Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis

Abstract

Aims/hypothesis Supervised exercise programmes improve glycaemic control in type 2 diabetes, but training characteristics associated with reduction in HbA 1c remain unclear. We conducted a systematic review with meta-regression analysis of randomised clinical trials (RCTs) assessing the association between intensity and volume of exercise training (aerobic, resistance or combined) and HbA 1c changes in patients with type 2 diabetes. Methods Five electronic databases were searched to retrieve RCTs of at least 12 weeks' duration, consisting of supervised exercise training vs no intervention, that reported HbA 1c changes and exercise characteristics. Two independent reviewers conducted study selection and data extraction.Results Twenty-six RCTs (2,253 patients) met the inclusion criteria. In multivariate analysis, baseline HbA 1c and exercise frequency explained nearly 58% of between-study variance. Baseline HbA 1c was inversely correlated with HbA 1c reductions after the three types of exercise training. In aerobic training, exercise volume (represented by frequency of sessions) was associated with changes in HbA 1c (weighted r0−0.64), while no variables were correlated with glycaemic control induced by resistance training. In combined training, weekly volume of resistance exercise explained heterogeneity in multivariate analysis and was associated with changes in HbA 1c levels (weighted r0−0.70). Conclusions/interpretation Reduction in HbA 1c is associated with exercise frequency in supervised aerobic training, and with weekly volume of resistance exercise in supervised combined training. Therefore, exercise volume is a major determinant of glycaemic control in patients with type 2 diabetes.

Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis

“…However, these probabilities should not be overinterpreted, particularly since they are not very large (not close to 80-90%). A dose-response meta-regression analysis by Umpierre et al [48] summarised the effects of CT, AET and RT on glycaemic control in patients with type 2 diabetes and concluded that the reduction in HbA 1c was associated with exercise frequency in supervised AET, and with the weekly volume of RT in supervised CT. Regarding the optimal dose, the authors speculated that there should be a minimal amount of AET (33 min per session) to elicit the effects of highvolume RT in CT [11].…”

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“…Se encontró una reducción significativa en las cantidades de HbA1c (−0,73 %; IC95 %: −1,06 % a −0,40 %). Una segunda revisión sistemática de la literatura del mismo autor [30] demostró cómo a mayor frecuencia de sesiones de ejercicio aeróbico a la semana se presentaban mayores reducciones en las concentraciones de HbA1c; también se encontró una disminución del 0,39 % adicional por cada sesión de ejercicio. Cabe recalcar que solamente aconsejar actividad física no tiene un efecto significativo en la HbA1c.…”