Skip to main content

Advertisement

SpringerLink
Log in

Effects of exercise training parameters on cardiorespiratory fitness of individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

  • Review Article
  • Published:
Journal of Diabetes & Metabolic Disorders Aims and scope Submit manuscript

Abstract

Purpose

To assess the effects of exercise training parameters on cardiorespiratory fitness of individuals with type 2 diabetes mellitus (T2DM).

Methods

This systematic review was registered on PROSPERO (CRD42020210470). Searches were performed on PubMed, PEDro EMBASE, MEDLINE (Ovid), LILACS, PsycINFO, SCIELO, CINAHL, and Cochrane Library. The primary outcome was cardiorespiratory fitness, defined as maximal oxygen uptake (VO2max) during a maximal or submaximal exercise test. Two independent reviewers extracted data and assessed the risk of bias. Data were pooled using a random effects model and expressed as mean difference (MD) and 95% confidence interval (95%CI). Heterogeneity (I2) was assessed using Cochran’s Q test. The risk of bias and quality of evidence was assessed using the Cochrane risk of bias tool and GRADE.

Results

Twenty-two studies comparing exercise and control groups were included. The risk of bias indicated some concerns in most studies, and the quality of evidence was rated very low. Interventions with moderate (MD = 1.91, 95%CI = .58 to 3.34) and progressive exercise intensity (MD = 2.70, 95%CI = 2.43 to 2.96) and volume (MD = 1.72, 95%CI = .59 to 2.85) showed greater improvements in VO2max.

Conclusions

Protocols that progressively increased exercise training parameters improved the cardiorespiratory fitness response. Progressive exercise might be more suitable for individuals with T2DM. Our conclusion may be limited due to the very low quality of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Karalliedde J, Gnudi L. Diabetes mellitus, a complex and heterogeneous disease, and the role of insulin resistance as a determinant of diabetic kidney disease. Nephrol Dial Transplant [Internet]. 2014;31(2):gfu405. Available from: https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfu405. Accessed 13 Mar 2023

  2. Sampath Kumar A, Maiya AG, Shastry BA, Vaishali K, Ravishankar N, Hazari A, et al. Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis. Ann Phys Rehabil Med [Internet]. 2019;62(2):98–103. https://doi.org/10.1016/j.rehab.2018.11.001.

  3. Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J [Internet]. 2019;41(2):1–69. Available from: https://academic.oup.com/eurheartj/article/41/2/255/5556890. Accessed 13 Mar 2023

  4. International Diabetes Federation. IDF Diabetes Atlas 2021 – 10th edition. 2021. Available from: https://diabetesatlas.org/atlas/tenth-edition/. Accessed 13 Mar 2023

  5. Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuñiga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol [Internet]. 2018;17(1):122. https://doi.org/10.1186/s12933-018-0762-4.

    Article  CAS  PubMed  Google Scholar 

  6. Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004;141(6):421.

  7. Ross R, Blair SN, Arena R, Church TS, Després JP, Franklin BA, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American heart association. Circulation [Internet]. 2016;134(24):e653–99. Available from: https://doi.org/10.1161/CIR.0000000000000461.

  8. Myers J, de Souza e Silva CG, Doom R, Fonda H, Chan K, Kamil-Rosenberg S, et al. Cardiorespiratory fitness and health care costs in diabetes: The veterans exercise testing study. Am J Med [Internet]. 2019;132(9):1084–90. Available from: https://doi.org/10.1016/j.amjmed.2019.04.006.

  9. Wei M, Gibbons LW, Kampert JB, Nichaman MZ, Blair SN. Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med [Internet]. 2000;132(8):605. Available from: https://doi.org/10.7326/0003-4819-132-8-200004180-00002. Accessed 13 Mar 2023

  10. Al-Mallah MH, Sakr S, Al-Qunaibet A. Cardiorespiratory fitness and cardiovascular disease prevention: an update. Curr Atheroscler Rep [Internet]. 2018;20(1):1. Available from: http://link.springer.com/10.1007/s11883-018-0711-4. Accessed 13 Mar 2023

  11. Loprinzi PD, Pariser G. Cardiorespiratory fitness levels and its correlates among adults with diabetes. Cardiopulm Phys Ther J [Internet]. 2013;24(2):27–34. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691706/. Accessed 13 Mar 2023

  12. Baldi JC, Aoina JL, Oxenham HC, Bagg W, Doughty RN. Reduced exercise arteriovenous O 2 difference in Type 2 diabetes. J Appl Physiol [Internet]. 2003;94(3):1033–8. Available from: https://www.physiology.org/doi/10.1152/japplphysiol.00879.2002. Accessed 13 Mar 2023

  13. Rahbar S, Naimi SS, Soltani AR, Rahimi A, Akbarzadeh Baghban A, Khorami N. Are twenty-four sessions of aerobic exercise sufficient for improving cardiac parameters in diabetes mellitus? A randomized controlled trial. J Tehran Univ Hear Cent. 2018;13(2)43–51 [Internet]. 2018;13(2):43–51. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246440/pdf/JTHC-13-43.pdf. Accessed 13 Mar 2023

  14. Saghand MR, Rajabi H, Dehkhoda M, Hoseini A. The effects of eight weeks high-intensity interval training vs continuous moderate-intensity training on plasma dickkopf-1 and glycemic control in patients with type 2 diabetes. Ann Appl Sport Sci. 2020;8(2):1–7.

    Google Scholar 

  15. Way KL, Sabag A, Sultana RN, Baker MK, Keating SE, Lanting S, et al. The effect of low-volume high-intensity interval training on cardiovascular health outcomes in type 2 diabetes: A randomised controlled trial. Int J Cardiol [Internet]. 2020;320:148–54. Available from: https://doi.org/10.1016/j.ijcard.2020.06.019..

  16. Byrne H, Caulfield B, De Vito G. Effects of self-directed exercise programmes on individuals with type 2 diabetes mellitus: a systematic review evaluating their effect on HbA and other metabolic outcomes, physical characteristics, cardiorespiratory fitness and functional outcomes. Sport Med [Internet]. 2017;47(4):717–33. Available from: https://doi.org/10.1007/s40279-016-0593-y.

  17. Pan B, Ge L, Xun Y qin, Chen Y jing, Gao C yun, Han X, et al. Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Int J Behav Nutr Phys Act [Internet]. 2018;15(1):72. Available from: https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-018-0703-3. Accessed 13 Mar 2023

  18. Boulé NG, Kenny GP, Haddad E, Wells GA, Sigal RJ. Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia [Internet]. 2003;46(8):1071–81. Available from: http://link.springer.com/10.1007/s00125-003-1160-2. Accessed 13 Mar 2023

  19. Esteves MDL, Gouveia Rodrigues RJA, Pinheiro PG, Brás RMM, Rodrigues Gouveia AIAD, O´Hara K de LS, et al. Physical activity patterns and perceptions among type 2 diabetic and non-diabetic Portuguese. Ann Appl Sport Sci [Internet]. 2019;7(4):36–42. Available from: http://aassjournal.com/article-1-810-en.html. Accessed 13 Mar 2023

  20. Esteves M, Gouveia A, Rodrigues R, Pinheiro P, Bras R, O’Hara K, et al. Supervised exercise patterns among diabetic and non-diabetic Portuguese adults. Ann Appl Sport Sci. 2019;7(3):49-56. Available from: https://doi.org/10.29252/aassjournal.2626.

  21. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev [Internet]. 2016;5(1):2–10. https://doi.org/10.1186/s13643-016-0384-4.

    Article  Google Scholar 

  22. Higgins JPT, Sterne JAC, Savović J, Page MJ, Hróbjartsson A, Boutron I, et al. Cochrane methods 2016 [Internet]. Chandler J, McKenzie J, Boutron I, Welch V, editors. vol. 10, Cochrane Methods. Cochrane Database of Systematic Reviews 2016. 2016. Available from: http://doi.wiley.com/10.1002/14651858.CD201601. Accessed 13 Mar 2023

  23. Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: A new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol [Internet]. 2011;64(4):380–2. Available from: https://linkinghub.elsevier.com/retrieve/pii/S089543561000329X. Accessed 13 Mar 2023

  24. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Lawrence Erlbaum Associates; 1988.

  25. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med [Internet]. 2002;21(11):1539–58. Available from: http://doi.wiley.com/10.1002/sim.1186. Accessed 13 Mar 2023

  26. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ [Internet]. 1997;315(7109):629–34. Available from: http://www.bmj.com/cgi/doi/10.1136/bmj.315.7109.629. Accessed 13 Mar 2023

  27. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ WV. Cochrane handbook for systematic reviews of interventions version 6.0 [Internet]. 2019. Available from: www.training.cochrane.org/handbook. Accessed 13 Mar 2023

  28. Balducci S, Zanuso S, Nicolucci A, Fernando F, Cavallo S, Cardelli P, et al. Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. Nutr Metab Cardiovasc Dis [Internet]. 2010;20(8):608–17. Available from: https://pubmed.ncbi.nlm.nih.gov/19695853/. Accessed 13 Mar 2023

  29. Balducci S, Zanuso S, Nicolucci A, P DF, Cavallo S, Cardelli P, et al. Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES). Arch Intern Med [Internet]. 2010;170(20):1794–803. Available from: http://link.springer.com/10.1007/s12170-011-0203-3. Accessed 13 Mar 2023

  30. Magalhaes JP, Judice PB, Ribeiro R, Andrade R, Raposo J, Dores H, et al. Effectiveness of high-intensity interval training combined with resistance training versus continuous moderate-intensity training combined with resistance training in patients with type 2 diabetes: A one-year randomized controlled trial. Diab Obes Metab [Internet]. 2019;21(3):550–9. Available from: https://pubmed.ncbi.nlm.nih.gov/30284352/. Accessed 13 Mar 2023

  31. Santos-de-Araújo AD, Bassi-Dibai D, Veiga TP, Caruso FCR, Mendes RG, Júnior JCB, et al. Circulatory and ventilatory power in diabetic patients: Secondary analysis of a randomized controlled trial. Physiother Res Int [Internet]. 2020;25(3):e1830. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/pri.1830. Accessed 13 Mar 2023

  32. Lambers S, Van Laethem C, Van Acker K, Calders P. Influence of combined exercise training on indices of obesity, diabetes and cardiovascular risk in type 2 diabetes patients. Clin Rehabil [Internet]. 2008;22(6):483–92. Available from: http://journals.sagepub.com/doi/10.1177/0269215508084582. Accessed 13 Mar 2023

  33. Brun JFF, Bordenave S, Mercier J, Jaussent A, Picot MCC, Préfaut C, et al. Cost-sparing effect of twice-weekly targeted endurance training in type 2 diabetics: A one-year controlled randomized trial. Diabetes Metab [Internet]. 2008;34(3):258–65. Available from: https://pubmed.ncbi.nlm.nih.gov/18468933/. Accessed 13 Mar 2023

  34. Dobrosielski DA, Gibbs BB, Ouyang P, Bonekamp S, Clark JM, Wang NYNY, et al. Effect of exercise on blood pressure in type 2 diabetes: A randomized controlled trial. J Gen Intern Med [Internet]. 2012;27(11):1453–9. Available from: https://doi.org/10.1007/s11606-012-2103-8.

  35. Larose J, Sigal RJ, Khandwala F, Prud’homme D, Boulé NG, Kenny GP. Associations between physical fitness and HbA1c in type 2 diabetes mellitus. Diabetologia [Internet]. 2011;54(1):93–102. Available from: https://pubmed.ncbi.nlm.nih.gov/20953579/. Accessed 13 Mar 2023

  36. Annibalini G, Lucertini F, Agostini D, Vallorani L, Gioacchini A, Barbieri E, et al. Concurrent aerobic and resistance training has anti-inflammatory effects and increases both plasma and leukocyte levels of IGF-1 in late middle-aged type 2 diabetic patients. Oxid Med Cell Longev [Internet]. 2017;2017:1–10. Available from: https://doi.org/10.1155/2017/3937842.

  37. Kadoglou NPEPE, Vrabas ISS, Sailer N, Kapelouzou A, Fotiadis G, Noussios G, et al. Exercise ameliorates serum MMP-9 and TIMP-2 levels in patients with type 2 diabetes. Diabetes Metab [Internet]. 2010;36(2):144–51. Available from: https://doi.org/10.1016/j.diabet.2009.11.004..

  38. Karstoft K, Winding K, Knudsen SH, Nielsen JS, Thomsen C, Pedersen BK, et al. The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: A randomized, controlled trial. Diabetes Care [Internet]. 2013;36(2):228–36. Available from: https://doi.org/10.2337/dc12-0658..

  39. Suryanegara J, Cassidy S, Ninkovic V, Popovic D, Grbovic M, Okwose N, et al. High intensity interval training protects the heart during increased metabolic demand in patients with type 2 diabetes: a randomised controlled trial. Acta Diabetol [Internet]. 2019;56(3):321–9. Available from: https://doi.org/10.1007/s00592-018-1245-5.

  40. Taghizadeh M, Ahmadizad S, Naderi M. Effects of endurance training on hsa-miR-223, P2RY12 receptor expression and platelet function in type 2 diabetic patients. Clin Hemorheol Microcirc [Internet]. 2018;68(4):391–9. Available from: https://www.medra.org/servlet/aliasResolver?alias=iospress&doi=10.3233/CH-170300. Accessed 13 Mar 2023

  41. Arefirad T, Shakeri N, Ebrahim K, Nasli-Esfahani E. Effects of interval training on cardio metabolic risk factors and nitric oxide in type 2 diabetes patients: a randomized controlled trial. J Diabetes Metab Disord [Internet]. 2020; Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L2006857872&from=exportU2-L2006857872. Accessed 13 Mar 2023

  42. Banitalebi E, Kazemi A, Faramarzi M, Nasiri S, Haghighi MM. Effects of sprint interval or combined aerobic and resistance training on myokines in overweight women with type 2 diabetes: A randomized controlled trial. Life Sci [Internet]. 2019;217:101–9. Available from: https://doi.org/10.1016/j.lfs.2018.11.062..

  43. Belli T, Ribeiro LFP, Ackermann MA, Baldissera V, Gobatto CA, Galdino da Silva R. Effects of 12-week overground walking training at ventilatory threshold velocity in type 2 diabetic women. Diabetes Res Clin Pract [Internet]. 2011;93(3):337–43. Available from: https://doi.org/10.1016/j.diabres.2011.05.007.

  44. Emerenziani G Pietro, Gallotta MC, Meucci M, Di Luigi L, Migliaccio S, Donini LM, et al. Effects of aerobic exercise based upon heart rate at aerobic threshold in obese elderly subjects with type 2 diabetes. Int J Endocrinol [Internet]. 2015;2015(16):1–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26089890. Accessed 13 Mar 2023

  45. Ghardashi-Afousi A, Davoodi M, Hesamabadi BK, Asvadi-Fard M, Bigi MAB, Izadi MR, et al. Improved carotid intima-media thickness-induced high-intensity interval training associated with decreased serum levels of Dkk-1 and sclerostin in type 2 diabetes. J Diabetes Complicat [Internet]. 2020;34(1):107469. Available from: https://doi.org/10.1016/j.jdiacomp.2019.107469.

  46. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C. Physical activity/exercise and type 2 diabetes. Diabetes Care [Internet]. 2004;27(10):2518–39. Available from: https://doi.org/10.2337/diacare.27.10.2518..

  47. Umpierre D. Physical activity advice only or structured exercise training and association with HbA 1c levels in type 2 diabetes. JAMA [Internet]. 2011;305(17):1790. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2011.576. Accessed 13 Mar 2023

  48. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, et al. Exercise standards for testing and training. Circulation [Internet]. 2001;104(14):1694–740. Available from: https://www.ahajournals.org/doi/10.1161/hc3901.095960. Accessed 13 Mar 2023

  49. Kodama S. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women. JAMA [Internet]. 2009;301(19):2024. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2009.681. Accessed 13 Mar 2023

  50. Röhling M, Strom A, Bönhof G, Püttgen S, Bódis K, Müssig K, et al. Differential patterns of impaired cardiorespiratory fitness and cardiac autonomic dysfunction in recently diagnosed type 1 and type 2 diabetes. Diabetes Care [Internet]. 2017;40(2):246–52. Available from: https://doi.org/10.2337/dc16-1898.

  51. Seixas MB, de Melo Ghisi GL, Oh P, Pereira DS, Moreira APB, Jansen AK, et al. Feasibility of remote delivering an exercise and lifestyle education program for individuals living with prediabetes and diabetes in Brazil. Int J Environ Res Public Health. 2022;19(24):1–13.

    Article  Google Scholar 

  52. Ghisi GL de M, Aultman C, Konidis R, Foster E, Tahsinul A, Sandison N, et al. Effectiveness of an education intervention associated with an exercise program in improving disease-related knowledge and health behaviours among diabetes patients. Patient Educ Couns [Internet]. 2020;103(9):1790–7. Available from: https://www.sciencedirect.com/science/article/pii/S0738399120301944. Accessed 13 Mar 2023

Download references

Acknowledgements

The authors acknowledge the financial support provided by FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais), CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), and CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico).

Funding

Although GG is supported by FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais) Scholarship the funding bodies played no role in the design of the study and collection, analysis, or interpretation of data or in writing the manuscript.

Author information

Authors and Affiliations

  1. Graduate Program in Rehabilitation Sciences, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, CEP: 31270-901, Brazil

    Gabriela do Nascimento Cândido

  2. Graduate Program in Rehabilitation Sciences and Physical-Functional Performance, Faculty of Physical Therapy, Federal University of Juiz de Fora, Av. Eugênio Do Nascimento S/N, Juiz de Fora, MG, CEP: 36038-330, Brazil

    Ana Paula Delgado Bomtempo Batalha

  3. Myant Inc, Toronto, Canada

    Gabriela Suéllen da Silva Chaves

  4. Department of Physical Therapy, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, CEP: 31270-901, Brazil

    Daniele Sirineu Pereira & Raquel Rodrigues Britto

Authors
  1. Gabriela do Nascimento Cândido
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Paula Delgado Bomtempo Batalha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriela Suéllen da Silva Chaves
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniele Sirineu Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raquel Rodrigues Britto
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors were substantially involved in the conception of the research, including selecting the research questions, determining key search terms, and the inclusion/exclusion criteria. GG and AP undertook the literature searches, screening, and data extraction. GS assisted with the analysis and image creation. GC, GS, RB, and DS drafted the initial paper. RB assisted with screening, reviewing a subset of abstracts identified by GC, and reviewing data extraction. GC and RB contributed to data interpretation. GC prepared the manuscript for journal submission. GC, RB and GS edited revisions of the manuscript, and read and approved the final submitted version of the manuscript.

Corresponding author

Correspondence to Gabriela do Nascimento Cândido.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 226 KB)

Appendix

Appendix

Table 5

Table 5 Search strategy per database
Full size table

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

do Nascimento Cândido, G., Batalha, A.P.D.B., da Silva Chaves, G.S. et al. Effects of exercise training parameters on cardiorespiratory fitness of individuals with type 2 diabetes mellitus: a systematic review and meta-analysis. J Diabetes Metab Disord 22, 97–118 (2023). https://doi.org/10.1007/s40200-023-01205-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40200-023-01205-5

Keywords

Search

Navigation