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.
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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.
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.
Managed by Massimo Federici.
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Rees, J.L., Johnson, S.T. & Boulé, N.G. Aquatic exercise for adults with type 2 diabetes: a meta-analysis. Acta Diabetol 54, 895–904 (2017). https://doi.org/10.1007/s00592-017-1023-9
- Type 2 diabetes mellitus
- Aquatic exercise
- Glycated hemoglobin