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Clinical Research

Effect of exercise training on insulin-stimulated glucose disposal: a systematic review and meta-analysis of randomized controlled trials

International Journal of Obesity volume 47, pages 348–357 (2023)Cite this article

Subjects

Abstract

Background and objective

The effect of exercise training on whole-body insulin sensitivity has not been systematically summarized. We aimed to summarize the data from randomized controlled trials evaluating the effect of exercise training on insulin action, in adults.

Subjects

MEDLINE, EMBASE, and CENTRAL databases were searched until January 2021. Randomized controlled trials lasting ≥4 weeks, including adults, and evaluating the effect of exercise on insulin-stimulated glucose disposal measured using the hyperinsulinemic euglycemic clamp, were included.

Methods

Three reviewers extracted summary data from published trials. The primary outcome was insulin-stimulated glucose disposal. Standardized weighted mean differences (SMD) in glucose disposal between intervention and control were compared. The PEDro scale was used to assess risk of bias.

Results

We included 25 trials (36 interventions, N = 851). Exercise increased insulin-stimulated glucose disposal relative to control, SMD = 0.52 (95% confidence interval [CI]: 0.39, 0.65; p < 0.001; I2 = 47%) without significantly suppressing hepatic glucose production. In trials without isotopic tracers, exercise increased glucose disposal (SMD = 0.63; 95% CI: 0.48, 0.77; p < 0.001, I2 = 55%). In trials with isotopic tracers, exercise increased glucose disposal only when tracers were added to the exogenous glucose used for clamping (SMD = 0.34; 95% CI: 0.03, 0.66, p = 0.034. I2 = 0%). In a meta-regression model including aerobic exercise, weight change, and tracer technique, only percent weight change explained between trial heterogeneity (β = 0.069; 95% CI: 0.005, 0.013). The PEDro rating indicated relatively low risk of bias (5.8 ± 0.22).

Conclusions

Exercise training for at least four weeks significantly increases insulin-stimulated glucose disposal. Weight loss maximizes the effect and may be needed to improve hepatic insulin sensitivity. Differences in tracer methodology contribute to divergent outcomes and should be considered when assessing conclusions from research examining the effect of exercise on insulin action.

Registration

PROSPERO (CRD42019124381).

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Fig. 1: PRISMA 2020 flow chart.
Fig. 2: Forest Plot of Exercise-induced Change in Glucose Disposal.
Fig. 3: Forest Plot of the Exercise-induced Change in Glucose Disposal in the Sub-group Analysis.

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Data availability

The protocol for the study (CRD42019124381) is publicly available at: https://www.crd.york.ac.uk/prospero/. The datasets generated and analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported in part by a grant from the National Institute on Aging (5K99AG065419-02), the National Cancer Institute (R00 CA218603), the National Institute of General Medical Sciences which funds the Louisiana Clinical and Translational Science Center (U54 GM104940), and the National Institute of Diabetes and Digestive and Kidney Diseases (T32 DK064584) of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding

National Institute on Aging.

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Authors and Affiliations

  1. Nutrition and Chronic Disease, Pennington Biomedical Research Center, Baton Rouge, LA, USA

    Candida J. Rebello

  2. Biostatistics, Pennington Biomedical Research Center, Baton Rouge, LA, USA

    Dachuan Zhang & William D. Johnson

  3. Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, LA, USA

    John P. Kirwan

  4. Interventional Resources, Pennington Biomedical Research Center, Baton Rouge, LA, USA

    Adam C. Lowe & Carlante J. Emerson

  5. Clinical Science, Pennington Biomedical Research Center, Baton Rouge, LA, USA

    Chelsea L. Kracht

  6. Library and Information Center, Pennington Biomedical Research Center, Baton Rouge, LA, USA

    Lori C. Steib

  7. Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA, USA

    Frank L. Greenway

  8. Cancer Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA, USA

    Justin C. Brown

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Contributions

CJR: conceptualization of research question, methodology, screening and extraction of data, interpretation of data, writing—original draft preparation, review and editing; DZ: Analysis and interpretation of data, and writing—review and editing; JPK; interpretation of data, and writing—review and editing ACL: screening and extraction of data, interpretation of data, writing—review and editing CJE: screening and extraction of data, interpretation of data, writing—review and editing; CLK: methodology, writing—review and editing; LCS: methodology, writing—review and editing; FLG: interpretation, writing—review and editing; WDJ: analysis and interpretation of data, writing—review and editing; JCB: conceptualization of research question, methodology, analysis and interpretation of data, writing—review and editing.

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Rebello, C.J., Zhang, D., Kirwan, J.P. et al. Effect of exercise training on insulin-stimulated glucose disposal: a systematic review and meta-analysis of randomized controlled trials. Int J Obes 47, 348–357 (2023). https://doi.org/10.1038/s41366-023-01283-8

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