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In Search of the Ideal Resistance Training Program to Improve Glycemic Control and its Indication for Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

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Abstract

Background

Resistance training (RT) is effective for glycemic control in type 2 diabetes mellitus (T2DM) patients. However, the characteristics of an RT program that will maximize its effect and those of patients that will especially benefit from RT are unknown.

Objective

The objectives of this systematic review were to identify via a comprehensive meta-analysis the characteristics of an RT program for patients with T2DM that might increase the patients’ improvement in glycemic control and the characteristics of patients that will benefit from RT.

Data Sources

Electronic-based literature searches of MEDLINE and EMBASE entries from 1 January 1966 to 25 August 2014 were conducted to identify clinical trials examining the effect of RT on glycemic control among patients with T2DM. Study keywords were text words and thesaurus terms related to RT and T2DM.

Study Selection

Studies were included if they (1) were clinical trials consisting of two groups with and without RT exercise intervention; (2) had an intervention period of at least 5 weeks; (3) clarified that all patients had T2DM; and (4) reported or made it possible to estimate the effect size [i.e., change in glycosylated hemoglobin (HbA1c) in the RT group minus that in the control group] and its corresponding standard error.

Study Appraisal and Synthesis Methods

The effect size in each study was pooled with a random-effects model. Analyses were stratified by several key characteristics of the patients and RT exercise programs; meta-regression analysis was then used to detect a difference in the effect size among strata within each factor. Linear regression analyses were added by entering each of the following profiles: patients’ baseline characteristics [mean baseline age, body mass index (BMI), and HbA1c levels] and exercise characteristics (total sets per week, total sets per bout of exercise, frequency, and intensity).

Results

There were 23 eligible studies comprising 954 patients with T2DM. The pooled effect size (95 % confidence interval) was −0.34 % (−0.53 to −0.16). A program with multiple sets (≥21 vs. <21) per one RT bout was associated with a large effect size (P = 0.03); however, the linear correlation between the number of sets and effect size was not significant (P = 0.56). A larger effect size was observed in studies with participants with diabetes of a relatively short duration (<6 vs. ≥6 years; P = 0.04) or a high baseline HbA1c [≥7.5 % (58 mmol/mol) vs. <7.5 %; P = 0.01] while a smaller effect size was observed in studies with a particularly high mean baseline BMI value (≥32 vs. <32 kg/m2; P = 0.03). Linear regression analyses predicted that each increment of 1 % in the baseline HbA1c would enlarge the effect size by 0.036 %, while each increment of 1 kg/m2 in the baseline BMI decreased it by 0.070 % in the range between 22.3 and 38.8 kg/m2.

Conclusion

In terms of glycemic control, RT could be recommended in the early stage of T2DM, especially for patients with relatively poor glycemic control. More benefit would be elicited in less obese patients within a limited range of the BMI. A substantial amount of exercise might be required to stimulate post-exercise glucose uptake, although the dose-dependency was not specifically clarified.

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Acknowledgments

All authors thank Ms Mami Haga and Ms Natsuko Tada of the University of Niigata for their excellent secretarial work.

All study members contributed substantially to the following: (1) conception and design of the study or acquisition of data, or analysis and interpretation of data; (2) drafting the article or reviewing it; and (3) providing final approval of the version to be published. In addition, all of the authors certify that they have participated sufficiently in the work to believe in its overall validity and to take public responsibility for appropriate portions of its context. HI, SK, and HS played leading roles in the conception and design of the study, all processes of the study methods, and drafting all sections of the manuscript. KF and ASH selected studies that met the inclusion criteria and acquired the full-paper version of studies that underwent further review. RH and YY gave various opinions in interpretation of the study results and helped to draft the manuscript. NO and HS designed the study’s analytic strategy and provided technical support in carrying out the statistical analyses. OH supervised the study and revised the draft critically for important intellectual content. HI, SK, and HS had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Sone and Dr Kodama are recipients of a Grant-in-Aid for Scientific Research (#20300227 and #26870208, respectively), both from the Japan Society for the Promotion of Science (JSPS). The sponsors had no influence over the design or conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Niigata, Japan

    Hajime Ishiguro, Reiko Hirasawa, Nobumasa Ohara, Osamu Hanyu & Hirohito Sone

  2. Department of Laboratory Medicine and Clinical Epidemiology, for Prevention of Noncommunicable Diseases, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuoh-ku, Niigata, 951-8510, Japan

    Satoru Kodama

  3. Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture, Niigata, Niigata, Japan

    Chika Horikawa

  4. Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan

    Kazuya Fujihara & Hitoshi Shimano

  5. Faculty of Human Welfare, Child Studies, Seigakuin University, Saitama, Japan

    Ayumi Sugawara Hirose

  6. Department of Faculty of Health and Nutrition, Yamanashi Gakuin University, Kofu, Yamanashi, Japan

    Yoko Yachi

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  1. Hajime Ishiguro
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  8. Nobumasa Ohara
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Correspondence to Satoru Kodama.

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Hajime Ishiguro, Satoru Kodama, Chika Horikawa, Kazuya Fujihara, Ayumi Sugawara Hirose, Reiko Hirasawa, Yoko Yachi, Nobumasa Ohara, Hitoshi Shimano, Osamu Hanyu, and Hirohito Sone declare that they have no conflict of interest.

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Ishiguro, H., Kodama, S., Horikawa, C. et al. In Search of the Ideal Resistance Training Program to Improve Glycemic Control and its Indication for Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Sports Med 46, 67–77 (2016). https://doi.org/10.1007/s40279-015-0379-7

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