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.

2型糖尿病患者通常缺乏足够的安全运动意识，运动依从性不高，需要专业人员进行运动干预管理以更好地改善2型糖尿病患者的病情。值得参考的策略就是利用社区卫生工作者为患者提供运动干预的管理。目前关于运动干预管理方面的研究缺乏，且通常2型糖尿病患者健康管理的研究仅提及运动而没有具体的运动管理措施，尚缺少相关的定量系统评价。

系统评价基于社区卫生工作者管理下的运动干预对2型糖尿病患者的健康影响及具体的运动干预方案。

计算机检索8个中英文数据库，包括PubMed、Cochrane Library、Web of Science、Embase、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库（CBM），筛选基于社区卫生工作者管理下的运动干预对2型糖尿病患者影响的随机对照试验，其中干预组采取基于社区卫生工作者管理下的运动干预方案，对照组采取常规护理。检索时间从建库至2022-10-17。文献筛选、质量评价和数据提取由2名研究人员独立完成。使用RevMan 5.4和Stata 15.1软件进行Meta分析。通过亚组分析和敏感性分析寻找异质性来源。预先确定的亚组为干预周期（3个月、6个月、>6个月）、运动频率（3次/周、>3次/周）和单次运动时间（≤30 min/次、>30 min/次）。

本研究最终纳入11篇文献，共有受试者1 079例，其中干预组550例，对照组529例。Meta分析结果显示，基于社区卫生工作者管理模式下的运动干预较对照组更能降低2型糖尿病患者的糖化血红蛋白（MD=-1.07，95%CI=-1.31~-0.83，P<0.000 01）、空腹血糖（MD=-1.26，95%CI=-1.57~-0.96，P<0.000 01）、餐后2 h血糖（MD=-1.47，95%CI=-1.90~-1.04，P<0.000 01）、总胆固醇（MD=-1.02，95%CI=-1.52~-0.51，P<0.000 1）、低密度脂蛋白（MD=-0.62，95%CI=-0.87~-0.37，P<0.000 01）和三酰甘油水平（MD=-0.71，95%CI=-1.13~-0.28，P=0.001），而对高密度脂蛋白的改善程度无显著差异（MD=0.09，95%CI=-0.02~0.21，P=0.11）。亚组分析结果显示，与3次/周的运动频率相比，>3次/周的运动频率对总胆固醇的改善更显著（P=0.02）；与≤30 min/次的单次运动时间相比，>30 min/次的单次运动时间对餐后2 h血糖的改善更显著（P=0.001）；与6个月以及更长时间的干预周期相比，干预周期为3个月的运动干预对糖化血红蛋白（P<0.000 01）、三酰甘油（P=0.008）的改善更显著。Egger's检验显示糖化血红蛋白（P=0.34）、空腹血糖（P=0.281）未表现出显著的发表偏倚。证据质量评价结果显示，糖化血红蛋白和空腹血糖为低级证据，餐后2 h血糖和血脂相关结局指标为极低级证据。

基于社区卫生工作者管理下的运动干预可以显著改善2型糖尿病患者的血糖和血脂水平。社区卫生工作者在今后针对2型糖尿病的运动干预管理中，推荐按照>30 min/次、>3次/周、持续≥3个月的有氧运动干预来制订运动方案。如果2型糖尿病患者伴有血脂异常的情况，则建议运动干预周期最好持续6个月及以上。