Effects of Long-Term Exercise Interventions on Glycaemic Control in Type 1 and Type 2 Diabetes: a Systematic Review

Abstract

Aim: Physical activity is one of the cornerstones in the prevention and management of diabetes mellitus, but the effects of different training forms on metabolic control still remain unclear. The aims of this review are to summarize the recommendations of 5 selected diabetes associations and to systematically review the effects of long-term supervised exercise interventions without calorie-restriction on glycemic control in people with type 1 and 2 diabetes focusing on resistance, endurance and combined training consisting of both endurance and resistance training.

Methods: Literature searches were performed using MEDLINE for articles published between January 1, 2000 and March 17, 2015. Of 76 articles retrieved, 15 randomized and controlled studies met the inclusion criteria and allowed for examining the effect of exercise training in type 1 and 2 diabetes.

Results: Diabetes associations recommend volume-focused exercise in their guidelines. In our analysis, all 3 training forms have the potential to improve the glycemic control, as assessed by HbA_1c (absolute changes in HbA_1c ranging from −0.1% to −1.1% (−1.1 to −12 mmol/mol) in resistance training, from −0.2% to −1.6% (−2.2 to −17.5 mmol/mol) in endurance training and from +0.1% to −1.5% (+1.1 to −16.4 mmol/mol) in combined training, respectively).

Conclusions: There is evidence that combined exercise training may improve glycemic control to a greater extent than single forms of exercise, especially under moderate-intensive training conditions with equal training durations. In addition, intensity of training appears to be an important determinant of the degree of metabolic improvement. Nonetheless, it is still unknown to what extent exercise effects glycemic homeostasis.

Key words

resistance training - endurance training - combined training - glycemic control - systematic review

• References

• 1 Tamayo T, Rosenbauer J, Wild SH et al. Diabetes in Europe: an update. Diabetes Res Clin Pract 2014; 103: 206-217
• 2 Hu FB, Li TY, Colditz GA et al. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA 2003; 289: 1785-1791
• 3 Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care 2011; 34: 1249-1257
• 4 Yardley JE, Hay J, Abou-Setta AM et al. A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes. Diabetes Res Clin Pract 2014; 106: 393-400
• 5 Tonoli C, Heyman E, Roelands B et al. Effects of different types of acute and chronic (training) exercise on glycaemic control in type 1 diabetes mellitus: a meta-analysis. Sports Med 2012; 42: 1059-1080
• 6 Look AHEAD Research Group . Wing RR, Bolin P, Brancati FL et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369: 145-154
• 7 Schwingshackl L, Dias S, Strasser B et al. Impact of different training modalities on anthropometric and metabolic characteristics in overweight/obese subjects: a systematic review and network meta-analysis. PLoS One 2013; 8: e82853
• 8 Schwingshackl L, Missbach B, Dias S et al. Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis. Diabetologia 2014; 57: 1789-1797
• 9 Esefeld K, Zimmer P, Stummvoll M et al. Diabetes, Sport und Bewegung. Diabetologie und Stoffwechsel 2014; 9: 196-201
• 10 American Diabetes Association . Standards of medical care in diabetes – 2014. Diabetes Care 2014; 37: 14-80
• 11 Nagi D, Gallen I. ABCD position statement on physical activity and exercise in diabetes. Practical Diabetes Int 2010; 27: 158-163
• 12 Canadian Diabetes Association Clinical Practice Guidelines Expert Committee . Sigal RJ, Armstrong MJ, Colby P et al. Physical activity and diabetes. Can J Diabetes 2013; 37: 40-44
• 13 European Society of Cardiology (ESC); European Association for the Study of Diabetes (EASD) . Rydén L, Grant PJ, Anker SD et al. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD – summary. Diab Vasc Dis Res 2014; 11: 133-173
• 14 Umpierre D, Ribeiro PA, Kramer CK et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 2011; 305: 1790-1799
• 15 Umpierre D, Ribeiro PA, Schaan BD et al. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia 2013; 56: 242-251
• 16 Cramer H, Lauche R, Haller H et al. Effects of yoga on cardiovascular disease risk factors: a systematic review and meta-analysis. Int J Cardiol 2014; 173: 170-183
• 17 Lee MS, Jun JH, Lim HJ et al. A systematic review and meta-analysis of tai chi for treating type 2 diabetes. Maturitas 2015; 80: 14-23
• 18 McGinley SK, Armstrong MJ, Boulé NG et al. Effects of exercise training using resistance bands on glycaemic control and strength in type 2 diabetes mellitus: a meta-analysis of randomised controlled trials. Acta Diabetol 2015; 52: 221-230
• 19 Kadoglou NP, Fotiadis G, Kapelouzou A et al. The differential anti-inflammatory effects of exercise modalities and their association with early carotid atherosclerosis progression in patients with type 2 diabetes. Diabet Med 2013; 30: 41-50
• 20 Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev 2006; 3: CD002968
• 21 Bjarnason-Wehrens B, Schulz O, Gielen S et al. Leitlinie körperliche Aktivität zur Sekundärprävention und Therapie kardiovaskulärer Erkrankungen. Clin Res Cardiol Suppl 2009; 4: 1-44
• 22 Laaksonen DE, Atalay M, Niskanen LK et al. Aerobic exercise and the lipid profile in type 1 diabetic men: a randomized controlled trial. Med Sci Sports Exerc 2000; 32: 1541-1548
• 23 Sigal RJ, Kenny GP, Boulé NG et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007; 147: 357-369
• 24 Lambers S, Van Laethem C, Van Acker K et al. Influence of combined exercise training on indices of obesity, diabetes and cardiovascular risk in type 2 diabetes patients. Clin Rehabil 2008; 22: 483-492
• 25 Balducci S, Zanuso S, Nicolucci A et al. Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. Nutr Metab Cardiovasc Dis 2010; 20: 608-617
• 26 Sridhar B, Haleagrahara N, Bhat R et al. Increase in the heart rate variability with deep breathing in diabetic patients after 12-month exercise training. Tohoku J Exp Med 2010; 220: 107-113
• 27 Church TS, Blair SN, Cocreham S et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA 2010; 304: 2253-2262
• 28 Oliveira C, Simões M, Carvalho J et al. Combined exercise for patients with type 2 diabetes mellitus: a systematic review. Diabetes Res Clin Pract 2012; 98: 187-198
• 29 Gordon BA, Benson AC, Bird SR et al. Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res Clin Pract 2009; 83: 157-175
• 30 Castaneda C, Layne JE, Munoz-Orians L et al. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care 2002; 25: 2335-2341
• 31 Salem MA, Aboelasrar MA, Elbarbary NS et al. Is exercise a therapeutic tool for improvement of cardiovascular risk factors in adolescents with type 1 diabetes mellitus? A randomised controlled trial. Diabetol Metab Syndr 2010; 2: 47-56
• 32 Tessier D, Ménard J, Fülöp T et al. Effects of aerobic physical exercise in the elderly with type 2 diabetes mellitus. Arch Gerontol Geriatr 2000; 31: 121-132
• 33 Balducci S, Leonetti F, Di Mario U et al. Is a long-term aerobic plus resistance training program feasible for and effective on metabolic profiles in type 2 diabetic patients?. Diabetes Care 2004; 27: 841-842
• 34 Wagner H, Degerblad M, Thorell A et al. Combined treatment with exercise training and acarbose improves metabolic control and cardiovascular risk factor profile in subjects with mild type 2 diabetes. Diabetes Care 2006; 29: 1471-1477
• 35 Praet SF, van Rooij ES, Wijtvliet A et al. Brisk walking compared with an individualised medical fitness programme for patients with type 2 diabetes: a randomised controlled trial. Diabetologia 2008; 51: 736-746
• 36 Loimaala A, Groundstroem K, Rinne M et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol 2009; 103: 972-977
• 37 Okada S, Hiuge A, Makino H et al. Effect of exercise intervention on endothelial function and incidence of cardiovascular disease in patients with type 2 diabetes. J Atheroscler Thromb 2010; 17: 828-833
• 38 Mann S, Beedie C, Balducci S et al. Changes in insulin sensitivity in response to different modalities of exercise: a review of the evidence. Diabetes Metab Res Rev 2014; 30: 257-268
• 39 Tjønna AE, Lee SJ, Rognmo Ø et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation 2008; 118: 346-354
• 40 Weston KS, Wisløff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med 2014; 48: 1227-1234
• 41 Wisløff U, Støylen A, Loennechen JP et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation 2007; 115: 3086-3094
• 42 Schjerve IE, Tyldum GA, Tjønna AE et al. Both aerobic endurance and strength training programmes improve cardiovascular health in obese adults. Clin Sci 2008; 115: 283-293
• 43 Mora-Rodriguez R, Ortega JF, Hamouti N et al. Time-course effects of aerobic interval training and detraining in patients with metabolic syndrome. Nutr Metab Cardiovasc Dis 2014; 24: 792-798
• 44 Shaban N, Kenno KA, Milne KJ. The effects of a 2 week modified high intensity interval training program on the homeostatic model of insulin resistance (HOMA-IR) in adults with type 2 diabetes. J Sports Med Phys Fitness 2014; 54: 203-209
• 45 Little JP, Gillen JB, Percival ME et al. Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J Appl Physiol (1985) 2011; 111: 1554-1560
• 46 Stanford KI, Goodyear LJ. Exercise and type 2 diabetes: molecular mechanisms regulating glucose uptake in skeletal muscle. Adv Physiol Educ 2014; 38: 308-314
• 47 Roden M. Exercise in type 2 diabetes: to resist or to endure?. Diabetologia 2012; 55: 1235-1239
• 48 Röhling M, Herder C, Stemper T et al. Influence of acute and chronic exercise on glucose uptake. J Diabetes Res 2016; 2016: 2868652
• 49 Gleeson M, Bishop NC, Stensel DJ et al. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol 2011; 11: 607-615
• 50 Herder C, Peltonen M, Koenig W et al. Finnish Diabetes Prevention Study Group. Anti-inflammatory effect of lifestyle changes in the Finnish Diabetes Prevention Study. Diabetologia 2009; 52: 433-442