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The relationship between the level of exercise and hemoglobin A1c in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

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Abstract

Purpose

The aim of the study was to evaluate the relationship between changes in hemoglobin A1c (HbA1c) and exercise levels in type 2 diabetes mellitus (T2DM) patients when performing various types of exercise.

Methods

The inclusion criteria were randomized controlled trials involving adults with T2DM, intervention involving exercise alone, the overall duration of intervention ≥12 weeks, and reporting HbA1c. Weighted mean difference (WMD) was defined as the mean difference between the intervention group and the control group weighted by the inverse of the squared standard error for each study, and all WMDs were pooled as overall effects. A meta-regression analysis was performed to evaluate the relationship between the exercise level and the WMD in HbA1c.

Results

Forty-eight studies (2395 subjects) were analyzed. The pooled WMD in HbA1c decreased significantly (−0.5% [95% confidence intervals: −0.6 to −0.4]) but contained significant heterogeneity (Q = 103.8, P < 0.01; I2 = 36.6%). A meta-regression analysis showed that the intensity (metabolic equivalents [METs]), time (min/session), or frequency (sessions/week) of the exercise was not associated with the HbA1c. However, the overall duration of exercise (weeks) was significantly associated with the WMD in HbA1c (meta-regression coefficient: 0.01 [95% confidence intervals: 0.002−0.016]; R2 = 70.0%), and that result did not contain significant heterogeneity (P > 0.05; I2 = 14.7%).

Conclusions

The exercise intervention decreases HbA1c in T2DM patients. In addition, exercise for an extended duration was associated with an increase in HbA1c, so the effects of exercise may be evident early on, but results suggested that exercise for a prolonged period alone may increase HbA1c.

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Data availability

All data are available in submitted paper or as electronic supplementary material.

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Acknowledgements

The authors wish to sincerely thank the staff of Osaka City University Media Center Library Service for collecting the articles used in this analysis and to thank the staff of Toin University of Yokohama Library, National Museum of Ethnology, and National Institute of Public Health for facilitating a search of the literature in electronic databases.

Author contributions

Y.I. conceived the study, conducted a literature search, analyzed the data, and drafted the paper. N.A. conducted a literature search, analyzed the data, and drafted the paper. S.M. conceived the study and drafted the paper. All authors have approved the final paper and agree with its submission to the journal.

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Authors and Affiliations

  1. Osaka City University, Osaka, 558-8585, Japan

    Yutaka Igarashi

  2. Japan Institute of Sports Sciences, Tokyo, 115-0056, Japan

    Nobuhiko Akazawa

  3. Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, 305-8574, Japan

    Nobuhiko Akazawa & Seiji Maeda

  4. Faculty of Sport Sciences, Waseda University, Saitama, 359-1192, Japan

    Seiji Maeda

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  1. Yutaka Igarashi
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Igarashi, Y., Akazawa, N. & Maeda, S. The relationship between the level of exercise and hemoglobin A1c in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Endocrine 74, 546–558 (2021). https://doi.org/10.1007/s12020-021-02817-8

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