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Meta-Analysis
. 2018 May 2;17(1):64.
doi: 10.1186/s12933-018-0711-2.

Exercise training and endothelial function in patients with type 2 diabetes: a meta-analysis

Shanhu Qiu  1 , Xue Cai  1 , Han Yin  1 , Zilin Sun  2 , Martina Zügel  3 , Jürgen Michael Steinacker  3 , Uwe Schumann  3
Affiliations
Meta-Analysis

Exercise training and endothelial function in patients with type 2 diabetes: a meta-analysis

Shanhu Qiu et al. Cardiovasc Diabetol. .

Abstract

Background and aims: Exercise training is considered a cornerstone in the management of type 2 diabetes, which is associated with impaired endothelial function. However, the association of exercise training with endothelial function in type 2 diabetes patients has not been fully understood. This meta-analysis aimed to investigate their associations with focus on exercise types.

Methods: Databases were searched up to January 2018 for studies evaluating the influences of exercise training with durations ≥ 8 weeks on endothelial function assessed by flow-mediated dilation (FMD) among type 2 diabetes patients or between type 2 diabetics and non-diabetics. Data were pooled using random-effects models to obtain the weighted mean differences (WMDs) and 95% confidence intervals (CIs).

Results: Sixteen databases were included. Exercise training resulted in an overall improvement in FMD by 1.77% (95% CI 0.94-2.59%) in type 2 diabetes patients. Specifically, both aerobic and combined aerobic and resistance exercise increased FMD by 1.21% (95% CI 0.23-2.19%) and 2.49% (95% CI 1.17-3.81%), respectively; but resistance exercise only showed a trend. High-intensity interval aerobic exercise did not significantly improve FMD over moderate-intensity continuous exercise. Notably, the improvement in FMD among type 2 diabetes patients was smaller compared with non-diabetics in response to exercise training (WMD - 0.72%, 95% CI - 1.36 to - 0.08%) or specifically to aerobic exercise (WMD - 0.65%, 95% CI - 1.31 to 0.01%).

Conclusions: Exercise training, in particular aerobic and combined exercise, improves endothelial function in type 2 diabetes patients, but such an improvement appears to be weakened compared with non-diabetics. Trial registration PROSPERO CRD42018087376.

Keywords: Endothelial function; Exercise training; Flow-mediated dilation; Type 2 diabetes.

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Figures

Fig. 1
Fig. 1
Literature search and study selection. a The database of the Cochrane Central Register of Controlled Trials was chosen. b Two studies allowed for three independent comparisons for each [17, 18]
Fig. 2
Fig. 2
Pooled estimates of the effects of exercise training on FMD among type 2 diabetes patients or between type 2 diabetics versus non-diabetics. a Meta-analysis of the exercise training effects on FMD in type 2 diabetes patients compared with non-exercise controls. b Meta-analysis of the exercise training effects on FMD in type 2 diabetes patients across different exercise types. c Meta-analysis of the exercise training effects on FMD in type 2 diabetics versus non-diabetics. FMD flow-mediated dilation, Int intervention, Con control, WMD weighted mean difference, CI confidence interval, HIIT high-intensity interval training, MICT moderate-intensity continuous training, NA not applicable. a Both studies allowed for two independent comparisons for each versus non-exercise controls [17, 18]. b Standard deviations were obtained using the transformations from t and P values for differences in means according to the methods suggested in Cochrane Handbook for Systematic Reviews [29]. c Change-from-baseline standard deviations were obtained using a correlation coefficient of 0.50 according to the methods suggested in Cochrane Handbook for Systematic Reviews [29]
See this image and copyright information in PMC

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