Introduction
Methods
Search strategy and study selection
Data extraction and quality assessment
Data synthesis and statistical analysis
Results
Literature search and study characteristics
Study, country | Agea, year | BMIa, kg/m2 | Descriptions of intervention and control groups | Duration, weeks | Cuff pressure, mmHg | Results on FMDb |
---|---|---|---|---|---|---|
A. Exercise training and endothelial function in type 2 diabetes | ||||||
(i) Aerobic exercise | ||||||
Choi et al. 2012 [16]; Korea | 53.8 | 26.8 in average | Intervention: 60 min/session of walking at moderate intensity, 5 times/week | 12 | 250 mmHg | No change |
55.0 | 26.8 in average | Control: maintained usual activities and were required not to exercise | ||||
Kwon et al. [17]; Koreac | 55.5 | 26.7 | Intervention: 60 min/session of walking at moderate intensity, 5 times/week | 12 | 250 mmHg | Increase |
58.9 | 27 | Control: maintained usual activities and were required not to exercise | ||||
Mitranun et al. [18]; Thailandc | 61.2 | 29.6 | Intervention: 20–30 min/session of walking or running consisted of 4–6 intervals of 1 min exercise at 80–85% VO2peak with a 4 min exercise at 50–60% VO2peak, 3 times/week | 12 | 50 mmHg over SBP | Increase |
60.9 | 29.7 | Control: maintained sedentary as previous | ||||
Mitranun et al. [18]; Thailandc | 61.7 | 29.4 | Intervention: 20–30 min/session of walking or running at 60–65% VO2peak, 3 times/week | 12 | 50 mmHg over SBP | Increase |
60.9 | 29.7 | Control: maintained sedentary as previous | ||||
Wycherley et al. 2008 [19]; Australia | 51.7 | 33.6 | Intervention: 25–60 min/session of walking or jogging at intensity increasing from 60 to 80% HRmax, 4–5 times/week, plus a moderate energy-restricted dietary programme | 12 | 200 mmHg | No change |
53.0 | 34.6 | Control: a moderate energy-restricted dietary program as intervention | ||||
(ii) Aerobic combined with resistance exercise | ||||||
Gibbs et al. 2012 [20]; USA | 58 | 32.3 | Intervention: 45 min of aerobic exercise at 60–90% HRmax, along with 7 weight training exercises with two sets of 12–15 repetitions at 50% of 1-repetition maximum for each session, 3 times/week, plus usual care | 26 | > 200 mmHg | No change |
56 | 33.5 | Control: usual care | ||||
Maiorana et al. 2001 [21]; Australia | 52 | NS | Intervention: 60 min/session (15 exercises) of combined aerobic exercise (riding/walking) at 70–85% HRmax and resistance training at 55–65% MVC, with training intensity and duration gradually increased, 3 times/week, | 8 | 250 mmHg | Increase |
52 | NS | Control: were not required to exercise | ||||
Naylor et al. 2016 [22]; Australia | 17.3 | 36.1 | Intervention: 60 min/session of combined aerobic exercise at 65–85% HRmax and resistance training at 55–70% MVC, with training volume gradually increased, 3 times/week, plus standard care | 12 | 220 mmHg | No change |
15.3 | 30.0 | Control: standard care | ||||
Okada et al. 2010 [23]; Japan | 61.9 | 25.7 | Intervention: 20 min of aerobic dancing, 20 min of bicycle riding, and 20 min of resistance training for each session, 3–5 times/week, plus usual care | 12 | 220 mmHg | No change |
64.5 | 24.5 | Control: usual care | ||||
(iii) Resistance exercise | ||||||
Kwon et al. [17]; Koreac | 56.3 | 27.4 | Intervention: 40 min of resistance bands exercise at gradually increased intensities, three sets of 10–15 exercises for each session, 3 times/week | 12 | 250 mmHg | No change |
58.9 | 27 | Control: maintained usual activities and were not required to exercise | ||||
(iv) Interval versus continuous aerobic exercise | ||||||
Hollekim-Strand et al. 2014 [24]; Norway | 58.6 | 30.2 | Interval: 25 min/session of walking or jogging consisted of four intervals of 4 min exercise at 90–95% HRmax with a 3 min exercise at 70% HRmax, 3 times/week | 12 | NS | Increase |
54.7 | 29.7 | Continuous: 210 min/week of home-based moderate intensity exercise | ||||
Mitranun et al. [18]; Thailandc | 61.2 | 29.6 | Interval: 20–30 min/session of walking or running consisted of 4–6 intervals of 1 min exercise at 80–85% VO2peak with a 4 min exercise at 50–60% VO2peak, 3 times/week | 12 | 50 mmHg over SBP | No change |
61.7 | 29.4 | Continuous: 20–30 min/session of walking or running at 60–65% VO2peak, 3 times/week | ||||
(v) Aerobic versus resistance exercise | ||||||
Kwon et al. [17]; Koreac | 55.5 | 26.7 | Aerobic: 60 min/session of walking at moderate intensity, 5 times/week | 12 | 250 mmHg | No change |
56.3 | 27.4 | Resistance: 40 min of resistance bands exercise at gradually increased intensities, 3 sets of 10–15 exercises for each session, 3 times/week | ||||
B. Exercise training and endothelial function in type 2 diabetes versus non-diabetes | ||||||
Allen et al. [31]; USA | 66 | 27 | Diabetics: 30–40 min/session of walking, with intensities gradually increased from the one set to the workload resulting in claudication pain during maximal treadmill test, 3 times/week | 12 | 240 mmHg | NA |
69 | 25 | Non-diabetics: the same as diabetics | ||||
Madsen et al. [32]; Denmark | 56 | 31.1 | Diabetics: 20 min/session of cycling consisted of 10 intervals of 1 min exercise at 65–69% HRmax with a 1 min active recovery exercise, 3 times/week | 8 | ≥220 mmHg | NA |
52 | 30.5 | Non-diabetics: the same as diabetics | ||||
Schreuder et al. [33]; Netherlands | 59 | 32.4 | Diabetics: 55 min/session of a circuit of resistance exercises (six exercises, 3 series of 12 repetitions for each exercise) interspersed with aerobic exercise (cycling/running, 5 min for each) at 70–75% HRR, with intensities gradually increased, 3 times/week | 8 | 220 mmHg | NA |
58 | 26.9 | Non-diabetics: the same as diabetics |
Exercise training and endothelial function in type 2 diabetes
Compared with non-exercise controls
Variables | All exercise | Aerobic exercise | Combined exercise | ||||||
---|---|---|---|---|---|---|---|---|---|
N |
β
|
P
| N |
β
|
P
| N |
β
|
P
| |
Age (log-transformed)a | 10 | − 0.53 | 0.72 | 5 | 20.1 | 0.17 | 4 | − 0.06 | 0.97 |
Disease durationa | 6 | − 0.03 | 0.82 | 3 | − 0.08 | 0.69 | 2 | NA | NA |
Training duration | 10 | − 0.10 | 0.26 | 5 | NA | NA | 4 | − 0.13 | 0.17 |
Proportion of malesa | 10 | 0.01 | 0.50 | 5 | − 0.04 | 0.20 | 4 | 0.06 | 0.28 |
Baseline dataa | |||||||||
FMD at baseline | 9 | 0.43 | 0.23 | 5 | 1.33 | 0.29 | 3 | 1.16 | 0.48 |
Body mass index | 10 | − 0.16 | 0.34 | 5 | − 0.30 | 0.19 | 4 | − 0.32 | 0.34 |
Systolic blood pressure | 6 | 0.03 | 0.70 | 4 | − 0.10 | 0.34 | 2 | NA | NA |
Diastolic blood pressure | 6 | 0.01 | 0.95 | 4 | 0.41 | 0.30 | 2 | NA | NA |
Mean arterial pressure | 7 | 0.23 | 0.05 | 4 | − 0.19 | 0.76 | 3 | 0.20 | 0.28 |
Fasting blood glucose | 6 | 0.17 | 0.73 | 4 | − 0.71 | 0.29 | 2 | NA | NA |
Hemoglobin A1c | 10 | 1.11 | 0.09 | 5 | − 1.97 | 0.44 | 4 | 1.21 | 0.17 |
Peak oxygen consumption | 8 | − 0.01 | 0.95 | 3 | − 3.27 | 0.61 | 4 | − 0.03 | 0.95 |
Change scores post-exercise interventionb | |||||||||
Body mass index | 6 | − 2.10 | 0.55 | 3 | − 4.64 | 0.57 | 3 | 3.60 | 0.59 |
Systolic blood pressure | 6 | − 0.16 | 0.30 | 4 | − 0.20 | 0.28 | 2 | NA | NA |
Diastolic blood pressure | 6 | − 0.10 | 0.55 | 4 | − 0.22 | 0.35 | 2 | NA | NA |
Fasting blood glucose | 5 | 1.44 | 0.62 | 4 | − 4.66 | 0.34 | 1 | NA | NA |
Hemoglobin A1c | 9 | − 2.52 | 0.24 | 5 | − 5.02 | 0.12 | 3 | 1.96 | 0.73 |
Peak oxygen consumption | 6 | − 0.38 | 0.74 | 3 | 1.14 | 0.55 | 3 | − 1.40 | 0.52 |
Study characteristics | All exercise | Aerobic exercise | Combined exercise | ||||||
---|---|---|---|---|---|---|---|---|---|
N | WMD (%) | 95% CI | N | WMD (%) | 95% CI | N | WMD (%) | 95% CI | |
Exercise training as the sole intervention | 8 | 2.00 | 1.23–2.77% | 4 | 1.64 | 0.79–2.49% | 3 | 2.47 | 0.70–4.23% |
No or minor changes in medication use | 8 | 2.16 | 1.48–2.85% | 4 | 1.64 | 0.79–2.49% | 3 | 3.20 | 2.10–4.30% |
Using intention-to-treat analysis | 8 | 2.39 | 1.64–3.15% | 3 | 2.27 | 0.94–3.61% | 4 | 2.49 | 1.17–3.81% |