title: Impact of walking on glycemic control and other cardiovascular risk factors in type 2 diabetes: a meta-analysis.
abstract: BACKGROUND
  Walking is the most popular and most preferred exercise among type 2 diabetes patients, yet compelling evidence regarding its beneficial effects on cardiovascular risk factors is still lacking. The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the association between walking and glycemic control and other cardiovascular risk factors in type 2 diabetes patients.
  
  
  METHODS
  Three databases were searched up to August 2014. English-language RCTs were eligible for inclusion if they had assessed the walking effects (duration ≥8 weeks) on glycemic control or other cardiovascular risk factors among type 2 diabetes patients. Data were pooled using a random-effects model. Subgroup analyses based on supervision status and meta-regression analyses of variables regarding characteristics of participants and walking were performed to investigate their association with glycemic control.
  
  
  RESULTS
  Eighteen studies involving 20 RCTs (866 participants) were included. Walking significantly decreased glycosylated haemoglobin A1c (HbA1c) by 0.50% (95% confidence intervals [CI]: -0.78% to -0.21%). Supervised walking was associated with a pronounced decrease in HbA1c (WMD -0.58%, 95% CI: -0.93% to -0.23%), whereas non-supervised walking was not. Further subgroup analysis suggested non-supervised walking using motivational strategies is also effective in decreasing HbA1c (WMD -0.53%, 95% CI: -1.05% to -0.02%). Effects of covariates on HbA1c change were generally unclear. For other cardiovascular risk factors, walking significantly reduced body mass index (BMI) and lowered diastolic blood pressure (DBP), but non-significantly lowered systolic blood pressure (SBP), or changed high-density or low-density lipoprotein cholesterol levels.
  
  
  CONCLUSIONS
  This meta-analysis supports that walking decreases HbA1c among type 2 diabetes patients. Supervision or the use of motivational strategies should be suggested when prescribed walking to ensure optimal glycemic control. Walking also reduces BMI and lowers DBP, however, it remains insufficient regarding the association of walking with lowered SBP or improved lipoprotein profiles.
  
  
  BACKGROUND
  PROSPERO CRD42014009515.
authors.affiliation: Division of Sports and Rehabilitation Medicine, Department of Medicine II, Ulm University, Ulm, Germany; Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, Nanjing, P. R. China.
authors.forename: Shanhu
authors.initials: S
authors.lastname: Qiu
authors.affiliation: Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, Nanjing, P. R. China.
authors.forename: Xue
authors.initials: X
authors.lastname: Cai
authors.affiliation: Division of Sports and Rehabilitation Medicine, Department of Medicine II, Ulm University, Ulm, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Schumann
authors.affiliation: Division of Sports and Rehabilitation Medicine, Department of Medicine II, Ulm University, Ulm, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Velders
authors.affiliation: Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, Nanjing, P. R. China.
authors.forename: Zilin
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Division of Sports and Rehabilitation Medicine, Department of Medicine II, Ulm University, Ulm, Germany.
authors.forename: Jürgen Michael
authors.initials: JM
authors.lastname: Steinacker
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D005081:Exercise Therapy / Q000009:adverse effects; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D012307:Risk Factors; D016138:Walking
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human