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Exercise Timing in Type 2 Diabetes Mellitus

A Systematic Review

TEO, SHAUN Y. M.1; KANALEY, JILL A.2; GUELFI, KYM J.3; COOK, SUMMER B.4; HEBERT, JEFFREY J.1,5; FORREST, MITCHELL R. L.1; FAIRCHILD, TIMOTHY J.1

Medicine & Science in Sports & Exercise: December 2018 - Volume 50 - Issue 12 - p 2387–2397
doi: 10.1249/MSS.0000000000001732
CLINICAL SCIENCES

Purpose The timing of exercise relative to meal consumption has recently been identified as potentially moderating the effectiveness of exercise on glycemic responses in type 2 diabetes mellitus (T2DM). The aim of this study was to systematically review the literature related to exercise timing, relative to meal consumption, and glycemic control in individuals with T2DM.

Methods Systematic searches in PubMed, EMBASE, CINAHL, Cochrane Library, and ClinicalTrials.gov Registry databases were performed to identify articles published in English from inception to October 2017. Two authors independently extracted data and evaluated the quality of studies using the Cochrane Collaboration Data Collection Form and the Cochrane Collaboration Risk of Bias Assessment Tool, respectively. A qualitative synthesis was performed on the included studies, and results summarized in tables.

Results Nineteen randomized controlled trials with a total of 346 participants were included. Improvements in glycemia (glucose concentrations and glucose area under the curve) and insulin area under the curve appeared more consistent when exercise was performed during the postmeal period as compared with the premeal period; however, this observation was largely based on indirect comparisons between studies.

Conclusions There is some evidence from randomized controlled trials that exercise performed 30 min after meal consumption may convey greater improvements in glycemic control for individuals with T2DM. However, there are only two studies that have directly assessed the role of exercise timing on glycemic management, and adopted methodologies are heterogeneous. Future low-risk trials in this field are warranted.

1School of Psychology and Exercise Science, Murdoch University, Perth, AUSTRALIA;

2Faculty of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO;

3School of Human Sciences, University of Western Australia, Perth, AUSTRALIA;

4Department of Kinesiology, University of New Hampshire, Durham, NH; and

5Faculty of Kinesiology, University of New Brunswick, Fredericton and Saint John, CANADA

Address for correspondence: Timothy J. Fairchild, Ph.D., School of Psychology and Exercise Science, Murdoch University, 90 South Street, Murdoch WA 6150; E-mail: t.fairchild@murdoch.edu.au.

Submitted for publication December 2017.

Accepted for publication July 2018.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.acsm-msse.org).

© 2018 American College of Sports Medicine