Document Detail

Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis.
MedLine Citation:
PMID:  21540423     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Regular exercise improves glucose control in diabetes, but the association of different exercise training interventions on glucose control is unclear.
OBJECTIVE: To conduct a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) assessing associations of structured exercise training regimens (aerobic, resistance, or both) and physical activity advice with or without dietary cointervention on change in hemoglobin A(1c) (HbA(1c)) in type 2 diabetes patients.
DATA SOURCES: MEDLINE, Cochrane-CENTRAL, EMBASE,, LILACS, and SPORTDiscus databases were searched from January 1980 through February 2011.
STUDY SELECTION: RCTs of at least 12 weeks' duration that evaluated the ability of structured exercise training or physical activity advice to lower HbA(1c) levels as compared with a control group in patients with type 2 diabetes.
DATA EXTRACTION: Two independent reviewers extracted data and assessed quality of the included studies.
DATA SYNTHESIS: Of 4191 articles retrieved, 47 RCTs (8538 patients) were included. Pooled mean differences in HbA(1c) levels between intervention and control groups were calculated using a random-effects model. Overall, structured exercise training (23 studies) was associated with a decline in HbA(1c) level (-0.67%; 95% confidence interval [CI], -0.84% to -0.49%; I(2), 91.3%) compared with control participants. In addition, structured aerobic exercise (-0.73%; 95% CI, -1.06% to -0.40%; I(2), 92.8%), structured resistance training (-0.57%; 95% CI, -1.14% to -0.01%; I(2), 92.5%), and both combined (-0.51%; 95% CI, -0.79% to -0.23%; I(2), 67.5%) were each associated with declines in HbA(1C) levels compared with control participants. Structured exercise durations of more than 150 minutes per week were associated with HbA(1c) reductions of 0.89%, while structured exercise durations of 150 minutes or less per week were associated with HbA(1C) reductions of 0.36%. Overall, interventions of physical activity advice (24 studies) were associated with lower HbA(1c) levels (-0.43%; 95% CI, -0.59% to -0.28%; I(2), 62.9%) compared with control participants. Combined physical activity advice and dietary advice was associated with decreased HbA(1c) (-0.58%; 95% CI, -0.74% to -0.43%; I(2), 57.5%) as compared with control participants. Physical activity advice alone was not associated with HbA(1c) changes.
CONCLUSIONS: Structured exercise training that consists of aerobic exercise, resistance training, or both combined is associated with HbA(1c) reduction in patients with type 2 diabetes. Structured exercise training of more than 150 minutes per week is associated with greater HbA(1c) declines than that of 150 minutes or less per week. Physical activity advice is associated with lower HbA(1c), but only when combined with dietary advice.
Daniel Umpierre; Paula A B Ribeiro; Caroline K Kramer; Cristiane B Leitão; Alessandra T N Zucatti; Mirela J Azevedo; Jorge L Gross; Jorge P Ribeiro; Beatriz D Schaan
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  JAMA     Volume:  305     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-04     Completed Date:  2011-05-09     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1790-9     Citation Subset:  AIM; IM    
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MeSH Terms
Blood Glucose*
Diabetes Mellitus, Type 2 / therapy*
Exercise Therapy*
Hemoglobin A, Glycosylated
Intervention Studies
Middle Aged
Outcome Assessment (Health Care)
Patient Education as Topic
Randomized Controlled Trials as Topic*
Resistance Training
Weight Loss
Reg. No./Substance:
0/Blood Glucose; 0/Hemoglobin A, Glycosylated; 0/hemoglobin A1c protein, human
Comment In:
JAMA. 2011 Aug 10;306(6):607; author reply 608-9   [PMID:  21828319 ]
Praxis (Bern 1994). 2011 Sep 7;100(18):1125-6   [PMID:  21932202 ]
JAMA. 2011 May 4;305(17):1808-9   [PMID:  21540427 ]
JAMA. 2011 Aug 10;306(6):607-8; author reply 608-10   [PMID:  21828318 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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