PHYSICAL EXERCISE IMPACT ON GLYCEMIC CONTROL, ELECTROCARDIOGRAPH PARAMETERS, IMMUNE AND VASCULAR FUNCTION AND QUALITY OF LIFE, IN DIABETIC CONDITIONS

To evaluate the effects of aerobic, resistance, and combined exercise interventions on HbA1c levels, immune function (white blood cell count), vascular function (Nitric oxide levels), electrocardiograph parameters, and quality of life in adults with diabetes.

This systematic review adhered to PRISMA guidelines and was registered with INPALSY (registration number INPALSY202250016). Literature searches across eight databases (AMED, CINAHL, Cochrane Library, MEDLINE, PsycINFO, PubMed, EMBASE, and EMCARE) up to July 2024 identified randomized controlled trials (RCTs) on exercise interventions for adults aged 18 and older with type 2 diabetes. Non-randomized studies and those with severe comorbidities were excluded. Two independent reviewers confirmed eligibility through full-text assessments and resolved discrepancies. Data extraction captured study characteristics, demographics, interventions, and outcomes, with quality assessed using the PEDro scale and GRADE approach. Descriptive statistics summarized findings, and meta-analysis was performed, assessing heterogeneity with the I² statistic. Subgroup analyses examined variations by exercise type, duration, and demographics, with statistical analyses conducted using RevMan software, calculating standardized mean differences for continuous outcomes at p 0.05.

In 38 studies with 1701 participants (864 males and 798 females, 39 without gender specificity) lasting 3 months to 2 years, aerobic exercise was prescribed at 3 to 5 days per week (150-300 minutes of moderate or 75-150 minutes of vigorous intensity), while resistance training occurred 2 to 3 days per week (2-3 sets of 8-12 repetitions at 60-80% of one-repetition maximum). Significant reductions in HbA1c were observed: aerobic exercise reduced it by 0.7% (95% CI: -0.9 to -0.5), resistance training by 0.5% (95% CI: -0.7 to -0.3), and combined exercise by 0.9% (95% CI: -1.1 to -0.7).  Only 27 showed significant improvements in HbA1c (p 0.05), while control groups recorded a mean reduction of 0.2% (95% CI: -0.4 to 0.0). Combined exercise yielded a standardized mean difference (SMD) of -0.45. Aerobic exercise normalized left ventricular diastolic dysfunction based on the ECG parameters, and quality of life improved in three out of four studies, although one study reported no significant changes in white blood cell count following resistance exercise.

Aerobic and resistance training significantly enhance glycemic control in adults with type 2 diabetes, with combined regimens providing the most benefits. Aerobic exercise also normalizes left ventricular diastolic dysfunction. Although quality of life improves, the variability in immune responses after resistance training necessitates further research.

Integrating structured exercise is crucial for enhancing health outcomes, while promoting personalized prescriptions to improve adherence. Public health initiatives promoting physical activity are essential as diabetes prevalence rises. Future research should focus on long-term effects and the impact of diverse exercise modalities on various populations.