Patients with type 2 diabetes usually lack sufficient awareness of safe exercise and have poor exercise compliance, which requires the management of exercise interventions by professionals to improve the health status of patients with type 2 diabetes. A strategy worth considering is the management of exercise interventions for patients by community health workers. Currently, there is a lack of research on the management of exercise interventions, and studies on the health management of patients with type 2 diabetes usually only mention exercise without specific exercise management measures. Additionally, there is a lack of quantitative systematic reviews.

To systematically review the health effects of exercise interventions based on community health workers' management for patients with type 2 diabetes and specific exercise intervention programs.

Eight Chinese and English databases, including PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang Data, VIP and CBM were searched by computer from inception to October 17, 2022, to screen randomized controlled trials on the effects of exercise interventions based on community health workers' management for patients with type 2 diabetes, in which the intervention group adopted an exercise intervention program based on community health workers' management and the control group adopted conventional care. Literature screening, quality assessment, and data extraction were performed independently by 2 investigators. Meta-analysis was performed using RevMan 5.4 and Stata 15.1 software. Sensitivity and subgroup analyses were carried out to find sources of heterogeneity. Pre-identified subgroups were intervention duration (3 months; 6 months; >6 months), frequency of exercise (3 times/week; >3 times/week), and duration of the single exercise session (≤30 min/session; >30 min/session) .

A total of 1 079 subjects from 11 articles were finally included in this review, of which 550 were in the intervention group and 529 in the control group. The results of the Meta-analysis revealed that the exercise interventions based on community health workers' management were more effective than the control groups in reducing glycated hemoglobin (MD=-1.07, 95%CI=-1.31 to -0.83, P<0.000 01), fasting blood glucose (MD=-1.26, 95%CI=-1.57 to -0.96, P<0.000 01), 2-hour plasma glucose (MD=-1.47, 95%CI=-1.90 to -1.04, P<0.000 01), total cholesterol (MD=-1.02, 95%CI=-1.52 to -0.51, P<0.000 1), low-density lipoprotein (MD=-0.62, 95%CI=-0.87 to -0.37, and P<0.000 01) and triglyceride levels (MD=-0.71, 95%CI=-1.13 to -0.28, P=0.001), whereas there was no significant difference in the improvement of high-density lipoprotein (MD=0.09, 95%CI=-0.02 to 0.21, P=0.11). Subgroup analysis showed more significant improvements in total cholesterol with exercise frequency of more than three times/week compared with three times/week (P=0.02) ; improvement in 2-hour plasma glucose was more significant with >30 min/session compared with ≤30 min/session (P=0.001) ; single exercise session of three months duration showed more significant improvements in glycated hemoglobin (P<0.000 01) and triglycerides (P=0.008) compared with duration of six months and longer. Egger's test indicated that glycated hemoglobin (P=0.34), and fasting blood glucose (P=0.281) did not show any significant publication bias. The quality of evidence evaluation demonstrated that glycated hemoglobin and fasting blood glucose were low-level evidence, and 2-hour plasma glucose and lipid-related outcomes were very low-level evidence.

Exercise interventions based on community health workers' management could significantly improve blood glucose and lipid levels in patients with type 2 diabetes. Community health workers are recommended to develop an exercise program based on aerobic exercise intervention of >30 min/session, >3 sessions/week, and duration of ≥3 months in future exercise intervention management for type 2 diabetes. If the patients with type 2 diabetes mellitus have concurrent dyslipidemia, it is recommended that the duration of the exercise intervention should ideally last for more than 6 months.