A systematic search was conducted in PubMed, Cochrane Library, EmBase, Web of Science, CNKI, and Wanfang Data Knowledge Service Platform to identify relevant studies published from database inception to June 15, 2024, on the effects of exercise on glycemic metabolism in East Asian patients with T2DM. The study type was limited to randomized controlled trials (RCTs), where the intervention group received exercise interventions and the control group did not. Two researchers independently screened the literature based on inclusion and exclusion criteria and extracted relevant data. Publication bias was assessed using Egger's test in Stata 17.0 and funnel plots in RevMan 5.3. Meta-analysis was performed using RevMan 5.3.

A total of 21 RCTs involving 1289 participants (675 in the intervention group and 614 in the control group) were included. Publication bias assessment indicated overall good quality of the included studies. The random-effects model showed that exercise interventions significantly reduced fasting blood glucose (MD=-1.31 mg/L, 95% CI: -1.55 to -1.07, P < 0.001), glycated hemoglobin A1c (HbA1c) (MD=-0.34, 95% CI: -0.45 to -0.22, P < 0.001), homeostatic model assessment of insulin resistance (HOMA-IR) (MD=-0.39, 95% CI: -0.54 to -0.23, P < 0.001), and fasting insulin (MD=-0.71 μIU/mL, 95% CI: -1.18 to -0.24, P=0.003) in the intervention group. Heterogeneity was observed in the effects of different exercise modalities on glycemic metabolism. Aerobic training (MD=-1.49 mg/L, 95% CI: -2.53 to -0.44, P=0.005) and combined training (MD=-1.41 mg/L, 95% CI: -1.87 to -0.95, P < 0.001) were more effective than resistance training in reducing fasting blood glucose. Combined training (MD=-0.47, 95% CI: -0.81 to -0.31, P=0.007) was superior to aerobic and resistance training in reducing HbA1c. Only aerobic training (MD=-0.48, 95% CI: -0.89 to -0.07, P=0.020) and combined training (MD=-0.35, 95% CI: -0.69 to -0.01, P=0.040) significantly reduced HOMA-IR, with aerobic training showing a greater effect than combined training. Subgroup analyses based on age group, exercise duration, session length, frequency, and intensity revealed that aerobic training performed less than 5 times per week for no more than 1 hour per session significantly improved fasting blood glucose in East Asian patients with T2DM.

Exercise interventions can improve glycemic control and reduce insulin resistance in East Asian patients with T2DM. Aerobic exercise and combined exercise are more effective exercise prescriptions for glycemic management in this population.

This cross-sectional observational study employed convenience sampling to recruit 2021-grade(8th grade) students from Jining No.7 Middle School in Shandong Province on June 5, 2023. Data collection included questionnaires, physical examinations, and imaging assessments to obtain general information, secondary sexual characteristics development, and bone age. Venous blood samples were collected to measure fasting blood glucose(FBG), fasting insulin(FINS), homeostasis model assessment of insulin resistance(HOMA-IR), and 25-hydroxyvitamin D[25(OH)D] levels. Spearman correlation analysis and multivariate linear regression models were used to examine the associations between serum vitamin D levels and FBG, FINS, and HOMA-IR.

The study included 168 pubertal adolescents[69 females(41.1%), 99 males(58.9%); mean age(13.27±0.46) years]. All participants had entered puberty based on sexual development assessment. Vitamin D deficiency was observed in 41 participants(24.4%), insufficiency in 109(64.9%), and sufficiency in 18(10.7%). The median HOMA-IR was 3.49(2.57, 5.14).Significant differences were found across vitamin D status groups for HOMA-IR [4.45(2.54, 6.62) vs. 3.58(2.74, 5.13) vs. 2.25(1.62, 3.40), P=0.003] and FINS[21.5(13.4, 30.1) mU/L vs. 16.5(13.0, 23.9) mU/L vs. 11.2(8.3, 17.8) mU/L, P=0.006], showing decreasing trends with improving vitamin D status. Spearman analysis revealed significant inverse correlations between serum 25(OH)D levels and FBG(r=-0.171, P=0.027), FINS(r=-0.234, P=0.002), and HOMA-IR(r=-0.250, P=0.001).After adjusting for age, sex, body mass index, and daily outdoor activity time, multivariate linear regression demonstrated that log-transformed 25(OH)D levels were independently and inversely associated with FBG(β=-0.324, P=0.022), lnFINS(β=-0.241, P=0.048), and lnHOMA-IR(β=-0.312, P=0.017).

Vitamin D deficiency/insufficiency is prevalent among pubertal adolescents, and serum vitamin D levels show a significant inverse association with insulin resistance. These findings suggest the potential importance of vitamin D status in metabolic health during puberty.

This prospective cross-sectional study utilized convenience sampling, enrolling 2021-grade students from Jining No. 7 Middle School on June 5, 2023. Moderate-intensity exercise frequency was assessed via standardized questionnaires, serum 25-hydroxyvitamin D levels were measured using chemiluminescence, and triglyceride levels were determined via fully automated biochemical analysis. Spearman's rank correlation analysis was employed to examine the relationships among moderate-intensity exercise, triglyceride, and vitamin D. A mediation model was constructed using the Baron & Kenny causal steps approach, adjusting for confounders including age, sex, body mass index (BMI), dairy intake, sweet food consumption, and fast-food intake. Subgroup analyses were performed based on BMI. The significance of the mediation effect was confirmed using both the Bootstrap and Sobel tests.

A total of 354 adolescents meeting the inclusion criteria were enrolled, including 142 females (40.11%) and 212 males (59.89%), with a median age of 13.25(12.83, 13.83)years. Spearman's analysis revealed a significant negative correlation between moderate-intensity exercise and triglyceride levels (r=-0.21, P < 0.001), a significant negative correlation between vitamin D and triglyceride (r=-0.30, P < 0.001), and a significant positive correlation between moderate-intensity exercise and vitamin D levels (r=0.26, P < 0.001). The mediation model indicated that vitamin D partially mediated the triglyceride-lowering effect of exercise (52.22%, 95% CI: -0.027 to -0.009, P < 0.001), with the effect remaining significant after confounder adjustment (47.83%, 95% CI: -0.019 to -0.005). Subgroup analysis showed that in adolescents with BMI < 24 kg/m², vitamin D accounted for 82.01% of the mediation effect between exercise and triglyceride (95% CI: -0.022 to -0.005, P=0.005), which remained significant after adjustment (81.20%, 95% CI: -0.022 to -0.005, P=0.005). In contrast, among adolescents with BMI ≥24 kg/m², the mediation effect was nonsignificant before (3.38%, 95% CI: -0.014 to 0.009, P=0.760) and after adjustment (7.51%, 95% CI: -0.019 to 0.012, P=0.621).

Vitamin D serves as a key mediator in the triglyceride-lowering effect of exercise among adolescents, independent of age, sex, and dietary habits. This mediation effect is particularly pronounced in adolescents with BMI < 24 kg/m². The underlying mechanism may involve vitamin D-regulated lipid metabolism-related gene expression and suppression of inflammatory pathways, suggesting that targeting vitamin D signaling could be a potential molecular strategy for early intervention in adolescent dyslipidemia.

This prospective longitudinal cohort study employed convenience sampling to recruit adolescents receiving structured athletic training at Jining Sports Training Center in June 2023. Baseline measurements included height, weight, body mass index (BMI), blood pressure, heart rate, waist circumference, and hip circumference. Questionnaires assessed sleep duration, screen time, and household income. Follow-up measurements in June 2024 repeated these assessments while adding bioelectrical impedance analysis for body composition (lean mass, skeletal muscle mass, fat mass, and body fat percentage). Linear regression models examined associations between training type (direct-contact vs. non-contact sports) and follow-up body fat percentage, BMI, and waist circumference as dependent variables, adjusting for covariates.

The study included 110 adolescents (39 female, 71 male) with median age 13.21 years (IQR: 12.46-14.33). Participants comprised 65 direct-contact and 45 non-contact athletes. Baseline prevalence rates were 27.27% for overweight/obesity, 24.55% for elevated waist circumference, and 16.36% for elevated blood pressure. At follow-up, corresponding rates were 24.55%, 26.36%, and 13.64% respectively. The elevated blood pressure subgroup showed significantly higher waist circumference (P=0.034), elevated waist circumference rate (P=0.011), and body composition weight (P=0.049) compared to normotensive peers. Longitudinal analysis revealed 56.36% of participants increased BMI and 63.64% increased waist circumference. Adjusted linear regression demonstrated significant inverse associations between direct-contact training and body fat percentage (β=-6.57, 95% CI: -9.37 to -3.78, P < 0.001), BMI(β=-1.30, 95% CI: -2.50 to -0.11, P=0.036), and waist circumference(β=-2.31, 95% CI: -4.40 to -0.22, P=0.034).

Despite regular athletic training, substantial proportions of adolescents exhibited overweight/obesity, abdominal obesity, and elevated blood pressure, warranting clinical attention. Training modality appears to influence body composition changes, with direct-contact sports associated with more favorable adiposity-related outcomes.

This cross-sectional study used stratified sampling to select adolescents aged 11-15 years from a sports school and some ordinary middle schools in Shandong Province in June 2023. The participants were divided into two groups: competitive sports group (high exercise intensity), and general sports group (moderate exercise intensity), based on their exercise intensity. Ultrasound images of long bones from nine body regions (including 3 upper limb bones and 6 lower limb bones) were collected for both groups. Two sonographers interpreted the images and calculated the ultrasound OR values (the ratio of ossification center length to epiphyseal length on the standard ultrasound section). The intraclass correlation coefficient (ICC) was used to assess the consistency of image interpretation between the observers. Differences in ultrasound OR values between the two groups were compared, and multivariate Logistic regression analysis was performed to assess the correlation between ultrasound OR values and exercise intensity.

A total of 252 adolescents who met the inclusion and exclusion criteria were included, with 154 in the competitive sports group (97 males and 57 females) and 98 in the general sports group (52 males and 46 females). The median height and average daily exercise duration were significantly higher in the competitive sports group than in the general sports group (all P < 0.001). The overall ICC for the interpretation of ultrasound OR values of long bones at 9 sites in 50 adolescents by the two sonographers was 0.930 (range: 0.853-0.964), indicating excellent inter-observer consistency. The medial femoral ultrasound OR values were higher in the competitive sports group than in the general sports group for both males and females (males: 0.87±0.07 vs. 0.84±0.04, P=0.025; females: 0.90±0.06 vs.0.85±0.14, P=0.027). Additionally, the differences in ultrasound OR values between the groups were observed in the lateral femoral and fibular bones in males and the radial bone in females (all P < 0.05). Multivariate Logistic regression analysis showed that the reciprocal of the medial femoral ultrasound OR value was correlated with exercise intensity (OR=0.046, 95% CI: 0.012-0.145, P=0.043), indicating that a decrease of 0.1 in the reciprocal of the medial femoral ultrasound OR value (equivalent to an increase of approximately 0.05-0.10 in the ultrasound OR value) was associated with a 2.17-fold increase in the likelihood of high-intensity exercise.

The medial femoral ultrasound OR value was correlated with exercise intensity among adolescents. This indicator may serve as an objective imaging parameter for assessing whether adolescent exercise meets recommended standards.