Exercise timing in type 2 diabetes mellitus: A systematic review

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.