Therapeutic and Preventive Role of Integrated Moderate-to-Vigorous Recreational Activity Programs in Type 2 Diabetes Care: A Systematic Review and Meta-Analysis.

INTRODUCTION

The global burden of type 2 diabetes mellitus (T2DM) is rising, with physical inactivity being a key modifiable risk factor. While structured exercise is known to improve glycemic control, the role of integrated moderate-to-vigorous recreational and sports activities in managing T2DM remains underexplored.

METHODS

This systematic review examined the therapeutic and preventive effects of moderate-to-vigorous recreational activity programs on individuals with T2DM and prediabetes. A comprehensive search of eight databases was conducted for interventional studies published in English between November 2023 and March 2024. Eligible studies involved adult participants (≥ 18 years) undergoing structured sports or recreational activity interventions, with outcomes including glycemic control, cardiovascular risk factors, physical fitness, and adverse events.

RESULTS

Nine randomized controlled trials from diverse global settings were included. Interventions included high-intensity interval training, recreational soccer, cycling, and pedometer-guided walking, among others. Significant improvements were observed in glycated hemoglobin (HbA1c), with pooled analysis indicating a moderate standardized reduction (Hedges' g = 0.54, 95% confidence interval (CI) 0.16-0.92), equivalent to decreases of up to - 1.8% in individual trials. Body mass index also decreased modestly (pooled mean difference - 0.34 kg/m2, 95% CI - 0.53 to - 0.15). Additional benefits were observed in fasting plasma glucose, lipid profiles, blood pressure, body composition, and muscular endurance. Adherence rates across trials were high, and adverse events were minimal, typically limited to transient dizziness or breathlessness.

CONCLUSION

Moderate-to-vigorous recreational activity programs are effective, safe, and scalable adjuncts to standard diabetes care. While smaller trials often reported larger effects and larger multimodal studies showed more modest outcomes, sensitivity analyses confirmed the robustness of the overall findings. Future research should address these sources of bias by standardizing outcome reporting, ensuring adequate sample sizes, and testing long-term sustainability and integration into health systems, particularly for individuals with comorbidities or limited mobility.

TRIAL REGISTRATION: Registration number CRD42024499785.