Schwingshackl Lukas, Missbach Benjamin, Dias Sofia, König Jürgen, Hoffmann Georg
Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Althanstraße 14 (UZAII), 1090, Vienna, Austria,
Diabetologia. 2014 Sep;57(9):1789-97. doi: 10.1007/s00125-014-3303-z. Epub 2014 Jul 5.
AIMS/HYPOTHESIS: This study aimed to systematically review randomised controlled trials comparing the effects of aerobic exercise training (AET), resistance training (RT) and combined training (CT) on glycaemic control and blood lipids in patients with type 2 diabetes mellitus.
Searches were performed in MEDLINE, EMBASE and the Cochrane Library. Inclusion criteria were: type 2 diabetes mellitus, adult, supervised training and a minimum intervention period of 8 weeks. Pooled effects were calculated by fixed/random effect pairwise and Bayesian fixed/random effects network meta-analyses.
A total of 14 trials enrolling 915 participants were included. AET was more effective than RT in improving HbA1c levels (mean difference [MD] -0.20% [-2.2 mmol/mol]; 95% CI -0.32, -0.08; p = 0.0007, 10 trials/515 participants) and fasting glucose (MD -0.9 mmol/l; 95% CI -1.71, -0.09; p = 0.03, 8 trials/245 participants). Compared with AET, CT resulted in a significantly more pronounced reduction in HbA1c (MD -0.17% [-1.87 mmol/mol]; 95% CI -0.31, -0.03; p = 0.02, 9 trials/493 participants). Compared with RT, the MD of the change in HbA1c (MD -0.62%, [-6.82 mmol/mol]; 95% CI -0.95, -0.30; p = 0.0002, 5 trials/362 participants], fasting glucose (MD -1.99 mmol/l; 95% CI -3.07, -0.90; p = 0.0003, 3 trials/99 participants) and triacylglycerols (MD -0.28 mmol/l; 95% CI -0.46, -0.10; p = 0.003, 4 trials/213 participants) were all in favour of CT. The exclusion of trials with a high risk of bias yielded only non-significant results.
CONCLUSIONS/INTERPRETATION: The present data suggest that CT might be the most efficacious exercise modality to improve glycaemic control and blood lipids. Interpretation with respect to clinical relevance is limited by the low quality of the studies included and the limited information on the clinically important outcomes or adverse effects of exercise.
目的/假设：本研究旨在系统评价比较有氧运动训练（AET）、抗阻训练（RT）和联合训练（CT）对2型糖尿病患者血糖控制和血脂影响的随机对照试验。
在MEDLINE、EMBASE和Cochrane图书馆进行检索。纳入标准为：2型糖尿病、成年人、有监督的训练且最短干预期为8周。通过固定/随机效应成对和贝叶斯固定/随机效应网络荟萃分析计算合并效应。
共纳入14项试验，915名参与者。在改善糖化血红蛋白水平方面，AET比RT更有效（平均差值[MD] -0.20% [-2.2 mmol/mol]；95%置信区间 -0.32，-0.08；p = 0.0007，10项试验/515名参与者），在空腹血糖方面也是如此（MD -0.9 mmol/l；95%置信区间 -1.71，-0.09；p = 0.03，8项试验/245名参与者）。与AET相比，CT导致糖化血红蛋白水平显著降低（MD -0.17% [-1.87 mmol/mol]；95%置信区间 -0.31，-0.03；p = 0.02，9项试验/493名参与者）。与RT相比，糖化血红蛋白变化的MD（MD -0.62%，[-6.82 mmol/mol]；95%置信区间 -0.95，-0.30；p = 0.0002，5项试验/362名参与者）、空腹血糖（MD -1.99 mmol/l；95%置信区间 -3.07，-0.90；p = 0.0003，3项试验/99名参与者）和甘油三酯（MD -0.28 mmol/l；95%置信区间 -0.46，-0.10；p = 0.003，4项试验/213名参与者）均有利于CT。排除偏倚风险高的试验仅得到无显著意义的结果。
结论/解读：目前的数据表明，CT可能是改善血糖控制和血脂最有效的运动方式。由于纳入研究的质量较低以及关于运动的临床重要结局或不良反应的信息有限，对临床相关性的解读受到限制。
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