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 Cochrane Collaboration Risk of Bias Assessment Tool respectively. A qualitative synthesis was performed on the included studies, and results summarized in tables. Results 19 randomized controlled trials (RCTs) with a total of 346 participants were included. Improvements in glycemia (glucose concentrations and glucose-AUC) and insulin-AUC appeared more consistent when exercise was performed during the post-meal period as compared to the pre-meal period, however, this observation was largely based on indirect comparisons between studies. Conclusions There is some evidence from RCTs 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 which 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. Corresponding Author: Timothy J. Fairchild, School of Psychology and Exercise Science, Murdoch University, 90 South Street, Murdoch WA 6150, +61 (08) 9360 2959. t.fairchild@murdoch.edu.au ST is supported by an Australian Government Research Training Program (RTP) Scholarship. No additional sources of funding were declared by the remaining authors. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Accepted for Publication: 4 July 2018 © 2018 American College of Sports Medicine

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