Effect of Aerobic and Resistant Exercise Intervention on Inflammaging of Type 2 Diabetes Mellitus in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis |
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| Affiliation: | 1. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;2. Department of Microbiology and Immunology, Yong Yoo Lin School of Medicine, National University of Singapore, Singapore;3. NUSMED Immunology Translational Research Programme, National University of Singapore, Singapore;4. Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Japan;5. NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore;1. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy;2. Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy;3. Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy;4. Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden;5. Department of Human Neuroscience, “Sapienza” University, Rome, Italy;6. National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy;7. Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy;1. Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan;2. Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan;3. Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia;4. Center for Research, Diagnostics and Vaccine Development, Taiwan Centers for Disease Control, Taipei, Taiwan;5. Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan;6. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan;7. School of Medicine, National Yang-Ming University, Taipei, Taiwan;8. Department of Neurology, Min-Sheng General Hospital, Taoyuan, Taiwan;9. Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan;10. Graduate Institute of Psychology, College of Science, National Taiwan University, Taipei, Taiwan;11. Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan;1. National Clinician Scholar Program, University of Pennsylvania, Philadelphia, PA, USA;2. Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA;3. Duke Margolis Center for Health Policy, Washington, DC, USA;4. National Pharmaceutical Council, Washington, DC, USA;5. University of Pennsylvania Department of Medical Ethics and Health Policy, Philadelphia, PA, USA |
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| Abstract: | ObjectivesTo examine the effect of aerobic and resistant exercise intervention on inflammaging in middle-aged and older adults with type 2 diabetes mellitus (T2DM) using inflammatory cytokines, such as interleukin (IL)-1 β, IL-6, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) as biomarkers.DesignSystematic review and meta-analysis.Setting and ParticipantsMiddle-aged and older adults with T2DM in the community.MethodsArticles were searched from 8 electronic databases. Randomized control trials (RCTs) published in English, from inception to October 31, 2021, were included in this review. Two authors conducted data extraction and quality appraisal independently following guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was conducted using Review Manager. Heterogeneity was investigated using subgroup and sensitivity analysis.ResultsThis review included 14 RCTs. The meta-analysis showed significant improvement in IL-6 [Z = 3.05; 95% confidence interval (CI): ?3.60 to ?0.79; P = .002], CRP (Z = 2.44; 95% CI: ?0.55 to ?0.06; P = .01) and TNF-α levels (Z = 2.96; 95% CI: ?2.21 to ?0.45; P = .003) post-exercise programs. Subgroup analysis revealed that combined aerobic and resistance exercises and long-term exercises have more significant improvement to the outcomes than usual care. Based on the Grades of Recommendation, Assessment, Development and Evaluation system, considerable risk of bias and low level of certainty were revealed in all biomarker outcomes.Conclusions and ImplicationsExercise intervention is effective in improving inflammatory, metabolic, and lipid markers in middle-aged and older adults with T2DM. By modifying the levels of these markers with exercise, inflammation and insulin resistance can be improved. Long-term, combined aerobic and resistance exercise interventions have more significant effect on biomarkers. The small sample size of this meta-analysis limited the generalizability of the results. Future studies can consider adopting a more optimized exercise regimen to achieve effective T2DM management in middle-aged and older adults. Similar studies should expand to other populations and larger sample sizes to explore replicability of these effects. |
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| Keywords: | Aerobic exercises resistance exercises type 2 diabetes mellitus older adult interleukin-6 C-reactive protein |
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