Resistance Exercise Intensity is Correlated with Attenuation of HbA1c and Insulin in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

Int J Environ Res Public Health. 2019 Jan 7;16(1):140. doi: 10.3390/ijerph16010140.


We investigated the influence of resistance exercise (RE) with different intensities on HbA1c, insulin and blood glucose levels in patients with type 2 diabetes (T2D). Diabetes trials that compared RE group with a control were included in meta-analysis. Exercise intensities were categorized into low-to-moderate-intensity and high-intensity subgroups. Intensity effect on glycemic control was determined by meta-regression analysis, and risk-of-bias was assessed using Cochrane Collaboration tool. 24 trials met the inclusion criteria, comprised of 962 patients of exercise (n = 491) and control (n = 471). Meta-regression analysis showed decreased HbA1c (p = 0.006) and insulin (p = 0.015) after RE was correlated with intensity. Subgroup analysis revealed decreased HbA1c was greater with high intensity (-0.61; 95% CI -0.90, -0.33) than low-to-moderate intensity (-0.23; 95% CI -0.41, -0.05). Insulin levels were significantly decreased only with high intensity (-4.60; 95% CI -7.53, -1.67), not with low-to-moderate intensity (0.07; 95% CI -3.28, 3.42). Notably, values between the subgroups were statistically significant for both HbA1c (p = 0.03) and insulin (p = 0.04), indicative of profound benefits of high-intensity RE. Pooled outcomes of 15 trials showed only a decreased trend in blood glucose with RE (p = 0.09), and this tendency was not associated with intensity. Our meta-analysis provides additional evidence that high-intensity RE has greater beneficial effects than low-to-moderate-intensity in attenuation of HbA1c and insulin in T2D patients.

Keywords: diabetes; glycosylated hemoglobin; insulin; meta-regression; strength training.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Blood Glucose / analysis
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / therapy*
  • Exercise
  • Glycated Hemoglobin / analysis*
  • Humans
  • Insulin / blood*
  • Resistance Training / methods*


  • Blood Glucose
  • Glycated Hemoglobin A
  • Insulin