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Diabetologia
Published in: Diabetologia 8/2003

01-08-2003 | Article

Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus

Authors: N. G. Boulé, G. P. Kenny, E. Haddad, G. A. Wells, Dr. R. J. Sigal

Published in: Diabetologia | Issue 8/2003

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Abstract

Aims/hypothesis

Low cardiorespiratory fitness is a powerful and independent predictor of mortality in people with diabetes. Several studies have examined the effects of exercise on cardiorespiratory fitness in Type 2 diabetic individuals. However, these studies had relatively small sample sizes and highly variable results. Therefore the aim of this study was to systematically review and quantify the effects of exercise on cardiorespiratory fitness in Type 2 diabetic individuals.

Methods

MEDLINE, EMBASE, and four other databases were searched up to March 2002 for randomized, controlled trials evaluating effects of structured aerobic exercise interventions of 8 weeks or more on cardiorespiratory fitness in adults with Type 2 diabetes. Cardiorespiratory fitness was defined as maximal oxygen uptake (VO2max) during a maximal exercise test.

Results

Seven studies, presenting data for nine randomized trials comparing exercise and control groups (overall n=266), met the inclusion criteria. Mean exercise characteristics were as follows: 3.4 sessions per week, 49 min per session for 20 weeks. Exercise intensity ranged from 50% to 75% of VO2max. There was an 11.8% increase in VO2max in the exercise group and a 1.0% decrease in the control group (post intervention standardized mean difference =0.53, p<0.003). Studies with higher exercise intensities tended to produce larger improvements in VO2max. Exercise intensity predicted post-intervention weighted mean difference in HbA1c (r=−0.91, p=0.002) to a larger extent than did exercise volume (r=−0.46, p=0.26).

Conclusions/interpretation

Regular exercise has a statistically and clinically significant effect on VO2max in Type 2 diabetic individuals. Higher intensity exercise could have additional benefits on cardiorespiratory fitness and HbA1c.
Literature
1.
Fletcher GF, Balady GJ, Amsterdam EA et al. (2001) Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 104:1694–1740PubMed
2.
Wei M, Gibbons LW, Kampert JB, Nichaman MZ, Blair SN (2000) Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with Type 2 diabetes. Ann Intern Med 132:605–611PubMed
3.
Kohl HW, Gordon NF, Villegas JA, Blair SN (1992) Cardiorespiratory fitness, glycemic status, and mortality risk in men. Diabetes Care 15:184–192PubMed
4.
Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE (2002) Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 346:793–801CrossRefPubMed
5.
Blair SN, Kohl HW, 3rd, Barlow CE, Paffenbarger RS Jr, Gibbons LW, Macera CA (1995) Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA 273:1093–1098PubMed
6.
Erikssen G, Liestol K, Bjornholt J, Thaulow E, Sandvik L, Erikssen J (1998) Changes in physical fitness and changes in mortality. Lancet 352:759–762PubMed
7.
Kunitomi M, Takahashi K, Wada J et al. (2000) Re-evaluation of exercise prescription for Japanese type 2 diabetic patients by ventilatory threshold. Diabetes Res Clin Pract 50:109–115CrossRefPubMed
8.
Regensteiner JG, Sippel J, McFarling ET, Wolfel EE, Hiatt WR (1995) Effects of non-insulin-dependent diabetes on oxygen consumption during treadmill exercise. Med Sci Sports Exerc 27:875–881PubMed
9.
Lillioja S, Young AA, Culter CL et al. (1987) Skeletal muscle capillary density and fiber type are possible determinants of in vivo insulin resistance in man. J Clin Invest 80:415–424PubMed
10.
Nyholm B, Qu Z, Kaal A et al. (1997) Evidence of an increased number of type IIb muscle fibers in insulin- resistant first-degree relatives of patients with NIDDM. Diabetes 46:1822–1828PubMed
11.
Simoneau JA, Kelley DE (1997) Altered glycolytic and oxidative capacities of skeletal muscle contribute to insulin resistance in NIDDM. J Appl Physiol 83:166–171PubMed
12.
Regensteiner JG, Bauer TA, Reusch JE et al. (1998) Abnormal oxygen uptake kinetic responses in women with type II diabetes mellitus. J Appl Physiol 85:310–317PubMed
13.
Brandenburg SL, Reuch JEB, Bauer TA, Jeffers BW, Hiatt WR, Regensteiner JG (1999) Effects of exercise training on oxygen uptake kinetic responses in women with type 2 diabetes. Diabetes Care 22:1640–1646PubMed
14.
Estacio RO, Regensteiner JG, Wolfel EE, Jeffers B, Dickenson M, Schrier RW (1998) The association between diabetic complications and exercise capacity in NIDDM patients. Diabetes Care 21:291–295PubMed
15.
Albright A, Franz M, Hornsby G et al. (2000) American College of Sports Medicine position stand. Exercise and type 2 diabetes. Med Sci Sports Exerc 32:1345–1360PubMed
16.
Bouchard C, An P, Rice T et al. (1999) Familial aggregation of VO(2max) response to exercise training: results from the HERITAGE Family Study. J Appl Physiol 87:1003–1008PubMed
17.
Ford ES, Herman WH (1995) Leisure-time physical activity patterns in the U.S. diabetic population. Findings from the 1990 National Health Interview Survey—Health Promotion and Disease Prevention Supplement. Diabetes Care 18:27–33PubMed
18.
Dunstan DW, Mori TA, Puddey IB et al. (1997) The independent and combined effects of aerobic exercise and dietary fish intake on serum lipids and glycemic control in NIDDM. A randomized controlled study. Diabetes Care 20:913–921PubMed
19.
Tessier D, Ménard J, Fulop T et al. (2000) Effects of aerobic physical exercie in elderly with type 2 diabetes mellitus. Arch Gerontol Geriatr 31:121–132CrossRefPubMed
20.
Yeater RA, Ullrich IH, Maxwell LP, Goetsch VL (1990) Coronary risk factors in type II diabetes: response to low-intensity aerobic exercise. W V Med J 86:287–290PubMed
21.
Vanninen E, Uusitupa M, Siitonen O, Laitinen J, Lansimies E (1992) Habitual physical activity, aerobic capacity and metabolic control in patients with newly-diagnosed Type 2 (non-insulin-dependent) diabetes mellitus: effect of 1-year diet and exercise intervention. Diabetologia 35:340–346PubMed
22.
Raz I, Hauser E, Bursztyn M (1994) Moderate exercise improves glucose metabolism in uncontrolled elderly patients with non-insulin-dependent diabetes mellitus. Isr J Med Sci 30:766–770PubMed
23.
Ronnemaa T, Mattila K, Lehtonen A, Kallio V (1986) A controlled randomized study on the effect of long-term physical exercise on the metabolic control in type 2 diabetic patients. Acta Med Scand 220:219–224PubMed
24.
Mourier A, Gautier JF, De Kerviler E et al. (1997) Mobilization of visceral adipose tissue related to the improvement in insulin sensitivity in response to physical training in NIDDM. Effects of branched-chain amino acid supplements. Diabetes Care 20:385–391PubMed
25.
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie R, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUORUM statement. Lancet 354:1896–1900CrossRefPubMed
26.
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. JAMA 286:1218–1227PubMed
27.
Dickersin K, Scherer R, Lefebvre C (1994) Identifying relevant studies for systematic reviews. BMJ 309:1286–1291PubMed
28.
Earle CC, Pham B, Wells GA (2000) An assessment of methods to combine published survival curves. Med Decis Making 20:104–111PubMed
29.
Ainsworth BE, Haksell WL, Leon AS et al. (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25:71–80PubMed
30.
American College of Sports Medicine (1991) Guidelines for Exercise Testing and Prescription, 4th edn. Lea & Febiger, Philadelphia
31.
Jadad AR, Moore RA, Carroll D et al. (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12
32.
Schultz KF, Chalmers I, Hayes RJ, Altman DG (1995) Empirical evidence of bias: Dimensions of methodological quality associated with treatment effects in controlled trials. JAMA 273:408–412PubMed
33.
The Cochrane Collaboration (2000). Appendix K. Statistical methods used in MetaView. Review Manager (RevMan) 4.1 User Guide, The Cochrane Collaboration, Oxford
34.
Mulrow CD, Oxman AD (1997) Analysing and presenting results. Cochrane collaboration handbook, Sect. 8. The Cochrane Collaboration, Oxford
35.
Lehmann R, Vokac A, Niedermann K, Agosti K, Spinas GA (1995) Loss of abdominal fat and improvement of the cardiovascular risk profile by regular moderate exercise training in patients with NIDDM. Diabetologia 38:1313–1319CrossRefPubMed
36.
Lehmann R, Engler H, Honegger R, Riesen W, Spinas GA (2001) Alterations of lipolytic enzymes and high-density lipoprotein subfractions induced by physical activity in type 2 diabetes mellitus. Eur J Clin Invest 31:37–44CrossRefPubMed
37.
Verity LS, Ismail AH (1989) Effects of exercise on cardiovascular disease risk in women with NIDDM. Diabetes Res Clin Pract 6:27–35PubMed
38.
Maiorana A, O'Driscoll G, Cheetham C et al. (2001) The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes. J Am Coll Cardiol 38:860–866CrossRefPubMed
39.
Maiorana A, O'Driscoll G, Goodman C, Taylor R, Green D (2002) Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 56:115–123CrossRefPubMed
40.
Dunstan DW, Puddey IB, Beilin LJ, Burke V, Morton AR, Stanton KG (1998) Effects of a short-term circuit weight training program on glycaemic control in NIDDM. Diabetes Res Clin Pract 40:53–61CrossRefPubMed
41.
Honkola A, Forsen T, Eriksson J (1997) Resistance training improves the metabolic profile in individuals with type 2 diabetes. Acta Diabetol 34:245–248CrossRefPubMed
42.
Bogardus C, Ravussin E, Robbins DC, Wolfe RR, Horton ES, Sims EAH (1984) Effects of physical training and diet therapy on carbohydrate metabolism in patients with glucose intolerance and non-insulin-dependent diabetes mellitus. Diabetes 33:311–318PubMed
43.
Smutok MA, Reece C, Kokkinos PF et al. (1994) Effects of exercise training modality on glucose tolerance in men with abnormal glucose regulation. Int J Sports Med 15:283–289PubMed
44.
Wing RR, Epstein LH, Paternostro-Bayles M, Kriska A, Nowalk MP, Gooding W (1988) Exercise in a behavioural weight control programme for obese patients with Type 2 (non-insulin-dependent) diabetes. Diabetologia 31:902–909PubMed
45.
Agurs-Collins TD, Kumanyika SK, Ten Have TR, Adams-Campbell LL (1997) A randomized controlled trial of weight reduction and exercise for diabetes management in older African-American subjects. Diabetes Care 20:1503–1511PubMed
46.
Fujii S (1992) Physical exercise therapy in diabetes mellitus—the role of clinical laboratory examinations. Rinsho Byori 40:1129–1135PubMed
47.
Fujii S, Okuno Y, Okada K et al. (1982) Effects of physical training on glucose tolerance and insulin response in diabetics. Osaka City Med J 28:1–8PubMed
48.
Kaplan RM, Wilson DK, Hartwell SL, Merino KL, Wallace JP (1985) Prospective evaluation of HDL cholesterol changes after diet and physical conditioning programs for patients with Type 2 diabetes mellitus. Diabetes Care 8:343–348PubMed
49.
Kaplan RM, Hartwell SL, Wilson DK, Wallace JP (1987) Effects of diet and exercise interventions on control and quality of life in non-insulin-dependent diabetes mellitus. J Gen Intern Med 2:220–228PubMed
50.
Blonk MC, Jacobs MA, Biesheuvel EH, Weeda-Mannak WL, Heine RJ (1994) Influences on weight loss in type 2 diabetic patients: little long-term benefit from group behaviour therapy and exercise training. Diabet Med 11:449–457PubMed
51.
Samaras K, Ashwell S, Mackintosh AM, Fleury AC, Campbell LV, Chisholm DJ (1997) Will older sedentary people with non-insulin-dependent diabetes mellitus start exercising? A health promotion model. Diabetes Res Clin Pract 37:121–128CrossRefPubMed
52.
Skarfors ET, Wegener TA, Lithell H, Selinus I (1987) Physical training as treatment for Type 2 (non-insulin-dependent) diabetes in elderly men—a feasibility study over 2 years. Diabetologia 30:930–933PubMed
53.
Dunstan DW, Mori TA, Puddey IB et al. (1999) A randomised, controlled study of the effects of aerobic exercise and dietary fish on coagulation and fibrinolytic factors in type 2 diabetics. Thrombosis and Haemostasis 81:367–372PubMed
54.
Mori TA, Dunstan DW, Burke V et al. (1999) Effect of dietary fish and exercise training on urinary F2-isoprostane excretion in non-insulin-dependent diabetic patients. Metabolism 48:1402–1408PubMed
55.
Ronnemaa T, Marniemi J, Puukka P, Kuusi T (1988) Effects of long-term physical exercise on serum lipids, lipoproteins and lipid metabolizing enzymes in type 2 (non-insulin-dependent) diabetic patients. Diabetes Res 7:79–84PubMed
56.
Vanninen E, Uusitupa M, Lansimies E, Siitonen O, Laitinen J (1993) Effect of metabolic control on autonomic function in obese patients with newly diagnosed type 2 diabetes. Diabet Med 10:66–73PubMed
57.
Uusitupa MI (1996) Early lifestyle intervention in patients with non-insulin-dependent diabetes mellitus and impaired glucose tolerance. Ann Med 28:445–449PubMed
58.
Hauser E. The effects of physical activity on weight, glucose metabolism and lipid profile in uncontrolled type 2 diabetic patients. The school of Public Health and Community Medicine. The Hebrew University, Jerusalem
59.
Boudou P, De Kerviler E, Vexiau P, Fiet J, Cathelineau G, Gautier J (2000) Effects of a single bout of exercise and exercise training on steroid levels in middle-aged type 2 diabetic men: relationship to abdominal adipose tissue distribution and metabolic status. Diabetes Metab 26:450–457PubMed
60.
Boudou P, Kerviler E de, Erlich D, Vexiau P, Gautier JF (2001) Exercise training-induced triglyceride lowering negatively correlates with DHEA levels in men with type 2 diabetes. Int J Obes 25:1108–1112CrossRef
61.
American College of Sports Medicine (1995) Guidelines for exercise testing and exercise prescription, 5th edn. Lea & Febiger, Philadelphia
62.
Ainsworth BE, Haskell WL, Whitt MC et al. (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32:S498–S504PubMed
63.
Goodpaster BH, Thaete FL, Simoneau JA, Kelley DE (1997) Subcutaneous abdominal fat and thigh muscle composition predict insulin sensitivity independently of visceral fat. Diabetes 46:1579–1585PubMed
64.
Simoneau JA, Colberg SR, Thaete FL, Kelley DE (1995) Skeletal muscle glycolytic and oxidative enzyme capacities are determinants of insulin sensitivity and muscle composition in obese women. FASEB J 9:273–278PubMed
65.
Roy TM, Peterson HR, Snider HL et al. (1989) Autonomic influences on cardiovascular performance in diabetic subjects. Am J Med 87:382–388PubMed
66.
American College of Sports Medicine (1998) American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 30:992–1008PubMed
67.
Whipp BJ, Davis JA, Torres F, Wasserman K (1981) A test to determine parameters of aerobic function during exercise. J Appl Physiol 50:217–221PubMed
68.
Astrand PO (1977) Textbook of work physiology. McGraw-Hill, New York, pp 333–365
Metadata
Title
Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus
Authors
N. G. Boulé
G. P. Kenny
E. Haddad
G. A. Wells
Dr. R. J. Sigal
Publication date
01-08-2003
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 8/2003
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-003-1160-2

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