Exercise for type 2 diabetes mellitus - PubMed (original) (raw)

Review

Exercise for type 2 diabetes mellitus

D E Thomas et al. Cochrane Database Syst Rev. 2006.

Abstract

Background: Exercise is generally recommended for people with type 2 diabetes mellitus. However, some studies evaluate an exercise intervention including diet or behaviour modification or both, and the effects of diet and exercise are not differentiated. Some exercise studies involve low participant numbers, lacking power to show significant differences which may appear in larger trials.

Objectives: To assess the effects of exercise in type 2 diabetes mellitus.

Search strategy: Trials were identified through the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and manual searches of bibliographies. Date of last search was March 3, 2005.

Selection criteria: All randomised controlled trials comparing any type of well-documented aerobic, fitness or progressive resistance training exercise with no exercise in people with type 2 diabetes mellitus.

Data collection and analysis: Two authors independently selected trials, assessed trial quality and extracted data. Study authors were contacted for additional information. Any information on adverse effects was collected from the trials.

Main results: Fourteen randomised controlled trials comparing exercise against no exercise in type 2 diabetes were identified involving 377 participants. Trials ranged from eight weeks to twelve months duration. Compared with the control, the exercise intervention significantly improved glycaemic control as indicated by a decrease in glycated haemoglobin levels of 0.6% (-0.6 % HbA(1c), 95% confidence interval (CI) -0.9 to -0.3; P < 0.05). This result is both statistically and clinically significant. There was no significant difference between groups in whole body mass, probably due to an increase in fat free mass (muscle) with exercise, as reported in one trial (6.3 kg, 95% CI 0.0 to 12.6). There was a reduction in visceral adipose tissue with exercise (-45.5 cm(2), 95% CI -63.8 to -27.3), and subcutaneous adipose tissue also decreased. No study reported adverse effects in the exercise group or diabetic complications. The exercise intervention significantly increased insulin response (131 AUC, 95% CI 20 to 242) (one trial), and decreased plasma triglycerides (-0.25 mmol/L, 95% CI -0.48 to -0.02). No significant difference was found between groups in quality of life (one trial), plasma cholesterol or blood pressure.

Authors' conclusions: The meta-analysis shows that exercise significantly improves glycaemic control and reduces visceral adipose tissue and plasma triglycerides, but not plasma cholesterol, in people with type 2 diabetes, even without weight loss.

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Conflict of interest statement

None known.

Figures

1.1

1.1. Analysis

Comparison 1 Exercise vs no exercise, Outcome 1 Glycated haemoglobin (%).

1.2

1.2. Analysis

Comparison 1 Exercise vs no exercise, Outcome 2 Visceral adipose tissue (cm2).

1.3

1.3. Analysis

Comparison 1 Exercise vs no exercise, Outcome 3 Subcutaneous adipose tissue (cm2).

1.4

1.4. Analysis

Comparison 1 Exercise vs no exercise, Outcome 4 Body Mass (kg).

1.5

1.5. Analysis

Comparison 1 Exercise vs no exercise, Outcome 5 Triglycerides (mmol/litre).

1.6

1.6. Analysis

Comparison 1 Exercise vs no exercise, Outcome 6 Maximal exercise capacity (VO2max)(ml/(kg*min)).

1.7

1.7. Analysis

Comparison 1 Exercise vs no exercise, Outcome 7 Systolic blood pressure (mmHg).

1.8

1.8. Analysis

Comparison 1 Exercise vs no exercise, Outcome 8 Diastolic blood pressure (mmHg).

1.9

1.9. Analysis

Comparison 1 Exercise vs no exercise, Outcome 9 Fasting plasma glucose concentration (mmol/L).

1.10

1.10. Analysis

Comparison 1 Exercise vs no exercise, Outcome 10 Insulin (fasting concentration (pmol/litre).

1.11

1.11. Analysis

Comparison 1 Exercise vs no exercise, Outcome 11 Body Mass index (kg/m2).

1.12

1.12. Analysis

Comparison 1 Exercise vs no exercise, Outcome 12 Total cholesterol (mmol/l).

1.13

1.13. Analysis

Comparison 1 Exercise vs no exercise, Outcome 13 HDL‐cholesterol (mmol/).

1.14

1.14. Analysis

Comparison 1 Exercise vs no exercise, Outcome 14 LDL‐cholesterol (mmol/).

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References

References to studies included in this review

Baldi 2003 {published data only}
    1. Baldi JC, Snowling N. Resistance training improves glycaemic control in obese type 2 diabetic men. International Journal of Sports Medicine 2003;24 (6):419‐23. - PubMed
Cuff 2003 {published data only}
    1. Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective Exercise Modality to Reduce Insulin Resistance in Women With Type 2 Diabetes. Diabetes Care 2003;26 (11):2977‐82. - PubMed
Dela 2004 {published data only}
    1. Dela F, Linstow ME, Mikines KJ, Galbo H. Physical training may enhance beta‐cell function in type 2 diabetes. American Journal of Physiological and Endocrinological Metabolism 2004;287 (5):E1024‐31. - PubMed
Dunstan 1998 {published data only}
    1. Dunstan DW, Puddey IB, Beilin LJ, Burke V, Morton AR, Stanton KG. Effects of a short‐term circuit weight training program on glycaemic control in NIDDM. Diabetes Research and Clinical Practice 1998;40:53‐61. - PubMed
Dunstan 2002 {published data only}
    1. Dunstan DW, Daly RM, Owen N, Jolley D, Court D, Shaw J, Zimmet P. High‐intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care 2002;25 (10):1729‐36. - PubMed
Loimaala 2003 {published data only}
    1. Loimaala A, Huikuri HV, Koobi T, Rinne M, Nenonen A, Vuori I. Exercise training improves baroreflex sensitivity in type 2 diabetes. Diabetes 2003;52 (7):1837‐42. - PubMed
Maiorana 2002 {published data only}
    1. Maiorana A, O'Driscoll G, Goodman C, Taylor R, Green D. Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Research & Clinical Practice 2002;56(2):115‐23. - PubMed
Mourier 1997 {published data only}
    1. Boudou P, Kerviler E, Erlich D, Vexiau P, Gautier JF. Exercise training‐induced triglyceride lowering negatively correlates with DHEA levels in men with type 2 diabetes. International Journal of Obesity & Related Metabolic Disorders: Journal of the International Association for the Study of Obesity 2001;25(8):1108‐12. - PubMed
    1. Mourier A, Gautier J‐F, Kerviler E, Bigard AX, Villette J‐M, et al. Mobilization of Visceral Adipose Tissue Related to the Improvement in Insulin Sensitivity in Response to Physical Training in NIDDM. Diabetes Care 1997;20(3):385‐91. - PubMed
Raz 1994 {published data only}
    1. Raz I, Hauser E, Bursztyn M. Moderate exercise improves glucose metabolism in uncontrolled elderly patients with non‐insulin‐dependent diabetes mellitus. Israeli Journal of Medical Science 1994;30:766‐70. - PubMed
Ronnemaa 1986 {published data only}
    1. Ronnemaa T, Marniemi J, Puukka P, Kuusi T. Effects of long‐term physical exercise on serum lipids, lipoproteins and lipid metabolizing enzymes in type 2 (non‐insulin‐dependent) diabetic patients. Diabetes Research 1988;7:79‐84. - PubMed
    1. Ronnemaa T, Mattila K, Lehtonen A, Kallio V. A controlled randomized study on the effect of long‐term physical exercise on the metabolic control in type 2 diabetic patients. Acta Medica Scandinavia 1986;220:219‐24. - PubMed
Tessier 2000 {published data only}
    1. Tessier D, Menard J, Fulop T, Ardilouze J, Roy M, Dubuc N, et al. Effects of aerobic physical exercise in the elderly with type 2 diabetes mellitus. Archives of Gerontology & Geriatrics 2000;31(2):121‐32. - PubMed
Tsujiuchi 2002 {published data only}
    1. Tsujiuchi T, Kumano H, Yoshiuchi K, He D, Tsujiuchi Y, Kuboki T, et al. The effect of Qi‐gong relaxation exercise on the control of type 2 diabetes mellitus: a randomized controlled trial. Diabetes Care 2002;25(1):241‐2. - PubMed
Wing 1988b {published data only}
    1. Wing RR, Epstein LH, Paternostro‐Bayles M, Kristka A, Nowalk MP, Gooding W. Exercise in a behavioural weight control programme for obese patients with type 2 (non‐insulin‐dependent) diabetes. Diabetologia 1988;31:902‐9. - PubMed
Yeater 1990 {published data only}
    1. Yeater R A, Ullrich IH, Maxwell L P, Goetsch V l. Coronary risk factors in type II diabetes: response to low‐intensity aerobic exercise. West Virginia Medical Journal 1990;86(7):287‐90. - PubMed

References to studies excluded from this review

Agurs‐Collins 1997 {published data only}
    1. Agurs‐Collins TD, Kumanyika SK, Have TR, Adams‐Campbell LL. A randomized controlled trial of weight reduction and exercise for diabetes management in older african‐american subjects. Diabetes Care 1997;20(10):1503‐11. - PubMed
Biermann 1986 {published data only}
    1. Biermann J. Modification of disordered glucose metabolism by physical training of low intensity. Zeitschrift fur die Gesamte Innere Medizin und Ihre Grenzgebiete 1‐7‐1986;41(13):375‐7. - PubMed
Blonk 1994 {published data only}
    1. Blonk MC, Jacobs MAJM, Biesheuvel EHE, Weeda‐Mannak WL, Heine RJ. Influences on weight loss in type 2 diabetic patients: Little long‐term benefit from group behaviour therapy and exercise training. Diabetic Medicine 1994;11:449‐57. - PubMed
Bogardus 1984 {published data only}
    1. Bogardus C, Ravussin E, Robbins DC, Wolfe RR, Horton ES, Sims EA. Effects of physical training and diet therapy on carbohydrate metabolism in patients with glucose intolerance and non‐insulin‐dependent diabetes mellitus. Diabetes 1984;33(4):311‐8. - PubMed
Dunstan 1997 {published data only}
    1. Dunstan DW, Mori TA, Puddey IB, Beilin LJ, Burke V, Morton AR, et al. A randomised, controlled study of the effects of aerobic exercise and dietary fish on coagulation and fibrinolytic factors in type 2 diabetics. Thrombosis & Haemostasis 1999;81(3):367‐72. - PubMed
    1. Dunstan DW, Mori TA, Puddey IB, Beilin LJ, Burke V, Morton AR, et al. The independent and combined effects of aerobic exercise and dietary fish intake on serum lipids and glycemic control in NIDDM. Diabetes Care 1997;20(6):913‐21. - PubMed
Ferrier 2004 {published data only}
    1. Ferrier KE, Nestel P, Taylor A, Drew BG, Kingwell BA. Diet but not aerobic exercise training reduces skeletal muscle TNF‐alpha in overweight humans. Diabetologia 2004;47(4):630‐7. - PubMed
Fujii 1982 {published data only}
    1. Fujii S, Okuno Y, Okada K, Tanaka S, Seki J, Wada M, et al. Effects of physical training on glucose tolerance and insulin response in diabetics.. Osaka City Medical Journal 1982;28:1‐8. - PubMed
Honkola 1997 {published data only}
    1. Honkola A, Forsen T, Eriksson J. Resistance training improves the metabolic profile in individuals with type 2 diabetes. Acta Diabetologia 1997;34:245‐8. - PubMed
Ishii 1998 {published data only}
    1. Ishii T, Yamakita T, Sato T, Tanaka S, Fujii S. Resistance training improves insulin sensitivity in niddm subjects without altering maximal oxygen uptake. Diabetes Care 1988;21(8):1353‐5. - PubMed
Kaplan 1985 {published data only}
    1. Kaplan RM, Wilson DK, Hartwell SL, Merino KL, Wallace JP. Prospective evaluation of HDL cholesterol change after diet and physical conditioning programs for patients with type II Diabetes Mellitus. Diabetes Care 1985;8(4):343‐8. - PubMed
Kaplan 1987 {published data only}
    1. Kaplan RM, Hartwell SL, Wilson DK, Wallace JP. Effects of diet and exercise interventions on control and quality of life in non‐insulin‐dependent diabetes mellitus. Journal of General Internal Medicine 1987;2:220‐7. - PubMed
Khan 1995 {published data only}
    1. Khan S, Rupp J. The effect of exercise conditioning, diet, and drug therapy on glycosylated hemoglobin levels in type 2 (NIDDM) diabetics. The Journal of Sports Medicine and Physical Fitness 1995;35:281‐8. - PubMed
Lehmann 1995 {published data only}
    1. Lehmann R, Vokac A, Niedermann K, Agosti K, Spinas GA. Loss of abdominal fat and improvement of the cardiovascular risk profile by regular moderate exercise training in patients with NIDDM. Diabetologia 1995;38:1313‐9. - PubMed
Ligtenberg 1997 {published data only}
    1. Ligtenberg PC, Hoekstra JBL, Bol E, Zonderland ML, Erkelens DW. Effects of physical training on metabolic control in elederly type 2 diabetes mellitus patients. Clinical Science 1997;93:127‐35. - PubMed
Samaras 1997 {published data only}
    1. Samaras K, Ashwell S, Mackintosh AM, Fleury AC, Campbell LV, Chisholm DJ. Will older sedentary people with non‐insulin‐dependent diabetes mellitus start exercising? A health promotion model. Diabetes Research & Clinical Practice 1997;37(2):121‐8. - PubMed
Skarfors 1987 {published data only}
    1. Skarfors ET, Wegerner TA, Lithell H, Selinus I. Physical training as treatment for type 2 (non‐insulin‐dependent) diabetes in elderly men. A feasibility study over 2 years. Diabetologia 1987;30:930‐3. - PubMed
Vanninen 1992 {published data only}
    1. Vanninen E, Uusitupa M, Siitonen O, Laitinen J, Lansimies E. 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 1992;35:340‐6. - PubMed
Verity 1989 {published data only}
    1. Verity LS, Ismail AH. Effects of exercise on cardiovascular disease risk in women with NIDDM. Diabetes Research & Clinical Practice 1989;6(1):27‐35. - PubMed
Wing 1988a {published data only}
    1. Wing RR, Epstein LH, Paternostro‐Bayles M, Kristka A, Nowalk MP, Gooding W. Exercise in a behavioural weight control programme for obese patients with type 2 (non‐insulin‐dependent) diabetes. Diabetologia 1988;31:902‐9. - PubMed
Yamanouchi 1995 {published data only}
    1. Yamanouchi K, Shinozaki T, Chikada K, Nishikawa T, Ito K, Shimizu S, et al. Daily walking combined with diet therapy is a useful means for obese NIDDM patients not only to reduce body weight but also to improve insulin sensitivity. Diabetes Care 1995;18(6):775‐8. - PubMed

Additional references

ADA 1997
    1. American Diabetes Association. Diabetes mellitus and exercise. Diabetes Care 1997;20(12):1908‐12. - PubMed
ADA 1997b
    1. American Diabetes Association. Report on the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997;20:1183‐97. - PubMed
Albright 2005
    1. Albright A, Franz M, Hornsby G, Kriska A, Marrero D, et al. American College of Sports Medicine Position Stand: Exercise and Type 2 Diabetes. Medicine and Science in Sports and Exercise 2005:1345‐60. - PubMed
Bouchard 1994
    1. Bouchard C, Shephard RJ, Stephens TE. Physical activity fitness, and health: international proceedings and consensus statement. Champaign, Ill, Human Kinetics Publishers, 1994.
Boule 2001
    1. Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta‐analysis of controlled clinical trials. Journal of the American Medical Association 2001 September;286(10):1218‐27. - PubMed
Brown 1996
    1. Brown SA, Upchurch S, Anding R, Winter M, Ramirez G. Promoting weight loss in type II diabetes. Diabetes Care 1996;19(6):613‐24. - PubMed
Campbell 1995
    1. Campbell IW, Howlett HC. Worldwide experience of metformin as an effective glucose‐lowering agent: a meta‐analysis. Diabetes Metabolism Reviews 1995;11 Suppl 1:S57‐S62. - PubMed
Constantini 2005
    1. Constantini N, Harman‐Boehm I, Dubnov G. Exercise prescription for diabetics: more than a general recommendation. Harefuah 2005;144(10):717‐23, 750. - PubMed
Cooper 1994
    1. Cooper H, Hedges LV. The handbook of research synthesis. NewYork: Russell Safe Foundation, 1994.
Després 1997
    1. Després JP. Visceral obesity, insulin resistance, and dyslipidemia: contribution of endurance exercise training to the treatment of the plurimetabolic syndrome. Exercise and Sport Science Reviews 1997;25:271‐300. - PubMed
Fleiss 1981
    1. Fleiss. Statistical Methods for Rates and Proportions. 2nd Edition. New York: Wiley, 1981:217‐34.
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐560. - PMC - PubMed
Ivy 1997
    1. Ivy JL. Role of exercise training in the prevention and treatment of insulin resistance and non‐insulin‐dependent diabetes mellitus. Sports Medicine 1997;24(5):321‐36. - PubMed
Jadad 1996
    1. Jadad A, Moore A, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled Clinical Trials 1996;17:1‐12. - PubMed
Johansen 1999
    1. K. Johansen. Efficacy of metformin in the treatment of NIDDM. Meta‐analysis. Diabetes Care 1999;22(1):33‐7. - PubMed
Joslin 1959
    1. Joslin EP, Root EF, White P. The Treatment of Diabetes Mellitus. Philadelphia: Lea & Febiger, 1959:243‐300.
Kelley 1995
    1. Kelley G, Tran ZV. Aerobic exercise and normotensive adults: a meta‐analysis. Medicine & Science in Sports & Exercise 1995;27(10):1371‐7. - PubMed
King 1995
    1. King DS, Baldus PJ, Sharp RL, Kesl LD, Feltmeyer TL, Riddle MS. Time course for exercise‐induced alterations in insulin action and glucose tolerance in middle‐aged people. Journal of Applied Physiology 1995;78(1):17‐22. - PubMed
Lamarche 1998
    1. Lamarche B, Tchernof A, Mauriege P, Cantin B, Dagenais GR, Lupien PJ, et al. Fasting insulin and apolipoprotein B levels and low‐density lipoprotein particle size as risk factors for ischemic heart disease. JAMA 1998;279(24):1955‐61. - PubMed
Meltzer 1998
    1. Meltzer S, Leiter L, Daneman D, et al. 1998 clinical practice guidelines for the management of diabetes in Canada. Canadian Medical Association Journal 1998;8 Suppl:S1‐S29. - PMC - PubMed
NDDG 1979
    1. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979;28:1039‐57. - PubMed
NIH 1998
    1. National Institutes of Health, National Heart Lung and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. The Evidence Report 1998. - PubMed
Peters 1996
    1. Peters AL, Davidson MB, Schriger DL, Hasselblad V. A clinical approach for the diagnosis of diabetes mellitus: an analysis using glycosylated hemoglobin levels. Meta‐analysis Research Group on the Diagnosis of Diabetes Using Glycated Hemoglobin Levels. JAMA 1996;276(15):1246‐52. - PubMed
Schultz 1995
    1. Schultz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408‐12. - PubMed
Shaw 2001
    1. Shaw K, Mar C, O'Rourke P, Tito F. Exercise for Obesity (Protocol for a Cochrane Review). Cochrane Database of Systematic Reviews 2004, Issue 1.
Stratton 2000
    1. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321(7258):405‐12. - PMC - PubMed
Wallberg‐H. 1998
    1. Wallberg‐Henriksson H, Rincon J, Zierath JR. Exercise in the management of non‐insulin‐dependent diabetes mellitus. Sports Medicine 1998;25(1):25‐35. - PubMed
WHO 1980
    1. WHO expert committee on diabetes mellitus. World Health Organization. Technical Report Series 1980; Vol. 646:1‐80. - PubMed
WHO 1999
    1. World Health Organization. World Health Report 1999.
Yki‐Yarvinen 1998
    1. Yki‐Yarvinen H. Toxicity of hyperglycaemia in type 2 diabetes. Diabetes and Metabolism Reviews 1998;14:S45‐S50. - PubMed

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