Meta-analysis of the effects of different exercise modes on cardiac function and peak oxygen uptake in patients with type 2 diabetes mellitus

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Type 2 diabetes mellitus (n=714). Intervention: Exercise training (high-intensity interval training [HIIT] or moderate-intensity continuous training [MICT]) vs. Usual care (standard type 2 diabetes mellitus management with no exercise intervention). Primary outcome: Left ventricular ejection fraction (LVEF) with HIIT vs usual care (MD 5.52%, 95% CI 2.31 to 8.73, p=0.0008).

Q: What does this research mean for the field?

High-intensity interval training significantly improves left ventricular ejection fraction and peak oxygen uptake in patients with type 2 diabetes mellitus, showing greater efficacy than moderate-intensity continuous training. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

He Jianghua; Ma Feier; Dong Zhu; Qiuying Li; Ya Wen

doi:10.3389/fphys.2024.1448385

November 12, 2024Frontiers in PhysiologyOpen Access

Meta-analysis of the effects of different exercise modes on cardiac function and peak oxygen uptake in patients with type 2 diabetes mellitus

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Key result

HIIT boosts LVEF by ~6 percentage points over usual care in type 2 diabetes.

MD +5.52%
95% CI 2.31 to 8.73
P=0.0008
n=714

Figures

Why the study?

Although exercise prevents cardiovascular events in patients with T2DM, its effects on cardiac structure and function require clarification.

Does structured exercise training (HIIT or MICT) improve cardiac structure, cardiac function, and peak oxygen uptake (VO2peak) compared to usual care in adult patients with type 2 diabetes mellitus?

Key Points

To evaluate the impact of different exercise modalities and intervention durations on cardiac structure, cardiac function, and peak oxygen uptake in patients with type 2 diabetes mellitus.
Systematic search of PubMed, Embase, EBSCO, Web of Science, and CNKI from January 2000 to July 2023 for clinical trials assessing exercise in type 2 diabetes mellitus (PROSPERO CRD4242018087376).
Identified 12 studies comprising 14 exercise arms and 714 participants (367 exercise, 347 usual care control) with mean ages ranging from 48 to 60 years.
Evaluated high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) across intervention durations ranging from 10 weeks to 3 years.
Both HIIT and MICT significantly increased left ventricular end-diastolic volume (MD: 19.44 mL, 95% CI: 13.72 to 25.17, p < 0.00001 vs. MD: 13.90 mL, 95% CI: 7.64 to 20.16, p < 0.0001), but only HIIT significantly increased left ventricular mass (MD: 17.04 g, 95% CI: 5.45 to 28.62, p = 0.004).
Left ventricular ejection fraction significantly improved with HIIT (MD: 5.52, 95% CI: 2.31 to 8.73, p = 0.0008) and with MICT in interventions lasting ≤6 months (MD: 1.36, 95% CI: 0.61 to 2.10, p = 0.0004), whereas systolic tissue velocity showed no significant change.
HIIT significantly enhanced VO2 peak (MD: 8.04, 95% CI: 6.26 to 9.83, p < 0.00001), as did MICT in interventions lasting ≤6 months (MD: 3.33, 95% CI: 2.39 to 4.27, p < 0.00001).

Study Design

Type

Meta-Analysis (n=714)

Blinding

Lack of subject and therapist blinding in all included studies; assessor blinding in 1 study

Randomization

Included 10 randomized controlled trials and 2 non-randomized controlled trials

Structured PICO

Does structured exercise training (HIIT or MICT) improve cardiac structure, cardiac function, and peak oxygen uptake (VO2peak) compared to usual care in adult patients with type 2 diabetes mellitus?

P

Population

714 adults with type 2 diabetes mellitus (mean age 48 to 60 years across 12 clinical trials) undergoing exercise interventions of 10 weeks to 3 years compared with usual care.

I

Intervention

Structured exercise interventions (14 exercise arms: 11 moderate-intensity continuous training [MICT] and 3 high-intensity interval training [HIIT] groups), with session lengths of 20 to 60 minutes, frequencies of 2 to 6 times/week, over durations ranging from 10 weeks to 3 years (≥8 weeks required for inclusion), without combined diet or other lifestyle interventions.

C

Comparator

Usual care (standard T2DM management framework with no exercise intervention).

O

Outcome

Changes in cardiac structure (left ventricular mass [LVM], left ventricular mass index [LVMI], left ventricular end-diastolic volume [LVEDV], left ventricular end-diastolic diameter [LVEDD]), cardiac systolic function (left ventricular ejection fraction [LVEF], systolic tissue velocity [S]), cardiac diastolic function (E, A, E/A ratio, E/e' ratio, E-wave deceleration time [Dt]), and cardiorespiratory fitness (VO2peak) evaluated via echocardiography or cardiac magnetic resonance imaging over 10 weeks to 3 years.surrogate

Main Result

Mean Difference: 5.52 (95% CI 2.31–8.73)

p-value: p=0.0008

This meta-analysis demonstrates that structured exercise—particularly high-intensity interval training (HIIT) over moderate-intensity continuous training (MICT)—significantly improves left ventricular systolic function (LVEF), cardiac structure (LVEDV, LVM), and peak oxygen uptake in patients with type 2 diabetes mellitus, though diastolic function parameters largely remained unchanged.

Limitations

In subgroup analyses by duration (>6 or ≤6 months), most included studies had an intervention duration of 3 months.
Heterogeneity in exercise interventions and study methods was not completely avoidable.
Subgroup analyses by exercise type (endurance, resistance, aerobic plus resistance), session frequency, session length, and imaging modality could not be conducted due to insufficient data.
Lack of blinded designs in included studies and nonrandom designs in two included studies.
Lack of blinded designs in the included studies
Inclusion of two non-randomized controlled studies (Sacre et al., 2014 and Schmidt et al., 2013)
Moderate or low certainty of evidence for most outcomes driven by high risk of bias and inconsistency

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

HIIT improves LVEF and VO2peak in T2DM; extends exercise evidence and supports preference over moderate training.

Abstract

Background The benefits of exercise for primary and secondary prevention of cardiovascular events have been reported in patients with type 2 diabetes mellitus (T2DM). However, the effects of exercise on cardiac structure and function require clarification. Methods A literature search for clinical studies reporting on the effects of exercise on cardiac structure, cardiac function, and VO 2 peak in T2DM patients was conducted. PubMed, Embase, EBSCO, Web of Science, and China National Knowledge Infrastructure were systematically searched for original articles published from January 2000 to July 2023. The effect size was expressed as the mean difference (MD) or standardized mean difference (SMD) and its 95% confidence interval (CI). Subgroup analyses were performed by exercise mode (high-intensity interval training [HIIT] or moderate-intensity continuous training [MICT]) and intervention duration (>6 or ≤6 months). Results Compared to usual care, both HIIT and MICT significantly affected left ventricular end-diastolic volume (MD: 19.44, 95% CI: 13.72 to 25.17, p < 0.00001; I 2 = 42%; MD: 13.90, 95% CI: 7.64 to 20.16, p < 0.0001; I 2 = 0%), but only HIIT significantly affected left ventricular mass (MD: 17.04 g, 95% CI: 5.45 to 28.62, p = 0.004; I 2 = 0%). HIIT significantly improved left ventricular ejection fraction (MD: 5.52, 95% CI: 2.31 to 8.73, p = 0.0008; I 2 = 0%), as did MICT in the ≤6 months subgroup (MD: 1.36, 95% CI: 0.61 to 2.10, p = 0.0004; I 2 = 0%). Neither significantly affected systolic tissue velocity. HIIT significantly improved VO 2 peak (MD: 8.04, 95% CI: 6.26 to 9.83, p < 0.00001; I 2 = 0%), as did MICT in the ≤6 months subgroup (MD: 3.33, 95% CI: 2.39 to 4.27, p < 0.00001; I 2 = 0%). Conclusion Exercise significantly improved cardiac structure, systolic function, and VO 2 peak, but did not significantly affect diastolic function in T2DM patients. HIIT seemed to be superior to MICT at improving VO 2 peak and left ventricular ejection fraction in T2DM patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ , PROSPERO registration no.: CRD4242018087376

Discussion

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Cite This Study

Jianghua et al. (2024) conducted a meta-analysis in Type 2 diabetes mellitus (n=714). Exercise training (high-intensity interval training [HIIT] or moderate-intensity continuous training [MICT]) vs. Usual care (standard type 2 diabetes mellitus management with no exercise intervention) was evaluated on Left ventricular ejection fraction (LVEF) with HIIT vs usual care (MD 5.52%, 95% CI 2.31 to 8.73, p=0.0008).

synapsesocial.com/papers/6a7dc114143763190a3c988a https://doi.org/10.3389/fphys.2024.1448385

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Meta-analysis of the effects of different exercise modes on cardiac function and peak oxygen uptake in patients with type 2 diabetes mellitus

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Meta-analysis of the effects of different exercise modes on cardiac function and peak oxygen uptake in patients with type 2 diabetes mellitus

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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