Aquatic exercise for adults with type 2 diabetes: a meta-analysis
- 444 Downloads
The purpose of this systematic review and meta-analysis was to examine the effects of aquatic exercise (AquaEx) on indicators of glycemic control (i.e., glycated hemoglobin [A1c] and fasting plasma glucose) in adults with type 2 diabetes mellitus (T2DM). It was hypothesized that AquaEx would improve glycemic control to a similar extent as land-based exercise (LandEx), but to a greater extent than non-exercise control (Ctrl).
A literature search was completed in February 2017 for studies examining AquaEx training in adults with T2DM. Assessment of glycemic control was necessary for inclusion, while secondary outcomes such as quality of life and cardiometabolic risk factors (i.e., blood pressure, triglycerides and total cholesterol) were considered, but not required for inclusion. Outcomes were measured before and after at least 8 weeks of AquaEx, and data were analyzed using weighted mean differences (WMDs) and fixed effect models, when appropriate.
Nine trials including 222 participants were identified. Three trials compared AquaEx to LandEx, two compared AquaEx to Crtl, and four had a pre-/post-design without a comparison group. Results indicate no difference in A1c between LandEx and AquaEx (WMD = −0.02%, 95% confidence interval = [−0.71, 0.66]). Post-intervention A1c was lower in AquaEx when compared to Crtl (WMD = −0.96%, [−1.87, −0.05]). Post-AquaEx A1c was lower compared to baseline (WMD = −0.48%, [−0.66, −0.30]).
A1c can be reduced after eight–twelve weeks of AquaEx. However, at this time few studies have examined whether changes in A1c are different from LandEx or Crtl.
KeywordsType 2 diabetes mellitus Aquatic exercise Glycated hemoglobin Swimming
The authors would like to thank Allison Sivak for assisting with the computerized literature searches and Meghan Ingstrup for assisting with data extraction. This study was supported by the University of Alberta, Faculty of Physical Education and Recreation, Physical Activity and Diabetes Laboratory. Jordan Rees was supported by graduate scholarships from the Alberta Diabetes Institute and the Canadian Institutes for Health Research.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors, with the exception of the eligible and previously published study by Johnson et al. .
All procedures performed in the study by Johnson et al. were in accordance with the ethical standards of the University of Alberta Research Ethics Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
All of the eligible articles included in the meta-analysis stated that they had obtained informed consent from participants.
- 1.Canadian C (2013) Diabetes Association Clinical Practice Guidelines Expert, R.J. Sigal, M.J. Armstrong, P. Colby, G.P. Kenny, R.C. Plotnikoff, S.M. Reichert, M.C. Riddell, Physical activity and diabetes. Can J Diabetes 37(Suppl 1):S40–S44Google Scholar
- 10.Douloumpakas I, Pyrpasopoulou A, Triantafyllou A, Sampanis C, Aslanidis S (2007) Prevalence of musculoskeletal disorders in patients with type 2 diabetes mellitus: a pilot study. Kippokratia 11(4):214–218Google Scholar
- 11.The Cochrane Collaboration (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. In: Hggins JPT, Green S, editors. Available from http://www.cochrane-handbook.org
- 12.Nuttamonwarakul A, Amatyakul S, Suksom D (2014) Effects of a water-based versus land-based exercise training on cutaneous microvascular reactivity and c-reactive protein in older women with type 2 diabetes mellitus. J Exerc Phys 17(4):27–33Google Scholar
- 13.Delevatti RS, Kanitz AC, Alberton CL, Marson EC, Lisboa SC, Pinho CD, Lovatel GA, Korb A, Bertoldi K, Macedo RC, Siqueira IR, Schaan BD, Kruel LF (2016) Glucose control can be similarly improved after aquatic or dry-land aerobic training in patients with type 2 diabetes: a randomized clinical trial. J Sci Med Sport 19(8):688–693CrossRefPubMedGoogle Scholar
- 16.Nuttamonwarakul A, Amatyakul S, Suksom D (2012) Twelve weeks of aqua-aerobic exercise improve physiological adaptations and glycemic control in elderly patients with type 2 diabetes. J Exerc Phys 15(2):64–70Google Scholar
- 19.Johnson ST, Mundt C, Boule N, Bell G, Vallance J, Taylor L, Johnson JA (2014) Improved functional status following the aquatic physical exercise for arthritis and diabetes (APEXD) study, Can J Diabetes 38(5):S63Google Scholar
- 20.Sporis G, Ruzic L, Nedic A (2013) The effects of aqua aerobic on patents with type 2 diabetes mellitus. Vjesn 28:33–38Google Scholar