1
|
Whipple MO, Pinto AJ, Abushamat LA, Bergouignan A, Chapman K, Huebschmann AG, Masters KS, Nadeau KJ, Scalzo RL, Schauer IE, Rafferty D, Reusch JE, Regensteiner JG. Sex Differences in Physical Activity Among Individuals With Type 2 Diabetes Across the Life Span: A Systematic Review and Meta-analysis. Diabetes Care 2022; 45:2163-2177. [PMID: 36044665 PMCID: PMC9472508 DOI: 10.2337/dc22-0576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Physical activity (PA) is a cornerstone of type 2 diabetes mellitus (T2DM) treatment. Sex differences in PA behavior or barriers/facilitators to PA among individuals with T2DM are unclear. PURPOSE To summarize the evidence related to sex differences in participation in PA and barriers/facilitators to PA among individuals with T2DM across the life span. DATA SOURCES Systematic searches (CRD42021254246) were conducted with Ovid MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), APA PsychInfo, and SPORTDiscus. STUDY SELECTION We included studies with assessment of PA, sedentary behaviors (SB), or barriers/facilitators to PA among individuals with T2DM by sex or gender. DATA EXTRACTION Participant characteristics, meeting PA guidelines, participation in PA and SB, and barriers/facilitators to PA were extracted by two independent reviewers. DATA SYNTHESIS A total of 53 articles (65,344 participants) were included in the systematic review and 21 articles in the meta-analysis. Sex differences were not observed in meeting of PA guidelines among adolescents (odds ratio 0.70 [95% CI 0.31, 1.59]), but males were more likely than females to meet PA guidelines among adults (1.65 [1.36, 2.01]) and older adults (1.63 [1.27, 2.09]). Males performed more moderate-to-vigorous PA (MVPA) than females across all age-groups. Common barriers to PA were lack of time (men) and lack of social support and motivation (women). LIMITATIONS Limitations include heterogeneity of measures used to assess PA and lack of stratification of data by sex. CONCLUSIONS Sex differences in meeting PA guidelines were not observed among adolescents but were apparent among adults and older adults with T2DM. Females consistently engaged in less MVPA than males across the life span.
Collapse
Affiliation(s)
- Mary O. Whipple
- School of Nursing, University of Minnesota, Minneapolis, MN
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ana J. Pinto
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Layla A. Abushamat
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX
| | - Audrey Bergouignan
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Hubert Curien Pluridisciplinary Institute UMR7178, CNRS and Université de Strasbourg, Strasbourg, France
| | - Kristina Chapman
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy G. Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kevin S. Masters
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Clinical Health Psychology, Department of Psychology, University of Colorado Denver, Denver, CO
| | - Kristen J. Nadeau
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca L. Scalzo
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Irene E. Schauer
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Deirdre Rafferty
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jane E.B. Reusch
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Judith G. Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| |
Collapse
|
2
|
Sebők J, Édel Z, Váncsa S, Farkas N, Kiss S, Erőss B, Török Z, Balogh G, Balogi Z, Nagy R, Hooper PL, Geiger PC, Wittmann I, Vigh L, Dembrovszky F, Hegyi P. Heat therapy shows benefit in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Int J Hyperthermia 2021; 38:1650-1659. [PMID: 34808071 DOI: 10.1080/02656736.2021.2003445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIMS Type-2 diabetes mellitus (T2DM) is a common health condition which prevalence increases with age. Besides lifestyle modifications, passive heating could be a promising intervention to improve glycemic control. This study aimed to assess the efficacy of passive heat therapy on glycemic and cardiovascular parameters, and body weight among patients with T2DM. METHODS A systematic review and meta-analysis were reported according to PRISMA Statement. We conducted a systematic search in three databases (MEDLINE, Embase, CENTRAL) from inception to 19 August 2021. We included interventional studies reporting on T2DM patients treated with heat therapy. The main outcomes were the changes in pre-and post-treatment cardiometabolic parameters (fasting plasma glucose, glycated plasma hemoglobin, and triglyceride). For these continuous variables, weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated. Study protocol number: CRD42020221500. RESULTS Five studies were included in the qualitative and quantitative synthesis, respectively. The results showed a not significant difference in the hemoglobin A1c [WMD -0.549%, 95% CI (-1.262, 0.164), p = 0.131], fasting glucose [WMD -0.290 mmol/l, 95% CI (-0.903, 0.324), p = 0.355]. Triglyceride [WMD 0.035 mmol/l, 95% CI (-0.130, 0.200), p = 0.677] levels were comparable regarding the pre-, and post intervention values. CONCLUSION Passive heating can be beneficial for patients with T2DM since the slight improvement in certain cardiometabolic parameters support that. However, further randomized controlled trials with longer intervention and follow-up periods are needed to confirm the beneficial effect of passive heat therapy.
Collapse
Affiliation(s)
- Judit Sebők
- 2nd Department of Medicine and Nephrology-Diabetes Center, Medical School, University of Pécs, Pécs, Hungary
| | - Zsófia Édel
- 2nd Department of Medicine and Nephrology-Diabetes Center, Medical School, University of Pécs, Pécs, Hungary
| | - Szilárd Váncsa
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Szabolcs Kiss
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zsolt Török
- LipidArt Ltd., Szeged, Hungary.,Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network, Szeged, Hungary
| | - Gábor Balogh
- LipidArt Ltd., Szeged, Hungary.,Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network, Szeged, Hungary
| | - Zsolt Balogi
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Rita Nagy
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Philip L Hooper
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Paige C Geiger
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pécs, Pécs, Hungary
| | - István Wittmann
- 2nd Department of Medicine and Nephrology-Diabetes Center, Medical School, University of Pécs, Pécs, Hungary
| | - László Vigh
- LipidArt Ltd., Szeged, Hungary.,Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network, Szeged, Hungary
| | - Fanni Dembrovszky
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| |
Collapse
|
3
|
James TJ, Corbett J, Cummings M, Allard S, Young JS, Towse J, Carey-Jones K, Eglin C, Hopkins B, Morgan C, Tipton M, Saynor ZL, Shepherd AI. Timing of acute passive heating on glucose tolerance and blood pressure in people with type 2 diabetes: a randomized, balanced crossover, control trial. J Appl Physiol (1985) 2021; 130:1093-1105. [PMID: 33411640 DOI: 10.1152/japplphysiol.00747.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is characterized by chronic hyperglycemia and progressive insulin resistance, leading to macro and microvascular dysfunction. Passive heating has potential to improve glucose homeostasis and act as an exercise mimetic. We assessed the effect of acute passive heating before or during an oral glucose tolerance test (OGTT) in people with T2DM. Twelve people with T2DM were randomly assigned to the following three conditions: 1) 3-h OGTT (control), 2) 1-h passive heating (40°C water) 30 min before an OGTT (HOT-OGTT), and 3) 1-h passive heating (40°C water) 30 min after commencing an OGTT (OGTT-HOT). Blood glucose concentration, insulin sensitivity, extracellular heat shock protein 70 (eHSP70), total energy expenditure (TEE), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded. Passive heating did not alter blood glucose concentration [control: 1,677 (386) arbitrary units (AU), HOT-OGTT: 1,797 (340) AU, and OGTT-HOT: 1,662 (364) AU, P = 0.28], insulin sensitivity (P = 0.15), or SBP (P = 0.18) but did increase eHSP70 concentration in both heating conditions [control: 203.48 (110.81) pg·mL-1; HOT-OGTT: 402.47 (79.02) pg·mL-1; and OGTT-HOT: 310.00 (60.53) pg·mL-1, P < 0.001], increased TEE (via fat oxidation) in the OGTT-HOT condition [control: 263 (33) kcal, HOT-OGTT: 278 (40) kcal, and OGTT-HOT: 304 (38) kcal, P = 0.001], increased HR in both heating conditions (P < 0.001), and reduced DBP in the OGTT-HOT condition (P < 0.01). Passive heating in close proximity to a glucose challenge does not alter glucose tolerance but does increase eHSP70 concentration and TEE and reduce blood pressure in people with T2DM.NEW & NOTEWORTHY This is the first study to investigate the timing of acute passive heating on glucose tolerance and extracellular heat shock protein 70 concentration ([eHSP70]) in people with type 2 diabetes. The principal novel findings from this study were that both passive heating conditions: 1) did not reduce the area under the curve or peak blood glucose concentration, 2) elevated heart rate, and 3) increased [eHSP70], which was blunted by glucose ingestion, while passive heating following glucose ingestion, 4) increased total energy expenditure, and 5) reduced diastolic blood pressure.
Collapse
Affiliation(s)
- Thomas J James
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom.,Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Jo Corbett
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Michael Cummings
- Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Sharon Allard
- Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - John S Young
- School of Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Jonathan Towse
- School of Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Kathryn Carey-Jones
- School of Biological Sciences, Faculty of Science and Health, University of Portsmouth, United Kingdom.,Oaks Healthcare, Cowplain Family Practice, Waterlooville, United Kingdom
| | - Clare Eglin
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Billy Hopkins
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Connor Morgan
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Michael Tipton
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Zoe L Saynor
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom.,Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Anthony I Shepherd
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom.,Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| |
Collapse
|
4
|
Johnson NA, Barwick AL, Searle A, Spink MJ, Twigg SM, Chuter VH. Self-reported physical activity in community-dwelling adults with diabetes and its association with diabetes complications. J Diabetes Complications 2019; 33:33-38. [PMID: 30470448 DOI: 10.1016/j.jdiacomp.2018.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/21/2022]
Abstract
AIMS To describe the physical activity levels of an Australian community-based adult population with diabetes, and investigate the interaction between diabetes complications and physical activity. METHODS Anthropometric, demographic, biochemical and self-reported physical activity measures (IPAQ) were performed. Associations and multiple regression analyses were undertaken between physical activity, known risk factors for diabetes complications, and history of cardiovascular disease (CVD), neuropathy and foot ulceration obtained from medical records. RESULTS 240 participants were recruited (96% type 2 diabetes; age 68.7 ± 10.5 y; 58% men; diabetes duration 14.3 ± 11.4 y). Sixty seven percent of participants reported undertaking moderate or vigorous intensity exercise to recommended levels, and 29% reported no moderate-vigorous exercise. In addition to being associated with known demographic and biochemical risk factors and other complications, diabetes complications were also associated with different physical activity behaviours. Individuals with a history of CVD were more likely to participate in moderate-vigorous exercise and meet exercise guidelines, individuals with neuropathy undertook less walking and moderate intensity exercise, and those with a history of foot ulceration sat more and participated less in vigorous exercise. CONCLUSIONS In Australian adults, the presence of diabetes complications may influence physical activity participation, and associate with characteristic physical activity approaches.
Collapse
Affiliation(s)
- Nathan A Johnson
- Faculty of Health Sciences, University of Sydney, NSW, Australia.
| | - Alex L Barwick
- School of Health Sciences, University of Newcastle, NSW, Australia; Southern Cross University, Bilinga, Gold Coast, QLD, Australia
| | - Angela Searle
- School of Health Sciences, University of Newcastle, NSW, Australia
| | - Martin J Spink
- School of Health Sciences, University of Newcastle, NSW, Australia
| | - Stephen M Twigg
- Central Clinical School, Faculty of Medicine and Heath, University of Sydney, NSW, Australia; Diabetes Centre, Dept. of Endocrinology, Royal Prince Alfred Hospital, NSW, Australia
| | - Vivienne H Chuter
- School of Health Sciences, University of Newcastle, NSW, Australia; Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, NSW, Australia
| |
Collapse
|
5
|
Rees JL, Johnson ST, Boulé NG. Aquatic exercise for adults with type 2 diabetes: a meta-analysis. Acta Diabetol 2017; 54:895-904. [PMID: 28691156 DOI: 10.1007/s00592-017-1023-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
AIMS The purpose of this systematic review and meta-analysis was to examine the effects of aquatic exercise (AquaEx) on indicators of glycemic control (i.e., glycated hemoglobin [A1c] and fasting plasma glucose) in adults with type 2 diabetes mellitus (T2DM). It was hypothesized that AquaEx would improve glycemic control to a similar extent as land-based exercise (LandEx), but to a greater extent than non-exercise control (Ctrl). METHODS A literature search was completed in February 2017 for studies examining AquaEx training in adults with T2DM. Assessment of glycemic control was necessary for inclusion, while secondary outcomes such as quality of life and cardiometabolic risk factors (i.e., blood pressure, triglycerides and total cholesterol) were considered, but not required for inclusion. Outcomes were measured before and after at least 8 weeks of AquaEx, and data were analyzed using weighted mean differences (WMDs) and fixed effect models, when appropriate. RESULTS Nine trials including 222 participants were identified. Three trials compared AquaEx to LandEx, two compared AquaEx to Crtl, and four had a pre-/post-design without a comparison group. Results indicate no difference in A1c between LandEx and AquaEx (WMD = -0.02%, 95% confidence interval = [-0.71, 0.66]). Post-intervention A1c was lower in AquaEx when compared to Crtl (WMD = -0.96%, [-1.87, -0.05]). Post-AquaEx A1c was lower compared to baseline (WMD = -0.48%, [-0.66, -0.30]). CONCLUSIONS A1c can be reduced after eight-twelve weeks of AquaEx. However, at this time few studies have examined whether changes in A1c are different from LandEx or Crtl.
Collapse
Affiliation(s)
- Jordan L Rees
- Faculty of Physical Education and Recreation, 1-052 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2E1, Canada
- Alberta Diabetes Institute, 1-052 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Steven T Johnson
- Alberta Diabetes Institute, 1-052 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2E1, Canada
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada
| | - Normand G Boulé
- Faculty of Physical Education and Recreation, 1-052 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
- Alberta Diabetes Institute, 1-052 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
| |
Collapse
|