Volume 31, Issue 1 (3-2024)
RJMS 2024, 31(1): 1-18 |
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Kazemi Nesab F, Zafarmand O, Sharafifard F. The Effect of High-Intensity Interval Training and Moderate-Intensity Continuous Training on Lipid Profile and Body Composition in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis. RJMS 2024; 31 (1) :1-18
URL: http://rjms.iums.ac.ir/article-1-8447-en.html
URL: http://rjms.iums.ac.ir/article-1-8447-en.html
Assistant Professor, Department of Physical Education and Sport Sciences, Faculty of Humanities, University of Kashan, Kashan, Iran , fkazeminasab@kashanu.ac.ir
Abstract: (573 Views)
Bakcground & Aims: Type 2 diabetes (T2DM) is a metabolic disease that is characterized by increased blood sugar concentration and includes 90 to 95% of all types of diabetes (1, 2). This disease is caused by insufficient production of insulin by pancreatic beta cells or due to lack of proper response to insulin by body cells (3, 4). Fat disorder is one of the common disorders in this disease, which causes the emergence and exacerbation of short-term and long-term complications of diabetes. Also, many of diabetic patients suffer from lipid disorders, which can lead to cardiovascular diseases (3). Genetic predisposition, environmental factors, abdominal obesity, the use of an inappropriate diet, as well as lack of physical activity and inactivity are among the risk factors for T2DM. Intervention and change in lifestyle, paying attention to anthropometric indicators (body mass index, fat and body fat percentage) and blood pressure are recommended for people with type 2 diabetes (4). Structured exercise methods have been promoted as a critical component of type 2 diabetes management. One of these training methods is high-intensity interval training (HIIT) (5). HIIT consists of short periods of high-intensity exercise with periods of active or passive rest and has shorter sessions compared to moderate-intensity continuous training (MICT) of similar energy expenditure (2). For this reason, it is considered an ideal activity to achieve further improvement in physiological variables (6, 7). Accordingly, the results of the original research studies show that HIIT causes a significant reduction in body fat percentage, body fat mass and body mass index (8-10). The results of original research studies show that intense interval training causes a significant decrease in LDL, TG, and TC and a significant increase in serum HDL (11, 12). Also, the results of meta-analysis studies have reported the positive effects of intense interval training on fat profile. Peng et al. (2023) in a systematic review and meta-analysis that examined 50 studies, evaluated the effect of low-volume HIIT on metabolic outcomes of lipid profile in patients with T2DM and reported that HIIT improved lipid profile in Diabetic people became (13). On the other hand, MICT increases metabolic capacity, improves aerobic system, increases sports performance and energy metabolism (14). Accordingly, the results of a research study show that MICT causes a significant decrease in body fat percentage, body fat mass and body mass index (9, 15). Also, the results of research studies showed that MICT improves blood sugar and lipid profiles (12, 16). On the other hand, MICT increases metabolic capacity, improves aerobic the system, increases sports performance and energy metabolism (14). Considering that exercise is one of the main and most important interventions in the management of obesity, cardiovascular diseases and diabetes, choosing the best exercise protocol for the treatment of diabetes and its complications is very important. Therefore, the aim of this randomized clinical trial meta-analysis study is to compare the effects of HIIT versus MICT on lipid profiles and body composition in T2DM patients.
Methods: A systematic search of English and Farsi articles published in PubMed, Web of Science, SID, and Magiran databases was conducted until August 2023. A meta-analysis was performed to compare the effects of HIIT and MICT on fat profile and body composition in type 2 diabetes. To conduct the meta-analysis, articles with the following characteristics were included in the study: 1- RCT randomized clinical trial studies and non-randomized NRs, published in Persian or English. 2- Studies conducted on type 2 diabetics. 3- Studies investigating the effect of HIIT against the MICT group. 4- Measuring studies on fat profile (HDL, LDL, TG, TC) and body composition (body fat percentage, body fat mass and body mass index). 5- Having the average and standard deviation data for the post-test and pre-test of the mentioned variables for subjects of both types of high-intensity interval training (HIIT) and moderate-intensity continuous training (MCIT). Exclusion criteria included animal studies, abstracts of articles presented in conferences, theses, crossover studies, review studies, and meta-analysis studies. Also, studies that investigated the effect of high-intensity interval training or moderate-intensity interval training with a control group (without exercise) were excluded from the present meta-analysis. subjects with an average age of 54.4-38 years in the HIIT group and 95 subjects with an average age of 70-1.55 in the MICT group, of which 129 subjects had an average age of 70-1.38. All participants were inactive before starting the exercise protocol. The number of study subjects was a minimum of 15 people (40) and a maximum of 44 people (35), and the minimum duration of each session was from 20 to 40 minutes for interval training and from 24 to 60 minutes for continuous training. The training intensity for intermittent exercises was from 40 to 100% of maximum oxygen consumption and for continuous exercises from 40 to 75% of maximum oxygen consumption. Mean difference and 95% confidence interval were calculated using using a effect model. Heterogeneity was evaluated using the I2 test, and diffusion bias was evaluated by visual analysis of funnel plot and Egger's test.
Results: A total of 10 studies including 11 exercise interventions and 297 patients with type 2 diabetes were meta-analyzed. The results showed that HIIT caused a significant change in serum LDL [WMD=0.84 mg/dl (-2.49 to 4.19], P=0.6], HDL [WMD=0.3 mmHg (-2.08 to 2.15], P=0.6], TG [WMD=1.06 mg/dl (-14.94 to 12.83], P=0.8], TC [WMD=2.38 (-8.1 to 3.32), P=0.4], fat percent [WMD=-0.61 (-3.64 to 2.41], P=0.6], and fat mass [WMD=-0.76 (-1.8 to 0.28), P=0.1], compared with MICT in patients with T2DM.
Conclusion: This study aimed to compare the effects of high-intensity interval training and moderate-intensity continuous training on fat profile and body composition in type 2 diabetic patients. The results of 10 studies with 277 diabetic patients indicated that high-intensity interval training caused a significant change in lipid profile (LDL, HDL, TC and TG) and body composition (BMI, body fat percentage and body fat mass) compared to the continuous training group. Not with moderate intensity. As a result, this research showed that there is no difference between HIIT and MICT in fat profile and body composition in adults. The results of the present meta-analysis are consistent with the results of a similar meta-analysis by Denardi et al., 2018, which examined 7 studies with 120 diabetic patients, and there was no difference between the two exercise methods on total cholesterol, triglycerides, HDL, LDL, and BMI (1). The results of the present meta-analysis showed that HIIT does not cause a significant change in lipid profile including LDL, HDL, TC and TG compared to MICT, which is in line with the previous meta-analysis study (1). The results of this systematic review article showed that there is no significant difference between the interventions. This is probably because subjects were within the normal range of total, HDL, and LDL cholesterol levels, which did not change much after exercise. In addition, the fact that there was no change or control in diet may account for the beneficial effects of exercise training. reduce the lipid profile. Improvements in triglyceride and HDL levels are important because of their association with cardiovascular disease. The effects of HIIT on lipid profiles in patients with type 2 diabetes are conflicting, with one study showing only a decrease in cholesterol (17) and another only an increase in HDL (18). While in the same studies, no effect of HIIT on triglycerides was shown in diabetic patients (17, 18). A previous meta-analysis that included only aerobic exercise and resistance exercise showed that a significant reduction in BMI and body mass was observed in diabetic patients who exercised compared to the control group (19). Jelliman et al reported that HIIT can reduce body mass and BMI compared to a control group (20). However, the included study had relatively inconsistent baseline levels. Because the included studies had different types of subjects such as healthy, overweight, type 2 diabetes and other chronic diseases. A previous meta-analysis study showed that HIIT is effective in reducing BMI and body weight in type 2 diabetic patients (2). Overall, there was a wide range of age at onset, duration of type 2 diabetes, presence of diabetic complications and insulin use, along with variations in session length and duration of intervention, monitoring, and a lack of information on dietary management and type of HIIT protocol used and reductions required. Antiglycemic drugs limited our ability to make direct comparisons between studies (5). The results of the present meta-analysis suggest that HIIT has similar benefits to MICT on fat profile and body composition, although HIIT is a more time-efficient training method.
Methods: A systematic search of English and Farsi articles published in PubMed, Web of Science, SID, and Magiran databases was conducted until August 2023. A meta-analysis was performed to compare the effects of HIIT and MICT on fat profile and body composition in type 2 diabetes. To conduct the meta-analysis, articles with the following characteristics were included in the study: 1- RCT randomized clinical trial studies and non-randomized NRs, published in Persian or English. 2- Studies conducted on type 2 diabetics. 3- Studies investigating the effect of HIIT against the MICT group. 4- Measuring studies on fat profile (HDL, LDL, TG, TC) and body composition (body fat percentage, body fat mass and body mass index). 5- Having the average and standard deviation data for the post-test and pre-test of the mentioned variables for subjects of both types of high-intensity interval training (HIIT) and moderate-intensity continuous training (MCIT). Exclusion criteria included animal studies, abstracts of articles presented in conferences, theses, crossover studies, review studies, and meta-analysis studies. Also, studies that investigated the effect of high-intensity interval training or moderate-intensity interval training with a control group (without exercise) were excluded from the present meta-analysis. subjects with an average age of 54.4-38 years in the HIIT group and 95 subjects with an average age of 70-1.55 in the MICT group, of which 129 subjects had an average age of 70-1.38. All participants were inactive before starting the exercise protocol. The number of study subjects was a minimum of 15 people (40) and a maximum of 44 people (35), and the minimum duration of each session was from 20 to 40 minutes for interval training and from 24 to 60 minutes for continuous training. The training intensity for intermittent exercises was from 40 to 100% of maximum oxygen consumption and for continuous exercises from 40 to 75% of maximum oxygen consumption. Mean difference and 95% confidence interval were calculated using using a effect model. Heterogeneity was evaluated using the I2 test, and diffusion bias was evaluated by visual analysis of funnel plot and Egger's test.
Results: A total of 10 studies including 11 exercise interventions and 297 patients with type 2 diabetes were meta-analyzed. The results showed that HIIT caused a significant change in serum LDL [WMD=0.84 mg/dl (-2.49 to 4.19], P=0.6], HDL [WMD=0.3 mmHg (-2.08 to 2.15], P=0.6], TG [WMD=1.06 mg/dl (-14.94 to 12.83], P=0.8], TC [WMD=2.38 (-8.1 to 3.32), P=0.4], fat percent [WMD=-0.61 (-3.64 to 2.41], P=0.6], and fat mass [WMD=-0.76 (-1.8 to 0.28), P=0.1], compared with MICT in patients with T2DM.
Conclusion: This study aimed to compare the effects of high-intensity interval training and moderate-intensity continuous training on fat profile and body composition in type 2 diabetic patients. The results of 10 studies with 277 diabetic patients indicated that high-intensity interval training caused a significant change in lipid profile (LDL, HDL, TC and TG) and body composition (BMI, body fat percentage and body fat mass) compared to the continuous training group. Not with moderate intensity. As a result, this research showed that there is no difference between HIIT and MICT in fat profile and body composition in adults. The results of the present meta-analysis are consistent with the results of a similar meta-analysis by Denardi et al., 2018, which examined 7 studies with 120 diabetic patients, and there was no difference between the two exercise methods on total cholesterol, triglycerides, HDL, LDL, and BMI (1). The results of the present meta-analysis showed that HIIT does not cause a significant change in lipid profile including LDL, HDL, TC and TG compared to MICT, which is in line with the previous meta-analysis study (1). The results of this systematic review article showed that there is no significant difference between the interventions. This is probably because subjects were within the normal range of total, HDL, and LDL cholesterol levels, which did not change much after exercise. In addition, the fact that there was no change or control in diet may account for the beneficial effects of exercise training. reduce the lipid profile. Improvements in triglyceride and HDL levels are important because of their association with cardiovascular disease. The effects of HIIT on lipid profiles in patients with type 2 diabetes are conflicting, with one study showing only a decrease in cholesterol (17) and another only an increase in HDL (18). While in the same studies, no effect of HIIT on triglycerides was shown in diabetic patients (17, 18). A previous meta-analysis that included only aerobic exercise and resistance exercise showed that a significant reduction in BMI and body mass was observed in diabetic patients who exercised compared to the control group (19). Jelliman et al reported that HIIT can reduce body mass and BMI compared to a control group (20). However, the included study had relatively inconsistent baseline levels. Because the included studies had different types of subjects such as healthy, overweight, type 2 diabetes and other chronic diseases. A previous meta-analysis study showed that HIIT is effective in reducing BMI and body weight in type 2 diabetic patients (2). Overall, there was a wide range of age at onset, duration of type 2 diabetes, presence of diabetic complications and insulin use, along with variations in session length and duration of intervention, monitoring, and a lack of information on dietary management and type of HIIT protocol used and reductions required. Antiglycemic drugs limited our ability to make direct comparisons between studies (5). The results of the present meta-analysis suggest that HIIT has similar benefits to MICT on fat profile and body composition, although HIIT is a more time-efficient training method.
Keywords: High-intensity interval training, Moderate-intensity continuous training, Lipid profile, Body composition, Type 2 diabetes
Type of Study: review article |
Subject:
Exercise Physiology
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