Comparing impacts of diverse exercise interventions on type 2 diabetes mellitus patients: a literature review and meta-analysis

Shuangtao Xing ¹ Yifan Zhang ¹ Yanjiao Chen ² Shijie Feng ³ Yiqing Zhang ¹ Paulo Moreira ^4,5,6*

• ¹ Henan Normal University, College of Physical Education, Xinxiang, China
• ² College of Social Affairs, Henan Normal University, Henan, Xinxiang, China
• ³ Physical Education Institute of Henan Normal University, Henan, Xinxiang, Peoples’ Republic of China., Xinxiang, China
• ⁴ International Healthcare Management Research & Development Center (IHM-RDC), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
• ⁵ Atlantica Instituto Universitario, Gestao em Saude, Oeiras, Portugal
• ⁶ Henan Normal University, School of Social Affairs, Henan, China, Xinxiang, Henan Province, China

Exercise interventions are a recommended method in the process of diabetes management from which patients can achieve the purpose of blood glucose control, increase muscle volume and improve insulin sensitivity, while also improving blood lipids, blood pressure and cardiovascular health. A few studies on the effects of physical exercise on diabetic patients have been published in recent years. This article focuses on exploring evidence on which exercise interventions generate which effects on diabetic patients, namely, high-intensity interval training (HIIT), methods training (MT), aerobic exercise training (AET), resistance training (RT), and combined training (CBT).Methods:Randomized controlled trials (RCTs) focused on effects of the exercise interventions on blood glucose and blood lipids of patients with type 2 diabetes mellitus were reviewed. A network meta-analysis was applied to compare effects of the five exercise interventions on diabetic patients, namely, impacts on glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), and low-density lipoprotein (LDL). The operation was strictly conducted following the PRISMA Protocol, and the Cochrane Risk of Bias Assessment Tool 2.0 was used to objectively evaluate the risk of bias in the implementation process.Results：This review included 25 RCTs in total, including 1711 subjects. Meta-analysis suggests that, compared with conventional therapeutic treatment, exercise interventions can reduce blood glucose indexes, namely HbA1c, FBG, TC, TG, HDL and LDL. HbA1c, FBG and TG; RT and AET exercise have been shown to reduce TC; HIIT, MT, AET and CBT to improve HDL, while HIIT MT, AET, and CBT exercise have been shown to improve HDL. MT and RT exercise types can reduce LDL. Evidence also suggests that MT exercise can be effective in lowering HbA1c, TG and LDL levels, and RT in cholesterol levels. HIIT exercise seems to achieve positive effects in improving FBG and HDL levels Conclusion:The five types of exercises generate different effects on the key diabetes clinical dimensions. MT seems to be the optimal choice to improve HbA1c, TG levels, and LDL, while HIIT to FBG and HDL levels, whereas RT exercise seems to be the optimal exercise in lowering cholesterol levels.