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Optimal Dose and Type of Physical Activity to Improve Glycemic Control in People Diagnosed With Type 2 Diabetes
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
The optimal dose or type of physical activity to control glycosylated hemoglobin (HbA1c) in people with diabetes remains unknown. Current guidelines do not include consideration of baseline HbA1c for activity prescription.
PURPOSE
To examine the dose-response relationship between physical activity and HbA1c (%) in individuals with type 2 diabetes.
DATA SOURCES
A systematic search was performed in Embase, MEDLINE, Scopus, CINAHL, SPORTDiscus, and Web of Science.
STUDY SELECTION
We included trials that involved participants diagnosed with type 2 diabetes that included any type of physical activity as intervention.
DATA EXTRACTION
Pre- and postintervention HbA1c data, population and interventions characteristics, and descriptive statistics were collected to calculate change scores for each study arm.
DATA SYNTHESIS
We used Bayesian random-effects meta-analyses to summarize high-quality evidence from 126 studies (6,718 participants). The optimal physical activity dose was 1,100 MET min/week, resulting in HbA1c reductions, ranging from -1.02% to -0.66% in severe uncontrolled diabetes, from -0.64% to -0.49% in uncontrolled diabetes, from -0.47% to -0.40% in controlled diabetes, and from -0.38% to -0.24% in prediabetes.
LIMITATIONS
The time required to achieve these HbA1c reductions could not be estimated due to the heterogeneity between interventions' duration and protocols and the interpersonal variability of this outcome.
CONCLUSIONS
The result of this meta-analysis provide key information about the optimal weekly dose of physical activity for people with diabetes with consideration of baseline HbA1c level, and the effectiveness of different types of active interventions. These results enable clinicians to prescribe tailored physical activity programs for this population.
Additional Info
Optimal Dose and Type of Physical Activity to Improve Glycemic Control in People Diagnosed With Type 2 Diabetes: A Systematic Review and Meta-analysis
Diabetes Care 2024 Feb 01;47(2)295-303, D Gallardo-Gómez, E Salazar-Martínez, RM Alfonso-Rosa, J Ramos-Munell, J Del Pozo-Cruz, B Del Pozo Cruz, F Álvarez-BarbosaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
At this point, with the mountain of evidence available, everyone knows that physical activity is a key component of managing type 2 diabetes. However, more precise guidelines related to specific activities and the level of activity really needed to achieve diabetes management and health goals are lacking. Some forms of activity can raise blood glucose, at least temporarily, whereas others generally lower blood glucose both acutely and chronically, and the exact exercise “dose” needed to achieve glycemic goals has not been determined for everyone.
This systematic review and meta-analysis examines the precise dose–response relationship between physical activity at different levels, including overall and specific types, and blood glucose management in adults with type 2 diabetes. Using data from over 6700 participants in 126 studies, the authors report a nonlinear, J-shaped dose–response relationship between the HbA1c values and levels of physical activity, with the optimal physical activity dose being 1100 MET minutes per week regardless of baseline HbA1c level. By way of clarification for the average reader, a “MET” is a metabolic equivalent that categorizes energy use at rest and during various levels of physical activity. Putting “MET minutes per week” in more usable terms, this is the equivalent of around 244 minutes per week of moderate-intensity aerobic physical activity (183–367 min/week, depending on intensity of 3–6 MET minutes) or around 157 minutes per week of vigorous-intensity aerobic activity (at 7 MET minutes). Current guidelines recommend 150 to 300 minutes of moderate activity per week, or half that much (75–150 minutes) of vigorous, or a combination of both intensities.
This review also gives guidelines for specific types of activities, with multicomponent, strength, and walking stated as being the most effective interventions for glycemic reductions. Recommended amounts of multicomponent activities include around 314 minutes per week of moderate-intensity activity or around 138 minutes per week of vigorous-intensity activity. For strength activities, goals should be around 314 minutes per week of moderate-intensity activity or around 183 minutes per week of vigorous-intensity activity. Finally, walking should be undertaken for around 256 minutes per week at a moderate pace or for around 157 minutes per week at a brisk one. Having such defined goals for optimal amounts for different activities may make it easier to prescribe the ones that meet each individual’s lifestyle and health goals. It is also notable that these durations are at the higher end of the current recommendations for adults.
Finally, their findings suggest that people with the worst glycemic management have the most to gain from doing any activity, which is not surprising given that it is easier to make changes to lower a high HbA1c level than to lower one that is already normal or near normal. Specifically, the authors found that the minimal effective doses to move from one level of glycemic management to the next lower one ranged among 150 to 810 MET minutes per week (in people starting with HbA1c ≥8.0%), 330 to 990 MET minutes per week (HbA1c, 7.0%–7.9%), and 570 to 900 MET minutes per week (HbA1c, 6.5%–6.9%). Comparing these numbers to an optimal dose of 1100 MET minutes per week, it is exceedingly apparent that getting people with type 2 diabetes off the couch and moving more will promote better health and longevity.