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Effects of Exercise on Glycemic Control and Body Mass in Type 2 Diabetes Mellitus A Meta-analysis of Controlled Clinical Trials

Normand G. Boulé, MA; Elizabeth Haddad, MD; Glen P. Kenny, PhD; George A. Wells, PhD; Ronald J. Sigal, MD, MPH
JAMA. 2001;286(10):1218-1227. doi:10.1001/jama.286.10.1218.
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Context Exercise 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.

Objective To systematically review and quantify the effect of exercise on glycosylated hemoglobin (HbA1c) and body mass in patients with type 2 diabetes.

Data Sources Database 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 Selection We 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 Extraction Two 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 Synthesis Twelve 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).

Conclusion 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.

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Figure 1. Differences in Glycosylated Hemoglobin (HbA1c) From Baseline to Postintervention
Graphic Jump Location
WMD indicates weighted mean difference; CI, confidence interval. Studies are placed in ascending order of the intensity of the exercise intervention and represent the mean difference and the 95% CI for baseline and postintervention measurements. Exercise vs nonexercise control: baseline values, the χ2 test for heterogeneity was 4.78 (P = .91) and the z score for overall effect was 0.45 (P = .65); postintervention values, the χ2 test for heterogeneity was 9.76 (P = .46) and the z score for overall effect was 4.01 (P<.001). Exercise and diet vs control: baseline values, the χ2 test for heterogeneity was 6.77 (P = .03) and the z score for overall effect was 0.60 (P = .55); postintervention values, the χ2 test for heterogeneity was 0.74 (P = .69) and the z score for overall effect was 2.66 (P = .008).
Figure 2. Differences in Body Mass From Baseline to Postintervention
Graphic Jump Location
SMD indicates standardized mean difference; CI, confidence interval. Studies are placed in ascending order of the duration of the exercise intervention and represent the mean difference and the 95% CI for baseline and postintervention measurements. Body mass was measured in kilograms except for the studies by Raz et al14 and Vanninen et al21 in which body mass index was measured in kilograms divided by meters squared. Exercise vs nonexercise control: baseline values, the χ2 test for heterogeneity was 5.97 (P = .92) and the z score for overall effect was 1.37 (P = .17); postintervention values, the χ2 test for heterogeneity was 5.28 (P = .95) and the z score for overall effect was 0.52 (P = .60). Exercise and diet vs control: baseline values, the χ2 test for heterogeneity was 1.13 (P = .57) and the z score for overall effect was 0.15 (P = .88); postintervention values, the χ2 test for heterogeneity was 0.13 (P = .94) and the z score for overall effect was 1.16 (P = .24).

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