Effect of aerobic exercise intensity on glycemic control in type 2 diabetes: a meta-analysis of head-to-head randomized trials

Mobile Health Biometrics to Enhance Exercise and Physical Activity Adherence in Type 2 Diabetes (MOTIVATE-T2D): a decentralised feasibility randomised controlled trial delivered across the UK and Canada

OBJECTIVES

Assess the feasibility of a mobile health (mHealth)-supported home-delivered physical activity (PA) intervention (MOTIVATE-T2D) in people with recently diagnosed type 2 diabetes (T2D).

DESIGN

Feasibility multicentre, parallel group, randomised controlled trial (RCT).

SETTING

Participants were recruited from England and Canada using a decentralised design.

PARTICIPANTS

Adults (40-75 years) recently diagnosed with T2D (5-24 months).

INTERVENTIONS

Participants were randomised 1:1 to intervention (MOTIVATE-T2D) or active control groups. Participants codesigned 6month- home-delivered, personalised, progressive PA programmes supported by virtual behavioural counselling. MOTIVATE-T2D used biofeedback from wearable technologies to support the programme. The active control group received the same intervention without wearables.

OUTCOMES

The primary outcomes were recruitment rate, retention and adherence to purposeful exercise. Clinical data on effectiveness were collected as exploratory outcomes at baseline, 6 and 12 months, with HbA1c and systolic blood pressure (BP) proposed as primary outcomes for a future full RCT.

RESULTS

n=135 eligible participants expressed an interest in the trial, resulting in 125 participants randomised (age 55±9 years, 48% female, 81% white), a recruitment rate of 93%. Retention at 12 months was 82%. MOTIVATE-T2D participants were more likely to start (OR 10.4, CI 3.4 to 32.1) and maintain purposeful exercise at 6 (OR 7.1, CI 3.2 to 15.7) and 12 months (OR 2.9, CI 1.2 to 7.4). Exploratory clinical outcomes showed a potential effect in favour of MOTIVATE-T2D, including proposed primary outcomes HbA1c and systolic BP (between-group mean differences: HbA1c: 6 months: -5% change from baseline, CI -10 to 2: 12 months: -2% change from baseline, CI -8 to -4; systolic BP: 6 months: -1 mm Hg, CI -5 to 3: 12 months: -4 mm Hg, CI -8 to 1).

CONCLUSIONS

Our findings support the feasibility of delivering the MOTIVATE-T2D mHealth-supported PA intervention for people with recently diagnosed T2D and progression to a full RCT to examine its clinical and cost-effectiveness.

TRIAL REGISTRATION NUMBER

ISRCTN: 14335124; ClinicalTrials.gov: NCT0465353.

Optimal strategies for exercise intervention in older people diabetic patients: The impacts of intensity, form, and frequency on glycemic control: An exercise prescription for older people with diabetes

OBJECTIVE

This study aims to investigate the optimal exercise intensity, type, and weekly duration for improving glycated haemoglobin (HbA1c) and fasting blood glucose (FBG) levels in older people individuals with diabetes.

MATERIALS AND METHODS

PubMed, EMBASE, Web of Science and other databases were searched to identify randomised controlled trials (RCTs) starting from January 2000 to February 2024 that reported improved effects on fasting glucose and glycated haemoglobin after different exercises in middle-aged and elderly diabetic patients. Meta-analyses Review Manager V.5.3 was used.

RESULTS

Meta-analysis showed that moderate- and high-intensity exercise had a significant effect on HbA1c levels, with a mean difference (MD) of -0.34 (95 % CI: -0.44 ∼ -0.24, p < 0.01) for moderate-intensity exercise and -0.54 (95 % CI: -0.78 ∼ -0.3, p < 0.001) for high-intensity exercise.. Both moderate-intensity and high-intensity exercise demonstrated statistical significance in lowering fasting blood glucose levels (p < 0.001). Additionally, there was no significant difference between aerobic and resistance exercise forms (p= 0.72). Furthermore, for reducing HbA1c levels, engageing in weekly exercise for at least 2.5 hours showed a MD of-0.44(95 % CI:-0.63∼0.25;p<0.001).

CONCLUSIONS

In summary, in terms of exercise intensity, medium and high-intensity exercise can significantly reduce HbA1c and FBG levels in middle-aged and older people diabetic patients; in terms of exercise form, the effects of different exercise forms within medium and high-intensity on HbA1c and FBG are not statistically significant; and in terms of exercise time, in moderate-intensity aerobic exercise, older people exercising for more than 2.5 h per week are more beneficial.

The Impact of Physical Activity in Patients With Type 2 Diabetes

Most patients with type 2 diabetes (T2DM) do not meet guideline-driven exercise recommendations. Physical activity (PA) is any form of bodily movement via skeletal muscle contraction. It can include walking, gardening, leisure activity, exercise, or movement for transportation or an occupation. Aerobic and resistance exercise have been well studied and are known to improve glycemic control in patients with T2DM. While data is less substantial, low-intensity PA such as walking, yoga, tai-chi, qigong, and activity for household tasks have also been shown to be effective methods of reducing hyperglycemia. Additionally, PA to break up sedentary behaviors can also have glycemic benefits. Healthcare providers should encourage patients to increase their PA as a more sustainable means of meeting guideline-directed exercise and activity recommendations. Discussing these changes with patients involves identifying motivators, setting goals, removing barriers, monitoring progress, and understanding the patient's social support and environment.

Characteristics of High-Intensity Interval Training Influence Anthropometrics, Glycemic Control, and Cardiorespiratory Fitness in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Exercise is a non-pharmacological intervention for type 2 diabetes mellitus (T2DM), including moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT). Despite diverse exercise protocol variations, the impact of these variations in HIIT on T2DM anthropometrics, glycemic control, and cardiorespiratory fitness (CRF) remains unclear.

OBJECTIVE

The aim was to examine the influence of HIIT protocol characteristics on anthropometrics, glycemic control, and CRF in T2DM patients and compare it to control (without exercise) and MICT.

METHODS

This review is registered in PROSPERO (CRD42021281398) and follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search, employing "high-intensity interval training" and "diabetes mellitus" in PubMed and Web of Science databases, with a "randomized controlled trial" filter, spanned articles up to January 2023.

RESULTS

Of 190 records, 29 trials were included, categorized by HIIT interval duration, training volume, and intervention period. Long-duration, high-volume, and long-term HIIT yields superior outcomes compared to control conditions for body mass, waist circumference, fasting plasma glucose, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), glycosylated hemoglobin (%HbA1c), and CRF. The findings favored HIIT over MICT for body mass in long-duration, high-volume, and short-term intervals (mean difference [MD] - 3.45, - 3.13, and - 5.42, respectively, all p < 0.05) and for CRF in long and medium work intervals and high volume (MD 1.91, 2.55, and 2.43, respectively, all p < 0.05), as well as in medium and long-term intervention (MD 2.66 and 2.21, respectively, all p < 0.05). Regardless of specific HIIT characteristics, no differences were found in the HIIT versus MICT comparison for glycemic control.

CONCLUSIONS

Specific HIIT protocol characteristics influence changes in anthropometrics, glycemic control, and CRF compared to control groups. However, compared to MICT, only longer duration, higher volume, and short-term HIIT improved body mass, waist circumference, and CRF in individuals with T2DM.

A free-living, walking-based, exercise programme, with exercise timed relative to breakfast, to improve metabolic health in people living with overweight and obesity: A feasibility study

Optimising the timing of food intake relative to exercise may maximise the effectiveness of free-living exercise programmes on improvements in glycaemic control and cardio-metabolic health. This study aimed to assess the feasibility of a free-living, walking-based exercise programme and determine whether undertaking each exercise session before or after breakfast would most benefit longer-term metabolic health. Thirty-four people living with obesity (43±12 y, BMI 35.1±5.1 kg.m-2) undertook a 12-week walking-based programme, consisting of two continuous (30-60 min at 50% HRmax) and two interval exercise sessions per week (30-60 min, alternating 3 min at 85% HRmax and 3 min at 50% HRmax). Participants were allocated to exercise before (FASTED) or after (FED) breakfast (n = 17 per group). Feasibility (acceptability, adherence and compliance) to the exercise intervention were assessed, as well as changes in anthropometric variables, 24-hour continuous glucose monitoring, serum biochemistry including HbA1c, lipid profile and liver transaminases. Exercise adherence (FASTED: 93±4%, FED: 95±5%) and compliance (FASTED: 85±10%, FED: 88±10%) was high in both groups, and participants described exercise monitoring, programme structure and support as facilitators to this. Body mass, BMI, waist-to-hip ratio and HbA1c decreased similarly between groups (all P<0.01). However, serum ALT concentrations decreased after FASTED (-16± -14%; P = 0.001), but not FED training (-2 ± -4%; P = 0.720). We demonstrate that a free-living walking-based exercise programme, with exercise timed relative to breakfast can achieve high adherence and compliance and improve some anthropometric variables and HbA1c. Whether FASTED exercise can elicit greater improvements in liver health requires further investigation.

The Effects of Aerobic Exercise Training on Testosterone Concentration in Individuals Who are Obese or Have Type 2 Diabetes: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity and type 2 diabetes (T2D) are associated with alterations in testosterone concentrations. While evidence indicates that aerobic training can influence testosterone in healthy populations or females with hyperandrogenism, its impact in individuals with obesity or T2D remains unclear. Thus, the aim of this study was to investigate whether aerobic training can influence circulating testosterone concentrations in individuals with obesity or T2D.

METHODS

EBSCOhost (CINAHL, MEDLINE, SPORTDiscus), PubMed and Embase were searched for articles published until August 2023. Eligible articles included individuals with obesity or T2D that underwent an aerobic exercise intervention with testosterone concentrations measured at baseline and post intervention. Two reviewers independently screened the seven articles included in this meta-analysis and conducted data extraction and risk of bias assessments.

RESULTS

A total of 103 participants (62 men / 41 women) from three randomised controlled trials and four non-randomised controlled trials were included. Effect sizes were computed with random effects models. Aerobic exercise moderately increased testosterone concentrations in men (g = 0.565, 95% CI = 0.307 to 0.822, p < 0.001), but had no significant effect in women (g = -0.523, 95% CI = -1.541, 0.496, p = 0.314). Aerobic exercise had no significant effect on sex hormone-binding globulin or markers of insulin sensitivity (p > 0.05).

CONCLUSIONS

Aerobic training may be used to increase testosterone concentrations in men with obesity or T2D, but potentially has no influence in women. Given the low number of studies, further studies investigating the effect of exercise on circulating sex hormones in men and women with obesity or T2D are needed.

Effects of HIIT Interventions on Cardiorespiratory Fitness and Glycemic Parameters in Adults with Type 1 Diabetes: A Systematic Review and Meta-Analysis

BACKGROUND

Individuals with type 1 diabetes mellitus (T1DM) face impaired cardiorespiratory fitness and glycemic control, increasing the risk of cardiovascular complications. High-intensity interval training (HIIT) has emerged as a promising exercise modality with potential benefits for both aspects in this population.

OBJECTIVES

The primary aim was to investigate the effects of HIIT on cardiorespiratory fitness and glycemic parameters in patients with T1DM. The secondary aim was to examine the most effective HIIT protocol for cardiorespiratory fitness and glycemic parameters in patients with T1DM.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Two major electronic databases (Web of Science and PubMed) were searched up to February 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomized and non-randomized trials involving adult patients with T1DM, free of complications and other diseases examining the effects of HIIT (HIIT pre vs. post; HIIT vs. control group or HIIT vs. moderate-intensity continuous training (MICT)) on cardiorespiratory fitness and glycemic parameters were included.

RESULTS

A total of ten studies met the inclusion criteria. The meta-analysis revealed a significant improvement in cardiorespiratory fitness following HIIT interventions (pre vs. post) in patients with T1DM (standardized mean difference (SMD) = 0.59, 95% confidence interval (CI) = 0.16 to 1, p = 0.01). Furthermore, HIIT (pre vs. post) was associated with significant improvements in 24-h mean glucose control (SMD = - 0.44, 95% CI = - 0.81 to - 0.06, p = 0.02), but the results (pre vs. post) failed to identify significant improvements in fasting glucose (SMD = - 0.26, 95% CI = - 0.78 to 0.24, p = 0.3) and glycated hemoglobin (HbA1C) values (SMD = - 0.28, 95% CI = - 0.61 to 0.05, p = 0.1). However, in comparison with a control group, HIIT showed significantly favorable effects on HbA1C (SMD = - 0.74, 95% CI = - 1.35 to - 0.14, p = 0.02). Finally, the meta-regression analysis did not find any moderating effect of any HIIT characteristics (i.e., intervention duration, session duration, work time, rest time, number of bouts, and intensity) on cardiorespiratory fitness and glycemic parameters.

CONCLUSION

Our systematic review and meta-analysis show that T1DM patients who performed a HIIT intervention significantly improved cardiorespiratory fitness and reduced their 24-h mean glucose levels, but not their HbA1C and fasting glucose. These findings support the application of HIIT interventions in T1DM patients. However, the guidelines for the most effective protocol remain unclear; hence, future studies are needed.

DASH diet vs. DASH diet plus physical activity in older patients with type 2 diabetes and high blood pressure: A randomized clinical trial

BACKGROUND AND AIMS

To evaluate the effect of lifestyle modification by adopting a DASH diet, with and without physical activity guidance, on blood pressure, glycemic control, lipid profile, weight, and body composition in older patients with type 2 diabetes mellitus (T2DM) and hypertension.

METHODS AND RESULTS

For this randomized clinical trial, we recruited patients aged 60 years or older with T2DM and uncontrolled hypertension. One group (DASH) received only DASH dietary guidance, while the other group (DASHPED) received dietary guidance and encouragement to walk with a pedometer. Outcomes of interest were (1) blood pressure, (2) physical activity, (3) weight, body mass index (BMI), and body composition, and (4) biochemical variables. Measurements were taken at baseline and 16 weeks after the intervention. We included 35 patients in the analysis. At the end of the study, the DASHPED group had an mean increase in physical activity of 1721 steps/day. Both groups displayed significantly reduced weight, BMI, and waking diastolic pressures on ambulatory blood pressure monitoring after the intervention. A trend of reduced sleeping diastolic pressure was found in the DASHPED group. Changes in weight, BMI, muscle mass, body fat, waist-hip ratio, glycemic control, lipid profile, and insulin sensitivity did not differ between the groups.

CONCLUSION

There was no difference in outcomes between the group that only dieted and the group that also performed increased physical activity, despite a significant increase in exercise. This reinforces the importance of dietary changes in immediate blood pressure control.

Aerobic training with moderate or high doses of vitamin D improve liver enzymes, LXRα and PGC-1α levels in rats with T2DM

Dysregulation of key transcription factors involved in hepatic energy metabolism, such as peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) and liver X receptor alpha (LXRα), has been observed in T2DM. The present study aims to investigate the effects of aerobic training and vitamin D supplementation on liver enzyme levels and the levels of PGC-1α and LXRα proteins in hepatocytes, in a rat model of T2DM. The study involved 56 male Wistar rats, divided into two groups: one was non-diabetic and acted as a control group (n = 8), and the other had induced diabetes (n = 48). The diabetic rats were then split into six subgroups: two groups received high or moderate doses of vitamin D and aerobic training (D + AT + HD and D + AT + MD); two groups received high or moderate doses of vitamin D alone (D + HD and D + MD); one group underwent aerobic training with vehicle (sesame oil; D + AT + oil), and one group was a diabetic control receiving only sesame oil (oil-receiving). The D + AT + HD and D + HD groups received 10,000 IU of vitamin D, while the D + AT + MD and D + MD groups received 5000 IU of vitamin D once a week by injection. The D + AT + oil group and the sham group received sesame oil. After eight weeks of treatment, body weight, BMI, food intake, serum insulin, glucose, 25-hydroxyvitamin D, ALT, AST, and visceral fat were measured. The levels of PGC-1α and LXRα proteins in the liver was assessed by western blotting. Statistical analysis was performed using the paired t-test, one-way analysis of variance (ANOVA), and the Tukey post hoc test at a significance level of P < 0.05. Body weight, food intake, and BMI decreased significantly in the D + AT + HD, D + AT + MD, D + AT + oil, D + HD, and D + MD groups with the highest reduction being observed in body weight and BMI in the D + AT + HD group. The D + AT + HD group exhibited the lowest levels of insulin, glucose, and HOMA-IR while the D + C group exhibited the highest levels among the diabetic groups. The D + AT + HD and D + AT + MD groups had lower levels of ALT and AST enzymes compared to the other groups with no significant difference between D + AT + HD and D + AT + MD. D + AT + HD (p = 0.001), D + AT + MD (p = 0.001), D + HD (p = 0.023), D + MD (p = 0.029), and D + AT + oil (p = 0.011) upregulated LXRα compared to D + C. Among these groups, D + AT + HD exhibited a more profound upregulation of LXRα than D + AT + MD, D + AT + oil, D + HD, and D + MD (p = 0.005; p = 0.002, p = 0.001, and p = 0.001, respectively). Similarly, D + AT + HD showed a more notable upregulation of PGC-1α compared to D + AT + oil, D + HD, and D + MD (p = 0.002; p = 0.001, and p = 0.001, respectively). Pearson correlation tests showed significant and negative correlations between serum 25-hydroxyvitamin levels and both visceral fat (r = - 0.365; p = 0.005) and HOMA-IR (r = - 0.118; p = 0.009); while positive and significant correlations between the liver-to-bodyweight ratio with both ALT and AST enzymes and also between QUICKI levels with LXRα (r = 0.578; p = 0.001) and PGC-1α (r = 0.628; p = 0.001). Combined administration of aerobic training and vitamin D supplementation potentially improves liver enzymes in type-2 diabetic rats that were simultaneous with upregulating the levels of PGC-1α and LXRα proteins in hepatocytes. These improvements were more significant when combining exercise with high-dose vitamin D supplementation. This study highlights the potential of this combination therapy as a new diabetes treatment strategy.

Determinants of diabetes self-care activities in patients with type 2 diabetes based on self-determination theory

AIMS

In type 2 diabetes control, self-management is an effective way to minimize the risk of developing complications and improve the quality of life. Self-determination theory (SDT) proposed a promising explanatory framework to predict self-regulated behavior which was particularly relevant for self-management. This study aimed to investigate whether SDT constructs can affect the self-management and controlling glycated hemoglobin A1c (HbA1c) levels in type 2 diabetic patients or not.

METHODS

This cross-sectional study was conducted from August to December 2022 at two diabetes clinics in Zahedan. The study included 300 patients with type 2 diabetes. Data collection was done using a researcher-administrated questionnaire that included demographic data, diabetes self-care activities, and self-determination constructs including autonomous support, autonomous motivation, and perceived competence.

RESULTS

The mean of the overall score of self-care activities was 34.62 ± 11.86 out of a maximum of 70. Patients in the fourth quarter (wealthiest) of the socioeconomic status had the highest mean self-care score (P = 0.003). There was a significant relationship between diet score with perceived competence (P = 0.009). Perceived competence (P<0.001) and controlled self-regulation (P<0.001) were the predictors of exercise score in diabetes patients. Independent self-regulation (P<0.001, r = 0.21) and overall self-regulation (P = 0.001, r = 0.19) were significantly related to blood-glucose testing score. There was a significant relationship between foot care score with perceived competence (P = 0.048, r = 0.11) and autonomous support (P = 0.013, r = 0.14). Multiple regression showed that exercise was the predictor of HbA1c (P = 0.014).

CONCLUSION

Exercise is crucial for achieving good individualized glycemic control and reducing the risk of diabetes complications. The findings provided valuable insights into the determinants of self-care activities in patients with type 2 diabetes and underscore the need for interventions that address socioeconomic disparities, enhance perceived competence, and provide autonomy support to improve diabetes self-care.

A Longitudinal Dose-Response Curve Between Leisure-Time Physical Activity and the Prevalence of Diabetes Based on the Different Levels of Cognitive Function Among Older Adults

This study investigated a dose-response relationship between Leisure-Time Physical Activity participation (LTPA) and the risk of diabetes and a comparison of the risk across different cognitive function groups among older adults. The Health and Retirement Study data were used from 2012 to 2020 (n = 18 746). This study conducted a Cox Proportional Hazard Regression to investigate the Dose-Response Curve between the prevalence of diabetes and the covariates following a level of LTPA participation. The result presented that the Odds Ratio continuously decreased as the level of LTPA participation increased. Among the three cognitive function groups, the high group (OR = .43, P < .05) and the mid group (OR = .71, P < .05) had a larger negative slope coefficient than the low group. This study found that LTPA participation reduces the risk of diabetes and gives evidence for the importance of cognitive function in reducing the prevalence of diabetes.

Role of diet and exercise in aging, Alzheimer's disease, and other chronic diseases

Alzheimer's disease (AD) is a progressive neurodegenerative disease, characterized by memory loss and multiple cognitive impairments. Genetic mutations cause a small proportion (1-2%) of early-onset AD, with mutations in amyloid precursor protein (APP), presenilin 1 (PS1) and presenilin 2 (PS2). Major contributing factors of late-onset AD are ApoE4 genotype, traumatic brain injury, diabetes, obesity, hypertension, cardiovascular conditions, in addition to lifestyle factors, such as unhealthy diet and lack of physical exercise. Disease progression can be delayed and/or prevented to a greater extent by adopting healthy lifestyle with balanced and antioxidant enriched diet and daily exercise. The interaction and interplay of diet, exercise, age, and pharmacological interventions holds a crucial role in the progression, pathogenesis and management of AD and its comorbidities, including diabetes, obesity, hypertension and cardiovascular conditions. Antioxidant enriched diet contributes to brain health, glucose control, weight management, and cardiovascular well-being. Regular exercise removes toxins including free radicals and enhances insulin sensitivity, and supports cardiovascular function. In the current article, we discussed, the role of diet, and exercise in aging, AD and other conditions including diabetes, obesity, hypertension, cardiovascular conditions. This article also highlights the impact of medication, socioeconomic and lifestyle factors, and pharmacological interventions. These aspects were discussed in different races and ethnic groups in Texas, and the US.

Time Spent Jogging/Running and Biological Aging in 4458 U.S. Adults: An NHANES Investigation

Telomere length is a good index of cellular aging. Longer telomeres are predictive of longer life, and healthy lifestyles are associated with longer telomeres. This study explored the relationship between time spent jogging or running each week and leukocyte telomere length (LTL) in 4458 randomly selected U.S. adults. The association was studied using data collected by the National Health and Nutrition Examination Survey (NHANES), and a cross-sectional design. Total weekly jog/run time was calculated from survey responses. From the minute totals, three categories were formed: <10 min/week, 10-74 min/week, and ≥75 min/week. Adults in the third category met the U.S. guidelines. Data were analyzed using one-way ANOVA. Partial correlation was used to adjust for differences in potential mediating factors, including demographic and lifestyle/medical factors. In the total sample, after adjusting for all the potential covariates, mean LTL significantly differed across the three jog/run categories (F = 4.1, p = 0.0272). Specifically, adults who met the guidelines via jogging and/or running had significantly longer telomeres than adults who performed no jogging/running. Adults in the middle category did not differ from the other two categories. A minimum of 75 min of jogging/running weekly is predictive of longer telomeres when compared to adults who do not jog or run regularly.

Effect of physical activity and different exercise modalities on glycemic control in people with prediabetes: a systematic review and meta-analysis of randomized controlled trials

Background

Numerous studies have shown the beneficial effects of exercise on glycemic control in people with prediabetes. However, the most effective exercise modality for improving glycemic control remains unclear. We aimed to assess which exercise training modality is most effective in improving glycemic control in a population with prediabetes.

Methods

We conducted searches in Pubmed/MEDLINE, EMBASE, SPORTDiscus, Web of Science, PEDro, BVS, and the Cochrane Library from inception to June 2022. Included studies reported fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and 2-hour postprandial (2hPP) levels and implemented an exercise program lasting at least 12 weeks in adults with prediabetes. We performed a direct meta-analysis using a random-effects model and a network meta-analysis. Cochran's Q statistic and the inconsistency I2 test were used to assess the heterogenicity between studies.

Results

Twenty trials were included, with 15 trials (comprising 775 participants with prediabetes) combined in the meta-analysis, and 13 in the network meta-analysis. The meta-analysis results did not show a statistically significant reduction in fasting plasma glucose (FPG) after aerobic training (AT) intervention compared to a control group (mean (95%CI) difference = -5.18 (-13.48; 3.12) mg/dL, Z=1.22, p=0.22). However, a difference of -7.25 (-13.79; -0.71) mg/dL, p=0.03, in FPG after interval training (IT) intervention was detected compared to a control group. After resistance training (RT) intervention, FPG was significantly lower -6.71 (-12.65,-0.77) mg/dL, Z=2.21, p=0.03, and HbA1c by -0.13 (-0.55, 0.29), p=0.54, compared to the control group. The impact of RT compared to no intervention on 2hPP was not statistically significant (p=0.26). The network meta-analysis did not show statistical significance. Most of the studies presented an unclear risk of bias, and a low and very low-quality of evidence. According to the GRADE criteria, the strength of the body of evidence was low.

Conclusion

Resistance training and IT had demonstrated benefits on glycemic indices, especially on FPG, in a population with prediabetes. Further studies with larger sample sizes and a more robust methodology that compare different types of exercise modalities, frequencies, and durations, are needed to establish a beneficial exercise intervention.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=370688, identifier CRD42022370688.

Sarcopenia and type 2 diabetes: Pathophysiology and potential therapeutic lifestyle interventions

AIMS

Sarcopenia generally refers to the age-related reduction in muscle strength, functional ability, and muscle mass. Sarcopenia is a multifactorial condition associated with poor glucose disposal, insulin resistance, and subsequently type 2 diabetes (T2D). The pathophysiological connection between sarcopenia and T2D is complex but likely involves glycemic control, inflammation, oxidative stress, and adiposity.

METHODS AND RESULTS

Resistance exercise and aerobic training are two lifestyle interventions that may improve glycemic control in older adults with T2D and counteract sarcopenia. Further, there is evidence that dietary protein, Omega-3 fatty acids, creatine monohydrate, and Vitamin D hold potential to augment some of these benefits from exercise.

CONCLUSIONS

The purpose of this narrative review is: (1) discuss the pathophysiological link between age-related sarcopenia and T2D, and (2) discuss lifestyle interventions involving physical activity and nutrition that may counteract sarcopenia and T2D.

Where to Start? Physical Assessment, Readiness, and Exercise Recommendations for People With Type 1 or Type 2 Diabetes

Exercise plays an important role in the management of diabetes and is associated with many benefits such as decreased morbidity and mortality. For people exhibiting signs and symptoms of cardiovascular disease, pre-exercise medical clearance is warranted; however, requiring broad screening requirements can lead to unnecessary barriers to initiating an exercise program. Robust evidence supports the promotion of both aerobic and resistance training, with evidence emerging on the importance of reducing sedentary time. For people with type 1 diabetes, there are special considerations, including hypoglycemia risk and prevention, exercise timing (including prandial status), and differences in glycemic responses based on biological sex.

Associations between adoption of eHealth management module and optimal control of HbA1c in diabetes patients

In January 2021, the eHealth App was launched in Hong Kong by the Hong Kong government to support the Electronic Health Record Sharing System (eHRSS). A Health Management Module in the eHealth App introduced new functions to record blood pressure, blood sugar, and heart rate, and downloading and sharing records. This study aims to compare the level of glycaemic control between users of the eHealth App and non-users. Type 2 diabetes patients who have joined the eHRSS with existing haemoglobin A1c (HbA1c) level records are recruited. Correlations between predictors and optimal HbA1c control (<7%) are examined using logistic regression analyses. A total of 109,823 participants are included, with 76,356 non-users of eHealth App, 31,723 users of eHealth App, and 1744 users of the eHealth Management Module together with the App. We collect HbA1c values from Jan 2021 to May 2022, and they are 6 months after the use of the App on average. Users of the eHealth Management Module are found to have more optimal HbA1c levels across all subgroups, with the strongest effect observed in younger females (aOR = 1.66, 95% CI = 1.27-2.17). eHealth App usage is also positively associated with optimal HbA1c levels, particularly amongst younger females (aOR = 1.17, 95% CI = 1.08-1.26). Overall, users of eHealth App and eHealth Management Module demonstrate more optimal HbA1c levels when compared with non-users, particularly among younger adults and females. These findings support its potential adoption in diabetes patients. Future studies should examine the impact of eHealth interventions on other clinical targets and diabetes complications.

The effects of three different low-volume aerobic training protocols on cardiometabolic parameters of type 2 diabetes patients: A randomized clinical trial

Objective

To compare the effects of different aerobic training protocols on cardiometabolic variables in patients with type 2 diabetes mellitus (T2DM).

Methods

This study was a parallel clinical trial. Fifty-two men and women with T2DM (>40 years) were randomly allocated into three groups, and 44 (22 males/22 females) were included in the final analysis. Exercise intensity was based on the speed corresponding to the maximum oxygen consumption (v V ˙ O2max). Moderate intensity continuous training (MICT) involved 14 minutes at 70% of v V ˙ O2max; short interval high-intensity interval training (S-HIIT) consisted of 20 bouts of 30 seconds at 100% of V˙O2max with 30 seconds passive recovery; long interval high-intensity training (L-HIIT) consisted of 5 bouts of 2 minutes at 100% of v V ˙ O2max with 2 minutes passive recovery. Training protocols were performed on a motorized treadmill two times per week for eight weeks. Glycated hemoglobin (Hb1Ac), total cholesterol, triglycerides, resting systolic blood pressure (SBP), resting diastolic blood pressure (DBP), resting heart rate (resting HR) and maximum oxygen consumption (V˙O2max) were measured before and after the exercise intervention. The study was registered on the Brazilian clinical trial records (ID: RBR45 4RJGC3).

Results

There was a significant difference between groups for changes on V ˙ O2max. Greater increases on V ˙ O2max were achieved for L-HIIT (p = 0.04) and S-HIIT (p = 0.01) in comparison to MICT group, with no significant difference between L-HIIT and S-HIIT (p = 0.9). Regarding comparison within groups, there were significant reductions on HbA1c and triglycerides levels only for L-HIIT (p< 0.05). V ˙ O2max significantly increased for both L-HIIT (MD = 3.2 ± 1.7 ml/kg/min, p< 0.001) and S-HIIT (MD = 3.4 ± 1.7, p< 0.001). There was a significant reduction on resting SBP for L-HIIT group (MD = -12.07 ± 15.3 mmHg, p< 0.01), but not for S-HIIT and MICT. There were no significant changes from pre- to post-training on fasting glycemia, total cholesterol, HDL, LDL, resting HR and resting DBP for any group (p > 0.05).

Conclusion

Low-volume HIIT promoted greater improvements in cardiorespiratory capacity in comparison with low-volume MICT, independent of the protocols used. There were no other differences between groups. All protocols improved at least one of the variables analyzed; however, the most evident benefits were after the high-intensity protocols, especially L-HIIT.

Skeletal muscle mechanisms contributing to improved glycemic control following intense interval exercise and training

High-intensity and sprint interval training (HIIT and SIT, respectively) enhance insulin sensitivity and glycemic control in both healthy adults and those with cardiometabolic diseases. The beneficial effects of intense interval training on glycemic control include both improvements seen in the hours to days following a single session of HIIT/SIT and those which accrue with chronic training. Skeletal muscle is the largest site of insulin-stimulated glucose uptake and plays an integral role in the beneficial effects of exercise on glycemic control. Here we summarize the skeletal muscle responses that contribute to improved glycemic control during and following a single session of interval exercise and evaluate the relationship between skeletal muscle remodelling and improved insulin sensitivity following HIIT/SIT training interventions. Recent evidence suggests that targeting skeletal muscle mechanisms via nutritional interventions around exercise, particularly with carbohydrate manipulation, can enhance the acute glycemic benefits of HIIT. There is also some evidence of sex-based differences in the glycemic benefits of intense interval exercise, with blunted responses observed after training in females relative to males. Differences in skeletal muscle metabolism between males and females may contribute to sex differences in insulin sensitivity following HIIT/SIT, but well-controlled studies evaluating purported muscle mechanisms alongside measurement of insulin sensitivity are needed. Given the greater representation of males in muscle physiology literature, there is also a need for more research involving female-only cohorts to enhance our basic understanding of how intense interval training influences muscle insulin sensitivity in females across the lifespan.

Perceptions of fracture and fall risk and of the benefits and barriers to exercise in adults with diabetes

The increased risk of fractures and falls is under-appreciated by adults living with diabetes and by their healthcare providers. Strategies to overcome perceived exercise barriers and exercise programs optimized for bone health should be implemented.

PURPOSE

The purpose of the study was to assess the perceptions of fracture and fall risk, and the perceived benefits of and barriers to exercise in adults ≥ 50 years old living with type 1 (T1D) and type 2 diabetes (T2D).

METHODS

Participants were recruited through social media and from medical clinics and invited to complete a self-administered online survey, comprising 38 close-ended questions and 4 open-ended questions.

RESULTS

A total of 446 participants completed the survey: 38% T1D, 59% T2D, and 3% with unreported diabetes type. Most participants did not believe that having diabetes increased their risk of fractures (81%) nor falls (68%), and more than 90% reported having not been informed about diabetes-related fracture risk by their physicians. Among exercise types, participation in moderate aerobic exercise was most common (54%), while only 31%, 32%, and 37% of participants engaged in strenuous aerobic, resistance, and balance/flexibility exercise, respectively. The most prevalent barrier to exercise for both T1D and T2D was a lack of motivation, reported by 54% of participants. Lack of time and fear of hypoglycemia were common exercise barriers reported by participants with T1D. Most participants owned a smart phone (69%), tablet (60%), or computer (56%), and 46% expressed an interest in partaking in virtually delivered exercise programs.

CONCLUSIONS

Adults living with diabetes have limited awareness of increased fall and fracture risk. These risks are insufficiently highlighted by health care providers; strategies to overcome perceived exercise barriers and exercise programs optimized for bone health should be implemented.

Comparative Effect of Three Different Exercise Intensities in Combination with Diazoxide on Contraction Capacity and Oxidative Stress of Skeletal Muscle in Obese Rats

Obesity is a chronic disease that impairs skeletal muscle function, affects the ability to contract, and promotes the development of fatigue. For this reason, the study of treatments that seek to reduce the harmful effects of obesity on muscle tissue has been deepened. Diazoxide treatment and various exercise protocols have been proposed to protect skeletal muscle against oxidative stress and its effects. However, the intensity and duration of exercise combined with diazoxide that would obtain the best results for improving skeletal muscle function in obese rats is unknown. To this end, this study evaluated the effects of three different exercise intensities combined with diazoxide on contraction capacity, resistance to fatigue, markers of oxidative stress, lipid peroxidation, ROS, and glutathione redox status of skeletal muscle. The results showed that treatments with diazoxide and exercise at different intensities improved muscle contraction capacity by reducing oxidative stress during obesity, with the best results being obtained with low-intensity exercise in combination with diazoxide. Therefore, these results suggest that diazoxide and low-intensity exercise improve muscle function during obesity by decreasing oxidative stress with the same efficiency as a moderate-intensity exercise protocol.

The effect of a 6-month walking program on biochemical parameters in sedentary adults with type 2 diabetes mellitus

This study assessed the effect of a 6-month walking program on biochemical parameters in patients with type-2 diabetes mellitus. A group of 40 sedentary patients with type-2 diabetes volunteered to participate in this study. Plasma glucose, triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase, urea, creatinine, uric acid, C-reactive protein (CRP), and erythrocyte sedimentation rate were measured. Differences in outcome measures between pre- and post-intervention were assessed using paired t-test or Wilcoxon signed-rank test, with effect sizes interpreted separately for normally (µ2: small 0.01-0.06, moderate 0.061-0.14, and large >0.14) and non-normally distributed data (r: small = 0.1-0.3, moderate = 0.3-0.5, and large >0.5). Significant (p < 0.001) large decrease between the initial and final measurements was observed for glucose (r = 0.62), total cholesterol (µ2 = 0.88), triglycerides (r = 0.62), LDL (r = 0.61), AST (µ2 = 0.82), ALT (µ2 = 0.79), gamma-glutamyl transferase (µ2 = 0.79), urea (µ2 = 0.92), creatinine (r = 0.62), uric acid (r = 0.62), CRP (µ2 = 0.80), and erythrocyte sedimentation rate (µ2 = 0.58). On the other hand, significant (p < 0.001) large increase between the initial and final measurements was observed for HDL (r = 0.62). Supervised 6-month aerobic walking program is an effective strategy in (1) reducing hyperglycemia; (2) increasing HDL and reducing LDL, and triglycerides; (3) reducing plasma biomarkers of liver dysfunction, kidney dysfunction, and inflammation in type-2 diabetic patients.

Dose-Dependent Effect of Supervised Aerobic Exercise on HbA1c in Patients with Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

Previous meta-analyses indicated that aerobic exercise can improve glycemic control. However, the optimum dose of exercise is still being discussed.

OBJECTIVE

The aim of this study was to examine the dose-dependent effect of supervised aerobic training (SAT) on glycated hemoglobin (HbA1c).

METHODS

We searched PubMed, Scopus, and Web of Science to May 2021 for randomized trials with an intervention period of 12 weeks or longer evaluating the effect of SAT on HbA1c in adults with type 2 diabetes mellitus. Secondary outcomes included quality of life, change in hypoglycemic medications, and adverse events. A random-effects dose-response meta-analysis was conducted.

RESULTS

The analysis of 26 trials with 1253 participants indicated that each 30-min/week SAT reduced HbA1c by - 0.22 percentage point (95% CI - 0.29 to - 0.15; GRADE = strong). Levels of HbA1c decreased proportionally with the increase in the duration of moderate to vigorous-intensity SAT to 100 min/week (mean difference100 min/week: - 0.96 percentage point, 95% CI - 1.25 to - 0.67), with flattening of the curve at higher duration. Aerobic exercise decreased antidiabetic medications by 13 per 100 patients (risk difference 0.13, 95% CI 0.02-0.23; 7 trials, n = 375; GRADE = moderate), and increased hypoglycemic reactions by 10 per 100 patients (risk difference: 0.10, 95% CI 0.03-0.17; 4 trials, n = 263; GRADE = low) and adverse events by 4 per 100 patients (risk difference: 0.04, 95% CI - 0.02 to 0.11; 2 trials, n = 236; GRADE = low). Limited evidence is available for quality of life.

CONCLUSIONS

Every 30 min/week of moderate to vigorous aerobic exercise can exert a significant effect on HbA1c, with the highest effect observed from 100 min/week and above. However, exercise durations above 100 min/week seem ineffective for further reductions.

PROTOCOL REGISTRATION

PROSPERO (CRD42021257251).

The effects of high-intensity interval training on glucose metabolism, cardiorespiratory fitness and weight control in subjects with diabetes: Systematic review a meta-analysis

AIM

The objective of this meta-analysis was to explore the effects of high-intensity interval training (HIIT) compared with control conditions (CON) or moderate intensity continuous training (MICT) on glycemic parameters in diabetes subjects.

METHODS

Pubmed, Embase and Google Scholar databases were searched for HIIT interventions that were carried out in diabetic subjects and exploring fasting glucose, glycated haemoglobin (HbA1c), fasting insulin and/or HOMA-IR.

RESULTS

This systematic review retrieved a total of 1741 studies of which 32 articles fulfilled the eligibility criteria. Nineteen trials were included in the meta-analysis since they compared HIIT intervention with CON or MICT group. There was a significantly reduction of fasting glucose of 13.3 mg/dL (p < 0.001), Hb1Ac -0.34% (p < 0.001), insulin -2.27 UI/L (p = 0.003), HOMA-IR -0.88 (p = 0.005) in the HIIT-group compared with CON-group. Nevertheless, this reduction was not significantly different when comparing HIIT with MICT (p = 0.140, p = 0.315, p = 0.520 and p = 0.389). Besides, there was a significant increase of absolute VO2max of 0.21 L/min (p < 0.001) and relative VO2max of 2.94 ml/kg/min (p < 0.001) in the HIIT-group compared with the CON-group and the MICT-group (0.22 L/min, p = 0.025) and (0.97 ml/kg/min, p = 0.045).

CONCLUSIONS

These findings revealed that HIIT intervention led to significant improvement in glycemic control and insulin resistance in subjects with diabetes compared with CON-group.

Aquatic Aerobic and Combined Training in Management of Type 2 Diabetes: The Diabetes and Aquatic Training Study (DATS): A Randomized Clinical Trial

BACKGROUND

To compare the effects of aquatic aerobic and combined (aerobic more resistance) training on glycemic control and other cardiometabolic outcomes in patients with type 2 diabetes.

METHODS

Patients were randomized to an aquatic aerobic training (AERO, n = 19; 57.5 [7.4] y; 9 [47%] women), or an aquatic combined training (COMBI, n = 19; 60.9 [7.4] y; 10 [53%] women), or an aquatic active procedure control (n = 19; 58.6 [9.7] y; 10 [53%] women) in 3 weekly sessions (50 min each), during 15 weeks. Glycated hemoglobin was the primary outcome, whereas insulin resistance markers, lipid profile, systemic inflammation, renin concentration, blood pressure, physical activity levels, and sitting time were secondary outcomes.

RESULTS

Glycated hemoglobin was reduced in all groups (P = .021), although changes were more marked in AERO (-0.36%) and COMBI (-0.44%) than in active control (-0.26%) group. Lipid profile was similarly modified in all groups. Diastolic blood pressure and renin concentration were also reduced in all groups; however, renin showed more marked reductions in AERO (-17.7 uIU/mL) and COMBI (-15.1 uIU/mL) than in active control (0.2 uIU/mL) group. Fasting insulin, triglycerides, C-reactive protein, systolic blood pressure, walking time, and sitting time on weekends were not modified.

CONCLUSION

AERO and COMBI presented similar effect to improve glycemic control and some cardiometabolic risk factors in patients with type 2 diabetes.

Physical Activity Participation in People With an Active Diabetic Foot Ulceration: A Scoping Review

BACKGROUND

Being physically active on a regular basis has a favourable impact on diabetes-related complications. With the exception of evidence advising individuals with an active diabetic foot ulceration (DFU) to avoid weight-bearing activity, no physical activity (PA) recommendations are currently provided for this population.

OBJECTIVE

The aim of this scoping review was to examine and map the existing research evidence of PA participation for individuals with an active DFU.

DESIGN

A scoping review using the Arksey and O'Malley framework was conducted in electronic databases and grey literature from inception to June 2020 to identify publications that investigated individuals with type 1 or type 2 diabetes and an active DFU at enrolment in relation to a PA intervention. Reported outcomes had to inform on effects of PA on any health or wound parameters.

RESULTS

Nineteen articles from 17 distinct studies met inclusion criteria. Fourteen of the included studies were published in the last 10 years. Types of exercises and materials used, duration of studies, offloading considerations and provision of wound care varied greatly between studies. Included studies are heterogenous in methodological designs and aims, and reporting was often lacking important components of wound care and PA interventions. A discussion based on descriptive statistics and narrative analysis is provided.

CONCLUSIONS

It is not possible from this scoping review to determine what would be the ideal components of a PA program for this specific population. Conclusions are limited by the quality and design of the included studies. No articles evaluated quality of life, mortality or cardiorespiratory capacity, nor were adverse effects routinely reported.

Physical Activity Patterns among Individuals with Prediabetes or Type 2 Diabetes across Two Years-A Longitudinal Latent Class Analysis

BACKGROUND

This study aimed to identify distinct profiles of physical activity (PA) patterns among individuals with prediabetes or type 2 diabetes participating in a two-year PA trial and to investigate predictors of the profiles.

METHODS

Data (n = 168, collected 2013-2020) from the cohort of a randomized trial aimed at increasing PA in individuals with prediabetes and type 2 diabetes were used. PA and sedentary behaviours were assessed by waist-worn ActiGraph GT1M accelerometers at baseline and at 6, 12, 18 and 24 months. Fifteen PA and sedentary variables were entered into a latent class mixed model for multivariate longitudinal outcomes. Multinominal regression analysis modelled profile membership based on baseline activity level, age, gender, BMI, disease status and group randomisation.

RESULTS

Two profiles of PA patterns were identified: "Increased activity" (n = 37, 22%) included participants increasing time in PA and decreasing sedentary time. "No change in activity" (n = 131, 78%) included participants with no or minor changes. "Increased activity" were younger (p = 0.003) and more active at baseline (p = 0.011), compared to "No change in activity". No other predictor was associated with profile membership.

CONCLUSIONS

A majority of participants maintained PA and sedentary patterns over two years despite being part of a PA intervention. Individuals improving PA patterns were younger and more active at baseline.

Effect of Application of Treadmill Training on Metabolic Control and Vitamin D Level in Saudi Patients with Type 2 Diabetes Mellitus

BACKGROUND

Diabetes mellitus type 2 and vitamin D deficiency are both prevalent in the Saudi Arabia. Vitamin D deficiency treatment with supplements carries a risk of intoxication.

AIM

The present study is aimed at elucidating the effect of exercise on modulation of metabolic status and vitamin D level in patients with type 2 diabetes mellitus (T2DM).

METHODS

A sum of 110 type 2 diabetic patients were voluntarily enrolled for the present investigation by dividing them into two separate groups (55 individuals for each group), the diabetic study group and diabetic control group. The diabetic study group was engaged in the training program using treadmill exercise. Laboratory parameters were monitored before and after the training program.

RESULTS

There were significant elevation in the diabetic study group compared to diabetic control group regarding postexercise vitamin D level, high-density lipoprotein (HDL) (p value ≤ 0.001, 0.045; respectively). In addition, triglycerides, low-density lipoprotein (LDL), glycosylated hemoglobin (HbA1C), and homeostatic model assessment-insulin resistance (HOMA-IR) were significantly decreased (p value < 0.001 for all mentioned parameters). Moreover, there were significant higher level in postexercise parameters as compared to preexercise level in the diabetic study group.

CONCLUSION

The exercise training program improved the metabolic control and vitamin D level after three months of intervention.

American Medical Society for Sports Medicine Position Statement on the Care of the Athlete and Athletic Person With Diabetes

ABSTRACT

The American Medical Society for Sports Medicine (AMSSM) developed this position statement to assist physicians and other health professionals in managing athletes and active people with diabetes. The AMSSM selected the author panel through an application process to identify members with clinical and academic expertise in the care of active patients with diabetes. This article reviews the current knowledge and gaps regarding the benefits and risks of various types of exercise and management issues for athletes and physically active people with diabetes, including nutrition and rehabilitation issues. Resistance exercises seem to be beneficial for patients with type 1 diabetes, and the new medications for patients with type 2 diabetes generally do not need adjustment with exercise. In preparing this statement, the authors conducted an evidence review and received open comment from the AMSSM Board of Directors before finalizing the recommendations.

Mobile Health Biometrics to Enhance Exercise and Physical Activity Adherence in Type 2 Diabetes (MOTIVATE-T2D): protocol for a feasibility randomised controlled trial

INTRODUCTION

Exercise and physical activity (PA) are fundamental to the treatment of type 2 diabetes. Current exercise and PA strategies for newly diagnosed individuals with type 2 diabetes are either clinically effective but unsuitable in routine practice (supervised exercise) or suitable in routine practice but clinically ineffective (PA advice). Mobile health (mHealth) technologies, offering biometric data to patients and healthcare professionals, may bridge the gap between supervised exercise and PA advice, enabling patients to engage in regular long-term physically active lifestyles. This feasibility randomised controlled trial (RCT) will evaluate the use of mHealth technology when incorporated into a structured home-based exercise and PA intervention, in those recently diagnosed with type 2 diabetes.

METHODS AND ANALYSIS

This feasibility multicentre, parallel group RCT will recruit 120 individuals with type 2 diabetes (diagnosis within 5-24 months, aged 40-75 years) in the UK (n=60) and Canada (n=60). Participants will undertake a 6-month structured exercise and PA intervention and be supported by an exercise specialist (active control). The intervention group will receive additional support from a smartwatch and phone app, providing real-time feedback and enabling improved communication between the exercise specialist and participant. Primary outcomes are recruitment rate, adherence to exercise and loss to follow-up. Secondary outcomes include a qualitative process evaluation and piloting of potential clinical outcome measures for a future RCT.

ETHICS AND DISSEMINATION

The trial was approved in the UK by the South East Scotland Research Ethics Committee 01 (20/SS/0101) and in Canada by the Clinical Research Ethics Board of the University of British Columbia (H20-01936), and is being conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. Results will be published in peer-reviewed journals and presented at national and international scientific meetings.

TRIAL REGISTRATION NUMBERS

ISRCTN14335124; ClinicalTrials.gov: NCT04653532.

Effect of high-intensity interval training protocols on VO2max and HbA1c level in people with type 2 diabetes: A systematic review and meta-analysis

BACKGROUND

The effect of high-intensity interval training (HIIT) protocols according to different work intervals, session volumes and training periods has not been evaluated in patients with type 2 diabetes mellitus (T2DM).

OBJECTIVE

This was a systematic review and meta-analysis of the effect of HIIT and its different protocols compared to moderate-intensity continuous training (MICT) and the control group on VO₂max and glycated hemoglobin (HbA1c) level in patients with T2DM.

METHODS

The search strategy considered studies published up to September 2020 in the databases MEDLINE (PubMed), EMBASE, Cochrane CENTRAL, Web of Science and SPORTDiscus. Two authors independently searched the selected databases for randomized clinical trials that compared HIIT to MICT or the control in adults with T2DM. A random-effects meta-analysis was performed and the data are presented as the mean difference (95% confidence intervals [95% CIs]) between HIIT, MICT and control groups.

RESULTS

A total of 20 studies (738 participants) were included. Overall, HIIT increased VO₂max by 5.09 mL/kg/min (95% CI 2.99; 7.19, I² = 80.89) versus the control and by 1.9 mL/kg/min (95% CI 0.81; 2.98, I² = 25.62) versus MICT. HIIT promoted a significant reduction in HbA1c level of -0.8% (95% CI -1.06; -0.49, I² = 77.31) versus the control but with no difference versus MICT. Moderate-interval, high-volume and long-term training promoted a greater increase in VO₂max. A long interval and moderate volume and period conferred a greater increase in VO₂max versus MICT. A short interval and moderate volume and period conferred a greater reduction in HbA1c level versus the control. No publication bias was detected, as evaluated by a funnel chart and Egger's test (p > 0.05).

CONCLUSIONS

As compared with MICT, HIIT had better effect on VO₂max and a similar effect on HbA1C level. Interval protocols, moderate to long training period and moderate to high volume may maximize the HIIT effect in patients with T2DM.

High intensity interval training versus moderate intensity continuous training for people with interstitial lung disease: protocol for a randomised controlled trial

Background

Interstitial lung disease is a debilitating condition associated with significant dyspnoea, fatigue, and poor exercise tolerance. Pulmonary rehabilitation is an effective and key intervention in people with interstitial lung disease. However, despite the best efforts of patients and clinicians, many of those who participate are not achieving clinically meaningful benefits. This assessor-blinded, multi-centre, randomised controlled trial aims to compare the clinical benefits of high intensity interval exercise training versus the standard pulmonary rehabilitation method of continuous training at moderate intensity in people with fibrotic interstitial lung disease.

Methods

Eligible participants will be randomised to either a standard pulmonary rehabilitation group using moderate intensity continuous exercise training or high intensity interval exercise training. Participants in both groups will undertake an 8-week pulmonary rehabilitation program of twice-weekly supervised exercise training including aerobic (cycling) and strengthening exercises. In addition, participants in both groups will be prescribed a home exercise program.

Outcomes will be assessed at baseline, upon completion of the intervention and at six months following the intervention by a blinded assessor. The primary outcome is endurance time on a constant work rate test. Secondary outcomes are functional capacity (6-min walk distance), health-related quality of life (Chronic Respiratory Disease Questionnaire (CRQ), St George’s Respiratory Questionnaire idiopathic pulmonary fibrosis specific version (SGRQ-I), breathlessness (Dyspnoea 12, Modified Medical Research Council Dyspnoea Scale), fatigue (fatigue severity scale), anxiety (Hospital Anxiety and Depression Scale), physical activity level (GeneActiv), skeletal muscle changes (ultrasonography) and completion and adherence to pulmonary rehabilitation.

Discussion

The standard exercise training strategies used in pulmonary rehabilitation may not provide an optimal exercise training stimulus for people with interstitial lung disease. This study will determine whether high intensity interval training can produce equivalent or even superior changes in exercise performance and symptoms. If high intensity interval training proves effective, it will provide an exercise training strategy that can readily be implemented into clinical practice for people with interstitial lung disease.

Trial registration ClinicalTrials.gov Registry (NCT03800914). Registered 11 January 2019, https://clinicaltrials.gov/ct2/show/NCT03800914

Australian New Zealand Clinical Trials Registry ACTRN12619000019101. Registered 9 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376050&isReview=true

Benefits of adding food education sessions to an exercise programme on cardiovascular risk factors in patients with type 2 diabetes

To evaluate the impact of adding food education sessions to an exercise programme on cardiovascular risk factors in middle-aged and older patients with type 2 diabetes (T2D), a randomised parallel-group study was performed. Glycated haemoglobin, body mass index (BMI), waist circumference, fat mass (FM) and blood pressure were assessed at baseline and after 9 months. The recruitment was made in three primary healthcare centres from Vila Real, Portugal. Thirty-three patients (65⋅4 ± 5⋅9 years old) were engaged in a 9-month community-based lifestyle intervention programme: a supervised exercise programme (EX; n = 15; combined aerobic, resistance, agility/balance and flexibility exercise; three sessions per week; 75 min per session); or the same exercise programme plus concomitant food education sessions (EXFE; n = 18; 15-min lectures and dual-task strategies during exercise (answer nutrition questions while walking); 16 weeks). Significant differences between groups were identified in the evolution of BMI (P < 0.001, ) and FM (P < 0.001, ), with best improvements observed in the EXFE group. The addition of a simple food education dietary intervention to an exercise programme improved body weight and composition, but not glycaemic control and blood pressure in middle-aged and older patients with T2D.

Acute and Chronic Effects of Low-Volume High-Intensity Interval Training Compared to Moderate-Intensity Continuous Training on Glycemic Control and Body Composition in Older Women with Type 2 Diabetes

Objective: To compare the acute and chronic effects of low-volume high-intensity interval training (HIIT) to moderate-intensity continuous training (MICT) on glycemic control, body composition and continuous glucose monitoring (CGM) in older women with type 2 diabetes (T2D). Methods: Thirty older women (68 ± 5 years) with T2D were randomized in two groups—HIIT (75 min/week) or MICT (150 min/week). Glucose homeostasis (A1c, glucose, insulin, HOMA-IR2) and body composition (iDXA) were measured before and after the 12-week exercise intervention. During the first and last week of training (24-h before and 48-h after exercise), the following CGM-derived data were measured: 24-h and peak glucose levels, glucose variability and time spent in hypoglycemia as well as severe and mild hyperglycemia. Results: While lean body mass increased (p = 0.035), total and trunk fat mass decreased (p ≤ 0.007), without any difference between groups (p ≥ 0.81). Fasting glucose levels (p = 0.001) and A1c (p = 0.014) significantly improved in MICT only, with a significant difference between groups for fasting glucose (p = 0.02). Neither HIIT nor MICT impacted CGM-derived data at week 1 (p ≥ 0.25). However, 24-h and peak glucose levels, as well as time spent in mild hyperglycemia, decreased in HIIT at week 12 (p ≤ 0.03). Conclusion: These results suggest that 12 weeks of low-volume HIIT is enough to provide similar benefit to MICT for body composition and improve the acute effect of exercise when measured with CGM.

Exercise-nutrient interactions for improved postprandial glycemic control and insulin sensitivity

Type 2 diabetes (T2D) is a rapidly growing yet largely preventable chronic disease. Exaggerated increases in blood glucose concentration following meals is a primary contributor to many long-term complications of the disease that decrease quality of life and reduce lifespan. Adverse health consequences also manifest years prior to the development of T2D due to underlying insulin resistance and exaggerated postprandial concentrations of the glucose-lowering hormone insulin. Postprandial hyperglycemic and hyperinsulinemic excursions can be improved by exercise, which contributes to the well-established benefits of physical activity for the prevention and treatment of T2D. The aim of this review is to describe the postprandial dysmetabolism that occurs in individuals at risk for and with T2D, and highlight how acute and chronic exercise can lower postprandial glucose and insulin excursions. In addition to describing the effects of traditional moderate-intensity continuous exercise on glycemic control, we highlight other forms of activity including low-intensity walking, high-intensity interval exercise, and resistance training. In an effort to improve knowledge translation and implementation of exercise for maximal glycemic benefits, we also describe how timing of exercise around meals and post-exercise nutrition can modify acute and chronic effects of exercise on glycemic control and insulin sensitivity. Novelty: Exaggerated postprandial blood glucose and insulin excursions are associated with disease risk. Both a single session and repeated sessions of exercise improve postprandial glycemic control in individuals with and without T2D. The glycemic benefits of exercise can be enhanced by considering the timing and macronutrient composition of meals around exercise.

Different Levels of Physical Activity, Physical Health, Happiness, and Depression among Older Adults with Diabetes

The purpose of this study was to investigate the relationship between different levels of physical activity (light, moderate, and vigorous), physical health, happiness, and depression among older adults with diabetes. Using data from the National Social Life, Health and Aging Project (NSHAP) Wave 3, the results indicate that moderate and/or vigorous physical activity is more effective than light physical activity for promoting physical health and happiness and lowering depression of older adults with diabetes. This study suggests that activity professionals and therapists working with older adults with diabetes need to encourage their participation in physical activity as well as adjust a level of physical activity intensity that is tailored to participants’ needs and expectations.

Changes Induced by Mind-Body Intervention Including Epigenetic Marks and Its Effects on Diabetes

Studies have evidenced that epigenetic marks associated with type 2 diabetes (T2D) can be inherited from parents or acquired through fetal and early-life events, as well as through lifelong environments or lifestyles, which can increase the risk of diabetes in adulthood. However, epigenetic modifications are reversible, and can be altered through proper intervention, thus mitigating the risk factors of T2D. Mind-body intervention (MBI) refers to interventions like meditation, yoga, and qigong, which deal with both physical and mental well-being. MBI not only induces psychological changes, such as alleviation of depression, anxiety, and stress, but also physiological changes like parasympathetic activation, lower cortisol secretion, reduced inflammation, and aging rate delay, which are all risk factors for T2D. Notably, MBI has been reported to reduce blood glucose in patients with T2D. Herein, based on recent findings, we review the effects of MBI on diabetes and the mechanisms involved, including epigenetic modifications.

The effects and acceptability of different exercise modes on glycemic control in type 2 diabetes mellitus: A protocol for systematic review and network meta-analysis

INTRODUCTION

Exercise has been believed to have positive effects on blood glucose control in patients with type 2 diabetes mellitus. However, few medical evidences have been found to ascertain which type of exercise has the best effect on blood glucose control in diabetes and which type of exercise is more acceptable. The purpose of this study is to compare the effects and acceptability of different exercise modes on glycemic control in type 2 diabetes patients by using systematic review and network meta-analysis.

METHODS AND ANALYSIS

Relevant randomized controlled trial studies will be searched from PubMed, EMbase, CochraneCENTRAL, CNKI, VIP, and Chinese medical paper libraries. Primary outcome indicators: glycosylated hemoglobin and dropout rate of the research (number of dropouts/numbers of initially enrolled subjects). Secondary outcome measures: fasting blood glucose, body weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol, triglycerides (TG), diastolic pressure, systolic pressure (SBP). Two reviewers are arranged to screen Title, Abstract, and then review full text to further extract data. Standard meta-analysis and network meta-analysis of the data are performed afterward. Methodological quality assessment is planned to be conducted using Cochrane risk of bias tool. The outcome will be analyzed statistically according to Bayesian analysis methods. After that, subgroup analysis is conducted on the duration of intervention, whether there is supervision of intervention, frequency of intervention per week, age, gender, and medication use.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42020175181.

DISCUSSION

The systematic review and network meta-analysis include evidence of the impact of different exercise modes on blood glucose control in type 2 diabetes mellitus. There are 2 innovative points in this study. One is to conduct a classified study on exercise in as much detail as possible, and the other is to study the acceptability of different exercise modes. The network meta-analysis will reduce the uncertainty of intervention and enable clinicians, sports practitioners, and patients to choose more effective and suitable exercise methods.

ETHICS AND DISSEMINATION

The findings of the study will be disseminated through publications in peer-reviewed journals and scientific conferences and symposia. Further, no ethical approval is required in this study.

Effects of aerobic training with and without progression on blood pressure in patients with type 2 diabetes: A systematic review with meta-analyses and meta-regressions

AIMS

To analyze the effects of aerobic training with and without progression on blood pressure in patients with type 2 diabetes.

METHODS

The databases used for the systematic search were PubMed, Cochrane Central, SPORTDiscus and LILACS. Studies which analyzed blood pressure before and after an intervention period of eight or more weeks of aerobic training compared to a control group without training in patients with type 2 diabetes were included.

RESULTS

Of the 4186 studies found, 17 clinical trials were included (912 participants). Systolic blood pressure (SBP) decreased after aerobic training with progression (-6.78 mmHg; 95% CI -8.36, -5.19; p < 0.001) and without progression (-8.07 mmHg; 95% CI -9.37, -6.77; p < 0.001). The same happened regarding diastolic blood pressure (DBP), which decreased with aerobic training with progression (-3.10 mmHg; 95% CI -4.90, -1.31; p < 0.001) and without progression (-5.71 mmHg; 95% CI -7.15, -4.28; p < 0.001).

CONCLUSION

Aerobic training is effective in reducing blood pressure in patients with type 2 diabetes, regardless of progression in training variables.

Accumulating Physical Activity in Short or Brief Bouts for Glycemic Control in Adults With Prediabetes and Diabetes

Clinical practice guidelines on physical activity and diabetes currently stipulate physical activity can be accumulated in bouts of ≥10 minutes to meet recommendations for health benefits. Individuals are also encouraged to interrupt prolonged sitting with brief activity breaks of ∼1 to 5 minutes in duration. Growing research highlights accumulating activity in shorter bouts across the day as a potential strategy to improve glycemic control and to help those who are largely sedentary meet physical activity guidelines. Research has shown favourable glycemic benefits for postprandial glucose and glycated hemoglobin with either 3 short (10 to 15 minutes) or frequent brief (1 to 5 minutes) bouts of activity spread around meals or throughout the day. To date, most studies examining accumulated activity were done with people with type 2 diabetes compared with sedentary conditions, were short term and measured various indices of glycemic control using continuous glucose monitoring. The 7 trials comparing accumulating 3 short bouts to a single bout showed comparable benefits for glycemic control (i.e. fasting glucose, 24 h mean glucose and postprandial hyperglycemia). Furthermore, timing short bouts around meals may improve postprandial glucose and hyperglycemia more than a single bout. It is unknown whether a threshold for the duration of accumulated bouts exists---that is, "how much is enough?" In this narrative review, we focus on the glycemic effects of physical activity accumulated in short or brief bouts for people with prediabetes and diabetes as compared with a single continuous bout. Given that poor adherence to physical activity recommendations and that fewer opportunities exist in modern societies for incidental (nonexercise) physical activity, accumulating activity may be a choice strategy for improving glycemic control in those with and at risk of diabetes.

The Impact of Exercise on Bone Health in Type 2 Diabetes Mellitus-a Systematic Review

PURPOSE OF REVIEW

Type 2 diabetes mellitus (T2DM) is associated with an increased fracture risk. Weight loss in T2DM management may result in lowering of bone mass. In this systematic literature review, we aimed to investigate how exercise affects bone health in people with T2DM. Furthermore, we examined the types of exercise with the potential to prevent and treat bone fragility in people with T2DM.

RECENT FINDINGS

Exercise differs in type, mechanical load, and intensity, as does the osteogenic response to exercise. Aerobic exercise improves metabolic health in people with T2DM. However, the weight-bearing component of exercise is essential to bone health. Weight loss interventions in T2DM induce a loss of bone mass that may be attenuated if accompanied by resistance or weight-bearing exercise. Combination of weight-bearing aerobic and resistance exercise seems to be preventive against excessive bone loss in people with T2DM. However, evidence is sparse and clinical trials investigating the effects of exercise on bone health in people with T2DM are warranted.

Skeletal Muscle Ratio: A Complete Mediator of Physical Activity and HbA1C in Type 2 Diabetes

BACKGROUND

An increase in the physical activity level reduces body weight, decreases body fat, increases skeletal muscle mass, and improves serum glucose; however, the influence of body composition parameters on the relationship between physical activity and serum glucose remains unclear.

OBJECTIVE

This study investigated whether skeletal muscle and visceral fat affect the relationship between high physical activity and long-term serum glucose goals.

METHOD

This cross-sectional study recruited patients with type 2 diabetes. The Chinese version of the International Physical Activity Questionnaire was used for estimating the physical activity level, and a bioimpedance device was used to measure the skeletal muscle ratio (skeletal muscle mass/total body weight, %) and visceral fat area (cm²). Hierarchical logistic regression models and mediation tests were conducted according to Hayes' procedures.

RESULTS

Of the total 543 Chinese individuals with type 2 diabetes enrolled, HbA1C levels of fewer than half (n = 243, 44.8%) met the target of ≤7.0%. The skeletal muscle ratio was found to be a complete mediator (OR = 0.920, 95% CI: 0.848 to 0.998; indirect effect: -0.238, 95% CI: -0.525 to -0.020) of the relationship between high physical activity and the target HbA1C level after controlling for visceral fat area (indirect effect: -0.013, 95% CI: -0.183 to 0.156), age, time since diabetes diagnosis, and rice intake.

CONCLUSION

Nurses should include an increase in the skeletal muscle ratio as an objective in physical activity interventions for patients with type 2 diabetes to help them achieve their long-term serum glucose goals.

Prehabilitation: metabolic considerations

PURPOSE OF REVIEW

The major components of ERAS attenuate the inflammatory response and modulate metabolism in direction of sparing body protein and preserving function. However, these perioperative interventions might have limited effectiveness on postoperative outcomes if preoperative risk factors are not addressed and optimized.

RECENT FINDINGS

The preoperative metabolic perturbations characterized by insulin resistance and sarcopenia might predispose patients to a higher degree of postoperative catabolism. High-risk populations for such metabolic disturbances include elderly and frail patients, and patients with metabolic syndrome. Research on the effect of prehabilitation on perioperative metabolism is limited, but recent findings suggest that interventions designed to improve insulin sensitivity prior to surgery might represent a promising therapeutic target to minimize surgical complications.

SUMMARY

The present paper will discuss the metabolic implications of modulating preoperative risk factors with elements of multimodal prehabilitation, such as exercise training and nutrition.

Towards better evidence-informed global action: lessons learnt from the Lancet series and recent developments in physical activity and public health

In the past few decades, the field of physical activity has grown and evolved in scope, depth, visibility and impact around the world. Global progress has been observed in research and practice in physical activity regarding surveillance, health outcomes, correlates/determinants, interventions, translation and policy. The 2012 and 2016 Lancet series on physical activity provide some of the most comprehensive global analysis on various topics within physical activity. Based on the Lancet series and other key developments in the field, literature searches, and expert group meetings and consultation, we provide a global summary on the progress of, gaps in and future directions for physical activity research in the following areas: (1) surveillance and trends, (2) correlates and determinants, (3) health outcomes and (4) interventions, programmes and policies. Besides lessons learnt within each specific area, several recommendations are shared across areas of research, including improvement in measurement, applying a global perspective with a growing emphasis on low-income and middle-income countries, improving inclusiveness and equity in research, making translation an integral part of research for real-world impact, taking an 'upstream' public health approach, and working across disciplines and sectors to co-design research and co-create solutions. We have summarised lessons learnt and recommendations for future research as 'roadmaps' in progress to encourage moving the field of physical activity towards achieving population-level impact globally.

Change in V˙O2peak in Response to Aerobic Exercise Training and the Relationship With Exercise Prescription in People With COPD: A Systematic Review and Meta-analysis

BACKGROUND

Despite the wide-ranging benefits of pulmonary rehabilitation, conflicting results remain regarding whether people with COPD can improve their peak oxygen uptake (V˙O_2peak) with aerobic training.

RESEARCH QUESTION

The goal of this study was to investigate the effect of aerobic training and exercise prescription on V˙O_2peak in COPD.

STUDY DESIGN AND METHODS

A systematic review was performed by using MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases for all studies measuring V˙O_2peak prior to and following supervised lower-limb aerobic training in COPD. A random effects meta-analysis limited to randomized controlled trials comparing aerobic training vs usual care was conducted. Other study designs were included in a secondary meta-analysis and meta-regression to investigate the influence of program and patient factors on outcome.

RESULTS

A total of 112 studies were included (participants, N = 3,484): 21 controlled trials (n = 489), of which 13 were randomized (n = 288) and 91 were uncontrolled (n = 2,995) studies. Meta-analysis found a moderate positive change in V˙O_2peak (standardized mean difference, 0.52; 95% CI, 0.34-0.69) with the intervention. The change in V˙O_2peak was positively associated with target duration of exercise session (P = .01) and, when studies > 1 year duration were excluded, greater total volume of exercise training (P = .01). Similarly, the change in V˙O_2peak was greater for programs > 12 weeks compared with those 6 to 12 weeks when adjusted for age and sex. However, reported prescribed exercise intensity (P = .77), training modality (P > .35), and mode (P = .29) did not affect V˙O_2peak. Cohorts with more severe airflow obstruction exhibited smaller improvements in V˙O_2peak (P < .001).

INTERPRETATION

Overall, people with COPD achieved moderate improvements in V˙O_2peak through supervised aerobic training. There is sufficient evidence to show that programs with greater total exercise volume, including duration of exercise session and program duration, are more effective. Reduced effects in severe disease suggest alternative aerobic training methods may be needed in this population.

CLINICAL TRIAL REGISTRATION

PROSPERO; No.: CRD42018099300; URL: https://www.crd.york.ac.uk/prospero/.