Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis
Open accessAbstract
Aims/hypothesis This study aimed to systematically review randomised controlled trials comparing the effects of aerobic exercise training (AET), resistance training (RT) and combined training (CT) on glycaemic control and blood lipids in patients with type 2 diabetes mellitus.Methods Searches were performed in MEDLINE, EMBASE and the Cochrane Library. Inclusion criteria were: type 2 diabetes mellitus, adult, supervised training and a minimum intervention period of 8 weeks. Pooled effects were calculated by fixed/random effect pairwise and Bayesian fixed/random effects network meta-analyses.Results A total of 14 trials enrolling 915 participants were included. AET was more effective than RT in improving HbA1c levels (mean difference [MD] -0.20% [-2.2 mmol/mol]; 95% CI -0.32, -0.08; p = 0.0007, 10 trials/515 participants) and fasting glucose (MD -0.9 mmol/l; 95% CI -1.71, -0.09; p = 0.03, 8 trials/245 participants). Compared with AET, CT resulted in a significantly more pronounced reduction in HbA1c (MD -0.17% [-1.87 mmol/mol]; 95% CI -0.31, -0.03; p = 0.02, 9 trials/493 participants). Compared with RT, the MD of the change in HbA1c (MD -0.62%, [-6.82 mmol/mol]; 95% CI -0.95, -0.30; p = 0.0002, 5 trials/362 participants], fasting glucose (MD -1.99 mmol/l; 95% CI -3.07, -0.90; p = 0.0003, 3 trials/99 participants) and triacylglycerols (MD -0.28 mmol/l; 95% CI -0.46, -0.10; p = 0.003, 4 trials/213 participants) were all in favour of CT. The exclusion of trials with a high risk of bias yielded only non-significant results.Conclusions/interpretation The present data suggest that CT might be the most efficacious exercise modality to improve glycaemic control and blood lipids. Interpretation with respect to clinical relevance is limited by the low quality of the studies included and the limited information on the clinically important outcomes or adverse effects of exercise.
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Meta-analyses suggested that aerobic or combined exercise is generally superior to resistance exercise on blood pressure, body fat, glucose metabolism, and lipid profile.
“meta-analyses suggested that aerobic or combined exercise is generally superior to resistance exercise on blood pressure,29 body fat,30 glucose metabolism, and lipid profile,31,32”
From Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial (2024) · cites this paper as [31]
The pairwise meta-analysis (page unavailable in our copy) found better HbA1c and fasting-glucose outcomes with aerobic and combined training than with resistance training, and lower triacylglycerols with combined training. It found no significant lipid-profile differences between aerobic and resistance training, so the claim is too broad on that point. The study was limited to adults with type 2 diabetes. (LLM, conf=0.82)
Experimental — accuracy not yet measuredBiguanides, alpha-glucosidase inhibitors, thiazolidinediones, basal insulin formulations, and GLP-1 receptor agonists have inhibitory effects on the onset of type 2 diabetes.
“Biguanides 45 , α‐glucosidase inhibitors 46 , 47 , 48 , thiazolidinediones (TZDs) 49 , basal insulin formulations 50 , and GLP‐1 receptor agonists (GLP‐1RA) 51 are shown to have inhibitory effects on the onset of type 2 diabetes.”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [45]
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- Authors
- Schwingshackl, L., Missbach, B., Dias, S., König, J., & Hoffmann, G.
- Affiliations
- University of Vienna (AT)
- University of Bristol (GB)
- Corresponding author
- Schwingshackl, Lukas
- Venue
- Diabetologia
- Published
- 2014-07-05
- Volume
- 57
- Issue
- 9
- Pages
- 1789-1797
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2030162189
- Cited by
- 264
- References
- 54
- Citations by year
- 2026: 15 · 2025: 27 · 2024: 24 · 2023: 32 · 2022: 18 · 2021: 22 · 2020: 27 · 2019: 19 · 2018: 29 · 2017: 16 · 2016: 22 · 2015: 11 · 2014: 2
- FWCI
- 1.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- type 2 diabetes, aerobic exercise training, resistance training, concurrent training, glycemic control, HbA1c, fasting blood glucose, serum lipids, triglycerides, LDL cholesterol, HDL cholesterol, exercise modality comparison, supervised exercise intervention, treatment effect heterogeneity
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 2, Humans, Lipids, Exercise, Resistance Training
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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