Research Article: Role of Exercise in the Management of Diabetes Mellitus: the Global Scenario

Date Published: November 13, 2013

Publisher: Public Library of Science

Author(s): Zar Chi Thent, Srijit Das, Leonard Joseph Henry, Hamid Reza Baradaran.


Exercise training programs have emerged as a useful therapeutic regimen for the management of type 2 diabetes mellitus (T2DM). Majority of the Western studies highlighted the effective role of exercise in T2DM. Therefore, the main aim was to focus on the extent, type of exercise and its clinical significance in T2DM in order to educate the clinicians from developing countries, especially in Asians.

Pubmed, Science Direct, Scopus, ISI Web of Knowledge and Google scholar were searched using the terms “type 2 diabetes mellitus,” “type 2 DM,” “exercise,” and/or “physical activity,” and “type 2 diabetes mellitus with exercise.” Only clinical or human studies published in English language between 2000 and 2012 were included. Certain criteria were assigned to achieve appropriate results.

Twenty five studies met the selected criteria. The majority of the studies were randomized controlled trial study design (65%). Most of the aerobic exercise based studies showed a beneficial effect in T2DM. Resistance exercise also proved to have positive effect on T2DM patients. Minimal studies related to other types of exercises such as yoga classes, joba riding and endurance-type exercise were found. On the other hand, United States of America (USA) showed strong interest of exercise management towards T2DM.

Aerobic exercise is more common in clinical practice compared to resistance exercise in managing T2DM. Treatment of T2DM with exercise training showed promising role in USA. A large number of researches are mandatory in the developing countries for incorporating exercise in the effective management of T2DM.

Partial Text

Physical exercise has been considered as one of the cornerstones in the treatment of diabetes mellitus along with nutrition and medication since from the past 100 years ago [1]. Diabetes mellitus, a chronic metabolic disease, is characterized by an increase in the blood-glucose level resulting from a relative insulin deficiency or insulin resistance or both. As a consequence, it can lead to glycation of tissues, which proceeds with acute metabolic disturbances and ends with organ damage with severe health deteriorations. Research studies over the years, reported that the worldwide prevalence of diabetes mellitus appears to be increasing alarmingly. It is estimated that 5.4% of total population would be affected with the disease by the year 2025 as initial reports showed 4.0% in the year 1995. Thus, proper management should be done in order to treat diabetes mellitus and its complications [2].

Conforming to the usual patients, intervention, comparison and outcome (PICO) format, the following review was planned accordingly. Conforming to this format, our patients were those who were above ≥18 years; intervention being the exercise; comparison being the different types of exercises employed in the treatment of T2DM; and the outcome was the benefit of exercise in T2DM.

Over 4500 articles of exercises and T2DM-related articles were obtained with computer search. Majorities of these articles were systemic reviews, literature reviews and case reports. Articles published earlier than the year 2000, were not selected for our systemic review. A vast majority of articles were on the animal studies in exercise treated T2DM, which were eventually not included. Other reasons for excluding few articles were: (a) the study design not clearly mentioned (b) studies associated with T2DM and obesity or metabolic syndrome (c) studies associated with combined treatment of exercise and modern drug therapy, including oral hypoglycemic agents and insulin and (d) the articles which could not be retrieved in full text.

Diabetes mellitus is a chronic endocrine disorder, and it needs the definite treatment. Several complications are associated with diabetes, and with lack of proper treatment would result in life-threatening condition. Many researches have shown that exercise plays a crucial role in improving T2DM. Exercise not only improves the glycemic control, but it can also improve the insulin sensitivity and restore the diabetic associated complication such as cardiovascular damage, which considered as one of the major complications. Based on the past findings, the present systemic review summarized the extent and the type of exercise among the T2DM population.

The present review was planned to reveal the importance of types of exercise and prevalence of exercise management in T2DM across the world, within recent years. It is expected that this systemic review would attract many researchers across the world especially in developing countries to perform further studies based on exercise management in diabetes or T2DM. From the published data, it can be also concluded that exercise based research for diabetes are less in the Asian countries. This may be attributed to the strong perception of medication for the disease in Asians. Yet another, medication comprises of major or minor side effects for the disease. It is noteworthy that the effect of exercise revealed beneficial results for T2DM deprived of any untoward effect. The present review showed that exercise related studies in diabetes were performed only in few selected countries in Asia such as Singapore, Iran and Japan and this justifies the utmost importance of future studies in Asian population. Detailed researches and further studies with certain distribution of information related to the importance of exercise in T2DM may be essential for the population in the developing countries.