Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Niigata, Japan.
Department of Laboratory Medicine and Clinical Epidemiology, for Prevention of Noncommunicable Diseases, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuoh-ku, Niigata, 951-8510, Japan.
Sports Med. 2016 Jan;46(1):67-77. doi: 10.1007/s40279-015-0379-7.
Resistance training (RT) is effective for glycemic control in type 2 diabetes mellitus (T2DM) patients. However, the characteristics of an RT program that will maximize its effect and those of patients that will especially benefit from RT are unknown.
The objectives of this systematic review were to identify via a comprehensive meta-analysis the characteristics of an RT program for patients with T2DM that might increase the patients' improvement in glycemic control and the characteristics of patients that will benefit from RT.
Electronic-based literature searches of MEDLINE and EMBASE entries from 1 January 1966 to 25 August 2014 were conducted to identify clinical trials examining the effect of RT on glycemic control among patients with T2DM. Study keywords were text words and thesaurus terms related to RT and T2DM.
Studies were included if they (1) were clinical trials consisting of two groups with and without RT exercise intervention; (2) had an intervention period of at least 5 weeks; (3) clarified that all patients had T2DM; and (4) reported or made it possible to estimate the effect size [i.e., change in glycosylated hemoglobin (HbA1c) in the RT group minus that in the control group] and its corresponding standard error.
The effect size in each study was pooled with a random-effects model. Analyses were stratified by several key characteristics of the patients and RT exercise programs; meta-regression analysis was then used to detect a difference in the effect size among strata within each factor. Linear regression analyses were added by entering each of the following profiles: patients' baseline characteristics [mean baseline age, body mass index (BMI), and HbA1c levels] and exercise characteristics (total sets per week, total sets per bout of exercise, frequency, and intensity).
There were 23 eligible studies comprising 954 patients with T2DM. The pooled effect size (95% confidence interval) was -0.34% (-0.53 to -0.16). A program with multiple sets (≥21 vs. <21) per one RT bout was associated with a large effect size (P = 0.03); however, the linear correlation between the number of sets and effect size was not significant (P = 0.56). A larger effect size was observed in studies with participants with diabetes of a relatively short duration (<6 vs. ≥6 years; P = 0.04) or a high baseline HbA1c [≥7.5% (58 mmol/mol) vs. <7.5 %; P = 0.01] while a smaller effect size was observed in studies with a particularly high mean baseline BMI value (≥32 vs. <32 kg/m(2); P = 0.03). Linear regression analyses predicted that each increment of 1% in the baseline HbA1c would enlarge the effect size by 0.036%, while each increment of 1 kg/m2 in the baseline BMI decreased it by 0.070% in the range between 22.3 and 38.8 kg/m2.
In terms of glycemic control, RT could be recommended in the early stage of T2DM, especially for patients with relatively poor glycemic control. More benefit would be elicited in less obese patients within a limited range of the BMI. A substantial amount of exercise might be required to stimulate post-exercise glucose uptake, although the dose-dependency was not specifically clarified.
抗阻训练（RT）对 2 型糖尿病（T2DM）患者的血糖控制有效。然而，能够最大程度发挥 RT 效果的 RT 方案的特点以及哪些患者将特别受益于 RT 仍不清楚。
本系统评价的目的是通过全面的荟萃分析确定 T2DM 患者 RT 方案的特点，这些特点可能会增加患者血糖控制的改善程度，并确定哪些患者将从 RT 中受益。
从 1966 年 1 月 1 日至 2014 年 8 月 25 日，对 MEDLINE 和 EMBASE 中的电子文献进行了检索，以确定研究 RT 对 T2DM 患者血糖控制影响的临床试验。研究关键词是与 RT 和 T2DM 相关的文本词和词库术语。
如果研究（1）为包含 RT 运动干预组和对照组的临床试验；（2）干预期至少 5 周；（3）明确所有患者均患有 T2DM；（4）报告或能够估计效应大小[即 RT 组糖化血红蛋白（HbA1c）变化减去对照组]及其相应的标准误差，则将其纳入研究。
使用随机效应模型对每个研究的效应大小进行汇总。按患者和 RT 运动方案的几个关键特征进行分层；然后使用荟萃回归分析检测每个因素中分层之间效应大小的差异。通过输入以下每个特征的线性回归分析添加分析：患者的基线特征[平均基线年龄、体重指数（BMI）和 HbA1c 水平]和运动特征（每周总组数、每组运动的总组数、频率和强度）。
共有 23 项符合条件的研究，包括 954 例 T2DM 患者。汇总的效应大小（95%置信区间）为-0.34%（-0.53 至-0.16）。一个 RT 疗程中具有多个（≥21 个 vs. <21 个）组的方案与较大的效应大小相关（P=0.03）；然而，组数与效应大小之间的线性相关性并不显著（P=0.56）。与糖尿病病程较短（<6 年 vs. ≥6 年；P=0.04）或基线 HbA1c 较高[≥7.5%（58 mmol/mol）vs. <7.5%；P=0.01]的患者相比，观察到较大的效应大小，而与基线 BMI 值特别高（≥32 公斤/米 2 vs. <32 公斤/米 2；P=0.03）的患者相比，观察到较小的效应大小。线性回归分析预测，基线 HbA1c 每增加 1%，效应大小就会增加 0.036%，而基线 BMI 每增加 1 公斤/米 2，就会减少 0.070%，范围在 22.3 到 38.8 公斤/米 2 之间。
就血糖控制而言，RT 可推荐用于 T2DM 的早期阶段，特别是对于血糖控制较差的患者。在 BMI 有限范围内，体重指数较低的患者可能会获得更多益处。尽管尚未明确剂量依赖性，但可能需要大量运动来刺激运动后的葡萄糖摄取。
