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

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Abstract

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.

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PROSPERO (CRD42021257251).

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Authors and Affiliations

  1. Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

    Ahmad Jayedi

  2. Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155/6117, Tehran, Iran

    Ahmad Jayedi & Sakineh Shab-Bidar

  3. Food Safety Research Center (Salt), Semnan University of Medical Sciences, Semnan, Iran

    Alireza Emadi

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  1. Ahmad Jayedi
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Correspondence to Sakineh Shab-Bidar.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Ahmad Jayedi, Alireza Emadi, and Sakineh Shab-bidar declare that they have no conflicts of interest.

Author Contributions

AJ contributed to the study conception, literature search, data extraction, data analysis, and manuscript drafting. AE contributed to the literature search, data extraction, and manuscript drafting. SS-B contributed to study conception and manuscript drafting. SS-B critically revised the manuscript. All authors take full responsibility for the analyses and interpretation of the report. SS-B is the guarantor. All authors read and approved the final manuscript.

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Jayedi, A., Emadi, A. & Shab-Bidar, S. Dose-Dependent Effect of Supervised Aerobic Exercise on HbA1c in Patients with Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials. Sports Med 52, 1919–1938 (2022). https://doi.org/10.1007/s40279-022-01673-4

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