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Evid Based Nurs 10:11 doi:10.1136/ebn.10.1.11
  • Treatment

Review: exercise improves glycaemic control and reduces plasma triglycerides and visceral adipose tissue in type 2 diabetes


 
 Q What are the effects of exercise in patients with type 2 diabetes mellitus?

METHODS

GraphicData sources:

Cochrane Central Register of Controlled Trials (Issue 1, 2005), Medline and EMBASE/Excerpta Medica (1966 to March 2005), and reference lists.

GraphicStudy selection and assessment:

randomised controlled trials (RCTs) that compared aerobic, fitness, or progressive resistance training exercise (for a period ⩾8 wks) with no exercise in patients with type 2 diabetes. Studies were excluded if interventions involved only a recommendation for increasing physical activity, were not directly supervised or well documented, or included a co-intervention in the treatment group that was not applied to the control group. Methodological quality of individual trials was assessed based on minimisation of selection, attribution, and detection bias. 14 trials (n = 377, mean age 45–65 y) met the selection criteria. Duration of interventions ranged from 2 to 12 months, with individual exercise sessions of 30–120 minutes.

GraphicOutcomes:

primary outcomes were glycaemic control (glycated haemoglobin and fasting plasma glucose concentrations) and body mass indices (body mass, body mass index [BMI], and visceral and subcutaneous adipose tissue); secondary outcomes included fasting insulin concentrations, blood lipid concentrations, and blood pressure.

MAIN RESULTS

Meta-analysis using a fixed effects model showed that exercise reduced glycated haemoglobin concentrations, plasma triglyceride concentrations, and visceral adipose tissue more than no exercise (table); exercise and no exercise did not differ for fasting plasma glucose concentrations, body mass or BMI, fasting plasma insulin concentrations, cholesterol concentrations, or blood pressure (table).

CONCLUSIONS

Exercise improves glycaemic control and reduces plasma triglyceride concentrations and visceral adipose tissue in type 2 diabetes. Exercise does not differ from no exercise for body mass or body mass index, cholesterol concentrations, or blood pressure.

Commentary

  1. Judith Carrier, RGN, MSc
  1. School of Nursing and Midwifery Studies
 Cardiff University, Caerleon, UK

      Physical activity is recommended as being particularly beneficial to patients with diabetes.1,2 The meta-analysis by Thomas et al included 14 RCTs that compared exercise with no exercise and found an overall reduction of 0.6% in glycated haemoglobin concentrations, their primary measure of glycaemic control. Reductions in glycated haemoglobin concentrations are likely to reduce the complications associated with diabetes, making this an important outcome.3

      Although the duration of individual studies varied, the review included trials from several countries, with samples of men and women with type 2 diabetes and a mean age ⩾45 years. Thus, the results are fairly generalisable for the primary outcomes of glycated haemoglobin and BMI but limited in terms of the results of the secondary outcomes because studies assessing these outcomes had much smaller samples.

      The results of Thomas et al reinforce the findings of an earlier systematic review, which found that dietary advice plus exercise was more beneficial than dietary advice alone in reducing glycated haemoglobin concentrations (based on 6 RCTs).4

      Maintaining patient motivation to exercise outside of a controlled trial setting can be difficult. Thomas et al note that the gradual increase from low intensity to regular moderate exercise may be a more successful approach than beginning with more intense levels of exercise, citing a study that attributed high rates of compliance to initial low intensity exercise and gradual progression of individualised exercise.5 The message for health professionals is that exercise is beneficial in reducing the complications of diabetes and that individualised exercise programmes should be a key component of lifestyle education.

      References

      Exercise v no exercise in patients with type 2 diabetes

      
 
 Q What are the effects of exercise in patients with type 2 diabetes mellitus?

      Footnotes

      • For correspondence: Dr D Thomas, University of Sydney, Children’s Hospital at Westmead, Westmead, New South Wales, Australia. dianat{at}chw.edu.au

      • Sources of funding: Nutricia, Australia and Financial Markets Foundation for Children, Australia.

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