Ma Jiang-Chen, Shu Song, Chen Tian-Xiao, Bai Hui-Jing, Yang Ya, Ding Xiao-Wei
Department of Geriatrics, The Affiliated Hangzhou First People's Hospital Chengbei Campus, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China.
Department of Geriatrics, Hangzhou Geriatric Hospital, Hangzhou 310000, Zhejiang Province, China.
World J Diabetes. 2025 Jul 15;16(7):108121. doi: 10.4239/wjd.v16.i7.108121.
Type 2 diabetes mellitus (T2DM), a chronic metabolic disease with a high global incidence, has become a serious public health challenge. China has the largest number of T2DM patients worldwide, imposing a significant economic burden on the healthcare system. T2DM is closely associated with insulin resistance, impaired pancreatic B cell function, and disordered glucose and lipid metabolism, which can lead to various complications, reducing patients' quality of life and increasing the risk of disability and death. Thus, finding effective preventive and intervention measures is crucial. Exercise therapy, a key part of diabetes management, has gained attention in recent years, with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.
To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.
Systematic searches were conducted using PubMed, EMBASE, Cochrane Library, and Chinese databases for relevant randomized controlled trials (RCTs). The inclusion criteria were participants aged ≥ 18 years with T2DM and the intervention involved combined resistance and aerobic exercise for ≥ 8 weeks. The primary outcome indicators were fasting blood glucose, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), glycated hemoglobin A1c (HbA1c), and total cholesterol (TC) levels. Data analysis was performed using RevMan software, and the interventional effects were assessed using weighted mean differences or standardized mean differences (SMD).
Six RCTs meeting the inclusion criteria were included, with a total sample size of 366 participants. The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM. Specific results were as follows: (1) For fasting blood glucose, combined exercise was more effective than aerobic exercise alone [SMD = 1.22; 95% confidence interval (95%CI): 0.70, 1.74; < 0.00001]; (2) LDL-C levels were significantly reduced by the combined intervention (SMD = 1.45; 95%CI: 1.18-1.72; < 0.00001); (3) The combined intervention significantly increased HDL-C levels (SMD = 1.42; 95%CI: 0.98-1.87; < 0.00001); (4) The combined intervention significantly reduced TG levels (SMD = 1.12; 95%CI: 0.85-1.39; < 0.00001; (5) No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group (SMD = -0.03; 95%CI: -1.09 to 1.04; < 0.00001); and (6) The combined exercise intervention group significantly reduced TC levels (SMD = 2.66; 95%CI: 1.93-3.38; < 0.00001). The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors, including the patient's age, baseline blood glucose levels, and exercise intensity.
Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose, LDL-C, HDL-C, TG, and TC levels in patients with T2DM, especially in terms of blood glucose control and cardiovascular risk, demonstrating better outcomes than aerobic exercise alone.
2型糖尿病（T2DM）是一种全球发病率较高的慢性代谢性疾病，已成为一项严峻的公共卫生挑战。中国是全球T2DM患者数量最多的国家，给医疗系统带来了巨大的经济负担。T2DM与胰岛素抵抗、胰腺β细胞功能受损以及糖脂代谢紊乱密切相关，可导致各种并发症，降低患者生活质量，增加残疾和死亡风险。因此，寻找有效的预防和干预措施至关重要。运动疗法作为糖尿病管理的关键部分，近年来受到关注，许多研究表明其对糖尿病患者血糖控制及其他方面有益。
评估抗阻运动与有氧运动联合干预对T2DM患者血糖控制和代谢指标的有效性，并探讨其在糖尿病管理中的应用。
通过PubMed、EMBASE、Cochrane图书馆及中文数据库系统检索相关随机对照试验（RCT）。纳入标准为年龄≥18岁的T2DM患者，干预措施为抗阻运动与有氧运动联合且持续≥8周。主要结局指标为空腹血糖、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）、糖化血红蛋白A1c（HbA1c）和总胆固醇（TC）水平。使用RevMan软件进行数据分析，采用加权均数差或标准化均数差（SMD）评估干预效果。
纳入6项符合纳入标准的RCT，共366例参与者。荟萃分析结果显示，抗阻运动与有氧运动联合可显著改善T2DM患者的多项代谢指标。具体结果如下：（1）对于空腹血糖，联合运动比单纯有氧运动更有效[SMD = 1.22；95%置信区间（95%CI）：0.70，1.74；P < 0.00001]；（2）联合干预显著降低LDL-C水平（SMD = 1.45；95%CI：1.18 - 1.72；P < 0.00001）；（3）联合干预显著提高HDL-C水平（SMD = 1.42；95%CI：0.98 - 1.87；P < 0.00001）；（4）联合干预显著降低TG水平（SMD = 1.12；95%CI：0.85 - 1.39；P < 0.00001）；（5）联合运动组与有氧运动组在HbA1c方面未观察到统计学显著差异（SMD = -0.03；95%CI：-1.09至1.04；P < 0.00001）；（6）联合运动干预组显著降低TC水平（SMD = 2.66；95%CI：1.93 - 3.38；P < 0.00001）。亚组分析结果表明，运动干预效果可能受多种因素影响，包括患者年龄、基线血糖水平和运动强度。
抗阻运动与有氧运动联合干预可显著改善T2DM患者的空腹血糖、LDL-C、HDL-C、TG和TC水平，尤其在血糖控制和心血管风险方面，显示出比单纯有氧运动更好的效果。
