Exercise for the management of type 2 diabetes: a review of the evidence
TL;DR: Considering the available evidence, it appears that resistance training could be an effective intervention to help glycemic control, especially considering that the effects of this form of intervention are comparable with what reported with aerobic exercise.
Abstract: The aim is to critically review the more relevant evidence on the interrelationships between exercise and metabolic outcomes. The research questions addressed in the recent specific literature with the most relevant randomized controlled trials, meta-analysis and cohort studies are presented in three domains: aerobic exercise, resistance exercise, combined aerobic and resistance exercise. From this review appear that the effects of aerobic exercise are well established, and interventions with more vigorous aerobic exercise programs resulted in greater reductions in HbA1c, greater increase in VO2max and greater increase in insulin sensitivity. Considering the available evidence, it appears that resistance training could be an effective intervention to help glycemic control, especially considering that the effects of this form of intervention are comparable with what reported with aerobic exercise. Less studies have investigated whether combined resistance and aerobic training offers a synergistic and incremental effect on glycemic control; however, from the available evidences appear that combined exercise training seems to determine additional change in HbA1c that can be seen significant if compared with aerobic training alone and resistance training alone.
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TL;DR: This review provides the reader with the up‐to‐date evidence‐based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia).
Abstract: This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.
2,068 citations
Cites background from "Exercise for the management of type..."
...Several reviews (Sigal et al., 2004; Zanuso et al., 2010) and meta-analyses (Boule et al., 2001; Snowling & Hopkins, 2006; Thomas et al., 2006; Umpierre et al., 2011) report that increased physical exercise produce a significant improvement in glucose control in people with type 2 diabetes,…...
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TL;DR: This is the first study to demonstrate that resistance exercise specifically improves NAFLD independent of any change in body weight and the long-term impact of this now requires evaluation.
Abstract: Background Lifestyle interventions focusing on weight loss remain the cornerstone of non-alcoholic fatty liver disease (NAFLD) management. Despite this, the weight losses achieved in research trials are not easily replicated in the clinic and there is an urgent need for therapies independent of weight loss. Aerobic exercise is not well sustained and the effectiveness of the better tolerated resistance exercise upon liver lipid and mediators of liver lipid has not been assessed. Methods Sedentary adults with clinically defined NAFLD were assigned to 8 weeks of resistance exercise (n=11) or continued normal treatment (n=8). Results 8 weeks of resistance exercise elicited a 13% relative reduction in liver lipid (14.0±9.1 vs 12.2±9.0; p 0.05). Conclusion This is the first study to demonstrate that resistance exercise specifically improves NAFLD independent of any change in body weight. These data demonstrate that resistance exercise may provide benefit for the management for non-alcoholic fatty liver, and the long-term impact of this now requires evaluation.
418 citations
TL;DR: There is sufficient evidence to recommend physical activity in the management of type 1 diabetes, but it is still unclear as to what form, duration and intensity should be recommended and whether there is benefit for many of the outcomes examined.
Abstract: Physical activity improves well-being and reduces the risk of heart disease, cancer and type 2 diabetes mellitus in the general population. In individuals with established type 2 diabetes, physical activity improves glucose and lipid levels, reduces weight and improves insulin resistance. In type 1 diabetes mellitus, however, the benefits of physical activity are less clear. There is poor evidence for a beneficial effect of physical activity on glycaemic control and microvascular complications, and significant risk of harm through hypoglycaemia. Here we review the literature relating to physical activity and health in type 1 diabetes. We examine its effect on a number of outcomes, including glycaemic control, lipids, blood pressure, diabetic complications, well-being and overall mortality. We conclude that whilst there is sufficient evidence to recommend physical activity in the management of type 1 diabetes, it is still unclear as to what form, duration and intensity should be recommended and whether there is benefit for many of the outcomes examined.
371 citations
Cites background from "Exercise for the management of type..."
...Supervised physical activity programmes do, however, improve fitness in patients with type 1 diabetes [19–21] (as well as those with type 2 diabetes [22])....
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TL;DR: Exercise training favorably affects glycemic parameters, lipid profile, blood pressure, and hs-CRP, and in addition, resistance and combined training can increase IRS-1 expression.
Abstract: The purpose of this study was to compare the effects of 3 different modalities of exercise on metabolic control, insulin resistance, inflammatory markers, adipocytokines, and tissue expression of insulin receptor substrate (IRS)-1 after 12 weeks of training among patients with type 2 diabetes mellitus. Forty-eight patients with type 2 diabetes mellitus were randomly assigned to 4 groups of training (3 times a week, 60 minutes per session): aerobic group (n = 12), resistance group (n = 12), combined (aerobic and resistance) group (n = 12), and control group (n = 12). Fasting and postprandial blood glucose, glycated hemoglobin, lipid profile, insulin resistance index (homeostasis model assessment of insulin resistance), adipocytokines (adiponectin, visfatin, and resistin), tumor necrosis factor, interleukin, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline and at the end of the study. Patients also underwent a muscle microbiopsy before and after training to quantify IRS-1 expression. All 4 groups displayed decreases in blood pressure, fasting plasma glucose, postprandial plasma glucose, lipid profile, and hs-CRP (P < .05); and there was no difference across the groups. After training, the IRS-1 expression increased by 65% in the resistance group (P < .05) and by 90% in the combined group (P < .01). Exercise training favorably affects glycemic parameters, lipid profile, blood pressure, and hs-CRP. In addition, resistance and combined training can increase IRS-1 expression.
334 citations
Cites background from "Exercise for the management of type..."
...Indeed, several studies have demonstrated that exercise alone has clinical benefits, such as improved insulin sensitivity, reductions in glycated hemoglobin (A1c) and increased peak oxygen consumption (VO2peak) [3-6]....
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...[3] Zanuso S, Jimenez A, Pugliese G, et al....
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TL;DR: In conclusion, multispecies probiotic supplementation, compared with placebo, for 8 weeks in diabetic patients prevented a rise in FPG and resulted in a decrease in serum hs-CRP and an increase in plasma total GSH.
Abstract: Background: We are aware of no study that has indicated the effects of daily consumption of multispecies probiotic supplements on metabolic profiles, high-sensiti
297 citations
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30 Aug 2004
TL;DR: This report is the first report of the Surgeon General on physical activity and health, and strong evidence is shown to indicate that regular physical activity will provide clear and substantial health gains.
Abstract: : This report is the first report of the Surgeon General on physical activity and health. For more than a century, the Surgeon General of the Public Health Service has focused the nation's attention on important public health issues. Reports from Surgeons General on the adverse health consequences of smoking triggered nationwide efforts to prevent tobacco use. Reports on nutrition, violence, and HIV/AlDS - to name but a few - have heightened America's awareness of important public health issues and have spawned major public health initiatives. This new report, which is a comprehensive review of the available scientific evidence about the relationship between physical activity and health status, follows in this notable tradition. Scientists and doctors have known for years that substantial benefits can be gained from regular physical activity. The expanding and strengthening evidence on the relationship between physical activity and health necessitates the focus this report brings to this important public health challenge. Although the science of physical activity is a complex and still-developing field, we have today strong evidence to indicate that regular physical activity will provide clear and substantial health gains. In this sense, the report is more than a summary of the science - it is a national call to action.
5,107 citations
TL;DR: Patients and providers should consider the potential for serious adverse cardiovascular effects of treatment with rosiglitazone for type 2 diabetes mellitus as well as the availability of outcome data for myocardial infarction and death from cardiovascular causes.
Abstract: �Rosiglitazone was associated with a significant increase in the risk of myocardial infarction and with an increase in the risk of death from cardiovascular causes that had borderline significance. Our study was limited by a lack of access to original source data, which would have enabled time-to-event analysis. Despite these limitations, patients and providers should consider the potential for serious adverse cardiovascular effects of treatment with rosiglitazone for type 2 diabetes.
4,570 citations
"Exercise for the management of type..." refers background in this paper
...Moreover, considering the potential adverse effects attributed to some drugs [6, 7], the clinical importance of physical activity, as well as that of therapeutic education [8] is even increasing....
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TL;DR: Exercise training reduces HbA1c by an amount that should decrease the risk of diabetic complications, but no significantly greater change in body mass was found when exercise groups were compared with control groups.
Abstract: ContextExercise is widely perceived to be beneficial for glycemic control and
weight loss in patients with type 2 diabetes. However, clinical trials on
the effects of exercise in patients with type 2 diabetes have had small sample
sizes and conflicting results.ObjectiveTo systematically review and quantify the effect of exercise on glycosylated
hemoglobin (HbA1c) and body mass in patients with type 2 diabetes.Data SourcesDatabase searches of MEDLINE, EMBASE, Sport Discuss, Health Star, Dissertation
Abstracts, and the Cochrane Controlled Trials Register for the period up to
and including December 2000. Additional data sources included bibliographies
of textbooks and articles identified by the database searches.Study SelectionWe selected studies that evaluated the effects of exercise interventions
(duration ≥8 weeks) in adults with type 2 diabetes. Fourteen (11 randomized
and 3 nonrandomized) controlled trials were included. Studies that included
drug cointerventions were excluded.Data ExtractionTwo reviewers independently extracted baseline and postintervention
means and SDs for the intervention and control groups. The characteristics
of the exercise interventions and the methodological quality of the trials
were also extracted.Data SynthesisTwelve aerobic training studies (mean [SD], 3.4 [0.9] times/week for
18 [15] weeks) and 2 resistance training studies (mean [SD], 10 [0.7] exercises,
2.5 [0.7] sets, 13 [0.7] repetitions, 2.5 [0.4] times/week for 15 [10] weeks)
were included in the analyses. The weighted mean postintervention HbA1c was lower in the exercise groups compared with the control groups
(7.65% vs 8.31%; weighted mean difference, −0.66%; P<.001). The difference in postintervention body mass between exercise
groups and control groups was not significant (83.02 kg vs 82.48 kg; weighted
mean difference, 0.54; P = .76).ConclusionExercise training reduces HbA1c by an amount that should
decrease the risk of diabetic complications, but no significantly greater
change in body mass was found when exercise groups were compared with control
groups.
1,660 citations
TL;DR: In this paper, the authors evaluated the effects of combined aerobic and resistance training compared with either type of exercise alone on hemoglobin A1c values in patients with type 2 diabetes.
Abstract: Background Previous trials have evaluated the effects of aerobic training alone and of resistance training alone on glycemic control in type 2 diabetes, as assessed by hemoglobin A1c values. However, none could assess incremental effects of combined aerobic and resistance training compared with either type of exercise alone. Objective To determine the effects of aerobic training alone, resistance training alone, and combined exercise training on hemoglobin A1c values in patients with type 2 diabetes. Design Randomized, controlled trial. Setting 8 community-based facilities. Patients 251 adults age 39 to 70 years with type 2 diabetes. A negative result on a stress test or clearance by a cardiologist, and adherence to exercise during a 4-week run-in period, were required before randomization. Interventions Aerobic training, resistance training, or both types of exercise (combined exercise training). A sedentary control group was included. Exercise training was performed 3 times weekly for 22 weeks (weeks 5 to 26 of the study). Measurements The primary outcome was the change in hemoglobin A1c value at 6 months. Secondary outcomes were changes in body composition, plasma lipid values, and blood pressure. Results The absolute change in the hemoglobin A1c value in the combined exercise training group compared with the control group was -0.51 percentage point (95% CI, -0.87 to -0.14) in the aerobic training group and -0.38 percentage point (CI, -0.72 to -0.22) in the resistance training group. Combined exercise training resulted in an additional change in the hemoglobin A1c value of -0.46 percentage point (CI, -0.83 to -0.09) compared with aerobic training alone and -0.59 percentage point (CI, -0.95 to -0.23) compared with resistance training alone. Changes in blood pressure and lipid values did not statistically significantly differ among groups. Adverse events were more common in the exercise groups. Limitations The generalizability of the results to patients who are less adherent to exercise programs is uncertain. The participants were not blinded, and the total duration of exercise was greater in the combined exercise training group than in the aerobic and resistance training groups. Conclusion Either aerobic or resistance training alone improves glycemic control in type 2 diabetes, but the improvements are greatest with combined aerobic and resistance training. ClinicalTrials.gov registration number: NCT00195884.
1,010 citations
TL;DR: There is firm and consistent evidence that programs of increased physical activity and modest weight loss reduce the incidence of type 2 diabetes in individuals with IGT.
Abstract: For decades, exercise has been considered a cornerstone of diabetes management, along with diet and medication. However, high-quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years. The present document summarizes the most clinically relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these. Our recently published technical review on physical activity/exercise and type 2 diabetes (1) includes greater detail on individual studies, on prevention of diabetes, and on the physiology of exercise.
The present statement focuses on type 2 diabetes. Issues primarily germane to type 1 diabetes will be covered in a subsequent technical review and ADA Statement. The levels of evidence used are defined by the ADA in ref. 2.
Two randomized trials each found that lifestyle interventions including ∼150 min/week of physical activity and diet-induced weight loss of 5–7% reduced the risk of progression from impaired glucose tolerance (IGT) to type 2 diabetes by 58% (3,4). A cluster-randomized trial found that diet alone, exercise alone, and combined diet and exercise were equally effective in reducting the progression from IGT to diabetes (5). Therefore, there is firm and consistent evidence that programs of increased physical activity and modest weight loss reduce the incidence of type 2 diabetes in individuals with IGT.
Boule et al. (6) undertook a systematic review and meta-analysis on the effects of structured exercise interventions in clinical trials of ≥8 weeks duration on HbA1c (A1C) and body mass in people with type 2 diabetes. Postintervention A1C was significantly lower in exercise than control groups (7.65 vs. 8.31%, weighted mean difference −0.66%; P < 0.001). In contrast, postintervention body weight did not differ between the exercise and control groups. Meta-regression confirmed that the beneficial effect of exercise on A1C …
943 citations