Intervention Review

Exercise for type 2 diabetes mellitus

  1. Diana Thomas1,*,
  2. Elizabeth J Elliott2,
  3. Geraldine A Naughton3

Editorial Group: Cochrane Metabolic and Endocrine Disorders Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 30 MAR 2005

DOI: 10.1002/14651858.CD002968.pub2

Database Title

Additional Information

How to Cite

Thomas D, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD002968. DOI: 10.1002/14651858.CD002968.pub2.

Author Information

  1. 1

    The Children's Hospital at Westmead, The University of Sydney, Centre for Evidence Based Paediatrics Gastroenterology and Nutrition (CEBPGAN), Westmead , Australia

  2. 2

    The Children's Hospital at Westmead; The University of Sydney, Department of Paediatrics and Child Health, Director of Centre for Evidence Based Paediatric Gastroenterology and Nutrition (CEBPGAN), Westmead, NSW, Australia

  3. 3

    Australian Catholic University, Director, Centre of Physical Activity Across the Life Span, Strathfield, Australia

*Diana Thomas, Centre for Evidence Based Paediatrics Gastroenterology and Nutrition (CEBPGAN), The Children's Hospital at Westmead, The University of Sydney, Locked Bag 4001, Westmead , NSW 2145, Australia. dianat@chw.edu.au. drdthomas@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Exercise is generally recommended for people with type 2 diabetes mellitus. However, some studies evaluate an exercise intervention including diet or behaviour modification or both, and the effects of diet and exercise are not differentiated. Some exercise studies involve low participant numbers, lacking power to show significant differences which may appear in larger trials.

Objectives

To assess the effects of exercise in type 2 diabetes mellitus.

Search methods

Trials were identified through the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and manual searches of bibliographies.

Selection criteria

All randomised controlled trials comparing any type of well-documented aerobic, fitness or progressive resistance training exercise with no exercise in people with type 2 diabetes mellitus.

Data collection and analysis

Two authors independently selected trials, assessed trial quality and extracted data. Study authors were contacted for additional information. Any information on adverse effects was collected from the trials.

Main results

Fourteen randomised controlled trials comparing exercise against no exercise in type 2 diabetes were identified involving 377 participants. Trials ranged from eight weeks to twelve months duration. Compared with the control, the exercise intervention significantly improved glycaemic control as indicated by a decrease in glycated haemoglobin levels of 0.6% (-0.6 % HbA1c, 95% confidence interval (CI) -0.9 to -0.3; P < 0.05). This result is both statistically and clinically significant. There was no significant difference between groups in whole body mass, probably due to an increase in fat free mass (muscle) with exercise, as reported in one trial (6.3 kg, 95% CI 0.0 to 12.6). There was a reduction in visceral adipose tissue with exercise (-45.5 cm2, 95% CI -63.8 to -27.3), and subcutaneous adipose tissue also decreased. No study reported adverse effects in the exercise group or diabetic complications. The exercise intervention significantly increased insulin response (131 AUC, 95% CI 20 to 242) (one trial), and decreased plasma triglycerides (-0.25 mmol/L, 95% CI -0.48 to -0.02). No significant difference was found between groups in quality of life (one trial), plasma cholesterol or blood pressure.

Authors' conclusions

The meta-analysis shows that exercise significantly improves glycaemic control and reduces visceral adipose tissue and plasma triglycerides, but not plasma cholesterol, in people with type 2 diabetes, even without weight loss.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Exercise for type 2 diabetes mellitus

Exercise, dietary changes and medications are frequently used in the management of type 2 diabetes. However, it is difficult to determine the independent effect of exercise from some trials because exercise has been combined with dietary modifications or medications, or compared with a control which includes another form of intervention. The review authors aimed to determine the effect of exercise on blood sugar control in type 2 diabetes.

This review found that exercise improves blood sugar control and that this effect is evident even without weight loss. Furthermore, exercise decreases body fat content, thus the failure to lose weight with exercise programmes is probably explained by the conversion of fat to muscle. Exercise improved the body's reaction to insulin and decreased blood lipids. Quality of life was only assessed in one study, which found no difference between the two groups. No significant difference was found between groups in blood levels of cholesterol or blood pressure. A total of 14 randomised controlled trials were assessed. These included 377 participants and compared groups that differed only with respect to an exercise programme intervention. The duration of the interventions in the studies ranged from eight weeks to one year. Two studies reported follow-up information, one at six months after the end of the six month exercise intervention and one at twelve months post-intervention. Generally, the studies were well-conducted, but blinding of outcome assessors was not reported and although all studies reported that randomisation was performed, few gave details of the method.

No adverse effects with exercise were reported. The effect of exercise on diabetic complications was not assessed in any of the studies.

The relatively short duration of trials prevented the reporting of any significant long term complications or mortality. Another limitation was the small number of participants included in the analyses for adiposity, blood pressure, cholesterol, body's muscle and quality of life.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

第二型糖尿病患的運動

通常建議第二型糖尿病患應該從事運動，然而運動介入評估的研究有些會加上飲食、行為的改變，因此無法將運動與飲食分開評估。此外，有些研究則是人數過少，因此大型研究出現有意義的差異，在小型研究可能無法顯現。

目標

評估運動對第二型糖尿病患的效果。

搜尋策略

從the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE 與手工進行檢索書目(bibliographies) 尋找相關研究，最後一次進行檢索的日期是2005年3月3日。

選擇標準

比較第二型糖尿病患沒有從事運動與從事任何類型、有充分佐證資料的有氧、健身或漸進式阻力訓練運動的所有隨機對照研究。

資料收集與分析

兩位作者獨立選取試驗，針對試驗的品質評估與選取資料，必要時聯繫研究作者以獲得更多資訊，並且收集任何有關試驗的副作用的資料。

主要結論

比較第二型糖尿病患沒有運動與有運動的14個隨機對照試驗，總共選取377人，研究期限從8個星期至12個月。結果有運動組的病患糖化血色素(HbA1c)下降0.6％((−0.6 % HbA1c, 95%CI(CI) 為 −0.9到−0.3; P < 0.05)，顯示血糖控制明顯改善，具有統計與臨床意義。至於整個身體質量在兩組並無顯著差異，原因可能如其中有一篇報告指出是由於運動後會增加去脂質量(fat free mass)，亦即肌肉重量增加(6.3公斤，95％CI為0.0到12.6)，此外，運動後內臟脂肪組織減少(−45.5平方厘米，95％CI為−63.8到−27.3) ，至於皮下脂肪也會減少。研究並未發現有副作用或糖尿病併發症。另一個試驗發現運動組的胰島素反應顯著增加(曲線下面積(AUC) 為131，95％CI為20至242)，同時三酸甘油酯降低(−0.25 毫莫耳/ 升(mmol / L)，95％CI為−0.48至−0.02)。至於生活品質、膽固醇和血壓並無顯著差異。

作者結論

統合分析(metaanalysis)顯示，第二型糖尿病患從事運動後即使體重沒有減少，仍可顯著改善血糖控制和減少內臟脂肪組織與血漿三酸甘油酯，但血漿膽固醇沒有差異。

翻譯人

本摘要由慈濟醫院傅振宗翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

運動可改善第二型糖尿病患者的血糖控制和減少體脂肪。雖然運動、飲食和藥物常用來治療第二型糖尿病患，然而有些運動相關的研究，由於第二型糖尿病患的管理常加上飲食改變或藥物治療，或是對照組有其他介入方式，因此很難決定運動的獨立效益。審查作者的目的是確定運動對血糖控制的效果，發現即使體重沒有減少，仍可顯著改善血糖控制。由於運動減少體脂含量，因此運動沒有減少體重的可能解釋為脂肪被轉換成肌肉。運動可以改善身體對胰島素的反應，並降低血脂肪。只有一個研究評估生活的品質，但是並未發現有差異，血液中的膽固醇和血壓亦無顯著差異。總共針對14個隨機對照試驗進行評估，包括377個參與者和對照組，進行有無運動的介入，研究期間從8個星期至1年，其中兩個研究有後續的報告，一個是在運動6個月介入研究結束六個月後，和另一個則是介入研究結束12個月後。一般來說，這些研究都是有良好的記錄，但評審對研究結果是否知曉並沒有說明，此外，儘管所有的研究都聲明是隨機抽樣，但是並未詳細說明抽樣方法。沒有運動後發生副作用的報告。沒有任一研究評估運動對糖尿病併發症的影響，或許是試驗的時間相對較短，因此無法對長期的併發症或死亡有任何評估報告。另一個限制是參與者過少，包括在分析肥胖，血壓，膽固醇，身體的肌肉和生活品質。

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