Evidence Summary

A systematic review from 2014 of adults and adolescents (323 participants; aged 15-50) with type 1 diabetes found that exercise training (at least twice weekly for longer than eight weeks) improved cardiorespiratory fitness by 3.45 ml/kg/min (95% CI 0.59 to 6.31, p = 0.02) compared with controls [1].

Another systematic review in 2017 of patients with T1DM (596 participants), looking at prospective randomised or control trials, found that exercise training (lasting 12 weeks or more) improved peak VO2 [2]. In exercised adults, there was a mean difference in peak VO2 of 4.08 ml/kg/min (95% CI 2.18–5.98, p < 0.0001). Results of a meta-analysis in 2019 of 24 studies (998 total participants diagnosed with T1DM) also indicated significant effects of exercise training, of no less than 4 weeks, on enhancing aerobic fitness (VO2max) [3]. In addition, a trial done in 2019 in the US (14 participants; 10 men, 4 women) found that six weeks of high-intensity interval training (HIT) improved VO2 peak to a similar extent as moderate-intensity continuous training (MICT) [4].

Quality of Evidence

A – High quality

Strength of Recommendation

1 – Strong recommendation

Conclusion

Physical activity leads to a significant and marked improvements in cardiorespiratory fitness and VO2 in people with type 1 diabetes. Exercise interventions should be recommended to most people, in most circumstances, unless otherwise indicated.

References

[1] Yardley JE, Hay J, Abou-Setta AM, Marks SD, McGavock J. A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes. Diabetes Res Clin Pract. 2014 Dec;106(3):393-400. doi: 10.1016/j.diabres.2014.09.038. Epub 2014 Oct 7. PMID: 25451913.

[2] Ostman C, Jewiss D, King N, Smart NA. Clinical outcomes to exercise training in type 1 diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2018 May;139:380-391. doi: 10.1016/j.diabres.2017.11.036. Epub 2017 Dec 6. PMID: 29223408.

[3] Wu N, Bredin SSD, Guan Y, Dickinson K, Kim DD, Chua Z, Kaufman K, Warburton DER. Cardiovascular Health Benefits of Exercise Training in Persons Living with Type 1 Diabetes: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2019; 8(2):253. https://doi.org/10.3390/jcm8020253

[4] Scott, S. N., Cocks, M., Andrews, R. C., Narendran, P., Purewal, T. S., Cuthbertson, D. J., … Shepherd, S. O. (2018). High-Intensity Interval Training Improves Aerobic Capacity Without a Detrimental Decline in Blood Glucose in People with Type 1 Diabetes. Journal of Clinical Endocrinology and Metabolism, 104(2), 604–612