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The Effect of Physical Activity Interventions on Glycosylated Haemoglobin (HbA1c) in Non-diabetic Populations: A Systematic Review and Meta-analysis

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Abstract

Background

Physical activity is widely perceived to be beneficial for preventing type 2 diabetes mellitus and for controlling glycaemic levels in patients with type 2 diabetes, but evidence supporting a positive effect in the control of glycaemic levels in healthy people is rather weak. The aim of this review was to estimate the effect of physical activity on glycaemic control measured by glycosylated haemoglobin (HbA1c) levels in non-diabetic populations, and to determine which type of physical activity has a greater influence on glycaemic control.

Methods

We systematically searched the MEDLINE, EMBASE, Cochrane Library and Web of Science databases, from inception to May 2017, for experimental studies addressing the effect of physical activity on glycaemic control measured by HbA1c levels in non-diabetic populations. The DerSimonian and Laird method was used to compute pooled estimates of effect size (ES) and respective 95% confidence intervals (CIs). The effect of physical activity on HbA1c levels was estimated in two ways: (1) physical activity intervention versus control; and (2) physical activity pre–post intervention. Additionally, subgroup analyses were performed based on age of participants and different aspects of the intervention.

Results

Fifteen published studies were included in the meta-analysis. In analyses comparing physical activity intervention and control, we found a decrease of HbA1c levels in favour of the intervention group (ES = 0.32; 95% CI 0.01–0.62) with substantial heterogeneity (I2 = 63.2%; p = 0.008). In the pre–post analysis, there was a decrease in HbA1c levels post physical activity intervention (ES = 0.17; 95% CI 0.01–0.33) with low heterogeneity (I2 = 25.8%; p = 0.164). Additionally, for physical activity intervention versus control, a decrease in HbA1c levels was observed in resistance exercise and in intervention length below 12 weeks. Furthermore, for pre–post effect analyses, a decrease in HbA1c levels was observed in the supervised physical activity programme, other type of exercises, intervention length below 12 weeks and exercise intervention week duration above 150 min subgroups.

Conclusions

This systematic review and meta-analysis provides an overview of the evidence supporting physical activity as a suitable intervention for glycaemic control as measured by HbA1c levels in non-diabetic populations.

Trial Registration

PROSPERO CRD42016050991.

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References

  1. Schulze MB, Hu FB. Primary prevention of diabetes: what can be done and how much can be prevented? Ann Rev Public Health. 2005;26:445–67.

    Article  Google Scholar 

  2. Hu FB, Stampfer MJ, Colditz GA, Ascherio A, Rexrode KM, Willett WC, et al. Physical activity and risk of stroke in women. JAMA. 2000;283:2961–7.

    Article  CAS  PubMed  Google Scholar 

  3. Colditz GA, Samplin-Salgado M, Ryan CT, Willett W, Trichopoulos D, Hunter D. Harvard report on cancer prevention. Vol 5. Fulfilling the potential for cancer prevention: policy approaches. Cancer Causes Control. 2002;13:199–212.

    Article  PubMed  Google Scholar 

  4. World Health Organization. Global recommendations on physical activity for health. Geneva: WHO; 2010.

    Google Scholar 

  5. Katzmarzyk PT, Lee IM, Martin CK, Blair SN. Epidemiology of physical activity and exercise training in the United States. Prog Cardiovasc Dis. 2017;60:3–10.

    Article  PubMed  Google Scholar 

  6. Arena R, Harrington RA, Després JP. A message from modern-day healthcare to physical activity and fitness: welcome home! Prog Cardiovasc Dis. 2015;57(4):293–5.

    Article  PubMed  Google Scholar 

  7. Sallis RE, Baggish AL, Franklin BA, Whitehead JR. The call for a physical activity vital sign in clinical practice. Am J Med. 2016;129(9):903–5.

    Article  PubMed  Google Scholar 

  8. Carlson SA, Fulton JE, Pratt M, Yang Z, Adams EK. Inadequate physical activity and health care expenditures in the United States. Prog Cardiovasc Dis. 2015;57(4):315–23.

    Article  PubMed  Google Scholar 

  9. Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. 2008;371(9626):1783–9.

    Article  PubMed  Google Scholar 

  10. Hardman AE, Stensel DJ. Physical activity and health: the evidence explained. 2nd ed. Oxon: Routledge; 2009.

    Google Scholar 

  11. Zisko N, Skjerve KN, Tari AR, Sandbakk SB, Wisloff U, Nes BM, et al. Personal activity intelligence (PAI), sedentary behavior and cardiovascular risk factor clustering—the HUNT Study. Prog Cardiovasc Dis. 2017;60:89–95.

    Article  PubMed  Google Scholar 

  12. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997;20(7):1183–97.

    Article  Google Scholar 

  13. Martínez-Vizcaíno V, Cavero-Redondo I, Álvarez-Bueno C, Rodriguez-Artalejo F. The accuracy of diagnostic methods for diabetic retinopathy: a systematic review and meta-analysis. PLoS One. 2016;11(4):e0154411.

    Article  PubMed  PubMed Central  Google Scholar 

  14. O’Sullivan CJ, Hynes N, Mahendran B, Andrews EJ, Avalos G, Tawfik S, et al. Haemoglobin A1c (HbA1C) in non-diabetic and diabetic vascular patients. Is HbA1C an independent risk factor and predictor of adverse outcome? Eur J Vas Endovasc Surg. 2006;32(2):188–97.

    Article  Google Scholar 

  15. Cavero-Redondo I, Peleteiro B, Álvarez-Bueno C, Rodríguez-Artalejo F, Martinez-Vizcaino V. Glycated haemoglobin A1c as a predictor of cardiovascular outcomes and all-cause mortality in diabetic and nondiabetic populations: a systematic review and meta-analysis. BMJ Open. 2003. https://doi.org/10.1136/bmjopen-2016-015801.

    Google Scholar 

  16. American Diabetes Association. Physical activity/exercise and diabetes mellitus. Diabetes Care. 2003;26(suppl 1):s73–7.

    Google Scholar 

  17. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.

    Article  PubMed  Google Scholar 

  18. Higgins JP, Green S, editors. Cochrane handbook for systematic reviews of interventions. 5.1.0 [Updated March 2011]. The Cochrane Collaboration, 2011. https://handbook.cochrane.org. Accessed 01 May 2017.

  19. Cavero-Redondo I, Peleteiro B, Álvarez-Bueno C, Rodríguez-Artalejo F, Martinez-Vizcaino V. Glycated haemoglobin A1c as a predictor of cardiovascular outcomes and all-cause mortality in diabetic and nondiabetic populations: a systematic review and meta-analysis. BMJ Open. 2017;7(7):e015949. https://doi.org/10.1136/bmjopen-2017-015949.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  21. National Collaborating Centre for Methods and Tools. Quality assessment tool for quantitative studies [updated 13 Apr 2010]. Hamilton: McMaster University; 2008.

    Google Scholar 

  22. Armijo-Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings GG. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract. 2012;18(1):12–8.

    Article  PubMed  Google Scholar 

  23. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Earlbaum Associates; 1988. p. 20–6.

    Google Scholar 

  24. Thompson SG, Sharp SJ. Explaining heterogeneity in meta-analysis: a comparison of methods. Stat Med. 1999;18(20):2693–708.

    Article  CAS  PubMed  Google Scholar 

  25. Sterne JA, Egger M, Smith GD. Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ. 2001;323:101–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method. Biometrics. 2000;56(2):455–63.

    Article  CAS  PubMed  Google Scholar 

  27. Ando D, Hosaka Y, Suzuki K, Yamagata Z. Effects of exercise training on circulating high molecular weight adiponectin and adiponectin oligomer composition: a randomized controlled trial. J Atheroscler Thromb. 2009;16(6):733–9.

    Article  CAS  PubMed  Google Scholar 

  28. Fantin F, Rossi A, Morgante S, Soave D, Bissoli L, Cazzadori M, et al. Supervised walking groups to increase physical activity in elderly women with and without hypertension: effect on pulse wave velocity. Hypertens Res. 2012;35(10):988–93.

    Article  PubMed  Google Scholar 

  29. Huang H, Kaoruko TADA, Murakami H, Saito Y, Otsuki T, Iemitsu M, et al. Influence of adiponectin gene polymorphism SNP276 (G/T) on adiponectin in response to exercise training. Endocr J. 2007;54(6):879–86.

    Article  CAS  PubMed  Google Scholar 

  30. Kallings LV, Johnson JS, Fisher RM, Faire UD, Ståhle A, Hemmingsson E, et al. Beneficial effects of individualized physical activity on prescription on body composition and cardiometabolic risk factors: results from a randomized controlled trial. Eur J Cardiovasc Prev Rehabil. 2009;16(1):80–4.

    Article  PubMed  Google Scholar 

  31. Lalande S, Okazaki K, Yamazaki T, Nose H, Joyner MJ, Johnson BD. Effects of interval walking on physical fitness in middle-aged individuals. J Prim Care Commun Health. 2010;1(2):104–10.

    Article  Google Scholar 

  32. Liu X, Miller YD, Burton NW, Brown WJ. A preliminary study of the effects of Tai Chi and Qigong medical exercise on indicators of metabolic syndrome, glycaemic control, health-related quality of life, and psychological health in adults with elevated blood glucose. Br J Sports Med. 2010;44(10):704–9.

    Article  CAS  PubMed  Google Scholar 

  33. Morey MC, Pieper CF, Edelman DE. Enhanced fitness: a randomized controlled trial of the effects of home-based physical activity counseling on glycemic control in older adults with prediabetes mellitus. J Am Geriatr Soc. 2012;60(9):1655–62.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Papp ME, Lindfors P, Nygren-Bonnier M, Gullstrand L, Wändell PE. Effects of high-intensity hatha yoga on cardiovascular fitness, adipocytokines, and apolipoproteins in healthy students: a randomized controlled study. J Altern Complement Med. 2016;22(1):81–7.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Sixt S, Rastan A, Desch S. Exercise training but not rosiglitazone improves endothelial function in prediabetic patients with coronary disease. Eur J Cardiovasc Prev Rehabil. 2008;15(4):473–8.

    Article  PubMed  Google Scholar 

  36. Sjöling M, Lundberg K, Englund E, Westman A, Jong MC. Effectiveness of motivational interviewing and physical activity on prescription on leisure exercise time in subjects suffering from mild to moderate hypertension. BMC Res Notes. 2011;4(1):352.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Tibana RA, Navalta J, Bottaro M. Effects of eight weeks of resistance training on the risk factors of metabolic syndrome in overweight/obese women-“A Pilot Study”. Diabetol Metab Syndr. 2013;5(1):11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Tsang TW, Kohn M, Chow CM, Fiatarone Singh M. A randomized controlled trial of Kung Fu training for metabolic health in overweight/obese adolescents: the “martial fitness” study. J Pediatr Endocrinol. 2009;22(7):595.

    Article  CAS  Google Scholar 

  39. Tsukui S, Kanda T, Nara M, Nishino M, Kondo T. KobayashiI. Moderate-intensity regular exercise decreases serum tumor necrosis factor-α and HbA1c levels in healthy women. Int J Obes. 2000;24(9):1207.

    Article  CAS  Google Scholar 

  40. Tsuzuku S, Kajioka T, Endo H, Abbott RD, Curb JD, Yano K. Favorable effects of non-instrumental resistance training on fat distribution and metabolic profiles in healthy elderly people. Eur J Appl Physiol. 2007;99(5):549–55.

    Article  CAS  PubMed  Google Scholar 

  41. Vizza L, Smith CA, Swaraj S, Agho K, Cheema BS. The feasibility of progressive resistance training in women with polycystic ovary syndrome: a pilot randomized controlled trial. BMC Sports Sci Med Rehabil. 2016;8(1):14.

    Article  PubMed  PubMed Central  Google Scholar 

  42. NGSP home (2017). http://www.ngsp.org/. Accessed 24 Oct 2017.

  43. Eyre H, Kahn R, Robertson RM, Clark NG, Doyle C, Hong Y, et al. Preventing cancer, cardiovascular disease, and diabetes. Circulation. 2004;109(25):3244–55.

    Article  PubMed  Google Scholar 

  44. Grundy SM, Balady GJ, Criqui MH, Fletcher G, Greenland P, Hiratzka LF, et al. Primary prevention of coronary heart disease: guidance from Framingham. Circulation. 1998;97(18):1876–87.

    Article  CAS  PubMed  Google Scholar 

  45. American Diabetes Association. Standards of medical care in diabetes—2017 abridged for primary care providers. Clin Diabetes. 2017;35(1):5–26.

    Article  PubMed Central  Google Scholar 

  46. Church TS, Blair SN, Cocreham S, Johannsen N, Johnson W, Kramer K, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2010;304:2253–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Byrne H, Caulfield B, De Vito G. Effects of self-directed exercise programmes on individuals with type 2 diabetes mellitus: a systematic review evaluating their effect on HbA1c and other metabolic outcomes, physical characteristics, cardiorespiratory fitness and functional outcomes. Sports Med. 2017;47(4):717–33.

    Article  PubMed  Google Scholar 

  48. Pai LW, Li TC, Hwu YJ, Chang SC, Chen LL, Chang PY. The effectiveness of regular leisure-time physical activities on long-term glycemic control in people with type 2 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2016;113:77–85.

    Article  PubMed  Google Scholar 

  49. Schwingshackl L, Missbach B, Dias S, König J, Hoffmann G. Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis. Diabetologia. 2014;57(9):1789–97.

    Article  CAS  PubMed  Google Scholar 

  50. Jelleyman C, Yates T, O’Donovan G, Gray LJ, King JA, Khunti K, et al. The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis. Obes Rev. 2015;16(11):942–61.

    Article  CAS  PubMed  Google Scholar 

  51. Sjøberg KA, Frøsig C, Kjøbsted R, Sylow L, Kleinert M, Betik AC, et al. Exercise increases human skeletal muscle insulin sensitivity via coordinated increases in microvascular perfusion and molecular signaling. Diabetes. 2017;66(6):1501–10.

    Article  PubMed  Google Scholar 

  52. Richter EA, Hargreaves M. Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol Rev. 2013;93(3):993–1017.

    Article  CAS  PubMed  Google Scholar 

  53. NICE. A rapid review of the effectiveness of exercise referral schemes to promote physical activity in adults. London: Public Health Collaborating Centre-Physical Activity; 2006. https://www.nice.org.uk/nicemedia/pdf/PAExercise_Referral_Review_Final_May_2006.pdf. Accessed 01 May 2017.

  54. Marcus BH, Williams DM, Dubbert PM, Sallis JF, King AC, Yancey AK, et al. Physical activity intervention studies. Circulation. 2006;114(24):2739–52.

    Article  PubMed  Google Scholar 

  55. Umpierre D, Ribeiro PA, Kramer CK, Leitão CB, Zucatti AT, Azevedo MJ, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305(17):1790–9.

    Article  CAS  PubMed  Google Scholar 

  56. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006;174(6):801–9.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardio-vascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Pract. 2005;18:491–519.

    Article  PubMed  Google Scholar 

  58. Chu P, Gotink RA, Yeh GY, Goldie SJ, Hunink MM. The effectiveness of yoga in modifying risk factors for cardiovascular disease and metabolic syndrome: a systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2016;23(3):291–307.

    Article  PubMed  Google Scholar 

  59. Haskell WL, Lee I-M, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423–34.

    Article  PubMed  Google Scholar 

  60. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.

    Article  PubMed  Google Scholar 

  61. King NA, Caudwell P, Hopkins M. Metabolic and behavioral compensatory responses to exercise interventions: barriers to weight loss. Obesity. 2007;15(6):1373–83.

    Article  PubMed  Google Scholar 

  62. Tahara Y, Shima K. Kinetics of HbA1c, glycated albumin, and fructosamine and analysis of their weight functions against preceding plasma glucose level. Diabetes Care. 1995;18(4):440–7.

    Article  CAS  PubMed  Google Scholar 

  63. Fedewa MV, Hathaway ED, Williams TD, Schmidt MD. Effect of exercise training on non-exercise physical activity: a systematic review and meta-analysis of randomized controlled trials. Sports Med. 2017;47(6):1171–82.

    Article  PubMed  Google Scholar 

  64. Stensel DJ, King JA, Thackray AE. Role of physical activity in regulating appetite and body fat. Nutr Bull. 2016;41(4):314–22.

    Article  Google Scholar 

  65. Campbell DT, Stanley JC. Experimental and quasi-experimental designs for research. San Francisco: Ravenio Books; 2015.

    Google Scholar 

  66. Hunter JE, Jensen JL, Rodgers R. The control group and meta-analysis. J Methods Meas Soc Sci. 2014;5(1):3–21.

    Article  Google Scholar 

  67. Button KS, Ioannidis JP, Mokrysz C, Nosek BA, Flint J, Robinson ES, et al. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci. 2013;14(5):365–76.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain

    Iván Cavero-Redondo, Celia Álvarez-Bueno, Miriam Garrido-Miguel & Vicente Martinez-Vizcaíno

  2. EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal

    Bárbara Peleteiro

  3. Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal

    Bárbara Peleteiro

  4. SPORT Research Group (CTS-1024), University of Almería, Almería, Spain

    Enrique G. Artero

  5. Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile

    Vicente Martinez-Vizcaíno

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  1. Iván Cavero-Redondo
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  2. Bárbara Peleteiro
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Contributions

VM-V and IC-R designed the review and meta-analysis. VM-V was the principal investigator and guarantor. IC-R and VM-V were the main coordinators of the review. BP, CA-B and VM-V conducted the review. MG-M, EGA and CA-B gave statistical and epidemiological support. IC-R wrote the article with the support of CA-B, EGA and BP. All authors revised and approved the final version of the manuscript.

Corresponding author

Correspondence to Celia Álvarez-Bueno.

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Funding

Ivan Cavero-Redondo is supported by a grant from the Universidad de Castilla-La Mancha (FPU13/01582). Celia Alvarez-Bueno is supported by a grant from the Spanish Ministry of Ministry of Education, Culture and Sport (FPU13/03137). Miriam Garrido-Miguel is supported by a Grant from the Spanish Ministry of Ministry of Education, Culture and Sport (FPU15/03847). No specific sources of funding were used to assist in the preparation of this article.

Conflict of interest

Ivan Cavero-Redondo, Barbara Peleteiro, Celia Alvarez-Bueno, Enrique Garcia Artero, Miriam Garrido-Miguel and Vicente Martinez-Vizcaino declare that they have no conflicts of interest relevant to the content of this review.

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Cavero-Redondo, I., Peleteiro, B., Álvarez-Bueno, C. et al. The Effect of Physical Activity Interventions on Glycosylated Haemoglobin (HbA1c) in Non-diabetic Populations: A Systematic Review and Meta-analysis. Sports Med 48, 1151–1164 (2018). https://doi.org/10.1007/s40279-018-0861-0

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