Skip to main content
Top
Published in: Acta Diabetologica 10/2017

01-10-2017 | Original Article

Aquatic exercise for adults with type 2 diabetes: a meta-analysis

Authors: Jordan L. Rees, Steven T. Johnson, Normand G. Boulé

Published in: Acta Diabetologica | Issue 10/2017

Login to get access

Abstract

Aims

The purpose of this systematic review and meta-analysis was to examine the effects of aquatic exercise (AquaEx) on indicators of glycemic control (i.e., glycated hemoglobin [A1c] and fasting plasma glucose) in adults with type 2 diabetes mellitus (T2DM). It was hypothesized that AquaEx would improve glycemic control to a similar extent as land-based exercise (LandEx), but to a greater extent than non-exercise control (Ctrl).

Methods

A literature search was completed in February 2017 for studies examining AquaEx training in adults with T2DM. Assessment of glycemic control was necessary for inclusion, while secondary outcomes such as quality of life and cardiometabolic risk factors (i.e., blood pressure, triglycerides and total cholesterol) were considered, but not required for inclusion. Outcomes were measured before and after at least 8 weeks of AquaEx, and data were analyzed using weighted mean differences (WMDs) and fixed effect models, when appropriate.

Results

Nine trials including 222 participants were identified. Three trials compared AquaEx to LandEx, two compared AquaEx to Crtl, and four had a pre-/post-design without a comparison group. Results indicate no difference in A1c between LandEx and AquaEx (WMD = −0.02%, 95% confidence interval = [−0.71, 0.66]). Post-intervention A1c was lower in AquaEx when compared to Crtl (WMD = −0.96%, [−1.87, −0.05]). Post-AquaEx A1c was lower compared to baseline (WMD = −0.48%, [−0.66, −0.30]).

Conclusions

A1c can be reduced after eight–twelve weeks of AquaEx. However, at this time few studies have examined whether changes in A1c are different from LandEx or Crtl.
Appendix
Available only for authorised users
Literature
1.
go back to reference Canadian C (2013) Diabetes Association Clinical Practice Guidelines Expert, R.J. Sigal, M.J. Armstrong, P. Colby, G.P. Kenny, R.C. Plotnikoff, S.M. Reichert, M.C. Riddell, Physical activity and diabetes. Can J Diabetes 37(Suppl 1):S40–S44 Canadian C (2013) Diabetes Association Clinical Practice Guidelines Expert, R.J. Sigal, M.J. Armstrong, P. Colby, G.P. Kenny, R.C. Plotnikoff, S.M. Reichert, M.C. Riddell, Physical activity and diabetes. Can J Diabetes 37(Suppl 1):S40–S44
2.
3.
go back to reference Williamson DA, Rejeski J, Lang W, Van Dorsten B, Fabricatore AN, Toledo K, Look ARG (2009) Impact of a weight management program on health-related quality of life in overweight adults with type 2 diabetes. Arch Intern Med 169(2):163–171CrossRefPubMedPubMedCentral Williamson DA, Rejeski J, Lang W, Van Dorsten B, Fabricatore AN, Toledo K, Look ARG (2009) Impact of a weight management program on health-related quality of life in overweight adults with type 2 diabetes. Arch Intern Med 169(2):163–171CrossRefPubMedPubMedCentral
4.
go back to reference Plotnikoff RC, Taylor LM, Wilson PM, Courneya KS, Sigal RJ, Birkett N, Raine K, Svenson LW (2006) Factors associated with physical activity in Canadian adults with diabetes. Med Sci Sports Exerc 38(8):1526–1534CrossRefPubMed Plotnikoff RC, Taylor LM, Wilson PM, Courneya KS, Sigal RJ, Birkett N, Raine K, Svenson LW (2006) Factors associated with physical activity in Canadian adults with diabetes. Med Sci Sports Exerc 38(8):1526–1534CrossRefPubMed
5.
go back to reference Pei L, Wang Y, Sun CY, Zhang Q (2016) Individual, social and environmental predictors of regular exercise among adults with type 2 diabetes and peripheral neuropathy in China. Int J Nurs Pract 22(5):451–460CrossRefPubMed Pei L, Wang Y, Sun CY, Zhang Q (2016) Individual, social and environmental predictors of regular exercise among adults with type 2 diabetes and peripheral neuropathy in China. Int J Nurs Pract 22(5):451–460CrossRefPubMed
6.
go back to reference Schutzer KA, Graves BS (2004) Barriers and motivations to exercise in older adults. Prev Med 39(5):1056–1061CrossRefPubMed Schutzer KA, Graves BS (2004) Barriers and motivations to exercise in older adults. Prev Med 39(5):1056–1061CrossRefPubMed
7.
go back to reference Cohen-Mansfield J, Marx MS, Guralnik JM (2003) Motivators and barriers to exercise in an older community-dwelling population. JAPA 11:242–253CrossRef Cohen-Mansfield J, Marx MS, Guralnik JM (2003) Motivators and barriers to exercise in an older community-dwelling population. JAPA 11:242–253CrossRef
8.
go back to reference Forbes CC, Plotnikoff RC, Courneya KS, Boule NG (2010) Physical activity preferences and type 2 diabetes: exploring demographic, cognitive, and behavioral differences. Diabetes Educ 36(5):801–815CrossRefPubMed Forbes CC, Plotnikoff RC, Courneya KS, Boule NG (2010) Physical activity preferences and type 2 diabetes: exploring demographic, cognitive, and behavioral differences. Diabetes Educ 36(5):801–815CrossRefPubMed
9.
go back to reference Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, Tate DF (2016) Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 39(11):2065–2079CrossRefPubMed Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, Tate DF (2016) Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 39(11):2065–2079CrossRefPubMed
10.
go back to reference Douloumpakas I, Pyrpasopoulou A, Triantafyllou A, Sampanis C, Aslanidis S (2007) Prevalence of musculoskeletal disorders in patients with type 2 diabetes mellitus: a pilot study. Kippokratia 11(4):214–218 Douloumpakas I, Pyrpasopoulou A, Triantafyllou A, Sampanis C, Aslanidis S (2007) Prevalence of musculoskeletal disorders in patients with type 2 diabetes mellitus: a pilot study. Kippokratia 11(4):214–218
11.
12.
go back to reference Nuttamonwarakul A, Amatyakul S, Suksom D (2014) Effects of a water-based versus land-based exercise training on cutaneous microvascular reactivity and c-reactive protein in older women with type 2 diabetes mellitus. J Exerc Phys 17(4):27–33 Nuttamonwarakul A, Amatyakul S, Suksom D (2014) Effects of a water-based versus land-based exercise training on cutaneous microvascular reactivity and c-reactive protein in older women with type 2 diabetes mellitus. J Exerc Phys 17(4):27–33
13.
go back to reference Delevatti RS, Kanitz AC, Alberton CL, Marson EC, Lisboa SC, Pinho CD, Lovatel GA, Korb A, Bertoldi K, Macedo RC, Siqueira IR, Schaan BD, Kruel LF (2016) Glucose control can be similarly improved after aquatic or dry-land aerobic training in patients with type 2 diabetes: a randomized clinical trial. J Sci Med Sport 19(8):688–693CrossRefPubMed Delevatti RS, Kanitz AC, Alberton CL, Marson EC, Lisboa SC, Pinho CD, Lovatel GA, Korb A, Bertoldi K, Macedo RC, Siqueira IR, Schaan BD, Kruel LF (2016) Glucose control can be similarly improved after aquatic or dry-land aerobic training in patients with type 2 diabetes: a randomized clinical trial. J Sci Med Sport 19(8):688–693CrossRefPubMed
14.
go back to reference Suntraluck S, Tanaka H, Suksom D (2017) The relative efficacy of land-based and water-based exercise training on macro- and micro-vascular functions in older patients with type 2 diabetes. J Ag Phys Act. doi:10.1123/japa.2016-0193 Suntraluck S, Tanaka H, Suksom D (2017) The relative efficacy of land-based and water-based exercise training on macro- and micro-vascular functions in older patients with type 2 diabetes. J Ag Phys Act. doi:10.​1123/​japa.​2016-0193
15.
go back to reference Asa C, Maria S, Katharina SS, Bert A (2012) Aquatic exercise is effective in improving exercise performance in patients with heart failure and type 2 diabetes mellitus. Evid Based Complement Alternat Med 2012:349209CrossRefPubMedPubMedCentral Asa C, Maria S, Katharina SS, Bert A (2012) Aquatic exercise is effective in improving exercise performance in patients with heart failure and type 2 diabetes mellitus. Evid Based Complement Alternat Med 2012:349209CrossRefPubMedPubMedCentral
16.
go back to reference Nuttamonwarakul A, Amatyakul S, Suksom D (2012) Twelve weeks of aqua-aerobic exercise improve physiological adaptations and glycemic control in elderly patients with type 2 diabetes. J Exerc Phys 15(2):64–70 Nuttamonwarakul A, Amatyakul S, Suksom D (2012) Twelve weeks of aqua-aerobic exercise improve physiological adaptations and glycemic control in elderly patients with type 2 diabetes. J Exerc Phys 15(2):64–70
17.
go back to reference Cugusi L, Cadeddu C, Nocco S et al (2015) Effects of an aquatic-based exercise program to improve cardiometabolic profile, quality of life, and physical activity levels in men with type 2 diabetes mellitus. PM R 7(2):141–148CrossRefPubMed Cugusi L, Cadeddu C, Nocco S et al (2015) Effects of an aquatic-based exercise program to improve cardiometabolic profile, quality of life, and physical activity levels in men with type 2 diabetes mellitus. PM R 7(2):141–148CrossRefPubMed
18.
go back to reference Conners RT, Morgan DW, Fuller DK, Caputo JL (2014) Underwater Treadmill Training, Glycemic Control, and Health-Related Fitness in Adults With Type 2 Diabetes. Int J Aquat Res Edu 8(4):382–396CrossRef Conners RT, Morgan DW, Fuller DK, Caputo JL (2014) Underwater Treadmill Training, Glycemic Control, and Health-Related Fitness in Adults With Type 2 Diabetes. Int J Aquat Res Edu 8(4):382–396CrossRef
19.
go back to reference Johnson ST, Mundt C, Boule N, Bell G, Vallance J, Taylor L, Johnson JA (2014) Improved functional status following the aquatic physical exercise for arthritis and diabetes (APEXD) study, Can J Diabetes 38(5):S63 Johnson ST, Mundt C, Boule N, Bell G, Vallance J, Taylor L, Johnson JA (2014) Improved functional status following the aquatic physical exercise for arthritis and diabetes (APEXD) study, Can J Diabetes 38(5):S63
20.
go back to reference Sporis G, Ruzic L, Nedic A (2013) The effects of aqua aerobic on patents with type 2 diabetes mellitus. Vjesn 28:33–38 Sporis G, Ruzic L, Nedic A (2013) The effects of aqua aerobic on patents with type 2 diabetes mellitus. Vjesn 28:33–38
21.
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 305(17):1790–1799CrossRefPubMed 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 305(17):1790–1799CrossRefPubMed
22.
go back to reference Boule NG, Hadden D, 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(10):1218–1227CrossRefPubMed Boule NG, Hadden D, 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(10):1218–1227CrossRefPubMed
23.
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(11):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(11):2518–2527CrossRefPubMed
24.
go back to reference Nagelkerk J, Reick K, Meengs L (2005) Perceived barriers and effective strategies to diabetes self-management. J Adv Nurs 54:151–158CrossRef Nagelkerk J, Reick K, Meengs L (2005) Perceived barriers and effective strategies to diabetes self-management. J Adv Nurs 54:151–158CrossRef
26.
go back to reference Nelson KM, Reiber G, Boyko EJ (2002) Diet and exercise among adults with type 2 diabetes. Diabetes Care 25(10):1722–1728CrossRefPubMed Nelson KM, Reiber G, Boyko EJ (2002) Diet and exercise among adults with type 2 diabetes. Diabetes Care 25(10):1722–1728CrossRefPubMed
27.
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(8):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(8):593–603CrossRefPubMed
28.
go back to reference Ross R, Dagnone D, Jones PJ, Smith H, Paddags A, Hudson R, Jannssen I (2000) Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. Ann Intern Med 133(2):92–103CrossRefPubMed Ross R, Dagnone D, Jones PJ, Smith H, Paddags A, Hudson R, Jannssen I (2000) Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. Ann Intern Med 133(2):92–103CrossRefPubMed
29.
go back to reference Weiss EP, Racette SB, Villareal DT et al (2006) Improvements in glucose tolerance and insulin action induced by increasing energy expenditure or decreasing energy intake: a randomized controlled trial. Am J Clin Nutr 84(5):1033–1042PubMedPubMedCentral Weiss EP, Racette SB, Villareal DT et al (2006) Improvements in glucose tolerance and insulin action induced by increasing energy expenditure or decreasing energy intake: a randomized controlled trial. Am J Clin Nutr 84(5):1033–1042PubMedPubMedCentral
30.
go back to reference Tuomilehto J, Lindstrom J, Eriksson J et al (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344(18):1343–1350CrossRefPubMed Tuomilehto J, Lindstrom J, Eriksson J et al (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344(18):1343–1350CrossRefPubMed
31.
go back to reference Balducci S, Zanuso S, Nicolucci A et al (2010) Effect of an intensive exercise intervention strategy on modifiable cardiovasular risk factors in subjects with type 2 diabetes mellitus. Arch Intern Med 170(20):1794–1803CrossRefPubMed Balducci S, Zanuso S, Nicolucci A et al (2010) Effect of an intensive exercise intervention strategy on modifiable cardiovasular risk factors in subjects with type 2 diabetes mellitus. Arch Intern Med 170(20):1794–1803CrossRefPubMed
32.
go back to reference Gobel S, Cysarz D, Edelhaueser F (2009) Water temperature affects heart rate and core body temperature during whole body immersion. Eur J Integr Med 1:256–257CrossRef Gobel S, Cysarz D, Edelhaueser F (2009) Water temperature affects heart rate and core body temperature during whole body immersion. Eur J Integr Med 1:256–257CrossRef
33.
go back to reference Hulens M, Vansant G, Claessens AL, Lysens R, Muls E (2003) Predictors of 6-minute walk test results in lean, obese and morbidly obese women. Scand J Med Sci Sports 13:98–105CrossRefPubMed Hulens M, Vansant G, Claessens AL, Lysens R, Muls E (2003) Predictors of 6-minute walk test results in lean, obese and morbidly obese women. Scand J Med Sci Sports 13:98–105CrossRefPubMed
Metadata
Title
Aquatic exercise for adults with type 2 diabetes: a meta-analysis
Authors
Jordan L. Rees
Steven T. Johnson
Normand G. Boulé
Publication date
01-10-2017
Publisher
Springer Milan
Published in
Acta Diabetologica / Issue 10/2017
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-017-1023-9

Other articles of this Issue 10/2017

Acta Diabetologica 10/2017 Go to the issue