{
  "abstract": "Objective: To evaluate the comparative efficacy and safety of structured exercise modalities on renal function and glycemic control in non-dialysis diabetic kidney disease (DKD).\n\nDesign: Systematic review and network meta-analysis.\n\nData sources: Six databases (PubMed, Embase, Cochrane CENTRAL, Web of Science, CNKI, Wanfang) were searched from inception to July 15, 2026.\n\nEligibility criteria for selecting studies: Randomized controlled trials (RCTs) evaluating structured exercise (aerobic, resistance, combined, or mind–body) versus usual care or an active comparator in adults with non-dialysis DKD (duration ≥4 weeks).\n\nOutcome measures: Renal endpoints were estimated glomerular filtration rate (eGFR) and urinary albumin excretion (UAE); glycemic endpoints were glycated hemoglobin (HbA1c) and fasting blood glucose (FBG).\n\nResults: Twenty RCTs (1,746 patients) were included. Compared with usual care, resistance training (RT) was the sole modality significantly increasing eGFR (mean difference [MD] 11.36 mL/min/1.73 m², 95% CI 4.47 to 18.25; low certainty) and outperforming aerobic training (MD 8.61, 2.22 to 15.00). Mind–body exercise (MBE) was the only intervention significantly reducing UAE (standardized mean difference –1.41, –2.67 to –0.16; low certainty). For glycemic regulation, RT (MD –1.65%), aerobic training (MD –1.07%), and combined training (CT; MD –0.70%) significantly lowered HbA1c (all low certainty). Significant FBG reductions occurred only with RT (MD –1.78 mmol/L; low certainty) and CT (MD –1.71 mmol/L; moderate certainty). In sensitivity analyses, RT’s eGFR benefit lost significance after excluding high-risk trials (MD 8.24, –1.17 to 17.64), and CT’s HbA1c reduction was attenuated in pure-exercise models (MD –0.60%, –1.39 to 0.19). Subgroup analyses showed CT uniquely sustained FBG reductions across short-term (≤12 weeks: MD –1.50) and longer-term (>12 weeks: MD –2.39) regimens. Structured safety was monitored in only five trials (25.0%): three reported mild, transient events without serious harm, while two explicitly declared zero adverse events. Thus, current evidence is insufficient to draw definitive conclusions regarding comparative safety.\n\nConclusions: Structured exercise confers distinct adaptations in non-dialysis DKD. Combined training provides a reliable foundation for sustained glycemic management, while mind–body exercise represents a viable strategy for albuminuria. Resistance training’s apparent renal benefit warrants caution due to fragility against bias. Prescriptions should be individualized rather than seeking a single optimal modality. Given the sparse monitoring of adverse events, comparative clinical safety cannot be definitively established and mandates routine surveillance.\n\nSystematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261489091.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Physical Education, Dankook University",
    "Winter Olympic College, Harbin Sport University",
    "Shenzhen Hospital of Guangzhou University of Chinese Medicine"
  ],
  "article_type": "systematic review",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yihang Gong"
    },
    {
      "affs": [
        1
      ],
      "name": "Jinhui Zheng"
    },
    {
      "affs": [
        2
      ],
      "name": "Wenrui Huang"
    },
    {
      "affs": [
        0
      ],
      "name": "Yongkyun Jeon"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dpk1bdsks5tz1.bib",
  "cited_by": 0,
  "doi": "10.3389/fendo.2026.1991940",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724325/?tool=EBI",
  "id": "dpk1bdsks5tz1",
  "issns": [
    "1664-2392"
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  "landing_url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1991940/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Systematic Review"
    ],
    [
      "openalex",
      "2727|Chronic Kidney Disease and Diabetes"
    ]
  ],
  "openalex": "W7222954838",
  "pdf_url": "https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2026.1991940/pdf",
  "pmcid": "PMC13724325",
  "pmid": "42973539",
  "published": "2026-10-19",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/dpk1bdsks5tz1.ris",
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      "first_seen": "2026-10-30T12:20:20Z",
      "native_id": "10.3389/fendo.2026.1991940",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1991940/full"
    },
    {
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  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:1664-2392",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Comparative efficacy of different exercise modalities on renal function and glycemic control in patients with non-dialysis diabetic kidney disease: a systematic review and network meta-analysis",
  "title_text": "Comparative efficacy of different exercise modalities on renal function and glycemic control in patients with non-dialysis diabetic kidney disease: a systematic review and network meta-analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:20:51Z",
  "url": "https://research.draconitic.com/paper/dpk1bdsks5tz1",
  "venue": "Frontiers in Endocrinology",
  "versions": []
}