Association between physical activity interventions and functional capacity in middle-aged adults and older individuals with type 2 diabetes: a protocol for a systematic review and meta-analysis of randomized or non-randomized clinical trials

Pfeifer, Lucinéia Orsolin; Nardi, Angélica Trevisan De; Silva, Larissa Xavier Neves da; Nascimento, Daniela Meirelles do; Botton, Cíntia Ehlers; Teodoro, Juliana Lopes; Schaan, Beatriz D.; Umpierre, Daniel

doi:10.31219/osf.io/kpg2m

Cited by 2 publications

(1 citation statement)

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“…As planned in our study protocol [27], when sufficient data (at least 10 studies) were available, we performed sex-stratified subgroup analysis and meta-regression with glycated hemoglobin (HbA1c) values. We also conducted a sensitivity analysis stratifying for randomized or non-randomized studies.…”

Section: Additional Analysesmentioning

confidence: 99%

Association between physical exercise interventions and functional capacity in individuals with type 2 diabetes: a systematic review and meta-analysis of controlled trials

Pfeifer

Nardi

Silva

et al. 2021

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Background: The prevalence of type 2 diabetes mellitus increases with age and people with type 2 diabetes are more affected by reductions in functional performance. Although exercise interventions are recommended for people with diabetes, it is relevant to assess the effects of different training modes on the available functional outcomes. Objective: To summarize the effects of distinct modes of exercise training in comparison to non-exercise on the functional capacity of adults with type 2 diabetes. Methods: A systematic review and meta-analysis of randomized (RCT) and non-randomized (NRS) controlled trials was conducted. Seven databases were searched from inception to January 2021. Eligible studies should last 8 weeks or longer, comparing structured exercise training and non-exercise control for one out of six pre-specified functional capacity outcomes (Timed Up and Go test, chair stands, walking performance, upper limb muscle strength, lower limb muscle strength, physical fitness parameter), in patients with type 2 diabetes, aged ≥45 years or older. The risk of biases was assessed with the Checklist Downs & Black. Pooled mean differences were calculated using a random-effects model, followed by sensitivity and meta-regression analyses. Results: Of 17165 references retrieved, 29 trials (1557 patients) were included. Among these, 13 studies used aerobic training, 6 studies used combined training, 4 studies used resistance training, 3 studies had multiple intervention arms and 3 studies used other types of training. Exercise training was associated with an increase in functional capacity outcomes, as reflected by changes in 6-minute-walk test (51.6 meters; 95% CI 7.6% to 95.6%; I2 92%), one-repetition maximum leg-press (18.0 kg; 95% CI 4.0% to 31.9%; I2 0%), and peak oxygen consumption (2.41 mL/kg min; 95% CI 1.89% to 2.92%; I2 100%) compared with control groups. In sensitivity and subgroup analyses using VO2max as outcome and stratified by for the type of study (RCT or NRS), duration of diabetes diagnosis, and sex, we observed overlapping confidence intervals. Meta-regression showed no association between HbA1C levels and VO2max (p = 0.34; I2 99.6%; R2 = 2.6%). Conclusion: Structured exercise training based on aerobic training, resistance training, combination of both, or composed by other types of training (i.e. Pilates, Tai Chi and Whole-body vibration) is associated with an improvement in functional capacity in patients with type 2 diabetes, except for the upper limb muscle strength. However, we could not identify potential effect predictors associated with directional summary estimates. Registration: This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42020162467); date of registration: 12/15/2019. The review protocol is hosted at the Open Science Framework (OSF) (Preprint DOI: 10.31219/osf.io/kpg2m). Funding: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001; National Institute of Science and Technology for Health Technology Assessment (IATS) – FAPERGS/Brasil; National Council on Technology and Scientific Development (CNPq).

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Section: Additional Analysesmentioning

confidence: 99%

Association between physical exercise interventions and functional capacity in individuals with type 2 diabetes: a systematic review and meta-analysis of controlled trials

Pfeifer

Nardi

Silva

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

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Association Between Physical Exercise Interventions Participation and Functional Capacity in Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Controlled Trials

et al. 2022

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Background The prevalence of type 2 diabetes mellitus increases with age, and people with type 2 diabetes are more affected by reductions in functional performance. Although exercise interventions are recommended for people with diabetes, it is relevant to assess the effects of different training modes on the available functional outcomes. Therefore, our purpose was to systematically assess the effect of different physical exercise modalities in patients with type 2 diabetes with an average age of 45 years or older on outcomes used to measure functional capacity. Methods A systematic review and meta-analysis of controlled trials was conducted. Seven databases were searched from January 1987 to December 2021 (PubMed, Physiotherapy Evidence Database, Cochrane Library, SPORTDiscus, and in grey literature: Open Grey and Google Scholar). Eligible studies should last 8 weeks or longer, comparing structured exercise training and non-exercise control for one out of six pre-specified functional capacity outcomes (Timed Up and Go test, chair stands, walking performance, upper-limb muscle strength, lower-limb muscle strength, physical fitness parameter), in patients with type 2 diabetes, aged ≥ 45 years. The risk of bias was assessed with the Downs & Black checklist. Pooled mean differences were calculated using a random-effects model, followed by sensitivity and meta-regression analyses. Results Of 18,112 references retrieved, 29 trials (1557 patients) were included. Among these, 13 studies used aerobic training, 6 studies used combined training, 4 studies used resistance training, 3 studies had multiple intervention arms and 3 studies used other types of training. Exercise training was associated with an increase in functional capacity outcomes, as reflected by changes in 6-min walk test (n = 8) [51.6 m; 95% CI 7.6% to 95.6%; I2 92%], one-repetition maximum leg-press (n = 3) [18.0 kg; 95% CI 4.0% to 31.9%; I2 0%], and maximum oxygen consumption (VO2max) (n = 20) [2.41 mL/kg·min; 95% CI 1.89% to 2.92%; I2 100%] compared with control groups. In sensitivity and subgroup analyses using VO2max as outcome and stratified by type of study (randomized and non-randomized controlled clinical trials), duration of diabetes diagnosis, and sex, we observed overlapping confidence intervals. Meta-regression showed no association between glycated hemoglobin (HbA1C) levels and VO2max [p = 0.34; I2 99.6%; R2 = 2.6%]. In addition, the quality of the included studies was mostly low. Conclusion The results indicate that structured physical exercise programs might improve functional capacity in patients with type 2 diabetes, except for the upper-limb muscle strength. However, we could not identify potential effect predictors associated with directional summary estimates. Trial registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42020162467); date of registration: 12/15/2019. The review protocol is hosted at the Open Science Framework (OSF) (Preprint https://doi.org/10.31219/osf.io/kpg2m).

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Association between physical activity interventions and functional capacity in middle-aged adults and older individuals with type 2 diabetes: a protocol for a systematic review and meta-analysis of randomized or non-randomized clinical trials

Cited by 2 publications

References 34 publications

Association between physical exercise interventions and functional capacity in individuals with type 2 diabetes: a systematic review and meta-analysis of controlled trials

Association between physical exercise interventions and functional capacity in individuals with type 2 diabetes: a systematic review and meta-analysis of controlled trials

Association Between Physical Exercise Interventions Participation and Functional Capacity in Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Controlled Trials

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