Comparative efficacy of various mind-body exercise types on cardiometabolic health in patients with type 2 diabetes: a network meta-analysis of randomized controlled trials

OBJECTIVE: This study aims to compare the efficacy of different mind-body exercises (MBEs) on cardiometabolic risk factors in patients with type 2 diabetes mellitus (T2DM) using a network meta-analysis of randomized controlled trials (RCTs). METHODS: This study followed PRISMA guidelines and was registered in PROSPERO (CRD42025630741). A systematic search of PubMed, Cochrane Library, Web of Science, and Embase was conducted up to December 15, 2024, using MeSH terms related to mind-body therapies and cardiometabolic risk in type 2 diabetes. Randomized controlled trials (RCTs) evaluating mind-body exercises (MBEs) on glucose metabolism, body composition, cardiovascular physiology, and lipid metabolism were included. Data extraction and risk of bias assessment (RoB 2 tool) were performed independently by two reviewers. Network meta-analysis was conducted using R (gemtc package) and Stata 17.0, with effect sizes reported as mean difference (MD) or standardized mean difference (SMD). Evidence quality was assessed using CINeMA. RESULTS: This network meta-analysis compared the effects of various mind-body exercise interventions on ten cardiometabolic risk factors. Meditative Exercise (ME) was most effective in reducing fasting plasma glucose (SUCRA = 97.9%, SMD = -7.23, 95% CI: -8.27 to -6.20), while Mindfulness Intervention Training (MIT) showed the greatest benefit for glycated hemoglobin (SUCRA = 92.2%, MD = -0.78, 95% CI: -1.12 to -0.44) and blood pressure reduction (SBP: SUCRA = 86.1%, MD = -13.00, 95% CI: -17.22 to -8.78; DBP: SUCRA = 99.8%, MD = -6.00, 95% CI: -7.64 to -4.36), significantly outperforming conventional exercise. Yoga with Meditation (YWM) was most effective in lowering body mass index (SUCRA = 99.4%, MD = -2.90, 95% CI: -4.05 to -1.75). CINeMA assessments rated most comparisons as very low certainty due to within-study bias and between-study heterogeneity. Nevertheless, consistency was supported by node-splitting analysis, and no significant publication bias was detected, indicating robust and reliable findings. CONCLUSION: Compared with conventional exercise intervention, MBE exerts unique and superior effects on various cardiometabolic risk factors in T2DM, underscoring their potential as effective and integrative interventions for personalized diabetes management. Clinicians should consider incorporating MBEs, such as MIT, ME, and YWM, into treatment plans based on individual patient needs, particularly for glycemic control, weight management, and cardiovascular health. Further research is warranted to explore the long-term benefits and optimal implementation strategies, especially given the heterogeneity in intervention protocols and the relatively short duration of the included trials.