Effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus: a systematic review and meta-analysis
Abstract Background Cardiac autonomic neuropathy (CAN) is an underdiagnosed complication of type 2 diabetes mellitus (T2DM) and is associated with cardiovascular morbidity and mortality. Cardiac autonomic reflex tests (CARTs) are the gold standard; they are non-invasive and clinically feasible for s...
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| Format: | Article |
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BMC
2025-02-01
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| Series: | Systematic Reviews |
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| Online Access: | https://doi.org/10.1186/s13643-025-02772-9 |
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| author | Sohini Raje G Arun Maiya Padmakumar R Mukund A. Prabhu Krishnananda Nayak Shivashankara KN BA Shastry Megha Nataraj |
| author_facet | Sohini Raje G Arun Maiya Padmakumar R Mukund A. Prabhu Krishnananda Nayak Shivashankara KN BA Shastry Megha Nataraj |
| author_sort | Sohini Raje |
| collection | DOAJ |
| description | Abstract Background Cardiac autonomic neuropathy (CAN) is an underdiagnosed complication of type 2 diabetes mellitus (T2DM) and is associated with cardiovascular morbidity and mortality. Cardiac autonomic reflex tests (CARTs) are the gold standard; they are non-invasive and clinically feasible for screening CAN. The objective of the present meta-analysis was to examine exercise’s effect on cardiac autonomic function using CARTs in T2DM. Methods The Preferred Reporting Items for Systematic Review and Meta-Analysis Checklist (PRISMA) was used. Electronic databases were systematically used to retrieve relevant studies after title and abstract screening. Studies utilizing exercise training with cardiac autonomic function (CARTs) outcomes in individuals with type 2 diabetes mellitus were included. The meta-analysis was conducted using RevMan 5.4.1, using the random effects model, and appropriate tests for heterogeneity. The Cohrane ROB-2 tool was used for randomized controlled trials (RCTs) and the ROBINS-I tool for non-RCT for risk of bias assessment were used. Results Three studies were included (two for meta-analysis), considering the outcome of the E:I ratio, 30:15 ratio, and Valsalva ratio. The studies did not show any influence on the E:I and 30:15 ratio in the pooled analysis with a low risk of ineffectiveness for the exercise intervention. Exercise training significantly affected the Valsalva ratio. A different type of exercise intervention was utilized in all three studies. There was a low to moderate certainty for the evidence. Conclusion The results indicate that further robust and high-quality randomized controlled trials utilizing cardiac autonomic reflex tests (which have clinical and physiological relevance) in type 2 diabetes mellitus are required for drawing conclusions. Systematic review registration PROSPERO CRD42023445561. |
| format | Article |
| id | doaj-art-53ff604513544c31a5a08d66aa96fb87 |
| institution | Kabale University |
| issn | 2046-4053 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Systematic Reviews |
| spelling | doaj-art-53ff604513544c31a5a08d66aa96fb872025-02-09T12:15:08ZengBMCSystematic Reviews2046-40532025-02-0114111210.1186/s13643-025-02772-9Effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus: a systematic review and meta-analysisSohini Raje0G Arun Maiya1Padmakumar R2Mukund A. Prabhu3Krishnananda Nayak4Shivashankara KN5BA Shastry6Megha Nataraj7Centre for Podiatry & Diabetic Foot Care and Research, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher EducationCentre for Podiatry & Diabetic Foot Care and Research, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher EducationDepartment of Cardiology, Kasturba Medical College-Manipal, Manipal Academy of Higher EducationDepartment of Cardiology, Kasturba Medical College-Manipal, Manipal Academy of Higher EducationDepartment of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher EducationDepartment of Medicine, Kasturba Medical College-Manipal, Manipal Academy of Higher EducationDepartment of Medicine, Kasturba Medical College-Manipal, Manipal Academy of Higher EducationDepartment of Cardiovascular & Respiratory Physiotherapy, MGM College of PhysiotherapyAbstract Background Cardiac autonomic neuropathy (CAN) is an underdiagnosed complication of type 2 diabetes mellitus (T2DM) and is associated with cardiovascular morbidity and mortality. Cardiac autonomic reflex tests (CARTs) are the gold standard; they are non-invasive and clinically feasible for screening CAN. The objective of the present meta-analysis was to examine exercise’s effect on cardiac autonomic function using CARTs in T2DM. Methods The Preferred Reporting Items for Systematic Review and Meta-Analysis Checklist (PRISMA) was used. Electronic databases were systematically used to retrieve relevant studies after title and abstract screening. Studies utilizing exercise training with cardiac autonomic function (CARTs) outcomes in individuals with type 2 diabetes mellitus were included. The meta-analysis was conducted using RevMan 5.4.1, using the random effects model, and appropriate tests for heterogeneity. The Cohrane ROB-2 tool was used for randomized controlled trials (RCTs) and the ROBINS-I tool for non-RCT for risk of bias assessment were used. Results Three studies were included (two for meta-analysis), considering the outcome of the E:I ratio, 30:15 ratio, and Valsalva ratio. The studies did not show any influence on the E:I and 30:15 ratio in the pooled analysis with a low risk of ineffectiveness for the exercise intervention. Exercise training significantly affected the Valsalva ratio. A different type of exercise intervention was utilized in all three studies. There was a low to moderate certainty for the evidence. Conclusion The results indicate that further robust and high-quality randomized controlled trials utilizing cardiac autonomic reflex tests (which have clinical and physiological relevance) in type 2 diabetes mellitus are required for drawing conclusions. Systematic review registration PROSPERO CRD42023445561.https://doi.org/10.1186/s13643-025-02772-9Type 2 diabetesCardiac autonomic functionExerciseCardiac autonomic neuropathyMeta-analysisLifestyle management |
| spellingShingle | Sohini Raje G Arun Maiya Padmakumar R Mukund A. Prabhu Krishnananda Nayak Shivashankara KN BA Shastry Megha Nataraj Effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus: a systematic review and meta-analysis Systematic Reviews Type 2 diabetes Cardiac autonomic function Exercise Cardiac autonomic neuropathy Meta-analysis Lifestyle management |
| title | Effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus: a systematic review and meta-analysis |
| title_full | Effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus: a systematic review and meta-analysis |
| title_fullStr | Effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus: a systematic review and meta-analysis |
| title_full_unstemmed | Effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus: a systematic review and meta-analysis |
| title_short | Effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus: a systematic review and meta-analysis |
| title_sort | effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus a systematic review and meta analysis |
| topic | Type 2 diabetes Cardiac autonomic function Exercise Cardiac autonomic neuropathy Meta-analysis Lifestyle management |
| url | https://doi.org/10.1186/s13643-025-02772-9 |
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