Background

Persistently elevated glycosylated hemoglobin (HbA1c) is associated with a higher risk of long-term vascular complications.

Objective

We evaluated the effect of different exercise modalities and doses on HbA1c levels in patients with type 2 diabetes.

Methods

A systematic search for randomized controlled trials involving exercise interventions in patients with type 2 diabetes was conducted across seven electronic databases, encompassing data from their inception up to October 2023. Two independent reviewers assessed the quality of the literature. Pairwise, network, and dose–response meta-analyses using the random-effects model were conducted to analyze the effect of exercise on HbA1c levels.

Results

A total of 85 randomized controlled trials with 5535 participants were included. The network meta-analysis showed that high-intensity interval training (HIIT) has the highest ranked (MD = − 0.78% [− 8.50 mmol/mol]; 95% CrI: − 1.04, − 0.51), followed by combined aerobic and resistance exercise (CE) (MD = − 0.54% [− 5.90 mmol/mol]; 95% CrI: − 0.69, − 0.40), yoga (MD = − 0.45% [− 4.92 mmol/mol]; 95% CrI: − 0.77, − 0.13), and continuous aerobic exercise (CAE) (MD = − 0.42% [− 4.58 mmol/mol]; 95% CrI: − 0.54, − 0.30). In addition, a significant improvement in HbA1c levels can be observed when the total exercise dose reaches 840 metabolic equivalent of tasks-min/week.

Conclusions

There was low-quality evidence that HIIT, CE, yoga, and CAE may be effective treatment modalities for improving HbA1c in patients with type 2 diabetes, and there was no significant difference in efficacy. Moreover, a non-linear dose–response relationship was found for total exercise and HbA1c levels. Future research should further investigate the specific effects of different exercise doses on HbA1c levels in patients with type 2 diabetes and provide a more personalized exercise prescription.

中文翻译：

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降低 2 型糖尿病患者糖化血红蛋白的最佳运动方式和剂量：具有成对、网络和剂量反应荟萃分析的系统评价

 背景

持续升高的糖化血红蛋白 （HbA1c） 与长期血管并发症的风险增加有关。

 目的

我们评估了不同运动方式和剂量对 2 型糖尿病患者 HbA1c 水平的影响。

 方法

在 7 个电子数据库中对涉及 2 型糖尿病患者运动干预的随机对照试验进行了系统检索，包括从建库到 2023 年 10 月的数据。两名独立评价员评估了文献的质量。使用随机效应模型进行成对、网络和剂量反应荟萃分析，以分析运动对 HbA1c 水平的影响。

 结果

共纳入 85 项随机对照试验，涉及 5535 名参与者。网络荟萃分析显示，高强度间歇训练 （HIIT） 排名最高（MD = − 0.78% [− 8.50 mmol/mol];95% CrI：− 1.04，− 0.51），其次是有氧和阻力运动 （CE） 相结合（MD = − 0.54% [− 5.90 mmol/mol];95% CrI：− 0.69，− 0.40）、瑜伽（MD = − 0.45% [− 4.92 mmol/mol];95% CrI： − 0.77， − 0.13） 和连续有氧运动 （CAE） （MD = − 0.42% [− 4.58 mmol/mol];95% CrI： − 0.54， − 0.30）。此外，当总运动剂量达到 840 代谢当量的任务分钟/周时，可以观察到 HbA1c 水平的显着改善。

 结论

有低质量的证据表明，HIIT、CE、瑜伽和 CAE 可能是改善 2 型糖尿病患者 HbA1c 的有效治疗方式，疗效没有显著差异。此外，发现总运动和 HbA1c 水平存在非线性剂量-反应关系。未来的研究应进一步调查不同运动剂量对 2 型糖尿病患者 HbA1c 水平的具体影响，并提供更加个性化的运动处方。