Evidence Summary
Quirk et al (1) looked at physical activity interventions in children and young people with Type 1 diabetes mellitus. The review looked at 10 randomised and 16 non-randomized studies. 9 studies measured BMI of which four were pooled in a meta-analysis and showed a significant change in BMI (195 participants, standardized mean difference -0.41, 95% CI -0.70 to -0.12; P = 0.006). Salem et al. (2) reported a significant decrease in BMI in groups of children who performed physical activity sessions once and three times per week, and the reduction was greater in those who participated three times a week. Salem et al. (2) reported a significant decrease in waist circumference in children and the greatest reduction in those who participated three times a week compared with once a week. Sideraviciute et al. (3) observed a higher BMI in adolescent girls with Type 1 diabetes compared with girls without diabetes before and after a swimming programme. The other three studies found no significant change in BMI. Nine studies measured body weight, three of which reported significant increases in body weight after physical activity [3,4,5]. Four studies reported waist circumference. Salem et al. (2) reported a significant decrease in waist circumference in children and the greatest reduction in those who participated three times a week compared with once a week. Six studies measured fat mass. Decreased fat-mass was observed in two studies after the intervention (3,6). Fat-free mass was found to increase in the physical activity group (7) and to be positively associated with time spent in moderate, vigorous and moderate-to-vigorous physical activity (8). Three studies reported lean body mass. Mosher et al. (6) reported that adolescent males with Type 1 diabetes gained lean body mass after 12 weeks of circuit training three times a week. Two studies reported no significant changes in skinfold thickness (6,9).

Quality of Evidence
Grade A – High quality evidence
Strength of Recommendation
Grade 2 – Moderate strength of recommendation – Some studies in the systematic review showed no difference in body composition

Conclusion
Physical activity interventions in children and young people with Type 1 diabetes mellitus improves body composition.

References
Quirk H, Blake H, Tennyson R et al. Physical activity interventions in children and young people with Type 1 diabetes mellitus: a systematic review with meta-analysis. Diabetes Med 2014;31(10):1163-73
Salem M, AboElAsrar M, Elbarbary et al. Is exercise a therapeutic tool for improvement of cardiovascular risk factors in adolescents with type 1 diabetes mellitus? A randomised controlled trial. Diabetol Metab Syndr 2010; 2: 47
Sideraviciute S, Gailiuniene A, Visagurskiene K et al. The effect of long-term swimming program on body composition, aerobic capacity and blood lipids in 14-19-year aged healthy girls and girls with type 1 diabetes mellitus. Medicina (Kaunas) 2006; 42: 661–666.
Larsson Y, Persson B, Sterky G, et al. Functional adaptation to rigorous training and exercise in diabetic and nondiabetic adolescents. J Appl Physiol 1964; 19: 629–635.
Baevre H, Sovik O, Wisnes A et al. Metabolic responses to physical training in young insulin-dependent diabetics. Scand J Clin Lab Invest 1985; 45: 109–114.
Mosher PE, Nash MS, Perry AC et al. Aerobic circuit exercise training: effect on adolescents with well-controlled insulin-dependent diabetes mellitus. Arch Phys Med Rehabil 1998; 79: 652–657.
Heyman E, Toutain C, Delamarche P et al. Exercise training and cardiovascular risk factors in type 1 diabetic adolescent girls. Pediatr Exerc Sci 2007; 19: 408.
Michaliszyn SF, Faulkner MS. Physical activity and sedentary behavior in adolescents with type 1 diabetes. Res Nurs Health 2010; 33: 441–449.
Stratton R, Wilson DP, Endres RK, et al.. Improved glycemic control after supervised 8-wk exercise program in insulin-dependent diabetic adolescents. Diabetes Care 1987; 10: 589–593. Evidence Summary Evidence Summary
Quirk et al (1) looked at physical activity interventions in children and young people with Type 1 diabetes mellitus. The review looked at 10 randomised and 16 non-randomized studies. 9 studies measured BMI of which four were pooled in a meta-analysis and showed a significant change in BMI (195 participants, standardized mean difference -0.41, 95% CI -0.70 to -0.12; P = 0.006). Salem et al. (2) reported a significant decrease in BMI in groups of children who performed physical activity sessions once and three times per week, and the reduction was greater in those who participated three times a week. Salem et al. (2) reported a significant decrease in waist circumference in children and the greatest reduction in those who participated three times a week compared with once a week. Sideraviciute et al. (3) observed a higher BMI in adolescent girls with Type 1 diabetes compared with girls without diabetes before and after a swimming programme. The other three studies found no significant change in BMI. Nine studies measured body weight, three of which reported significant increases in body weight after physical activity [3,4,5]. Four studies reported waist circumference. Salem et al. (2) reported a significant decrease in waist circumference in children and the greatest reduction in those who participated three times a week compared with once a week. Six studies measured fat mass. Decreased fat-mass was observed in two studies after the intervention (3,6). Fat-free mass was found to increase in the physical activity group (7) and to be positively associated with time spent in moderate, vigorous and moderate-to-vigorous physical activity (8). Three studies reported lean body mass. Mosher et al. (6) reported that adolescent males with Type 1 diabetes gained lean body mass after 12 weeks of circuit training three times a week. Two studies reported no significant changes in skinfold thickness (6,9).
Quality of Evidence
Grade A – High quality evidence
Strength of Recommendation
Grade 2 – Moderate strength of recommendation – Some studies in the systematic review showed no difference in body composition
Conclusion
Physical activity interventions in children and young people with Type 1 diabetes mellitus improves body composition.
References
Quirk H, Blake H, Tennyson R et al. Physical activity interventions in children and young people with Type 1 diabetes mellitus: a systematic review with meta-analysis. Diabetes Med 2014;31(10):1163-73
Salem M, AboElAsrar M, Elbarbary et al. Is exercise a therapeutic tool for improvement of cardiovascular risk factors in adolescents with type 1 diabetes mellitus? A randomised controlled trial. Diabetol Metab Syndr 2010; 2: 47
Sideraviciute S, Gailiuniene A, Visagurskiene K et al. The effect of long-term swimming program on body composition, aerobic capacity and blood lipids in 14-19-year aged healthy girls and girls with type 1 diabetes mellitus. Medicina (Kaunas) 2006; 42: 661–666.
Larsson Y, Persson B, Sterky G, et al. Functional adaptation to rigorous training and exercise in diabetic and nondiabetic adolescents. J Appl Physiol 1964; 19: 629–635.
Baevre H, Sovik O, Wisnes A et al. Metabolic responses to physical training in young insulin-dependent diabetics. Scand J Clin Lab Invest 1985; 45: 109–114.
Mosher PE, Nash MS, Perry AC et al. Aerobic circuit exercise training: effect on adolescents with well-controlled insulin-dependent diabetes mellitus. Arch Phys Med Rehabil 1998; 79: 652–657.
Heyman E, Toutain C, Delamarche P et al. Exercise training and cardiovascular risk factors in type 1 diabetic adolescent girls. Pediatr Exerc Sci 2007; 19: 408.
Michaliszyn SF, Faulkner MS. Physical activity and sedentary behavior in adolescents with type 1 diabetes. Res Nurs Health 2010; 33: 441–449.
Stratton R, Wilson DP, Endres RK, et al.. Improved glycemic control after supervised 8-wk exercise program in insulin-dependent diabetic adolescents. Diabetes Care 1987; 10: 589–593.