Background

The most effective way to cope with high blood sugar spikes is to engage in physical activity in temporal proximity to food intake. However, so far, it is unclear as to whether there is an optimal time for physical activity around food intake.

Objectives

We aimed to identify the impact of pre- and post-meal exercise on postprandial glucose excursions in humans with and without type 2 diabetes mellitus.

Methods

We conducted a systematic review with meta-analysis, PROSPERO registration number: CRD42022324070. We screened MEDLINE/PubMed, Cochrane/CINAHL/EMBASE, and Web of Knowledge until 1 May, 2022. We used the risk of bias rating with the crossover extension of the Cochrane risk of bias assessment tool II. Standardized mean differences (SMDs, Hedges’ g) with 95% confidence intervals (CIs) were calculated as pooled effect estimates of a random-effects meta-analysis. Eligibility criteria included three-armed randomized controlled trials comparing the acute effects of pre- and post-meal exercise to a no-exercise control in humans.

Results

Eight randomized controlled trials (crossover trials, high risk of bias) with 30 interventions in 116 participants (47 diagnosed with type 2 diabetes, 69 without type 2 diabetes) were eligible. Exercise after meal ingestion (real food or meal replacement drinks) led to a reduction in postprandial glucose excursions compared with exercise before eating (15 effect sizes; SMD = 0.47 [95% CI 0.23, 0.70]) and an inactive control condition (15 effect sizes; SMD = 0.55 [95% CI 0.34, 0.75]. Pre-meal exercise did not lead to significantly lower postprandial glucose compared to an inactive control (15 effect sizes; SMD = − 0.13 [95% CI − 0.42, 0.17]). The time between meal and exercise (estimate = − 0.0151; standard error = 0.00473; Z = − 3.19; p = 0.001; 95% CI − 0.024, − 0.006) had a moderating influence on postprandial glucose excursions.

Conclusions

Exercise, i.e., walking, has a greater acute beneficial impact on postprandial hyperglycemia when undertaken as soon as possible after a meal rather than after a longer interval or before eating.

Clinical Trial Registration

The review was pre-registered in the PROSPERO database (CRD42022324070). The date of submission was 07.04.2022, with the registration on 08.05.2022.

中文翻译：

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饭后休息一会儿，饭后走一英里？健康受试者和糖耐量受损患者对餐前和餐后运动的急性餐后血糖反应的系统评价和荟萃分析

背景

应对高血糖的最有效方法是在接近食物摄入的时间进行体力活动。然而，到目前为止，尚不清楚围绕食物摄入是否有最佳的身体活动时间。

目标

我们的目的是确定餐前和餐后运动对患有和不患有 2 型糖尿病的人类餐后血糖波动的影响。

方法

我们通过荟萃分析进行了系统评价，PROSPERO 注册号：CRD42022324070。我们筛选了 MEDLINE/PubMed、Cochrane/CINAHL/EMBASE 和 Web of Knowledge，直至 2022 年 5 月 1 日。我们使用偏倚风险评级和 Cochrane 偏倚风险评估工具 II 的交叉扩展。计算具有 95% 置信区间 (CI) 的标准化平均差（SMD、Hedges' g）作为随机效应荟萃分析的汇总效应估计。资格标准包括三组随机对照试验，比较餐前和餐后运动与不运动对照对人类的急性影响。

结果

8 项随机对照试验（交叉试验，高偏倚风险）符合资格，对 116 名参与者（47 名被诊断患有 2 型糖尿病，69 名没有 2 型糖尿病）进行了 30 项干预措施。与进食前运动相比，餐后运动（真正的食物或代餐饮料）导致餐后血糖波动减少（15 效应量；SMD = 0.47 [95% CI 0.23, 0.70]）和不活动对照条件（15 效应值）大小；SMD = 0.55 [95% CI 0.34, 0.75]。与不活动对照相比，餐前运动并未导致餐后血糖显着降低（15 个效应大小；SMD = − 0.13 [95% CI − 0.42, 0.17]）进餐和运动之间的时间（估计 = − 0.0151；标准误差 = 0.00473；Z  = − 3.19；p  = 0.001；95% CI − 0.024，− 0.006）对餐后血糖波动有调节影响。

结论

饭后尽快进行锻炼，即步行，对餐后高血糖具有更大的急性有益影响，而不是在较长时间间隔后或进食前进行。

临床试验注册

该综述已在 PROSPERO 数据库中预先注册（CRD42022324070）。提交日期为2022年4月7日，注册日期为2022年5月8日。