Cui Li, Lu Donglei, Tan Sijie, Cao Liquan
Tianjin Institute of Physical Education, Tianjin Key Laboratory of Sports and Health Integration and Health Promotion, Tianjin, China.
Front Endocrinol (Lausanne). 2025 Aug 6;16:1462104. doi: 10.3389/fendo.2025.1462104. eCollection 2025.
Type 2 diabetes mellitus (T2DM) is a leading cause of severe complications, projected to affect 693 million adults globally by 2045. Addressing obesity, a key factor in T2DM, through exercise can improve metabolic health and reduce inflammation. This study conducts a Bayesian network meta-analysis to evaluate the long-term effects of various combined interventions on inflammatory markers and metabolic health in overweight or obese individuals with T2DM.
We included randomized controlled trials (RCTs) from January 2000 to April 2023 that examined the effects of aerobic training (AT), resistance training (RT), combined aerobic and resistance training (ART), physical-mental training (PMT), whole-body vibration training (WBT), and acupuncture (ACT) on BMI, lipid profiles, fasting blood glucose (FBG), HbA1c, HOMA-IR, IL-6, and TNF-α. A comprehensive literature search was performed in PubMed, Web of Science, CNKI, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. Data extraction and quality assessment were independently conducted by two researchers, and Bayesian network meta-analysis was performed using R software.
A total of 128 RCTs were included. ART showed the most significant improvements in BMI, IL-6, and TNF-α levels. PMT was the most effective in improving lipid profiles (TG, TC, HDL-C, LDL-C) and insulin sensitivity markers (HbA1c, HOMA-IR). The SUCRA rankings indicated ART and PMT as the most beneficial interventions. Meta-regression analysis highlighted that VO improvements were closely associated with reductions in BMI and HbA1c.
ART and PMT demonstrated comprehensive benefits across multiple metabolic and inflammatory outcomes. ART effectively reduced BMI, improved glycemic control, and decreased inflammatory markers through mechanisms involving AMPK and mTOR pathways. PMT improved lipid metabolism and insulin sensitivity by reducing stress hormone levels and modulating endocrine and nervous system functions. A precise exercise prescription combining ART, PMT, AT, RT, and ACT is recommended to optimize metabolic health in T2DM patients. Future research should focus on individualized intervention strategies to enhance clinical outcomes.
PROSPERO, identifier CRD42024539376.
2型糖尿病（T2DM）是严重并发症的主要原因，预计到2045年全球将有6.93亿成年人受其影响。通过运动解决肥胖这一T2DM的关键因素，可以改善代谢健康并减轻炎症。本研究进行贝叶斯网络荟萃分析，以评估各种联合干预措施对超重或肥胖T2DM患者炎症标志物和代谢健康的长期影响。
我们纳入了2000年1月至2023年4月期间的随机对照试验（RCT），这些试验研究了有氧运动训练（AT）、抗阻训练（RT）、有氧和抗阻联合训练（ART）、身心训练（PMT）、全身振动训练（WBT）以及针灸（ACT）对体重指数（BMI）、血脂谱、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、胰岛素抵抗指数（HOMA-IR）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的影响。在PubMed、科学网、中国知网、MEDLINE、EMBASE以及Cochrane对照试验中心注册库进行了全面的文献检索。由两名研究人员独立进行数据提取和质量评估，并使用R软件进行贝叶斯网络荟萃分析。
共纳入128项RCT。ART在降低BMI、IL-6和TNF-α水平方面显示出最显著的改善。PMT在改善血脂谱（甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇）和胰岛素敏感性标志物（HbA1c、HOMA-IR）方面最有效。累积排序曲线下面积（SUCRA）排名表明ART和PMT是最有益的干预措施。荟萃回归分析强调，有氧运动能力（VO）的改善与BMI和HbA1c的降低密切相关。
ART和PMT在多个代谢和炎症结局方面显示出综合益处。ART通过涉及腺苷酸活化蛋白激酶（AMPK）和哺乳动物雷帕霉素靶蛋白（mTOR）途径的机制有效降低BMI、改善血糖控制并降低炎症标志物。PMT通过降低应激激素水平以及调节内分泌和神经系统功能改善脂质代谢和胰岛素敏感性。建议采用结合ART、PMT、AT、RT和ACT的精确运动处方来优化T2DM患者的代谢健康。未来的研究应侧重于个性化干预策略以提高临床疗效。
国际前瞻性系统评价注册库（PROSPERO），标识符CRD42024539376。
