabetes mellitus. Med Sci Sports Exerc 46:166
16.
go back to reference Han K, Koo B, Kim H et al (2008) Moderate intensity exercise was more effective in body fat loss, but vigorous exercise improved the insulin resistance in overweight type 2 diabetes mellitus. Diabetologia 51:S269 Han K, Koo B, Kim H et al (2008) Moderate intensity exercise was more effective in body fat loss, but vigorous exercise improved the insulin resistance in overweight type 2 diabetes mellitus. Diabetologia 51:S269
17.
go back to reference Han KA, Min KW, Koo BK, Pak KS, Kim HJ, Kim EJ (2009) Effects of moderate versus vigorous intensity exercise training on inflammatory markers, endothelial function, and insulin resistance in the patients with type 2 diabetes: longitudinal study. Diabetes 58:1080CrossRef Han KA, Min KW, Koo BK, Pak KS, Kim HJ, Kim EJ (2009) Effects of moderate versus vigorous intensity exercise training on inflammatory markers, endothelial function, and insulin resistance in the patients with type 2 diabetes: longitudinal study. Diabetes 58:1080CrossRef
18.
go back to reference Marianna B, Sgadari A, De Bellonia S, Bernabei R (2014) Hi-intensity interval training and constant load training induce similar muscle force changes in patients with type 2 diabetes mellitus. Med Sci Sports Exerc 46:167CrossRef Marianna B, Sgadari A, De Bellonia S, Bernabei R (2014) Hi-intensity interval training and constant load training induce similar muscle force changes in patients with type 2 diabetes mellitus. Med Sci Sports Exerc 46:167CrossRef
19.
go back to reference Yoon BK, Park SJ, Cha HR (2012) The effect of different exercise intensities on blood profiles and body composition for type II diabetes. Med Sci Sports Exerc 44:502 Yoon BK, Park SJ, Cha HR (2012) The effect of different exercise intensities on blood profiles and body composition for type II diabetes. Med Sci Sports Exerc 44:502
20.
go back to reference Pandey AK, Clarus S, Poirier P (2015) The comprative effect of burst exercise vs. sustained exercise on the cardiometabolic status of newly diagnosed diabetic patients. Can J Cardiol 31:S207CrossRef Pandey AK, Clarus S, Poirier P (2015) The comprative effect of burst exercise vs. sustained exercise on the cardiometabolic status of newly diagnosed diabetic patients. Can J Cardiol 31:S207CrossRef
21.
go back to reference Yan H, Prista A, Ranadive SM et al (2014) Effect of aerobic training on glucose control and blood pressure in T2DDM East African males. ISRN Endocrinol 2014:864897CrossRefPubMedPubMedCentral Yan H, Prista A, Ranadive SM et al (2014) Effect of aerobic training on glucose control and blood pressure in T2DDM East African males. ISRN Endocrinol 2014:864897CrossRefPubMedPubMedCentral
22.
go back to reference Jung JY, Han KA, Ahn HJ et al (2012) Effects of aerobic exercise intensity on abdominal and thigh adipose tissue and skeletal muscle attenuation in overweight women with type 2 diabetes mellitus. Diabetes Metab J 36:211–221CrossRefPubMedPubMedCentral Jung JY, Han KA, Ahn HJ et al (2012) Effects of aerobic exercise intensity on abdominal and thigh adipose tissue and skeletal muscle attenuation in overweight women with type 2 diabetes mellitus. Diabetes Metab J 36:211–221CrossRefPubMedPubMedCentral
23.
go back to reference Hamed NS, Raoof NALA (2014) Effect of high intensity interval training on diabetic obese women with polyneuropathy: a randomized controlled clinical trial. Phys Ther Rehabil 1:1–8CrossRef Hamed NS, Raoof NALA (2014) Effect of high intensity interval training on diabetic obese women with polyneuropathy: a randomized controlled clinical trial. Phys Ther Rehabil 1:1–8CrossRef
24.
go back to reference Hollekim-Strand SM, Bjorgaas MR, Albrektsen G, Tjonna AE, Wisloff U, Ingul CB (2014) High-intensity interval exercise effectively improves cardiac function in patients with type 2 diabetes mellitus and diastolic dysfunction: a randomized controlled trial. J Am Coll Cardiol 64:1758–1760CrossRefPubMed Hollekim-Strand SM, Bjorgaas MR, Albrektsen G, Tjonna AE, Wisloff U, Ingul CB (2014) High-intensity interval exercise effectively improves cardiac function in patients with type 2 diabetes mellitus and diastolic dysfunction: a randomized controlled trial. J Am Coll Cardiol 64:1758–1760CrossRefPubMed
25.
go back to reference Ku YH, Koo BK, Ahn HJ et al (2009) Effects of aerobic exercise intensity on insulin resistance in patients with type 2 diabetes mellitus. Korean Diabetes J 33:401–411CrossRef Ku YH, Koo BK, Ahn HJ et al (2009) Effects of aerobic exercise intensity on insulin resistance in patients with type 2 diabetes mellitus. Korean Diabetes J 33:401–411CrossRef
26.
go back to reference Lee SS, Yoo JH, So YS (2015) Effect of the low- versus high-intensity exercise training on endoplasmic reticulum stress and GLP-1 in adolescents with type 2 diabetes mellitus. J Phys Ther Sci 27:3063–3068CrossRefPubMedPubMedCentral Lee SS, Yoo JH, So YS (2015) Effect of the low- versus high-intensity exercise training on endoplasmic reticulum stress and GLP-1 in adolescents with type 2 diabetes mellitus. J Phys Ther Sci 27:3063–3068CrossRefPubMedPubMedCentral
27.
go back to reference Terada T, Friesen A, Chahal BS, Bell GJ, McCargar LJ, Boule NG (2013) Feasibility and preliminary efficacy of high intensity interval training in type 2 diabetes. Diabetes Res Clin Pract 99:120–129CrossRefPubMed Terada T, Friesen A, Chahal BS, Bell GJ, McCargar LJ, Boule NG (2013) Feasibility and preliminary efficacy of high intensity interval training in type 2 diabetes. Diabetes Res Clin Pract 99:120–129CrossRefPubMed
28.
go back to reference Karstoft K, Winding K, Knudsen SH et al (2013) The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes Care 36:228–236CrossRefPubMedPubMedCentral Karstoft K, Winding K, Knudsen SH et al (2013) The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes Care 36:228–236CrossRefPubMedPubMedCentral
29.
go back to reference Mitranun W, Deerochanawong C, Tanaka H, Suksom D (2014) Continuous vs interval training on glycemic control and macro- and microvascular reactivity in type 2 diabetic patients. Scand J Med Sci Sports 24:e69–e76CrossRefPubMed Mitranun W, Deerochanawong C, Tanaka H, Suksom D (2014) Continuous vs interval training on glycemic control and macro- and microvascular reactivity in type 2 diabetic patients. Scand J Med Sci Sports 24:e69–e76CrossRefPubMed
30.
go back to reference Hansen D, Dendale P, Jonkers RA et al (2009) Continuous low- to moderate-intensity exercise training is as effective as moderate- to high-intensity exercise training at lowering blood HbA(1c) in obese type 2 diabetes patients. Diabetologia 52:1789–1797CrossRefPubMedPubMedCentral Hansen D, Dendale P, Jonkers RA et al (2009) Continuous low- to moderate-intensity exercise training is as effective as moderate- to high-intensity exercise training at lowering blood HbA(1c) in obese type 2 diabetes patients. Diabetologia 52:1789–1797CrossRefPubMedPubMedCentral
31.
go back to reference Li J, Zhang W, Guo Q et al (2012) Duration of exercise as a key determinant of improvement in insulin sensitivity in type 2 diabetes patients. Tohoku J Exp Med 227:289–296CrossRefPubMed Li J, Zhang W, Guo Q et al (2012) Duration of exercise as a key determinant of improvement in insulin sensitivity in type 2 diabetes patients. Tohoku J Exp Med 227:289–296CrossRefPubMed
32.
go back to reference Krause M, Rodrigues-Krause J, O’Hagan C et al (2014) The effects of aerobic exercise training at two different intensities in obesity and type 2 diabetes: implications for oxidative stress, low-grade inflammation and nitric oxide production. Eur J Appl Physiol 114:251–260CrossRefPubMed Krause M, Rodrigues-Krause J, O’Hagan C et al (2014) The effects of aerobic exercise training at two different intensities in obesity and type 2 diabetes: implications for oxidative stress, low-grade inflammation and nitric oxide production. Eur J Appl Physiol 114:251–260CrossRefPubMed
33.
go back to reference Thompson SG, Higgins JPT (2002) How should meta-regression analyses be undertaken and interpreted? Stat Med 21:1559–1573CrossRefPubMed Thompson SG, Higgins JPT (2002) How should meta-regression analyses be undertaken and interpreted? Stat Med 21:1559–1573CrossRefPubMed
34.
go back to reference Snowling NJ, Hopkins WG (2006) Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 29:2518–2527CrossRefPubMed Snowling NJ, Hopkins WG (2006) Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 29:2518–2527CrossRefPubMed
35.
go back to reference MacLeod SF, Terada T, Chahal BS, Boule NG (2013) Exercise lowers postprandial glucose but not fasting glucose in type 2 diabetes: a meta-analysis of studies using continuous glucose monitoring. Diabetes Metab Res Rev 29:593–603CrossRefPubMed MacLeod SF, Terada T, Chahal BS, Boule NG (2013) Exercise lowers postprandial glucose but not fasting glucose in type 2 diabetes: a meta-analysis of studies using continuous glucose monitoring. Diabetes Metab Res Rev 29:593–603CrossRefPubMed
36.
go back to reference Jelleyman C, Yates T, O’Donovan G et al (2015) The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis. Obes Rev 16:942–961CrossRefPubMed Jelleyman C, Yates T, O’Donovan G et al (2015) The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis. Obes Rev 16:942–961CrossRefPubMed
37.
go back to reference Curry M, Mehta SP, Chaffin JC, Duran E, Washington B, Bose SS (2015) The effect of low-volume, high-intensity interval training on blood glucose markers, anthropometric measurements, and cardiorespiratory fitness in patients with type 2 diabetes. Crit Rev Phys Rehabil Med 27:19–35CrossRef Curry M, Mehta SP, Chaffin JC, Duran E, Washington B, Bose SS (2015) The effect of low-volume, high-intensity interval training on blood glucose markers, anthropometric measurements, and cardiorespiratory fitness in patients with type 2 diabetes. Crit Rev Phys Rehabil Med 27:19–35CrossRef
38.
go back to reference Balducci S, Zanuso S, Cardelli P et al (2012) Effect of high- versus low-intensity supervised aerobic and resistance training on modifiable cardiovascular risk factors in type 2 diabetes; the Italian Diabetes and Exercise Study (IDES). PLoS ONE 7:e49297CrossRefPubMedPubMedCentral Balducci S, Zanuso S, Cardelli P et al (2012) Effect of high- versus low-intensity supervised aerobic and resistance training on modifiable cardiovascular risk factors in type 2 diabetes; the Italian Diabetes and Exercise Study (IDES). PLoS ONE 7:e49297CrossRefPubMedPubMedCentral
Metadata
Title
Effect of aerobic exercise intensity on glycemic control in type 2 diabetes: a meta-analysis of head-to-head randomized trials
Authors
Yilina Liubaoerjijin
Tasuku Terada
Kevin Fletcher
Normand G. Boulé
Publication date
01-10-2016
Publisher
Springer Milan
Published in
Acta Diabetologica / Issue 5/2016
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-016-0870-0

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