| Objective:To study the effect of aerobic exercise(aerobic training,AT)combined with resistance exercise(resistance training,RT)in the hypoglycemic treatment of adult patients with type 2 diabetes(T2DM),and to explore the characteristics of patients benefited from combined exercise(aerobic training and resistance training,ART),in order to find the optimal exercise method to improve blood sugar and to provide data for the construction of a combined exercise program for patients with type 2 diabetes.Method:(1)Meta-analysis:A total of eight databases including PubMed,Embase,Cochrane Library,Web of Science,Tsinghua Tong Fang Knowledge Network Database(CNKI),China Biomedical Literature Database(CBM),Wan fang Data Knowledge Service Platform(Wan Fang),and Chinese Science and Technology Journal Database(VIP)were used to search for randomized controlled trials of aerobic combined resistance exercise in adults with type 2 diabetes.The search time was up to November 2021.Meta-analysis and systematic review of the literature that met the inclusion criteria were conducted.Cochrane systematic review was used to evaluate the quality of the literature.STATAMP 14.0 and Review Manager5.3 were used for statistic alanalysis.(2)Retrospective empirical study:Using the statistical method of self-control,a questionnaire was conducted for 32 patients who participated in the Sichuan Red Cross Foundation’s Law Health Sports Special Joint Exercise Hypoglycemic Project from July 2019 to December 2020 to analyze the effect of combined exercise on patients with type 2 diabetes.Results:A total of 44 randomized controlled trials were included in this metaanalysis.The intervention group was all aerobic combined with resistance exercise.The control group was the non-exercise group,the aerobic exercise group,or the resistance exercise group,including a total of 3898 T2DM patients.1 Comparison of the effects of combined exercise,aerobic exercise and resistance exercise on blood sugar:The glycosylated hemoglobin(HbA1C)in the ART group decreased by 0.65%compared with the AT group after treatment(P<0.05,I2=77%),and was significantly lower than that in the RT group by 0.71%(P<0.05,I2=70%).Fasting blood glucose(FBG)in the ART group after treatment was significantly lower than that in the AT group by 0.77mmol/L(P<0.05,I2=84%),and significantly lower than that in the RT group by 0.76mmol/L(P<0.05,I2=43%).1.1 Comparing the effects of combined exercise group and aerobic exercise group on HbA1C and FBG:Effects on HbA1c:In the subgroups with BMI<28kg/m2 and waist circumference<100cm,HbA1c in the combined exercise group was 0.67%and 0.81%lower than that in the aerobic exercise group,respectively(P<0.05).Effect on FBG:In the subgroup with disease duration<6 years,FBG in the combined exercise group was 0.90mmol/L lower than that in aerobic exercise(P<0.05).1.2 Comparing the effects of combined exercise group and resistance exercise group on HbA1C and FBG:Effect on HbA1c:In the subgroups with BMI≥30kg/m2 and age<60 years,the HbA1c of the combined exercise group was 0.48%and 0.76%lower than that of the resistance exercise group respectively(P<0.05).In the subgroups whose RT intensity was moderate to high intensity and AT was moderate intensity,the HbA1c of the combined exercise group was 0.35%and 0.78%lower than that of the resistance exercise group,respectively(P<0.05).Effect on FBG:In the subgroups with BMI>30kg/m2,disease duration>6 years,RT intensity of moderate to high intensity,AT moderate intensity,intervention time>6 months,AT frequency and RT frequency>3 times/week,combined Compared with the resistance exercise group,the FBG of the exercise group decreased by 1.88mmol/L,1.89mmol/L,0.53mmol/L,0.78mmol/L,0.60mmol/L,0.62mmol/L and 0.62mmol/L respectively(P<0.05).2 Comparison of blood sugar effects between combined exercise and non-exercise groups:Compared with the non-exercise control group,HbA1C in the ART group decreased by 0.79%(P<0.05).The FBG in the ART group after treatment was 0.97mmol/L lower than that in the non-exercise group(P<0.05).Retrospective empirical studies:(1)Effects of combined exercise on glucose metabolism:As compared to the baseline,the HbA1C could be reduced by 0.68%and 0.69%after having combined exercise for 3 months and 6 months respectively(P<0.05).In addition,conducting combined exercise 3 to 4 times/week could significantly lower the HbA1C(P=0.001).Moreover,having combined exercise for 6 months could reduce FBG by 1.08mmol/L(P=0.029).All observations were statistically significant.(2)Effects of combined exercise on lipid metabolism:ART could reduce TG value by 0.39mmol/L(F=4.18,P<0.05)after 6 months of exercise(P<0.05).However,the effect of combined exercise on total cholesterol and low-density lipoprotein was not statistically significant(P>0.05).ART had a positive regulating effect on HDL(F=32.29,P<0.001)by increasing it by 0.12mmol/L at 3 months of exercise(P<0.001),and 0.3mmol/L at 6 months of exercise(P<0.001).(3)The effect of combined exercise on other indicators:ART had no significant effect on uric acid(P>0.05).Besides,after 6 months of ART,arm circumference,leg circumference and waist-to-hip ratio were reduced by 0.58cm,0.59cm,and 0.02 respectively.The differences against the corresponding baselines were statistically significant(P<0.05).(4)In terms of the number of different types of hypoglycemic drugs used in a treatment plan,before combined exercise,31%of diabetic patients used one kind of hypoglycemic drugs,44%used two kinds in combination,and 19%of them used three kinds.In comparison,after combined exercise,patients using one type of hypoglycemic drugs accounted for 31%,and two types only 9%.Moreover,not only no one used a combination of three types anymore,but also 53%of the patients discontinued taking hypoglycemic drugs.(5)ART reduced the physiological function,psychological spirit,and treatment response of the specific scale of quality of life in patients with diabetes by 0.54,0.62,and 0.50,respectively,all of which were statistically significant(P<0.001),but had no effect on social relations(P=0.94).Conclusion:1 Conclusion of Meta-analysis:(1)In the overall study population,ART reduced HbA1C and FBG more than AT and RT did.(2)Compared with aerobic exercise:In non-obese patients with a baseline waist circumference<100 cm,the combined exercise regimen was superior to aerobic exercise in reducing HbA1C.In disease duration<6 years,ART was superior to aerobic exercise in reducing FBG regardless of the intensity,frequency,and duration of combined exercise.(3)Compared with resistance exercise:In non-elderly obese patients,combined exercise with moderate-to-high intensity RT and moderate-intensity AT can effectively reduce HbA1C.In obese patients with a course of disease≥ 6 years,when the intervention time is≥ 6 months,combined exercise with moderate-to-high intensity RT,moderate-intensity AT,and frequency of AT and RT>3 times/week can effectively reduce FBG.2 Conclusions of empirical research:The combined exercise could improve glycosylated hemoglobin,fasting blood glucose,and triglyceride.It could also positively regulate high-density lipoprotein,and reduce arm circumference,leg circumference and waist-to-hip ratio.Moreover,number of types of hypoglycemic drugs decreased significantly after 6 months of combined exercise.Overall,the combined exercise had a positive impact on the quality of life of diabetes patients. |
PDF Full Text Request