A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes
Section snippets
Background
Regular physical activity is associated with multiple health benefits for individuals with type 1 diabetes (T1D) [1]. Increased physical activity is associated with a lower risk of complications and an increased life expectancy [2], however, more than 60% of adults with T1D do not achieve recommended levels of physical activity [3]. Children with T1D also face barriers to achieving recommended physical activity targets [4]. In addition to conventional barriers to exercise (i.e. lack of time,
Methods
Using a previously published protocol [14], a systematic review applying methodological approaches outlined in the Methodological Expectations of Cochrane Intervention Reviews [15] was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria [16]. An expert panel from multiple fields (pediatrics, endocrinology, clinical epidemiology, exercise physiology) formulated the review question, reviewed the search strategies and review methods,
Results
Of the 14,663 citations obtained from electronic and hand-searches, 51 trial reports that potentially examined the effect of exercise on glycemic control in T1D individuals were identified. Forty-three reports were excluded: inappropriate population (n = 5); inappropriate intervention/control (n = 2); inappropriate study design (n = 21); full-text manuscripts unavailable for review through library services (n = 13); unable to translate non-English language (n = 2) (Fig. 1). Six unique trial reports [12],
Discussion
The current systematic review and meta-analysis supports observations of previous meta-analyses [10], [11], [13]. First, very few (only four) published randomized controlled trials could be identified comparing the effects of longer-term (i.e. >8 weeks) exercise training on HbA1c to performing no exercise in adults with T1D. Second, regular exercise training performed at least twice weekly for a minimum of eight weeks would appear to contribute to a significant absolute reduction in HbA1c in
Contribution statement
The authors contributed in the following ways: conception and design (AMAS, JM, SM), literature screening and conflict resolution (JH, JM, JY), analysis and interpretation of data (AMAS, JM), drafting the article (AMAS, JH, JY) or providing important revisions (JM, SM). All authors approved of the final version of the article.
Funding sources
Financial support for this systematic review was provided through the Robert Wallace Cameron Chair in Evidence-based Child Health (Grant # PEDS-311740), Manitoba Health Research Council and the Lawson Foundation (Grant # GRT 2012-059). JY was supported by a Manitoba Health Research Council/Manitoba Institute of Child Health Postdoctoral Fellowship and a Canadian Institutes of Health Research Postdoctoral Fellowship MFE: 131495. JMM is supported by a New Investigator Award from the Canadian
Conflicts of Interest statements
The authors have no conflicts of interest to declare.
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