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      Exercise modes and their association with hypoglycemia episodes in adults with type 1 diabetes mellitus: a systematic review

      systematic-review

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          Abstract

          Objective

          Type 1 diabetes mellitus rates are rising worldwide. The health benefits of physical exercise in this condition are many, but more than 60% do not participate, mainly from fear of hypoglycemia. This systematic review explores the effects of physical exercise modes on blood glucose levels in adults for hypoglycemia prevention.

          Research design and methods

          Predefined inclusion criteria were randomized or non-randomized cross-over trials of healthy non-obese adults with type 1 diabetes mellitus. Exercise interventions used standardized protocols of intensity and timing. Outcomes included hypoglycemia during or after exercise, and acute glycemic control. Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, SPORTDiscus, CochraneCENTRAL (1990 to 11 January 2018), and Embase (1988 to 9 April 2018) were searched using keywords and Medical Subject Heading (MeSH) terms. Inclusions, data extraction and quality assessment using the Critical Appraisal Skills Programme checklists were done by one researcher and checked by a second. Review Manager (V.5.3) was used for meta-analysis where four or more outcomes were reported.

          Results

          From 5459 citations, we included 15 small cross-over studies (3 non-randomized), 13 assessing aerobic (intermittent high-intensity exercise (IHE) vs continuous, or continuous vs rest) and 2 assessing resistance exercise versus rest. Study quality was good, and all outcome measures were reported. Thirteen gave hypoglycemia results, of which five had no episodes. Meta-analysis of hypoglycemia during or after IHE compared with continuous exercise showed no significant differences (n=5, OR=0.68 (95% CI 0.16 to 2.86), I 2=56%). For blood glucose there was little difference between groups at any time point.

          Conclusion

          IHE may be safer than continuous exercise because of lesser decline in blood glucose, but more research needs to demonstrate if this would be reflected in hypoglycemic episode rates.

          Trial registration number

          CRD42018068358.

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          Most cited references24

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          Barriers to Physical Activity Among Patients With Type 1 Diabetes

          Anne-Sophie Brazeau, Rémi Rabasa-Lhoret, Irene Strychar … (2008)
          OBJECTIVE—To determine, in an adult population with type 1 diabetes, barriers to regular physical activity using a diabetes-specific barriers measure (the Barriers to Physical Activity in Diabetes [type 1] [BAPAD1] scale) and factors associated with these barriers. RESEARCH DESIGN AND METHODS—One hundred adults with type 1 diabetes answered a questionnaire assessing perceived barriers to physical activity and related factors. A1C was obtained from the medical chart of each individual. RESULTS—Fear of hypoglycemia was identified as being the strongest barrier to physical activity. Greater knowledge about insulin pharmacokinetics and using appropriate approaches to minimize exercise-induced hypoglycemia were factors associated with fewer perceived barriers. Greater barriers were positively correlated with A1C levels (r = 0.203; P = 0.042) and negatively with well-being (r = −0.45; P < 0.001). CONCLUSIONS—Fear of hypoglycemia is the strongest barrier to regular physical activity in adults with type 1 diabetes, who should therefore be informed and supported in hypoglycemia management.
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            Barriers to participation in physical activity and exercise among middle-aged and elderly individuals.

            Maria Justine, Elena A. B. Azizan, V Hassan … (2013)
            INTRODUCTION Although the benefits of physical activity and exercise are widely acknowledged, many middle-aged and elderly individuals remain sedentary. This cross-sectional study aimed to identify the external and internal barriers to physical activity and exercise participation among middle-aged and elderly individuals, as well as identify any differences in these barriers between the two groups. METHODS Recruited individuals were categorised into either the middle-aged (age 45-59 years, n = 60) or elderly (age ≥ 60 years, n = 60) group. Data on demographics, anthropometry, as well as external and internal barriers to participation in physical activity and exercise were collected. RESULTS Analysis showed no significant differences in the total scores of all internal barriers between the two groups (p > 0.05). The total scores for most external barriers between the two groups also showed no significant differences (p > 0.05); only 'cost' (p = 0.045) and 'exercise interferes with social/family activities' (p = 0.011) showed significant differences. The most common external barriers among the middle-aged and elderly respondents were 'not enough time' (46.7% vs. 48.4%), 'no one to exercise with' (40.0% vs. 28.3%) and 'lack of facilities' (33.4% vs. 35.0%). The most common internal barriers for middle-aged respondents were 'too tired' (48.3%), 'already active enough' (38.3%), 'do not know how to do it' (36.7%) and 'too lazy' (36.7%), while those for elderly respondents were 'too tired' (51.7%), 'lack of motivation' (38.4%) and 'already active enough' (38.4%). CONCLUSION Middle-aged and elderly respondents presented with similar external and internal barriers to physical activity and exercise participation. These factors should be taken into account when healthcare policies are being designed and when interventions such as the provision of facilities to promote physical activity and exercise among older people are being considered.
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              The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes.

              Kym Guelfi, Paul Fournier, David T. W. Jones (2005)
              To compare the response of blood glucose levels to intermittent high-intensity exercise (IHE) and moderate-intensity exercise (MOD) in individuals with type 1 diabetes. Seven healthy individuals with type 1 diabetes were tested on two separate occasions, during which either a 30-min MOD or IHE protocol was performed. MOD consisted of continuous exercise at 40% Vo(2peak), while the IHE protocol involved a combination of continuous exercise at 40% Vo(2peak) interspersed with 4-s sprints performed every 2 min to simulate the activity patterns of team sports. Both exercise protocols resulted in a decline in blood glucose levels. However, the decline was greater with MOD (-4.4 +/- 1.2 mmol/l) compared with IHE (-2.9 +/- 0.8 mmol/l; P < 0.05), despite the performance of a greater amount of total work with IHE (P < 0.05). During 60 min of recovery from exercise, glucose levels remained higher in IHE compared with MOD (P < 0.05). Furthermore, glucose levels remained stable during recovery from IHE, while they continued to decrease after MOD (P < 0.05). The stabilization of blood glucose levels with IHE was associated with elevated levels of lactate, catecholamines, and growth hormone during early recovery from exercise (P < 0.05). There were no differences in free insulin, glucagon, cortisol, or free fatty acids between MOD and IHE. The decline in blood glucose levels is less with IHE compared with MOD during both exercise and recovery in individuals with type 1 diabetes.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open Diabetes Res Care
                Journal ID (iso-abbrev): BMJ Open Diabetes Res Care
                Journal ID (hwp): bmjdrc
                Journal ID (publisher-id): bmjdrc
                Title: BMJ Open Diabetes Research & Care
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2052-4897
                Publication date Collection: 2018
                Publication date (Electronic): 8 October 2018
                Volume: 6
                Issue: 1
                Electronic Location Identifier: e000578
                Affiliations
                [1 ] departmentFaculty of Health, Social Care and Education (FHSCE) , Anglia Ruskin University , Cambridge, UK
                [2 ] Freelance Research Consultant , Cambridge, UK
                Author notes
                [Correspondence to ] Professor Catherine A Meads; catherine.meads@ 123456anglia.ac.uk
                Article
                Publisher ID: bmjdrc-2018-000578
                DOI: 10.1136/bmjdrc-2018-000578
                PMC ID: 6203053
                PubMed ID: 30397494
                SO-VID: a3623d36-c973-4343-abb7-c473fe53f0a1
                Copyright © © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 10 July 2018
                Date revision received : 07 August 2018
                Date accepted : 16 August 2018
                Categories
                Subject: Clinical Care/Education/Nutrition
                Subject: 1506
                Subject: 1866
                Custom metadata
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                Keywords: systematic review,type 1 diabetes mellitus,exercise,hypoglycaemia
                Data availability:
                Keywords: systematic review, type 1 diabetes mellitus, exercise, hypoglycaemia

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