Effects of Different Types of Acute and Chronic (Training) Exercise on Glycaemic Control in Type 1 Diabetes Mellitus
- 1.9k Downloads
Exercise has been accepted and generally recommended for the management of type 1 diabetes mellitus (T1D) and for improving the overall quality of life in affected individuals. This meta-analysis was conducted to determine the overall effects of exercise (acute bouts of exercise and chronic exercise [or training]) on acute and chronic glycaemic control in patients with T1D, the effects of different types of exercise on glycaemic control and which conditions are required to obtain these positive effects.
PubMed, ISI Web of Knowledge and SPORTDiscus™ were consulted to identify studies on T1D and exercise. Cohen’s d statistics were used for calculating mean effect sizes (ES) as follows: small d = 0.3, medium d = 0.5 and large d = 0.8. Ninety-five percent confidence intervals (95% CIs) were used to establish the significance of our findings.
From a total of 937 studies, 33 that met the inclusion criteria were selected. Nine studies were used to calculate the ES of a single bout of aerobic exercise; 13 studies to calculate the ES of aerobic training; 2 studies to calculate the ES of strength training; 4 studies to calculate the ES of combined (aerobic and strength) training and 6 studies to calculate the ES of high-intensity exercise (HIE) and training. ES for exercise on acute glycaemic control were large, while they were small for chronic glycaemic control. Aerobic exercise, resistance exercise, mixed exercise (aerobic combined with resistance training) and HIE acutely decreased blood glucose levels. To prevent late-onset hypoglycaemic episodes, the use of single bouts of sprints into an aerobic exercise can be recommended. This meta-analysis also showed that a regular exercise training programme has a significant effect on acute and chronic glycaemic control, although not all exercise forms showed significant results. Specifically, aerobic training is a favourable tool for decreasing chronic glycaemic control, while resistance training, mixed and HIE did not significantly improve chronic glycaemic control. Although, this meta-analysis showed there was a tendency for improvement in glycaemic control due to resistance training or resistance training combined with endurance training, there were not enough studies and/or subjects to confirm this statistically.
Based on this meta-analysis, we can conclude that the addition of brief bouts of high-intensity, sprint-type exercise to aerobic exercise can minimize the risk of sustaining a hypoglycaemic episode. We can also conclude that only regular aerobic training will improve the glycated haemoglobin level of a patient with T1D.
KeywordsResistance Training Glycaemic Control HbA1c Level Aerobic Exercise Strength Training
The authors wish to acknowledge funding through the Vrije Universiteit Brussel (OZR2096BOF). Bart Roelands is a postdoctoral fellow of the Fund for Scientific Research Flanders (FWO). S.S. Cheung is supported by a Canada Research Chair. The authors have no conflicts of interest that are directly relevant to the content of this article.
- 1.Medicine ACoS. ACSM’s guidelines for exercise testing and prescription. 6th ed. Philadeplhia (PA): Lippincott Williams, Wilkins; 2000.Google Scholar
- 18.West DJ, Stephens JW, Bain SC, et al. A combined insulin reduction and carbohydrate feeding strategy 30 min before running best preserves blood glucose concentration after exercise through improved fuel oxidation in type 1 diabetes mellitus. J Sports Sci 2011 Feb; 29(3): 279–89.PubMedCrossRefGoogle Scholar
- 24.Wong CH, Chiang YC, Wai JP, et al. Effects of a homebased aerobic exercise programme in children with type 1 diabetes mellitus. J Clin Nurs 2010 Mar; 20(5–6): 681–91.Google Scholar
- 29.Sideraviciute S, Gailiuniene A, Visagurskiene K, et al. The effect of long-term swimming program on glycemia control in 14–19-year aged healthy girls and girls with type 1 diabetes mellitus. Medicina (Kaunas) 2006; 42(6): 513–8.Google Scholar
- 37.Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale (NJ): Lawrence Erlbaum Associates, 1988.Google Scholar
- 61.Clarke WL, Cox DJ, Gonder-Frederick LA, et al. The relationship between nonroutine use of insulin, food, and exercise and the occurrence of hypoglycemia in adults with IDDM and varying degrees of hypoglycemic awareness and metabolic control. Diabetes Educ 1997 Jan–Feb; 23(1): 55–8.PubMedCrossRefGoogle Scholar
- 76.Smith NJ, Stanitski CL, Dyment CL, et al. Glycemic control with physical trainin in insulin-dependent diabetes mellitus. Sports Med 1985; 139: 307–10.Google Scholar
- 77.Rabasa-Lhoret R, Bourque J, Ducros F, et al. Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (ultralente-lispro). Diabetes Care 2001 Apr; 24(4): 625–30.PubMedCrossRefGoogle Scholar
- 83.Baldi JC, Cassuto NA, Foxx-Lupo WT, et al. Glycemic status affects cardiopulmonary exercise response in athletes with type I diabetes. Med Sci Sports Exerc 2011 Aug; 42(8): 1454–9.Google Scholar
- 89.Sundell J. Resistance training is an effective tool against metabolic and frailty syndromes. Adv Prev Med 2011; 984683–7.Google Scholar
- 91.Brun J-F, Marti B, Fédou C, et al. Two parameters statistically explain blood glucose decrease during exercise at steady state in type 1 diabetics: pre-exercise blood glucose and insulinemia. Sci Sports. In press.Google Scholar