The Effects of Supervised Exercise Training on Weight Control and Other Metabolic Outcomes in Patients With Type 2 Diabetes: A Meta-Analysis

in International Journal of Sport Nutrition and Exercise Metabolism

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Xingyun ZhuDepartment of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China

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Fang ZhangDepartment of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China

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Jing ChenDepartment of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China

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Yingxi ZhaoNuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Tianhao BaDepartment of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China

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Chu LinDepartment of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China

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Yingli LuChina Institute of Sport Science, Beijing, China

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Tao YuChina Institute of Sport Science, Beijing, China

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Xiaoling CaiDepartment of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China

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Li ZhangChina Institute of Sport Science, Beijing, China

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Linong JiDepartment of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China

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Few studies have investigated the dose–response relationship between exercise and weight control. This study aimed to assess the effects of different types of supervised exercise training on weight control and other metabolic outcomes in patients with type 2 diabetes mellitus and explore the dose–response relationship between exercise volume/duration and these outcomes. PubMed/MEDLINE, Embase, and Cochrane databases were searched for studies between January 1980 and June 2019. Randomized control trials in type 2 diabetes mellitus patients with supervised exercise training versus control treatment were included. The primary outcome was changes in body weight (kg). The secondary outcomes included changes in waist circumference (cm) and total body fat percentage (%). Forty-two randomized control trials, including 3,625 patients with type 2 diabetes mellitus were included. Overall, exercise treatment was associated with significant reduction in body weight (weighted mean differences, −1.10 kg; 95% CI [−1.58, −0.62], p < .01), waist circumference (weighted mean differences, −2.51 cm; 95% CI [−3.25, −1.77], p < .01), and total body fat (weighted mean differences, −1.16%; 95% CI [−1.58%, −0.75%], p < .01). The percentage of total body fat was reduced by all types of exercise, with a significant difference between aerobic exercise and resistance exercise (p = .02) and a significant difference between combined exercise and resistance exercise (p < .01). A higher volume of aerobic exercise and a higher volume of resistance exercise were superior in reducing body weight. In conclusion, supervised exercise training improved metabolic outcomes in general, while different types and volume of exercises have their own merits.

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  • Arbor, A. (2019). Adipose tissue and the physiologic underpinnings of metabolic disease. Surgery for Obesity and Related Diseases, 14(11), 17551763. https://doi.org/10.1016/j.soard.2018.07.032

    • Search Google Scholar
    • Export Citation
  • Arora, E., Shenoy, S., & Sandhu, J.S. (2009). Effects of resistance training on metabolic profile of adults with type 2 diabetes. Indian Journal of Medical Research, 129(5), 515519. https://www.ncbi.nlm.nih.gov/pubmed/19675378

    • Search Google Scholar
    • Export Citation
  • Balducci, S., Zanuso, S., Nicolucci, A., De Feo, P., Cavallo, S., Cardelli, P., Fallucca, S., Alessi, E., Fallucca, F., Pugliese, G., & Italian Diabetes Exercise Study Investigator. (2010). Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: A randomized controlled trial: The Italian Diabetes and Exercise Study (IDES). Archives of Internal Medicine, 170(20), 17941803. https://doi.org/10.1001/archinternmed.2010.380

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bittel, A.J., Bittel, D.C., Mittendorfer, B., Patterson, B.W., Adewole, L., Yoshino, J., Porter, L.C., Abumrad, N.A., Reeds, D.N., Todd, W., Louis, S., Louis, S., & Louis, S. (2021). A single bout of resistance exercise improves postprandial lipid metabolism in overweight/obese men with prediabetes. HHS Public Access, 63(3), 611623. https://doi.org/10.1007/s00125-019-05070-x.A

    • Search Google Scholar
    • Export Citation
  • Bosma, M. (2014). Lipid homeostasis in exercise. Drug Discovery Today, 19(7), 10191023. https://doi.org/10.1016/j.drudis.2014.03.007

  • Colberg, S.R., Sigal, R.J., Yardley, J.E., Riddell, M.C., Dunstan, D.W., Dempsey, P.C., Horton, E.S., Castorino, K., & Tate, D.F. (2016). Physical activity/exercise and diabetes: A position statement of the American diabetes association. Diabetes Care, 39(11), 20652079. https://doi.org/10.2337/dc16-1728

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cosentino, F., Grant, P.J., Aboyans, V., Bailey, C.J., Ceriello, A., Delgado, V., Federici, M., Filippatos, G., Grobbee, D.E., Hansen, T.B., Huikuri, H.V, Johansson, I., Juni, P., Lettino, M., Marx, N., Mellbin, L.G., Ostgren, C.J., Rocca, B., Roffi, M., . . . ESC Scientific Document Group. (2020). 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. European Heart Journal, 41(2), 255323. https://doi.org/10.1093/eurheartj/ehz486

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cuff, D.J., Meneilly, G.S., Martin, A., Ignaszewski, A., Tildesley, H.D., & Frohlich, J.J. (2003). Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care, 26(11), 29772982. https://doi.org/10.2337/diacare.26.11.2977

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dela, F., Handberg, A., Mikines, K.J., Vinten, J., & Galbo, H. (1993). GLUT 4 and insulin receptor binding and kinase activity in trained human muscle. Journal of Physiology, 469, 615624. https://doi.org/10.1113/jphysiol.1993.sp019833

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dela, F., Mikines, K.J., Sonne, B., & Galbo, H. (1994). Effect of training on interaction between insulin and exercise in human muscle. Journal of Applied Physiology, 76(6), 23862393. https://doi.org/10.1152/jappl.1994.76.6.2386

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Diabetes Canada Clinical Practice Guidelines Expert Committee, Sigal, R.J., Armstrong, M.J., Bacon, S.L., Boule, N.G., Dasgupta, K., Kenny, G.P., & Riddell, M.C. (2018). Physical activity and diabetes. The Canadian Journal of Diabetes, 42(Suppl. 1), S54S63. https://doi.org/10.1016/j.jcjd.2017.10.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ferlazzo, A., Cravana, C., Fazio, E., & Medica, P. (2020). The different hormonal system during exercise stress coping in horses. Veterinary World, 13(5), 847859. https://doi.org/10.14202/vetworld.2020.847-859

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Foright, R.M., Presby, D.M., Sherk, V.D., Kahn, D., Checkley, L.A., Giles, E.D., Higgins, J.A., Jackman, M.R., Hill, J.O., Maclean, P.S., Anschutz, C., Campus, M., States, U., States, U., States, U., Services, S. I., States, U., Science, F., States, U., & Strasbourg, D. (2019). Is regular exercise an effective strategy for weight loss maintenance? HHS Public Access. 8693. https://doi.org/10.1016/j.physbeh.2018.01.025.Is

    • Search Google Scholar
    • Export Citation
  • Guyatt, G.H., Oxman, A.D., Vist, G.E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., Schunemann, H.J., & GRADE Working Group. (2008). GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 336(7650), 924926. https://doi.org/10.1136/bmj.39489.470347.AD

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hayashino, Y., Jackson, J.L., Fukumori, N., Nakamura, F., & Fukuhara, S. (2012). Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials. Diabetes Research and Clinical Practice, 98(3), 349360. https://doi.org/10.1016/j.diabres.2012.10.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Higgins, J.P., Altman, D.G., Gotzsche, P.C., Juni, P., Moher, D., Oxman, A.D., Savovic, J., Schulz, K.F., Weeks, L., Sterne, J.A., Cochrane Bias Methods Group, & Cochrane Statistical Methods Group. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 343, Article d5928. https://doi.org/10.1136/bmj.d5928

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hsieh, P.L., Tseng, C.H., Tseng, Y.J., & Yang, W.S. (2018). Resistance training improves muscle function and cardiometabolic risks but not quality of life in older people with type 2 diabetes mellitus: A randomized controlled trial. Journal of Geriatric Physical Therapy, 41(2), 6576. https://doi.org/10.1519/JPT.0000000000000107

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Igarashi, Y., Akazawa, N., & Maeda, S. (2018). Regular aerobic exercise and blood pressure in East Asians: A meta-analysis of randomized controlled trials. Clinical and Experimental Hypertension, 40(4), 378389. https://doi.org/10.1080/10641963.2017.1384483

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Igarashi, Y., Akazawa, N., & Maeda, S. (2019). Effects of aerobic exercise alone on lipids in healthy East Asians: A systematic review and meta-analysis. Journal of Atherosclerosis and Thrombosis, 26(5), 488503. https://doi.org/10.5551/jat.45864

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Inthout, J., Ioannidis, J.P.A., & Borm, G.F. (2014). The Hartung–Knapp–Sidik–Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian–Laird method. BMC Medical Research Metholodology, 112. https://doi.org/10.1186/1471-2288-14-25

    • Search Google Scholar
    • Export Citation
  • Inthout, J., Ioannidis, J.P.A., Rovers, M.M., & Goeman, J.J. (2016). Plea for routinely presenting prediction intervals in meta-analysis. BMI Open, 16. https://doi.org/10.1136/bmjopen-2015-010247

    • Search Google Scholar
    • Export Citation
  • Jensen, M.D., Ryan, D.H., Apovian, C.M., Ard, J.D., Comuzzie, A.G., Donato, K.A., Hu, F.B., Hubbard, V.S., Jakicic, J.M., Kushner, R.F., Loria, C.M., Millen, B.E., Nonas, C.A., Pi-Sunyer, F.X., Stevens, J., Stevens, V.J., Wadden, T.A., Wolfe, B.M., Yanovski, S.Z. (2014). 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/American Heart Association task force on practice guidelines and the obesity society. Circulation, 129(25 Suppl. 2), S102S138. https://doi.org/10.1161/01.cir.0000437739.71477.ee

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kiens, B. (2021). Skeletal muscle lipid metabolism in exercise and insulin resistance. Physiological Reviews, 86(1), 205243. https://doi.org/10.1152/physrev.00023.2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kim, K.B., Kim, K., Kim, C., Kang, S.J., Kim, H.J., Yoon, S., & Shin, Y.A. (2019). Effects of exercise on the body composition and lipid profile of individuals with obesity: A systematic review and meta-analysis. Journal of Obesity & Metabolic Syndrome, 28(4), 278294. https://doi.org/10.7570/jomes.2019.28.4.278

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lin, X., Zhang, X., Guo, J., Roberts, C.K., McKenzie, S., Wu, W.C., Liu, S., & Song, Y. (2015). Effects of exercise training on cardiorespiratory fitness and biomarkers of cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials. Journal of the American Heart Association, 4(7), Article e002014. https://doi.org/10.1161/JAHA.115.002014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McAllister, R.M., Hirai, T., & Musch, T.I. (1995). Contribution of endothelium-derived nitric oxide (EDNO) to the skeletal muscle blood flow response to exercise. Medicine and Science in Sports and Exercise, 27(8), 11451151. https://www.ncbi.nlm.nih.gov/pubmed/7476058

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pan, B., Ge, L., Xun, Y.Q., Chen, Y.J., Gao, C.Y., Han, X., Zuo, L.Q., Shan, H.Q., Yang, K.H., Ding, G.W., & Tian, J.H. (2018). Exercise training modalities in patients with type 2 diabetes mellitus: A systematic review and network meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 15(1), 72. https://doi.org/10.1186/s12966-018-0703-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pedersen, S.B., Bak, J.F., Holck, P., Schmitz, O., & Richelsen, B. (1999). Epinephrine stimulates human muscle lipoprotein lipase activity in vivo. Metabolism, 48(4), 461464. https://doi.org/10.1016/s0026-0495(99)90104-x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Physical Activity Guidelines Advisory Committee. (2008). Physical Activity Guidelines Advisory Committee Report. Department of Health and Human Services.

    • Search Google Scholar
    • Export Citation
  • Saydah, S.H., Eberhardt, M.S., Loria, C.M., & Brancati, F.L. (2002). Age and the burden of death attributable to diabetes in the United States. American Journal of Epidemiology, 156(8), 714719. https://doi.org/10.1093/aje/kwf111

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sellers, T.L., Jaussi, A.W., Yang, H.T., Heninger, R.W., & Winder, W.W. (1988). Effect of the exercise-induced increase in glucocorticoids on endurance in the rat. Journal of Applied Physiology, 65(1), 173178. https://doi.org/10.1152/jappl.1988.65.1.173

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sigal, R.J., Kenny, G.P., Boule, N.G., Wells, G.A., Prud’homme, D., Fortier, M., Reid, R.D., Tulloch, H., Coyle, D., Phillips, P., Jennings, A., & Jaffey, J. (2007). Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: A randomized trial. Annals of Internal Medicine, 147(6), 357369. https://doi.org/10.7326/0003-4819-147-6-200709180-00005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stoner, L., Beets, M.W., Brazendale, K., Moore, J.B., & Weaver, R.G. (2019). Exercise dose and weight loss in adolescents with overweight-obesity: A meta-regression. Sports Med, 49(1), 8394. https://doi.org/10.1007/s40279-018-01040-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Umpierre, D., Ribeiro, P.A., Kramer, C.K., Leitao, C.B., Zucatti, A.T., Azevedo, M.J., Gross, J.L., Ribeiro, J.P., & Schaan, B.D. (2011). Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: A systematic review and meta-analysis. Journal of the American Medical Association, 305(17), 17901799. https://doi.org/10.1001/jama.2011.576

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Umpierre, D., Ribeiro, P.A., Schaan, B.D., & Ribeiro, J.P. (2013). Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: A systematic review with meta-regression analysis. Diabetologia, 56(2), 242251. https://doi.org/10.1007/s00125-012-2774-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wallace, B.C., Small, K., Brodley, C.E., Lau, J., & Trikalinos, T.A. (2012). Deploying an interactive machine learning system in an evidence-based practice center: Abstrackr. Paper presented at the Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium, 819824.

    • Search Google Scholar
    • Export Citation
  • Warkentin, L.M., Majumdar, S.R., Johnson, J.A., Agborsangaya, C.B., Rueda-Clausen, C.F., Sharma, A.M., Klarenbach, S.W., Karmali, S., Birch, D.W., & Padwal, R.S. (2014). Weight loss required by the severely obese to achieve clinically important differences in health-related quality of life: Two-year prospective cohort study. BMC Medicine, 12, 175. https://doi.org/10.1186/s12916-014-0175-5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Watt, M.J., & Cheng, Y. (2017). Triglyceride metabolism in exercising muscle. Molecular and Cell Biology of Lipids, 1862(10), 12501259. https://doi.org/10.1016/j.bbalip.2017.06.015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wewege, M.A., Thom, J.M., Rye, K.A., & Parmenter, B.J. (2018). Aerobic, resistance or combined training: A systematic review and meta-analysis of exercise to reduce cardiovascular risk in adults with metabolic syndrome. Atherosclerosis, 274, 162171. https://doi.org/10.1016/j.atherosclerosis.2018.05.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wycherley, T.P., Noakes, M., Clifton, P.M., Cleanthous, X., Keogh, J.B., & Brinkworth, G.D. (2010). A high-protein diet with resistance exercise training improves weight loss and body composition in overweight and obese patients with type 2 diabetes. Diabetes Care, 33(5), 969976. https://doi.org/10.2337/dc09-1974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yang, Z., Scott, C.A., Mao, C., Tang, J., & Farmer, A.J. (2014). Resistance exercise versus aerobic exercise for type 2 diabetes: A systematic review and meta-analysis. Sports Med, 44(4), 487499. https://doi.org/10.1007/s40279-013-0128-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Zhao, M., Veeranki, S.P., Magnussen, C.G., & Xi, B. (2020). Recommended physical activity and all cause and cause specific mortality in US adults: Prospective cohort study. BMJ, 370, Article m2031. https://doi.org/10.1136/bmj.m2031

    • Search Google Scholar
    • Export Citation
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