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Association between Physical Activity Advice Only or Structured Exercise Training with Blood Pressure Levels in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

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Abstract

Background

Diabetes is associated with marked cardiovascular morbidity and mortality. However, the association between different types of exercise training and blood pressure (BP) changes is not fully clear in type 2 diabetes.

Objective

The aim of this systematic review and meta-analysis of randomized controlled clinical trials (RCTs) was to determine the effects of structured exercise training (aerobic [AER], resistance [RES], or combined [COMB]) and physical activity (PA) advice only on BP changes in patients with type 2 diabetes.

Methods

Searches in five electronic databases were conducted to retrieve studies published from 1980 to 2013. Eligible studies were RCTs consisting of structured exercise training or PA advice versus no intervention in patients with type 2 diabetes. We used random effect models to derive weighted mean differences (WMDs) of exercises on absolute changes in systolic BP (SBP) and diastolic BP (DBP).

Results

A total of 30 RCTs of structured training (2,217 patients) and 21 of PA advice (7,323 patients) were included. Data were extracted independently in duplicate. Structured exercise was associated with reductions in SBP (WMD −4.22 mmHg; 95 % confidence interval [CI] −5.89 to −2.56) and DBP (WMD −2.07 mmHg; 95 % CI −3.03 to −1.11) versus controls. In structured exercise interventions, AER and RES were associated with declines in BP, and COMB was not associated with BP changes. However, in sensitivity analysis, a high-intensity protocol within COMB was associated with declines in SBP (WMD −3.30 mmHg; 95 % CI −4.71 to −1.89). Structured exercise longer than 150 min/week was associated with greater BP reductions. PA advice only was associated with reduction in SBP (WMD −2.97 mmHg; 95 % CI −4.52 to −1.43) and DBP (WMD −1.41 mmHg; 95 % CI −1.94 to −0.88) versus controls.

Conclusions

AER, RES, and high-intensity combined training are associated with BP reduction in patients with type 2 diabetes, especially in exercise programs lasting more than 150 min/week. PA advice only is also associated with lower BP levels.

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Acknowledgments

Mrs. Figueira had full access to the data and takes full responsibility for its integrity.

Conception and design: Schaan, Leitão, Umpierre. Data search: Schaan, Leitão, Umpierre, Figueira, Zucatti. Analysis and interpretation of data: Schaan, Leitão, Umpierre, Figueira, Cureau, Dalzochio. Drafting of the manuscript: Schaan, Leitão, Umpierre, Figueira, Cureau. Revising the manuscript critically for important intellectual content: Schaan, Leitão, Umpierre, Figueira, Cureau. Final approval of the manuscript submitted: Schaan, Leitão, Umpierre, Figueira, Cureau, Zucatti, Dalzochio.

Funding for this manuscript was partially provided by Fundo de Incentivo à Pesquisa do HCPA (FIPE), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, PNPD 2818/2011).

Role of funding source: the sponsor of the manuscript had no role in the design of the review and meta-analysis, data collection, data analysis, data interpretation, or writing of the report.

All authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Exercise Pathophysiology Research Laboratory, Hospital de Clinicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, RS, Brazil

    Franciele R. Figueira, Daniel Umpierre & Mériane B. Dalzochio

  2. Postgraduate Program in Health Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, RS, Brazil

    Franciele R. Figueira, Felipe V. Cureau, Alessandra T. N. Zucatti, Cristiane B. Leitão & Beatriz D. Schaan

  3. Postgraduate Program in Health Sciences, Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, RS, Brazil

    Daniel Umpierre & Beatriz D. Schaan

  4. Endocrine Division, Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, prédio 12, 4º andar, 90035-003, Porto Alegre, RS, Brazil

    Beatriz D. Schaan

  5. Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, RS, Brazil

    Beatriz D. Schaan

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  1. Franciele R. Figueira
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Figueira, F.R., Umpierre, D., Cureau, F.V. et al. Association between Physical Activity Advice Only or Structured Exercise Training with Blood Pressure Levels in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. Sports Med 44, 1557–1572 (2014). https://doi.org/10.1007/s40279-014-0226-2

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