Abstract
Background: Exercise training is vital for glycaemic control in patients with type 2 diabetes mellitus (T2D). While the positive effects of supervised exercise training are well established, unsupervised training may offer an alternative and more sustainable means of realising the benefits of exercise away from a resource-heavy supervised setting.
Objective: To evaluate the available literature and compare the efficacy of supervised and unsupervised exercise training programs on glycemic control in patients with T2D.
Methods: CINAHL, MEDLINE, PubMed, and EMBASE, searched from inception to 20 July 2018. Only studies that included both supervised and unsupervised training were included.
Results: Four studies, involving 115 participants, were included. One compared supervised with unsupervised exercise training and three investigated the efficacy of unsupervised training following supervised training. While supervised training is effective for improving glycaemic control in patients with T2D, unsupervised training may not maintain these changes. Included studies lacked detail relating to the supervised and unsupervised training programs.
Conclusions: Given that exercise is a critical component for maintenance of glycaemic control in patients with T2D, and because unsupervised training has been shown to be effective in improving clinical outcomes in other disease populations, further research is warranted to compare supervised and unsupervised exercise training in patients with T2D. It is important that future studies report standardised and detailed descriptions of key elements that form the basis of supervised and unsupervised exercise training groups.
Keywords: Diabetes mellitus, Type 2, glycated hemoglobin A, exercise, resistance training, practice guideline.
[1]
Zimmet P, Alberti KGMM, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001; 414(6865): 782-7.
[http://dx.doi.org/10.1038/414782a] [PMID: 11742409]
[http://dx.doi.org/10.1038/414782a] [PMID: 11742409]
[2]
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27(5): 1047-53.
[http://dx.doi.org/10.2337/diacare.27.5.1047] [PMID: 15111519]
[http://dx.doi.org/10.2337/diacare.27.5.1047] [PMID: 15111519]
[3]
Sladek R, Rocheleau G, Rung J, et al. A genome-wide association study identifies novel risk loci for type 2 diabetes. Nature 2007; 445(7130): 881-5.
[http://dx.doi.org/10.1038/nature05616] [PMID: 17293876]
[http://dx.doi.org/10.1038/nature05616] [PMID: 17293876]
[4]
Solomon TP, Thyfault JP. Type 2 diabetes sits in a chair. Diabetes Obes Metab 2013; 15(11): 987-92.
[http://dx.doi.org/10.1111/dom.12105] [PMID: 23551885]
[http://dx.doi.org/10.1111/dom.12105] [PMID: 23551885]
[5]
Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 2018; 138: 271-81.
[http://dx.doi.org/10.1016/j.diabres.2018.02.023] [PMID: 29496507]
[http://dx.doi.org/10.1016/j.diabres.2018.02.023] [PMID: 29496507]
[6]
Sainsbury E, Shi Y, Flack J, Colagiuri S. Burden of diabetes in Australia: it’s time for more ac-tion 2018.Available from:. http://www.novonordisk.com.au/content/dam/australia/affiliate/www-novonordisk-au/Home/Documents/180712_Burden%20of%20Diabetes_Its%20Time%20for%20More%20Action%20Report_Digital_%20FINAL....pdf
[7]
Lee CM, Colagiuri R, Magliano DJ, et al. The cost of diabetes in adults in Australia. Diabetes Res Clin Pract 2013; 99(3): 385-90.
[http://dx.doi.org/10.1016/j.diabres.2012.12.002] [PMID: 23298663]
[http://dx.doi.org/10.1016/j.diabres.2012.12.002] [PMID: 23298663]
[8]
Colberg SR, Albright AL, Blissmer BJ, et al. American College of Sports Medicine.American Diabetes Association.Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exerc 2010; 42(12): 2282-303.
[http://dx.doi.org/10.1249/MSS.0b013e3181eeb61c] [PMID: 21084931]
[http://dx.doi.org/10.1249/MSS.0b013e3181eeb61c] [PMID: 21084931]
[9]
Pfeiffer AFH, Klein HH. The treatment of type 2 diabetes. Dtsch Arztebl Int 2014; 111(5): 69-81.
[PMID: 24612534]
[PMID: 24612534]
[10]
De Feo P, Schwarz P. Is physical exercise a core therapeutical element for most patients with type 2 diabetes? Diabetes Care 2013; 36(Suppl. 2): S149-54.
[http://dx.doi.org/10.2337/dcS13-2024] [PMID: 23882040]
[http://dx.doi.org/10.2337/dcS13-2024] [PMID: 23882040]
[11]
Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 1985; 100(2): 126-31.
[PMID: 3920711]
[PMID: 3920711]
[12]
O’Hagan C, De Vito G, Boreham CA. Exercise prescription in the treatment of type 2 diabetes mellitus : current practices, existing guidelines and future directions. Sports Med 2013; 43(1): 39-49.
[http://dx.doi.org/10.1007/s40279-012-0004-y] [PMID: 23315755]
[http://dx.doi.org/10.1007/s40279-012-0004-y] [PMID: 23315755]
[13]
Dixit S, Maiya A, Shastry B. Effect of aerobic exercise on quality of life in population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, randomized controlled trial. Qual Life Res 2014; 23(5): 1629-40.
[http://dx.doi.org/10.1007/s11136-013-0602-7] [PMID: 24326731]
[http://dx.doi.org/10.1007/s11136-013-0602-7] [PMID: 24326731]
[14]
Daly RM, Dunstan DW, Owen N, Jolley D, Shaw JE, Zimmet PZ. Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes? Osteoporos Int 2005; 16(12): 1703-12.
[http://dx.doi.org/10.1007/s00198-005-1906-4] [PMID: 15937634]
[http://dx.doi.org/10.1007/s00198-005-1906-4] [PMID: 15937634]
[15]
Dobrosielski DA, Gibbs BB, Ouyang P, et al. Effect of exercise on blood pressure in type 2 diabetes: a randomized controlled trial. J Gen Intern Med 2012; 27(11): 1453-9.
[http://dx.doi.org/10.1007/s11606-012-2103-8] [PMID: 22610907]
[http://dx.doi.org/10.1007/s11606-012-2103-8] [PMID: 22610907]
[16]
Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW. Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003. Diabetes Care 2007; 30(2): 203-9.
[http://dx.doi.org/10.2337/dc06-1128] [PMID: 17259482]
[http://dx.doi.org/10.2337/dc06-1128] [PMID: 17259482]
[17]
Thomas N, Alder E, Leese GP. Barriers to physical activity in patients with diabetes. Postgrad Med J 2004; 80(943): 287-91.
[http://dx.doi.org/10.1136/pgmj.2003.010553] [PMID: 15138320]
[http://dx.doi.org/10.1136/pgmj.2003.010553] [PMID: 15138320]
[18]
Jelleyman C, Yates T, O’Donovan G, et al. The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis. Obes Rev 2015; 16(11): 942-61.
[http://dx.doi.org/10.1111/obr.12317] [PMID: 26481101]
[http://dx.doi.org/10.1111/obr.12317] [PMID: 26481101]
[19]
Oliveira C, Simões M, Carvalho J, Ribeiro J. Combined exercise for people with type 2 diabetes mellitus: a systematic review. Diabetes Res Clin Pract 2012; 98(2): 187-98.
[http://dx.doi.org/10.1016/j.diabres.2012.08.004] [PMID: 22981711]
[http://dx.doi.org/10.1016/j.diabres.2012.08.004] [PMID: 22981711]
[20]
Umpierre D, Ribeiro PA, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 2011; 305(17): 1790-9.
[http://dx.doi.org/10.1001/jama.2011.576] [PMID: 21540423]
[http://dx.doi.org/10.1001/jama.2011.576] [PMID: 21540423]
[21]
Umpierre D, Ribeiro PA, Schaan BD, Ribeiro JP. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia 2013; 56(2): 242-51.
[http://dx.doi.org/10.1007/s00125-012-2774-z] [PMID: 23160642]
[http://dx.doi.org/10.1007/s00125-012-2774-z] [PMID: 23160642]
[22]
Yang Z, Scott CA, Mao C, Tang J, Farmer AJ. Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med 2014; 44(4): 487-99.
[http://dx.doi.org/10.1007/s40279-013-0128-8] [PMID: 24297743]
[http://dx.doi.org/10.1007/s40279-013-0128-8] [PMID: 24297743]
[23]
Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2012; 98(3): 349-60.
[http://dx.doi.org/10.1016/j.diabres.2012.10.004] [PMID: 23116535]
[http://dx.doi.org/10.1016/j.diabres.2012.10.004] [PMID: 23116535]
[24]
Hayashino Y, Jackson JL, Hirata T, et al. Effects of exercise on C-reactive protein, inflammatory cytokine and adipokine in patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Metabolism 2014; 63(3): 431-40.
[http://dx.doi.org/10.1016/j.metabol.2013.08.018] [PMID: 24355625]
[http://dx.doi.org/10.1016/j.metabol.2013.08.018] [PMID: 24355625]
[25]
Montero D, Walther G, Benamo E, Perez-Martin A, Vinet A. Effects of exercise training on arterial function in type 2 diabetes mellitus: a systematic review and meta-analysis. Sports Med 2013; 43(11): 1191-9.
[http://dx.doi.org/10.1007/s40279-013-0085-2] [PMID: 23912806]
[http://dx.doi.org/10.1007/s40279-013-0085-2] [PMID: 23912806]
[26]
van der Heijden MMP, van Dooren FEP, Pop VJM, Pouwer F. Effects of exercise training on quality of life, symptoms of depression, symptoms of anxiety and emotional well-being in type 2 diabetes mellitus: a systematic review. Diabetologia 2013; 56(6): 1210-25.
[http://dx.doi.org/10.1007/s00125-013-2871-7] [PMID: 23525683]
[http://dx.doi.org/10.1007/s00125-013-2871-7] [PMID: 23525683]
[27]
Egan AM, Mahmood WAW, Fenton R, et al. Barriers to exercise in obese patients with type 2 diabetes. QJM 2013; 106(7): 635-8.
[http://dx.doi.org/10.1093/qjmed/hct075] [PMID: 23525164]
[http://dx.doi.org/10.1093/qjmed/hct075] [PMID: 23525164]
[28]
Shultz JA, Sprague MA, Branen LJ, Lambeth S. A comparison of views of individuals with type 2 diabetes mellitus and diabetes educators about barriers to diet and exercise. J Health Commun 2001; 6(2): 99-115.
[http://dx.doi.org/10.1080/108107301750254457] [PMID: 11405082]
[http://dx.doi.org/10.1080/108107301750254457] [PMID: 11405082]
[29]
Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ 2010; 340: b5631.
[http://dx.doi.org/10.1136/bmj.b5631] [PMID: 20085991]
[http://dx.doi.org/10.1136/bmj.b5631] [PMID: 20085991]
[30]
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700.
[http://dx.doi.org/10.1136/bmj.b2700] [PMID: 19622552]
[http://dx.doi.org/10.1136/bmj.b2700] [PMID: 19622552]
[31]
Higgins JPT, Altman DG, Gøtzsche PC, et al. Cochrane Bias Methods Group.Cochrane Statistical Methods Group.The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.
[http://dx.doi.org/10.1136/bmj.d5928] [PMID: 22008217]
[http://dx.doi.org/10.1136/bmj.d5928] [PMID: 22008217]
[32]
Mshunqane N, Cohen D, Kalk JK. Effects of an exercise pro-gramme on non-insulin dependant diabetes mellitus. S Afr J Physiother 2004; 60(4): 26-35.
[http://dx.doi.org/10.4102/sajp.v60i4.192]
[http://dx.doi.org/10.4102/sajp.v60i4.192]
[33]
Dunstan DW, Daly RM, Owen N, et al. Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes. Diabetes Care 2005; 28(1): 3-9.
[http://dx.doi.org/10.2337/diacare.28.1.3] [PMID: 15616225]
[http://dx.doi.org/10.2337/diacare.28.1.3] [PMID: 15616225]
[34]
Dunstan DW, Vulikh E, Owen N, Jolley D, Shaw J, Zimmet P. Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes. Diabetes Care 2006; 29(12): 2586-91.
[http://dx.doi.org/10.2337/dc06-1310] [PMID: 17130189]
[http://dx.doi.org/10.2337/dc06-1310] [PMID: 17130189]
[35]
Leehey DJ, Collins E, Kramer HJ, et al. Structured exercise in obese diabetic patients with chronic kidney disease: a randomized controlled trial. Am J Nephrol 2016; 44(1): 54-62.
[http://dx.doi.org/10.1159/000447703] [PMID: 27385652]
[http://dx.doi.org/10.1159/000447703] [PMID: 27385652]
[36]
Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2001; 286(10): 1218-27.
[http://dx.doi.org/10.1001/jama.286.10.1218] [PMID: 11559268]
[http://dx.doi.org/10.1001/jama.286.10.1218] [PMID: 11559268]
[37]
Castaneda C, Layne JE, Munoz-Orians L, et al. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care 2002; 25(12): 2335-41.
[http://dx.doi.org/10.2337/diacare.25.12.2335] [PMID: 12453982]
[http://dx.doi.org/10.2337/diacare.25.12.2335] [PMID: 12453982]
[38]
Sigal RJ, Kenny GP, Boulé NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007; 147(6): 357-69.
[http://dx.doi.org/10.7326/0003-4819-147-6-200709180-00005] [PMID: 17876019]
[http://dx.doi.org/10.7326/0003-4819-147-6-200709180-00005] [PMID: 17876019]
[39]
Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA 2010; 304(20): 2253-62.
[http://dx.doi.org/10.1001/jama.2010.1710] [PMID: 21098771]
[http://dx.doi.org/10.1001/jama.2010.1710] [PMID: 21098771]
[40]
Mitranun W, Deerochanawong C, Tanaka H, Suksom D. Continuous vs interval training on glycemic control and macro- and microvascular reactivity in type 2 diabetic patients. Scand J Med Sci Sports 2014; 24(2): e69-76.
[http://dx.doi.org/10.1111/sms.12112] [PMID: 24102912]
[http://dx.doi.org/10.1111/sms.12112] [PMID: 24102912]
[41]
Hollekim-Strand SM, Bjørgaas MR, Albrektsen G, Tjønna AE, Wisløff U, Ingul CB. High-intensity interval exercise effectively improves cardiac function in patients with type 2 diabetes mellitus and diastolic dysfunction: a randomized controlled trial. J Am Coll Cardiol 2014; 64(16): 1758-60.
[http://dx.doi.org/10.1016/j.jacc.2014.07.971] [PMID: 25323267]
[http://dx.doi.org/10.1016/j.jacc.2014.07.971] [PMID: 25323267]
[42]
Madsen SM, Thorup AC, Overgaard K, Jeppesen PB. High intensity interval training improves glycaemic control and pancreatic β cell function of type 2 diabetes patients. PLoS One 2015; 10(8)e0133286
[http://dx.doi.org/10.1371/journal.pone.0133286] [PMID: 26258597]
[http://dx.doi.org/10.1371/journal.pone.0133286] [PMID: 26258597]
[43]
Hamasaki H. Interval exercise therapy for type 2 diabetes. Curr Diabetes Rev 2018; 14(2): 129-37.
[http://dx.doi.org/10.2174/1573399812666161101103655] [PMID: 27804850]
[http://dx.doi.org/10.2174/1573399812666161101103655] [PMID: 27804850]
[44]
Lee SF, Pei D, Chi MJ, Jeng C. An investigation and comparison of the effectiveness of different exercise programmes in improving glucose metabolism and pancreatic β cell function of type 2 diabetes patients. Int J Clin Pract 2015; 69(10): 1159-70.
[http://dx.doi.org/10.1111/ijcp.12679] [PMID: 26119968]
[http://dx.doi.org/10.1111/ijcp.12679] [PMID: 26119968]
[45]
Dadgostar H, Firouzinezhad S, Ansari M, Younespour S, Mahmoudpour A, Khamseh ME. Supervised group-exercise therapy versus home-based exercise therapy: Their effects on Quality of Life and cardiovascular risk factors in women with type 2 diabetes. Diabetes Metab Syndr 2016; 10(2)(Suppl. 1): S30-6.
[http://dx.doi.org/10.1016/j.dsx.2016.01.016] [PMID: 26822461]
[http://dx.doi.org/10.1016/j.dsx.2016.01.016] [PMID: 26822461]
[46]
Alam S, Stolinski M, Pentecost C, et al. The effect of a six-month exercise program on very low-density lipoprotein apolipoprotein B secretion in type 2 diabetes. J Clin Endocrinol Metab 2004; 89(2): 688-94.
[http://dx.doi.org/10.1210/jc.2003-031036] [PMID: 14764782]
[http://dx.doi.org/10.1210/jc.2003-031036] [PMID: 14764782]
[47]
Labrunée M, Antoine D, Vergès B, Robin I, Casillas JM, Gremeaux V. Effects of a home-based rehabilitation program in obese type 2 diabetics. Ann Phys Rehabil Med 2012; 55(6): 415-29.
[http://dx.doi.org/10.1016/j.rehab.2012.06.001] [PMID: 22921557]
[http://dx.doi.org/10.1016/j.rehab.2012.06.001] [PMID: 22921557]
[48]
Olsen DB, Scheede-Bergdahl C, Reving D, Boushel R, Dela F. The effect of rowing on endothelial function and insulin action in healthy controls and in patients with type 2 diabetes. Scand J Med Sci Sports 2011; 21(3): 420-30.
[http://dx.doi.org/10.1111/j.1600-0838.2009.01012.x] [PMID: 20146753]
[http://dx.doi.org/10.1111/j.1600-0838.2009.01012.x] [PMID: 20146753]
[49]
Plotnikoff RC, Eves N, Jung M, Sigal RJ, Padwal R, Karunamuni N. Multicomponent, home-based resistance training for obese adults with type 2 diabetes: a randomized controlled trial. Int J Obes 2010; 34(12): 1733-41.
[http://dx.doi.org/10.1038/ijo.2010.109] [PMID: 20531348]
[http://dx.doi.org/10.1038/ijo.2010.109] [PMID: 20531348]
[50]
Yang P, Oh P. Predicting aerobic fitness improvements after participation in a hybrid supervised and home-based exercise program in people with type 2 diabetes. Can J Diabetes 2013; 37(6): 388-93.
[http://dx.doi.org/10.1016/j.jcjd.2013.09.004] [PMID: 24321719]
[http://dx.doi.org/10.1016/j.jcjd.2013.09.004] [PMID: 24321719]
[51]
Hordern MD, Dunstan DW, Prins JB, Baker MK, Singh MA, Coombes JS. Exercise prescription for patients with type 2 diabetes and pre-diabetes: a position statement from Exercise and Sport Science Australia. J Sci Med Sport 2012; 15(1): 25-31.
[http://dx.doi.org/10.1016/j.jsams.2011.04.005] [PMID: 21621458]
[http://dx.doi.org/10.1016/j.jsams.2011.04.005] [PMID: 21621458]
[52]
Francois ME, Baldi JC, Manning PJ, et al. ‘Exercise snacks’ before meals: a novel strategy to improve glycaemic control in individuals with insulin resistance. Diabetologia 2014; 57(7): 1437-45.
[http://dx.doi.org/10.1007/s00125-014-3244-6] [PMID: 24817675]
[http://dx.doi.org/10.1007/s00125-014-3244-6] [PMID: 24817675]
[53]
Slade SC, Dionne CE, Underwood M, et al. Consensus on exercise reporting template (cert): modified delphi study. Phys Ther 2016; 96(10): 1514-24.
[http://dx.doi.org/10.2522/ptj.20150668] [PMID: 27149962]
[http://dx.doi.org/10.2522/ptj.20150668] [PMID: 27149962]
Article Metrics
13
3