Hua Chen, Chen Zhen, Cao Dongmei, Jia Juan, Chen Xiaomei, Yang Juan, Zhang Limin
The Second Affiliated Hospital of Army Medical University: Xinqiao Hospital, Chongqing, China.
Army Medical University Army Health Service Training Base, Chongqing, China.
BMC Sports Sci Med Rehabil. 2025 Jun 4;17(1):144. doi: 10.1186/s13102-025-01187-2.
Prediabetes significantly increases the risk of cardiovascular disease (CVD), including myocardial infarction, stroke, and cardiovascular death. However, the relative effectiveness of different types of exercise interventions in reducing CVD risk in this population is unclear. The aim of this systematic evaluation and network meta-analysis (NMA) was to compare the effectiveness of aerobic exercise (AE), resistance training (RT), mind-body training (MBT), and combined aerobic and resistance training (AE + RT) interventions on CVD events and their associated risk factors.
Randomized controlled trials (RCTs) published up to May 2025 were systematically searched in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database. Studies were required to report the effect of exercise interventions on cardiovascular event metrics such as Framingham score, 10-year CVD risk, and ICVD score. Two investigators independently completed screening, data extraction, and quality assessment. Network meta-analysis was performed using Stata 17.0, and intervention effects were ranked based on Surface Under the Cumulative Ranking (SUCRA) values.
A total of 6 RCTs involving 1,265 subjects were included. The results showed that RT was the most effective in reducing cardiovascular risk, showing the lowest SUCRA values for Framingham score, ICVD score, and insulin resistance (HOMA2-IR). This effect was statistically significant. AE + RT had the most significant advantage in reducing glycated hemoglobin (HbA1c, SUCRA = 26.7%, 95% CI [0.02, 0.89]) and triglycerides (TG, SUCRA = 9.1%). MBT had the optimal effect in improving lipids, as evidenced by higher High-Density Lipoprotein Cholesterol (SUCRA = 85.3%, 95% CI [4.05, 56.83]) and lower Low-Density Lipoprotein Cholesterol, both of which were statistically significant. No significant publication bias or consistency issues were identified in this study.
Different types of exercise interventions have differentiated advantages on cardiovascular risk and metabolic outcomes in prediabetic populations. RT is more suitable for controlling blood glucose and insulin resistance, AE + RT has the best effect on improving dual indexes of blood glucose and blood lipids, and MBT has a prominent role in lipid regulation. Compared with the traditional Meta-analysis, this study is the first to evaluate the relative effects of multiple exercise interventions through a network meta-analysis, which can provide a scientific basis for developing individualized and risk-oriented exercise prescriptions.
糖尿病前期会显著增加心血管疾病（CVD）的风险，包括心肌梗死、中风和心血管死亡。然而，不同类型的运动干预在降低该人群心血管疾病风险方面的相对有效性尚不清楚。本系统评价和网状Meta分析（NMA）的目的是比较有氧运动（AE）、抗阻训练（RT）、身心训练（MBT）以及有氧与抗阻联合训练（AE+RT）干预对心血管疾病事件及其相关危险因素的有效性。
截至2025年5月发表的随机对照试验（RCT）在PubMed、Embase、Cochrane图书馆、Web of Science、中国知网（CNKI）、万方数据库和维普数据库中进行了系统检索。研究需报告运动干预对心血管事件指标的影响，如弗雷明汉评分、10年心血管疾病风险和ICVD评分。两名研究者独立完成筛选、数据提取和质量评估。使用Stata 17.0进行网状Meta分析，并根据累积排序曲线下面积（SUCRA）值对干预效果进行排序。
共纳入6项涉及1265名受试者的RCT。结果显示，RT在降低心血管风险方面最有效，在弗雷明汉评分、ICVD评分和胰岛素抵抗（HOMA2-IR）方面的SUCRA值最低。这一效果具有统计学意义。AE+RT在降低糖化血红蛋白（HbA1c，SUCRA=26.7%，95%CI[0.02，0.89]）和甘油三酯（TG，SUCRA=9.1%）方面具有最显著优势。MBT在改善血脂方面效果最佳，高密度脂蛋白胆固醇升高（SUCRA=85.3%，95%CI[4.05，56.83]）和低密度脂蛋白胆固醇降低均证明了这一点，两者均具有统计学意义。本研究未发现明显的发表偏倚或一致性问题。
不同类型的运动干预在糖尿病前期人群的心血管风险和代谢结局方面具有不同优势。RT更适合控制血糖和胰岛素抵抗，AE+RT在改善血糖和血脂双重指标方面效果最佳，MBT在血脂调节方面具有突出作用。与传统Meta分析相比，本研究首次通过网状Meta分析评估了多种运动干预的相对效果，可为制定个性化、以风险为导向的运动处方提供科学依据。
