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A Meta-analysis of Controlled Clinical Trials

Normand G. Boulé, MA; Elizabeth Haddad, MD; Glen P. Kenny, PhD; George A. Wells, PhD; Ronald J. Sigal, MD,MPH

JAMA. 2001;286:1218-1227.

Context  Exercise is widely perceived to be beneficial for glycemic control and weight loss in patients with type 2 diabetes. However, clinical trials on the effects of exercise in patients with type 2 diabetes have had small sample sizes and conflicting results.

Objective  To systematically review and quantify the effect of exercise on glycosylated hemoglobin (HbA_1c) and body mass in patients with type 2 diabetes.

Data Sources  Database searches of MEDLINE, EMBASE, Sport Discuss, Health Star, Dissertation Abstracts, and the Cochrane Controlled Trials Register for the period up to and including December 2000. Additional data sources included bibliographies of textbooks and articles identified by the database searches.

Study Selection  We selected studies that evaluated the effects of exercise interventions (duration 8 weeks) in adults with type 2 diabetes. Fourteen (11 randomized and 3 nonrandomized) controlled trials were included. Studies that included drug cointerventions were excluded.

Data Extraction  Two reviewers independently extracted baseline and postintervention means and SDs for the intervention and control groups. The characteristics of the exercise interventions and the methodological quality of the trials were also extracted.

Data Synthesis  Twelve aerobic training studies (mean [SD], 3.4 [0.9] times/week for 18 [15] weeks) and 2 resistance training studies (mean [SD], 10 [0.7] exercises, 2.5 [0.7] sets, 13 [0.7] repetitions, 2.5 [0.4] times/week for 15 [10] weeks) were included in the analyses. The weighted mean postintervention HbA_1c was lower in the exercise groups compared with the control groups (7.65% vs 8.31%; weighted mean difference, -0.66%; P<.001). The difference in postintervention body mass between exercise groups and control groups was not significant (83.02 kg vs 82.48 kg; weighted mean difference, 0.54; P = .76).

Conclusion  Exercise training reduces HbA_1c by an amount that should decrease the risk of diabetic complications, but no significantly greater change in body mass was found when exercise groups were compared with control groups.

Author Affiliations: Departments of Medicine (Drs Wells and Sigal) and Epidemiology and Community Medicine (Dr Wells), School of Human Kinetics (Mr Boulé and Drs Kenny and Sigal), Faculty of Medicine (Dr Haddad), University of Ottawa, and Clinical Epidemiology Unit, Ottawa Health Research Institute (Mr Boulé and Drs Wells and Sigal), Ottawa, Ontario. Mr Boulé is now with the Division of Kinesiology, Laval University, Quebec City, Quebec. Dr Haddad is now with the Department of Surgery, University of Western Ontario, London.

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