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      Effects of combined aerobic and resistance training on glycemic control, blood pressure, inflammation, cardiorespiratory fitness and quality of life in patients with type 2 diabetes and overweight/obesity: a systematic review and meta-analysis

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          Abstract

          Background

          Structured aerobic or resistance training alone seems to be a beneficial tool for improving glucose homeostasis, chronic systemic inflammation, resting cardiovascular function, and mental health in people with obesity and type 2 diabetes mellitus (T2DM). The aim of the present study was to synthesize the available data on the effectiveness of combined aerobic and resistance training (CART) on glycemic control, blood pressure, inflammation, cardiorespiratory fitness (CRF), and quality of life (QoL) in overweight and obese individuals with T2DM.

          Methods

          A database search was carried out in PubMed, Web of Science, Scopus, Science Direct, Cochrane Library, and Google Scholar from inception up to May 2023. The Cochrane risk of bias tool was used to assess eligible studies, and the GRADE method to evaluate the reliability of evidence. A random-effects model was used, and data were analyzed using standardized mean differences and 95% confidence intervals. The study protocol was registered in the International Prospective Register of Systematic Reviews (ID: CRD42022355612).

          Results

          A total of 21,612 studies were retrieved; 20 studies were included, and data were extracted from 1,192 participants (mean age: 57 ± 7 years) who met the eligibility criteria. CART demonstrated significant improvements in body mass index, glycated hemoglobin, systolic and diastolic blood pressure, C-reactive protein, tumor necrosis factor-alpha, interleukin-6, CRF, and QoL compared to ST. These findings highlight the significance of exercise interventions such as CART as essential elements within comprehensive diabetes management strategies, ultimately enhancing overall health outcomes in individuals with T2DM and overweight/obesity.No differences were found in resting heart rate between CART and ST. An uncertain risk of bias and poor quality of evidence were found among the eligible studies.

          Conclusion

          These outcomes show clear evidence considering the positive role of CART in inducing beneficial changes in various cardiometabolic and mental health-related indicators in patients with T2DM and concurrent overweight/obesity. More studies with robust methodological design are warranted to examine the dose-response relationship, training parameters configuration, and mechanisms behind these positive adaptations.

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          Most cited references111

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association.

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              Exercise and Type 2 Diabetes

              Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.
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                Author and article information

                Contributors
                Journal
                PeerJ
                PeerJ
                PeerJ
                PeerJ
                PeerJ Inc. (San Diego, USA )
                2167-8359
                14 June 2024
                2024
                : 12
                : e17525
                Affiliations
                [1 ]Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia , Kelantan, Malaysia
                [2 ]Department of Physical Education and Sport Science, School of Physical Education, Sport Science and Dietetics, University of Thessaly , Trikala, Greece
                [3 ]Exercise Physiology Department, King Saud University , Riyadh, Saudi Arabia
                [4 ]Department of Food Science and Nutrition, College of Food and Agricultural Science, King Saud University , Riyadh, Saudi Arabia
                [5 ]Department of General Surgery, School of Medical Sciences, Universiti Sains Malaysia , Kelantan, Malaysia
                [6 ]Department of Zoology, Ahmadu Bello University , Zaria, Nigeria
                [7 ]Department of Sports Management, Faculty of Sport Sciences, Kirikkale University , Kirikkale, Turkey
                [8 ]Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University , Riyadh, Saudi Arabia
                [9 ]Department of Human Physiology, Federal University Dutse , Jigawa, Nigeria
                [10 ]Centro de Investigación y Diagnóstico en Salud y Deporte, Escuela Ciencias del Movimiento Humano y Calidad de Vida Universidad Nacional de Costa Rica , Heredia, Costa Rica
                Author information
                http://orcid.org/0000-0003-0844-1284
                http://orcid.org/0000-0001-9333-1957
                http://orcid.org/0000-0002-8499-1117
                http://orcid.org/0000-0003-0168-6721
                http://orcid.org/0000-0003-0003-9581
                http://orcid.org/0000-0001-7633-7900
                http://orcid.org/0000-0002-1100-4301
                http://orcid.org/0000-0002-7299-1072
                http://orcid.org/0000-0002-0717-8827
                Article
                17525
                10.7717/peerj.17525
                11182026
                38887616
                503f52da-f81f-45d4-bbd5-453c93c1425c
                © 2024 AL-Mhanna et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited.

                History
                : 18 January 2024
                : 16 May 2024
                Funding
                Funded by: Universiti Sains Malaysia
                Award ID: 304.PPSP.6315639
                This work was supported by the Universiti Sains Malaysia (Grant No. 304.PPSP.6315639). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Diabetes and Endocrinology
                Public Health
                Obesity
                Rehabilitation
                Sports Medicine

                exercise,physical activity,insulin resistance,metabolic syndrome,cardiometabolic health

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