# Mind–body exercise for improving balance, aerobic capacity, walking ability, muscle strength, and mental health in patients with type 2 diabetes: a network meta-analysis

## TL;DR

This study compares mind-body exercises like Pilates and yoga to see how they improve balance, walking, and mental health in people with type 2 diabetes.

## Contribution

A network meta-analysis ranks mind-body exercises for their effects on physical and psychological outcomes in type 2 diabetes patients.

## Key findings

- Pilates significantly improves balance and walking ability in type 2 diabetes patients.
- Mindfulness-based interventions reduce anxiety in individuals with type 2 diabetes.
- Evidence certainty for psychological outcomes is very low, requiring further research.

## Abstract

To compare and rank the effects of different mind–body exercise interventions on psychological and physical outcomes in individuals with type 2 diabetes mellitus using a network meta-analysis.

This study systematically searched PubMed, Embase, Web of Science, and the Cochrane Library, and conducted a frequentist network meta-analysis using Stata with SUCRA-based ranking; risk of bias was assessed using RoB 2.0, certainty of evidence evaluated with CINeMA, and robustness examined through sensitivity analyses and publication bias assessment using funnel plots.

This study provides preliminary, outcome-specific evidence based on 13 randomized controlled trials involving over 500 individuals with type 2 diabetes mellitus. Network meta-analysis suggested that Pilates significantly improved balance ability (SMD = 1.52, 95% CI 0.77–2.28) and walking ability (SMD = 1.20, 95% CI 0.28–2.12) compared with control. Walking Meditation showed a favorable effect on aerobic capacity (SMD = 1.40, 95% CI 0.44–2.37), while yoga improved muscle strength (SMD = 0.79, 95% CI 0.26–1.33). Mindfulness-based interventions were associated with reduced anxiety (SMD = 1.05, 95% CI 0.46–1.63). Sensitivity analyses indicated that physical function outcomes were generally robust, whereas psychological outcomes were sensitive to influential studies. The certainty of evidence was predominantly very low according to CINeMA assessment.

This network meta-analysis provides preliminary, outcome-specific evidence that mind–body exercise may improve physical function in type 2 diabetes, while effects on psychological outcomes remain uncertain and warrant further high-quality research.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251133289.