A randomized controlled trial of Baduanjin exercise to reduce the risk of atherosclerotic cardiovascular disease in patients with prediabetes

Demographics and Clinical Characteristics of Participants

As shown in Fig. 1, in May 2020, a total of 382 people were screened for this study, of whom 132 were eligible according to the inclusion criteria. One researcher used a random number table to randomly divide participants into three groups, with 44 people in each group. After one year of intervention (June 2020 to June 2021), 34 subjects were excluded due to relocation, disease incidence, insufficient exercise, incomplete data, or other factors. Thus, a total of 98 subjects completed this study, including 41 men and 57 women. Their average age was 59.35 ± 4.56 years. There were 34 participants in the BDJ group, 32 participants in the AT group, and 32 participants in the control group. We also studied the mean participation rate (%) of the two exercise groups, which was 88.24 ± 5.70% in the BDJ group and 87.29 ± 5.45% in the AT group. There was no significant difference in the attendance rate between the two groups (t = 0.687, p= 0.495, d = 0.169).

Basic data

Table 1 shows the basic data of the three groups. Chi-square tests and one-way analyzes of variance (ANOVA) revealed no significant differences between the groups at baseline (p> 0.05), indicating that the baseline data on each dependent variable among the three groups was homogeneous. Of the participants in our study, 73 (74.5%) were overweight or obese (BMI ≥ 24 kg/m²), 91 (92.9%) had abdominal obesity (WHtR > 0.5), 32 (32.7%) were taking antihypertensives and 31 (31.6%) were current smokers. Prior to the exercise intervention, some participants changed their antihypertensive drug dosage or smoking status, but during the intervention period, the number of participants taking antihypertensive drugs or smoking did not change; no participants took medications that affected blood glucose or blood lipid profiles.

Principle results

Comparison of blood glucose, blood lipid profiles, body shape, blood pressure and 10-year risk of ASCVD among the three groups

Tables 2, 3, 4, 5 report the results of the two-way repeated measures ANOVA used to assess group differences in dependent variables. According to the Shapiro‒Wilk test, all dependent variables were essentially normally distributed (p> 0.05). Box’s M test indicated that the variance-covariance matrix of the dependent variables was equal (p> 0.001). According to Mauchly’s sphericity test, none of the dependent variables satisfied the sphericity hypothesis (pp> 0.05). Repeated measures ANOVA indicated a significant effect of the Group × Time interaction on each dependent variable (pp

As shown in Table 2, at the 3rd month of intervention, both exercise groups showed significant decreases in FPG and 2-hPG compared to the control group (ppp= 0.029) and 12th month (d = 0.52, p= 0.036) of the intervention; aerobic exercise improved HbA1c to a greater extent. Compared to baseline, blood glucose and HbA1c in the control group increased significantly between 6 and 12 months of follow-up (pp

As shown in Table 3, at the 6th month of intervention, the BDJ and AT groups showed significant decreases in TC, TG, and LDL-C as well as significant increases in HDL-C compared to the control group (ppppp= 0.027).

Table 4 shows the comparison of body shape indicators. From the 6th month of intervention, the BDJ and AT groups showed significant decreases in waist circumference and weight compared to the control group (ppp

As shown in Table 5, in the control group, at 12 months follow-up, the 10-year risk of ASCVD in the control group was significantly higher than at baseline. [0.95 (− 0.33, − 1.57), p = 0.003]; the risk level has increased by 15.50%. Compared to the control group, at the 3rd month of intervention, both exercise groups showed significant decreases in the 10-year risk of ASCVD (BDJ: d = −0.51, p= 0.040; AT: d = − 0.66, p= 0.014). Over the intervention period, the improvement persisted and became more evident with the duration of the intervention. At the 12th month of intervention, the 10-year risk of ASCVD in the BDJ group and AT group was significantly lower than baseline [BDJ: − 2.05 (− 2.66, − 1.45), p < 0.001; AT: − 2.03 (− 2.65, − 1.41)], pp= 0.002).

Cox proportional hazards model for ASCVD risk over 10 years

Table 6 and Figure 2 show the results of the Cox proportional hazards model. Of the 98 participants, 55 (56.1%) had a decrease in their risk of ASCVD over 10 years, moving to low risk, and 43 participants had risk levels that remained or moved to low risk. medium or high. The results of the omnibus test show the importance of the new model (pp < 0.001] and AT group [HR = 6.895, 95% CI (2.693 to 17.654), p < 0.001] decreased significantly. Additionally, for hypertensive patients, the use of antihypertensives reduced the risk of ASCVD over 10 years [HR = 2.758, 95% CI (1.379 to 5.514), p = 0.004].

The evolution of the ASCVD risk trend at 10 years in the 3 groups.

Secondary results

As shown in Table 7, prediabetes has been divided into IFG and IGT. Before the intervention, there was no significant difference in the number of participants with IFG or IGT between the three groups (χ²= 2.541, p= 0.281). However, at the 12th month of intervention, there were significant differences in the number of people with different glycemic status between the three groups (χ²= 47.99, p2= 42.533, p2= 23.259, p2= 3.236, p= 0.198, d = 0.454).

Safety results

We performed a safety assessment when selecting participants for exercise abilities, and those who did not meet the inclusion criteria were excluded. Two weeks prior to the intervention, participants received tailored training to match the intensity of the exercise. During the intervention, we monitored participants’ subjective feelings, blood pressure, and heart rate. Those who could not continue due to illness or other reasons withdrew. No adverse events occurred during the intervention.