The Effect of Physical Activity Interventions on Glycosylated Haemoglobin (HbA1c) in Non-diabetic Populations: A Systematic Review and Meta-analysis
Physical activity is widely perceived to be beneficial for preventing type 2 diabetes mellitus and for controlling glycaemic levels in patients with type 2 diabetes, but evidence supporting a positive effect in the control of glycaemic levels in healthy people is rather weak. The aim of this review was to estimate the effect of physical activity on glycaemic control measured by glycosylated haemoglobin (HbA1c) levels in non-diabetic populations, and to determine which type of physical activity has a greater influence on glycaemic control.
We systematically searched the MEDLINE, EMBASE, Cochrane Library and Web of Science databases, from inception to May 2017, for experimental studies addressing the effect of physical activity on glycaemic control measured by HbA1c levels in non-diabetic populations. The DerSimonian and Laird method was used to compute pooled estimates of effect size (ES) and respective 95% confidence intervals (CIs). The effect of physical activity on HbA1c levels was estimated in two ways: (1) physical activity intervention versus control; and (2) physical activity pre–post intervention. Additionally, subgroup analyses were performed based on age of participants and different aspects of the intervention.
Fifteen published studies were included in the meta-analysis. In analyses comparing physical activity intervention and control, we found a decrease of HbA1c levels in favour of the intervention group (ES = 0.32; 95% CI 0.01–0.62) with substantial heterogeneity (I2 = 63.2%; p = 0.008). In the pre–post analysis, there was a decrease in HbA1c levels post physical activity intervention (ES = 0.17; 95% CI 0.01–0.33) with low heterogeneity (I2 = 25.8%; p = 0.164). Additionally, for physical activity intervention versus control, a decrease in HbA1c levels was observed in resistance exercise and in intervention length below 12 weeks. Furthermore, for pre–post effect analyses, a decrease in HbA1c levels was observed in the supervised physical activity programme, other type of exercises, intervention length below 12 weeks and exercise intervention week duration above 150 min subgroups.
This systematic review and meta-analysis provides an overview of the evidence supporting physical activity as a suitable intervention for glycaemic control as measured by HbA1c levels in non-diabetic populations.
VM-V and IC-R designed the review and meta-analysis. VM-V was the principal investigator and guarantor. IC-R and VM-V were the main coordinators of the review. BP, CA-B and VM-V conducted the review. MG-M, EGA and CA-B gave statistical and epidemiological support. IC-R wrote the article with the support of CA-B, EGA and BP. All authors revised and approved the final version of the manuscript.
Compliance with Ethical Standards
Ivan Cavero-Redondo is supported by a grant from the Universidad de Castilla-La Mancha (FPU13/01582). Celia Alvarez-Bueno is supported by a grant from the Spanish Ministry of Ministry of Education, Culture and Sport (FPU13/03137). Miriam Garrido-Miguel is supported by a Grant from the Spanish Ministry of Ministry of Education, Culture and Sport (FPU15/03847). No specific sources of funding were used to assist in the preparation of this article.
Conflict of interest
Ivan Cavero-Redondo, Barbara Peleteiro, Celia Alvarez-Bueno, Enrique Garcia Artero, Miriam Garrido-Miguel and Vicente Martinez-Vizcaino declare that they have no conflicts of interest relevant to the content of this review.
- 4.World Health Organization. Global recommendations on physical activity for health. Geneva: WHO; 2010.Google Scholar
- 10.Hardman AE, Stensel DJ. Physical activity and health: the evidence explained. 2nd ed. Oxon: Routledge; 2009.Google Scholar
- 15.Cavero-Redondo I, Peleteiro B, Álvarez-Bueno C, Rodríguez-Artalejo F, Martinez-Vizcaino V. Glycated haemoglobin A1c as a predictor of cardiovascular outcomes and all-cause mortality in diabetic and nondiabetic populations: a systematic review and meta-analysis. BMJ Open. 2003. https://doi.org/10.1136/bmjopen-2016-015801.Google Scholar
- 16.American Diabetes Association. Physical activity/exercise and diabetes mellitus. Diabetes Care. 2003;26(suppl 1):s73–7.Google Scholar
- 18.Higgins JP, Green S, editors. Cochrane handbook for systematic reviews of interventions. 5.1.0 [Updated March 2011]. The Cochrane Collaboration, 2011. https://handbook.cochrane.org. Accessed 01 May 2017.
- 19.Cavero-Redondo I, Peleteiro B, Álvarez-Bueno C, Rodríguez-Artalejo F, Martinez-Vizcaino V. Glycated haemoglobin A1c as a predictor of cardiovascular outcomes and all-cause mortality in diabetic and nondiabetic populations: a systematic review and meta-analysis. BMJ Open. 2017;7(7):e015949. https://doi.org/10.1136/bmjopen-2017-015949.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.National Collaborating Centre for Methods and Tools. Quality assessment tool for quantitative studies [updated 13 Apr 2010]. Hamilton: McMaster University; 2008.Google Scholar
- 22.Armijo-Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings GG. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract. 2012;18(1):12–8.CrossRefPubMedGoogle Scholar
- 23.Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Earlbaum Associates; 1988. p. 20–6.Google Scholar
- 30.Kallings LV, Johnson JS, Fisher RM, Faire UD, Ståhle A, Hemmingsson E, et al. Beneficial effects of individualized physical activity on prescription on body composition and cardiometabolic risk factors: results from a randomized controlled trial. Eur J Cardiovasc Prev Rehabil. 2009;16(1):80–4.CrossRefPubMedGoogle Scholar
- 32.Liu X, Miller YD, Burton NW, Brown WJ. A preliminary study of the effects of Tai Chi and Qigong medical exercise on indicators of metabolic syndrome, glycaemic control, health-related quality of life, and psychological health in adults with elevated blood glucose. Br J Sports Med. 2010;44(10):704–9.CrossRefPubMedGoogle Scholar
- 42.NGSP home (2017). http://www.ngsp.org/. Accessed 24 Oct 2017.
- 47.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 HbA1c and other metabolic outcomes, physical characteristics, cardiorespiratory fitness and functional outcomes. Sports Med. 2017;47(4):717–33.CrossRefPubMedGoogle Scholar
- 53.NICE. A rapid review of the effectiveness of exercise referral schemes to promote physical activity in adults. London: Public Health Collaborating Centre-Physical Activity; 2006. https://www.nice.org.uk/nicemedia/pdf/PAExercise_Referral_Review_Final_May_2006.pdf. Accessed 01 May 2017.
- 60.Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.CrossRefPubMedGoogle Scholar
- 65.Campbell DT, Stanley JC. Experimental and quasi-experimental designs for research. San Francisco: Ravenio Books; 2015.Google Scholar