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Amount and frequency of exercise affect glycaemic control more than exercise mode or intensity
  1. Alison R Harmer1,
  2. Mark R Elkins2,3
  1. 1Discipline of Physiotherapy, Clinical and Rehabilitation Sciences Research Group University of Sydney, Sydney, Australia
  2. 2Sydney Medical School, University of Sydney, Sydney, Australia
  3. 3Centre for Evidence-Based Physiotherapy, The George Institute for Global Health, Sydney, Australia
  1. Correspondence to Dr Mark R Elkins, Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia; mark.elkins{at}

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This section features a recent systematic review that is indexed on PEDro, the Physiotherapy Evidence Database ( PEDro is a free, web-based database of evidence relevant to physiotherapy.


The prevention and treatment of diabetes is vital.1 ,2 People with prediabetes and obesity are able to markedly reduce their risk of developing type 2 diabetes by lifestyle modification (increasing physical activity and losing weight via improved diet; number needed to treat (NNT)=7 over 3 years) or by medication (NNT=14).3 Among people who already have type 2 diabetes, exercise improves insulin action and reduces cardiovascular risk.4 Regular exercise per se (ie, without additional effects of a dietary intervention) significantly reduces glycosylated haemoglobin (HbA1c; indicative of improved glycaemic control) and visceral adiposity among people with type 2 diabetes.5 Improved glycaemic control is strongly associated with reduced microvascular complications6 and, among those with newly diagnosed type 2 diabetes, with a sustained reduction in cardiovascular events and mortality.7 Questions remain about whether the characteristics of the exercise undertaken influence the benefits obtained in glycaemic control.3 This systematic review sought to determine which aspects of exercise dosage were associated with greater benefit in glycaemic control among patients with type 2 diabetes.


The aim of this review was to synthesise the best available evidence about whether the frequency, intensity and duration of exercise influence HbA1c among people with type 2 diabetes. A subsequent aim was to assess these relationships independently for aerobic exercise, resistance exercise or combined aerobic and resistance exercise.

Searches and inclusion criteria

Five databases were searched for trials published between 1980 and 2012, using search terms for exercise, diabetes mellitus and physical activity. Reference lists of review articles and other relevant publications were also scanned. Only English, Spanish and Portuguese language publications were included. To be eligible, trials were …

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  • ▸ Umpierre D, Ribeiro PAB, Schaan BD, et al. The systematic review being appraised in this update. Diabetologia 2013;56:242–51.

  • Contributors ARH and MRE selected the systematic review. MRE wrote the first draft of the manuscript. ARH and MRE contributed to interpretation of the data and revision of the final manuscript, and are guarantors.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.