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
- 1Department of Physical Education, Dankook University
- 2Winter Olympic College, Harbin Sport University
- 3Shenzhen Hospital of Guangzhou University of Chinese Medicine
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).
Design: Systematic review and network meta-analysis.
Data sources: Six databases (PubMed, Embase, Cochrane CENTRAL, Web of Science, CNKI, Wanfang) were searched from inception to July 15, 2026.
Eligibility 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).
Outcome 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).
Results: 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.
Conclusions: 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.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261489091.
Related
- Comparative effects of different exercise training modalities on exercise capacity, pulmonary function, and health-related quality of life in patients with interstitial lung disease: a systematic review and network meta-analysis.
- Comparative effects of different exercise modalities and doses on lipid metabolism in patients with type 2 diabetes mellitus: a systematic review with Bayesian dose-response network meta-analysis.
- Comparative efficacy of exercise modalities for mild cognitive impairment in older adults: A network meta-analysis
- Comparative efficacy of digital health intervention delivery modalities on quality of life, anxiety, and depression in coronary heart disease: a systematic review and network meta-analysis
- A systematic review and meta-analysis of the effects of different exercise modalities on frailty in older adults
BibTeX
@article{gong2026comparative,
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}},
author = {Yihang Gong and Jinhui Zheng and Wenrui Huang and Yongkyun Jeon},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1991940},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1991940/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Yihang Gong
AU - Jinhui Zheng
AU - Wenrui Huang
AU - Yongkyun Jeon
PY - 2026
DA - 2026/10/19
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1991940
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1991940/full
AB - 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). Design: Systematic review and network meta-analysis. Data sources: Six databases (PubMed, Embase, Cochrane CENTRAL, Web of Science, CNKI, Wanfang) were searched from inception to July 15, 2026. Eligibility 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). Outcome 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). Results: 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. Conclusions: 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. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261489091.
SN - 1664-2392
ER -