Efficacy of aerobic exercise and a prudent diet for improving selected lipids and lipoproteins in adults: a meta-analysis of randomized controlled trials

Background Studies addressing the effects of aerobic exercise and a prudent diet on lipid and lipoprotein concentrations in adults have reached conflicting conclusions. The purpose of this study was to determine the effects of aerobic exercise combined with a prudent diet on lipid and lipoprotein concentrations in adults. Methods Studies were located by searching nine electronic databases, cross-referencing, and expert review. Two independent reviewers selected studies that met the following criteria: (1) randomized controlled trials, (2) aerobic exercise combined with diet recommendations (saturated/trans fat intake less than 10% of total calories and cholesterol less than 300 mg/day and/or fiber intake ≥25 g/day in women and ≥35 grams per day in men), (3) intervention ≥4 weeks, (4) humans ≥18 years of age, (5) published studies, including dissertations and Master\u27s theses, (6) studies published in any language, (7) studies published between January 1, 1955 and May 1, 2009, (8) assessment of one or more of the following lipid and lipoprotein concentrations: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), ratio of TC to HDL-C, non-HDL-C, low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG). Two reviewers independently extracted all data. Random-effects models that account for heterogeneity and 95% confidence intervals were used to pool findings. Results Of the 1,401 citations reviewed, six studies representing 16 groups (8 intervention, 8 control) and up to 559 men and women (282 intervention, 277 control) met the criteria for analysis. Statistically significant intervention minus control reductions were found for TC (-15.5 mg/dl, 95% CI, -20.3 to -10.7), TC:HDL-C (-0.4 mg/dl, 95% CI, -0.7 to -0.2), LDL-C (-9.2 mg/dl, 95% CI, -12.7 to -5.8) and TG (-10.6 mg/dl, 95% CI, -17.2 to -4.0) but not HDL-C (-0.5 mg/dl, 95% CI, -4.0 to 3.1). Changes were equivalent to reductions of 7.5%, 6.6%, 7.2% and 18.2% respectively, for TC, TC:HDL-C, LDL-C and TG. Because of missing variance statistics, non-HDL-C was excluded. Conclusions Aerobic exercise combined with a prudent diet is highly efficacious for improving TC, TC:HDL-C, LDL-C and TG, but not HDL-C concentrations, in adults. However, additional studies are needed, including effectiveness studies using intention-to-treat analysis

Prevention of type 2 diabetes and its complications in developing countries: a review.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a significant global public health problem affecting more than 285 million people worldwide. Over 70% of those with T2DM live in developing countries, and this proportion is increasing annually. Evidence suggests that lifestyle and other nonpharmacological interventions can delay and even prevent the development of T2DM and its complications; however, to date, programs that have been specifically adapted to the needs and circumstances of developing countries have not been well developed or evaluated. PURPOSE: The purpose of this article is to review published studies that evaluate lifestyle and other non-pharmacological interventions aimed at preventing T2DM and its complications in developing countries. METHODS: We undertook an electronic search of MEDLINE, PubMed, and EMBASE with the English language restriction and published until 30 September 2009. RESULTS: Nine relevant publications from seven studies were identified. The reported interventions predominantly used counseling and educational methods to improve diet and physical activity levels. Each intervention was found to be effective in reducing the risk of developing T2DM in people with impaired glucose tolerance, and improving glycemic control in people with T2DM. CONCLUSIONS: The current evidence concerning the prevention of T2DM and its complications in developing countries has shown reasonably consistent and positive results; however, the small number of studies creates some significant limitations. More research is needed to evaluate the benefits of low-cost screening tools, as well as the efficacy, cost-effectiveness, and sustainability of culturally appropriate interventions in such countries

Ejercicio de resistencia muscular en adultos con diabetes mellitus tipo 2 Exercício de resistência muscular em adultos com diabetes mellitus tipo 2 Endurance training in adults with diabetes mellitus type 2

Objetivos. Probar la efectividad del ejercicio de resistencia muscular en las cifras de hemoglobina glucosilada (HbA1c), en la fuerza muscular y en la fortaleza muscular percibida; explorar la influencia de la dieta, otros ejercicios, hipoglucemiantes y manifestaciones asociadas a episodios de hipoglucemia o hiperglucemia sobre el control glucémico de adultos con diabetes mellitus tipo 2 provenientes de los consultorios de endocrinología de dos hospitales públicos de la Ciudad de Monterrey, México. Procedimientos básicos. Se usó un diseño de 12 semanas de grupo control no equivalente con dos grupos, experimental (n1 = 14) y control (n2 = 11). Los participantes contaron con la recomendación de su médico para participar. Las sesiones de ejercicio fueron de una hora, dos veces por semana. Resultados. El grupo experimental mostró decremento significativo en el porcentaje de HbA1c, e incremento en la fuerza muscular y fortaleza muscular percibida (p < .001). Posterior a la intervención ocho de once alcanzaron valores normales de HbA1c. No hubo efecto de las covariables. Conclusiones. Este tipo de intervención puede ayudar al control glucémico en adultos con diabetes mellitus tipo 2.<br>Objetivos: Provar a efetividade do exercício de resistência muscular nas taxas de hemoglobina A glicosilada (HbA1c), na força muscular e no fortalecimento muscular percebido, explorar a influência da dieta, outros exercícios, hipoglicemiantes e manifestações associadas a episódios de hipoglicemia ou hiperglicemia sobre o controle glicêmico de adultos com diabetes mellitus tipo 2, provenientes dos consultórios de endocrinologia de dois hospitales públicos da Cidade de Monterrey, México. Procedimentos básicos: Foi utilizado um desenho de 12 semanas de grupo controle não equivalente com dois grupos, experimental (n1=14) e controle (n2=11). Os participantes tiveram recomendação de seu médico para participar. As sessões de exercício foram de uma hora, duas vezes por semana. Resultados: O grupo experimental apresentou decréscimo significativo nas taxas de HbA1c, incremento na força muscular e fortalecimento muscular percebido (p<. 001). Após a intervenção, oito em onze participantes alcançaram bom controle da hemoglobina A glicosilada. Nao houve efeito das co-variáveis. Conclusões: Este tipo de intervenção pode ajudar no controle glicêmico em adultos com diabetes mellitus tipo 2.<br>Objectives. Test the effects of an endurance training exercise on glycosylated hemoglobin (HbA1c) levels, muscle strength and perceived muscle strength. Explore the influence of diet, exercise, medication and manifestations of hypo or hyperglycemia in the blood glucose control of adults with diabetes mellitus type 2, who attended endocrinology clinics at two public hospitals in Monterrey, Mexico. Basic Procedures. A 12-week non equivalent control group design was used. At baseline, the experimental group consisted of 14 participants and the control group 11. The exercise sessions were held twice a week for one hour. All participants had received a verbal recommendation from their physician. Results. The experimental group displayed a significant decrease in HbA1c levels and increases in muscle strength and perceived muscle strength (p < .001). Eight participants out of eleven achieved normal HbA1c values after the intervention. No effect of the co-variables was found. Conclusions. This type of intervention can be of help to control blood glucose levels in adults with diabetes mellitus type 2