Effectiveness of Combined Aerobic and Resistance Exercise on Cognition, Metabolic Health, Physical Function, and Health-related Quality of Life in Middle-aged and Older Adults With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

Jinghua Zhang; Wilson Wai San Tam; Kanokwan Hounsri; Joji Kusuyama; Vivien Xi Wu

doi:10.1016/j.apmr.2023.10.005

Effectiveness of Combined Aerobic and Resistance Exercise on Cognition, Metabolic Health, Physical Function, and Health-related Quality of Life in Middle-aged and Older Adults With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

Arch Phys Med Rehabil. 2023 Oct 22:S0003-9993(23)00591-9. doi: 10.1016/j.apmr.2023.10.005. Online ahead of print.

Authors

Jinghua Zhang¹, Wilson Wai San Tam¹, Kanokwan Hounsri¹, Joji Kusuyama², Vivien Xi Wu³

Affiliations

¹ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore.
² Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan.
³ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore. Electronic address: nurwux@nus.edu.sg.

PMID: 37875170
DOI: 10.1016/j.apmr.2023.10.005

Abstract

Objectives: To evaluate the effectiveness of combined aerobic and resistance exercise on cognition, metabolic health, physical function, and health-related quality of life (HRQoL) in middle-aged and older adults with type 2 diabetes mellitus (T2DM).

Data source and study selection: Systematic search of CINAHL, Cochrane, EMBASE, Scopus, PubMed, ProQuest Dissertation and Thesis, PsycINFO, Web of Science databases, and gray literature from Google Scholar. Pertinent randomized controlled trials (RCTs) were selected. The Protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023387336).

Data extraction: The risk of bias was evaluated using the Cochrane Risk of Bias tool by 2 reviewers independently. Outcome data were extracted in a fixed-effect model if heterogeneity test were not significant and I²≤50%; otherwise, the random-effects model was used.

Data synthesis: Sixteen studies with 2426 participants were included in this review. Combined aerobic and resistance exercise had significant positive effects on cognition (SMD=0.34, 95% CI: 0.13 to 0.55), metabolic health on HbA1c (SMD=-0.35, 95% CI: -0.48 to -0.22) and lipid profile (total cholesterol SMD=-0.20, 95% CI: -0.34 to -0.07; low-density lipoprotein SMD=-0.19, 95% CI: -0.33 to -0.05; high-density lipoprotein SMD=0.25, 95% CI: 0.12 to 0.39; and triglycerides SMD=-0.18, 95% CI: -0.31 to -0.04), physical function on aerobic oxygen uptake (SMD=0.58, 95% CI: 0.21 to 0.95) and body mass index (MD=-1.33, 95% CI: -1.84 to -0.82), and physical HRQoL (MD=4.17, 95% CI: 0.86 to 7.48). Our results showed that clinically important effects on cognition may occur in combining the low-moderate intensity of aerobic exercise and progressive intensity of resistance training, the total duration of the exercise needs to be at least 135 minutes per week, among which, resistance training should be at least 60 minutes.

Conclusion: Combined aerobic and resistance exercise effectively improves cognition, ameliorates metabolic health, enhances physical function, and increases physical HRQoL in middle-aged and older adults with T2DM. More RCTs and longitudinal follow-ups are required to provide future evidence of structured combined aerobic and resistance exercise on other domains of cognition.

Keywords: Circuit-based exercise; Cognition; Dementia; Neurology; Non-insulin-dependent diabetes mellitus; Rehabilitation.

Publication types

Review