After Dinner Rest a While, After Supper Walk a Mile? A Systematic Review with Meta-analysis on the Acute Postprandial Glycemic Response to Exercise Before and After Meal Ingestion in Healthy Subjects and Patients with Impaired Glucose Tolerance
Open Access
- 30 January 2023
- journal article
- review article
- Published by Springer Science and Business Media LLC in Sports Medicine
- Vol. 53 (4), 849-869
- https://doi.org/10.1007/s40279-022-01808-7
Abstract
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.Funding Information
- Johann Wolfgang Goethe-Universität, Frankfurt am Main
This publication has 45 references indexed in Scilit:
- Independent and Combined Effects of Exercise Training and Metformin on Insulin Sensitivity in Individuals With PrediabetesDiabetes Care, 2011
- Combining short-term metformin treatment and one bout of exercise does not increase insulin action in insulin-resistant individualsAmerican Journal of Physiology-Endocrinology and Metabolism, 2010
- Postprandial Walking is Better for Lowering the Glycemic Effect of Dinner than Pre-Dinner Exercise in Type 2 Diabetic IndividualsJournal of the American Medical Directors Association, 2009
- The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and ElaborationPLoS Medicine, 2009
- Muscle glycogen content in type 2 diabetes mellitusAmerican Journal of Physiology-Endocrinology and Metabolism, 2004
- Hormonal Responses to Maximal and Submaximal Exercise in Trained and Untrained Men of Various AgesThe Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 1996
- Variance imputation for overviews of clinical trials with continuous responseJournal of Clinical Epidemiology, 1992
- Effect of Life-Style Activity of Varying Duration on Glycemic Control in Type II Diabetic WomenDiabetes Care, 1989
- Atherogenesis: a postprandial phenomenon.Circulation, 1979