Effect of Exercise Based on American College of Sports Medicine Recommendations on Glycemic Management in Patients with Type 1 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Exercise is a crucial lifestyle management strategy for individuals with type 1 diabetes (T1DM) to improve overall health, yet its benefits for glycemic control remain controversial. Although clinical trials have designed various exercise regimens, no studies have systematically demonstrated or compared which exercise program yields optimal outcomes for individuals with T1DM. To visually compare and identify a more reasonable exercise program, we used the comprehensive exercise prescription established by the American College of Sports Medicine (ACSM) as a foundation to compare the impact of glycemic management about exercise doses with different compliance to ACSM recommendations. We systematically searched for studies from PubMed, Embase, Web of Science, Cochrane, and OVID. Randomized controlled trials (RCTs) investigating the impact of exercise on glycemic management published between January 2000 and July 11, 2025 were included. The quality of the study was assessed by the Cochrane Collaboration Risk of Bias Tool. Subgroup analyses were performed by categorizing the interventions into high adherence versus low/uncertainty adherence to the exercise prescription developed by ACSM. To compare the results between subgroups, weighted mean difference (WMD) or standardized mean difference (SMD) were adopted, using random or fixed effects models accordingly. Fourteen studies were included in the meta-analysis, with 452 participants. Of which, 7 studies were categorized as high adherence with ACSM and 7 studies were categorized as low or uncertain adherence. Results showed exercise had significant effect on reducing Glycated Hemoglobin (HbA1c) (WMD = -0.52; 95% CI = [-0.74, -0.29]). The WMD for the high adherence group was -0.74 (95% CI: -1.04, -0.44), while for the low or uncertain adherence group was -0.21 (95% CI: [-0.56, 0.13]). Exercise programs with high adherence to the ACSM resulted in a markedly greater reduction in HbA1c compared to those with low adherence (p = 0.02). Data on triglyceride levels also showed greater improvements in the high adherence group. These findings collectively indicated that the ACSM prescription serves as an effective exercise guideline for individuals with type 1 diabetes.