Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Perú.
Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú.
Rev Peru Med Exp Salud Publica. 2024 Aug 19;41(2):146-155. doi: 10.17843/rpmesp.2024.412.12751.
OBJECTIVE.: To determine the effects of aerobic exercise on the components of the metabolic syndrome in older adult diabetic patients by means of a systematic review with meta-analysis.
MATERIALS AND METHODS.: We used the PubMed/Medline, Scopus, Cochrane library, Web of Science databases and the Google Scholar search engine. Randomized controlled trials (RCTs) were selected according to the inclusion criteria. Two reviewers independently determined whether studies met the inclusion criteria, extracted data, and used the Cochrane risk of bias tool (RoB 2). Quantitative analyses were performed in R v 4.0.5, using random effects.
RESULTS.: We identified 8697 studies, of which 7 RCTs were included in the qualitative synthesis. Most studies were assessed as having a high or low RoB in at least three domains. Meta-analysis showed that aerobic exercise was effective in improving glucose levels (standardized mean difference [SMD]: -1.04; 95% confidence interval [95% CI] -1.27, -0.81), systolic blood pressure (SMD: -0.79; 95% CI: -1.02, -0.56), diastolic blood pressure (SMD: -0.75; 95% CI: -0.98, -0.52), glycosylated hemoglobin (SMD: -0.57, 95% CI: -0.77, -0.37), HDL (SMD: 0.35, 95% CI: 0.15, 0.55), triglycerides (SMD: -0.26, 95% CI: -0.47, -0.06). No significant adverse effects were reported. The level of certainty of the results was low for fasting glucose, moderate for systolic and diastolic blood pressure, and very low for the other outcomes, in addition to few adverse effects. However, these results should be interpreted with caution due to the use of surrogate markers.
CONCLUSIONS.: Aerobic exercise was shown to have a significant improvement in the components of the metabolic syndrome in older diabetic adults, and no major adverse effects were reported. However, we recommend more RCTs with longer intervention time to establish the impact on symptoms and complications.
Motivation for the study. The motivation for this research arises from the high prevalence of metabolic syndrome and diabetes mellitus around the world. Despite their impact, there is a gap in knowledge regarding non-pharmacological interventions in older adults aimed at improving the metabolic profile of these patients. Main findings. Our results show a significant improvement in glucose, blood pressure, glycosylated hemoglobin, HDL, and triglyceride levels after the aerobic exercise intervention. In addition, no significant adverse effects were observed. Public health implications. Physical exercise is an affordable and globally available strategy. It improves the metabolic profile of older adult patients with metabolic syndrome.
通过系统评价和荟萃分析，确定有氧运动对老年糖尿病患者代谢综合征各组成部分的影响。
我们使用了 PubMed/Medline、Scopus、Cochrane 图书馆、Web of Science 数据库和 Google Scholar 搜索引擎。根据纳入标准选择随机对照试验（RCT）。两位评审员独立确定研究是否符合纳入标准、提取数据，并使用 Cochrane 偏倚风险工具（RoB 2）进行评估。使用 R v 4.0.5 进行定量分析，采用随机效应。
我们共检索到 8697 项研究，其中 7 项 RCT 纳入了定性综合分析。大多数研究在至少三个领域被评估为具有高或低 RoB。荟萃分析表明，有氧运动可有效改善血糖水平（标准化均数差 [SMD]：-1.04；95%置信区间 [95%CI] -1.27，-0.81）、收缩压（SMD：-0.79；95%CI：-1.02，-0.56）、舒张压（SMD：-0.75；95%CI：-0.98，-0.52）、糖化血红蛋白（SMD：-0.57，95%CI：-0.77，-0.37）、高密度脂蛋白（SMD：0.35，95%CI：0.15，0.55）、甘油三酯（SMD：-0.26，95%CI：-0.47，-0.06）。未报告有显著的不良反应。对于空腹血糖，结果的确定性水平为低，对于收缩压和舒张压为中，对于其他结果为极低，此外不良反应也很少。然而，由于使用了替代标志物，这些结果应谨慎解释。
有氧运动对老年糖尿病患者代谢综合征各组成部分有显著改善作用，且未报告有重大不良反应。然而，我们建议进行更多干预时间更长的 RCT，以确定其对症状和并发症的影响。
这项研究的动机源于全球范围内代谢综合征和糖尿病的高患病率。尽管其影响很大，但对于旨在改善这些患者代谢特征的非药物干预措施，我们的了解还存在差距。
我们的研究结果显示，有氧运动干预后，血糖、血压、糖化血红蛋白、高密度脂蛋白和甘油三酯水平显著改善。此外，未观察到显著的不良反应。
体育锻炼是一种负担得起且在全球范围内都可获得的策略。它可以改善老年代谢综合征患者的代谢特征。
