BACKGROUND: Although physical activity is considered to have significant benefits on health, individuals with diabetes mellitus type 2 are not physically active enough. The effectiveness of supervised exercise programmes in patients with intermittent claudication has been ascribed to the greater adherence to treatment. Physiotherapists could have an important role in encouraging and stimulating individuals to become physically active. It is not known whether supervised exercise programmes are more effective than usual care in increasing physical activity in patients with diabetes mellitus type 2. METHODS: Medline, Cochrane Central Register of Controlled Trials, PEDro, and Embase were searched for relevant studies published in the period 2000 to May 2009, as were the reference lists of the retrieved publications. Two authors independently assessed the methodological quality of the studies, using the Physiotherapy Evidence Database (PEDro) list. A best evidence synthesis was performed to obtain clinically relevant conclusions. RESULTS: Six randomized controlled trials comparing supervised exercise and advice met the inclusion criteria. The methodological quality ranged from 3 to 7 points. Best-evidence synthesis showed evidence that supervised exercise improved VO2max, muscle strength, and Hba1c in comparison with the effect of advice to increase physical activity. Studies with a high methodological quality also had the largest research populations. CONCLUSIONS: Despite the relatively small study populations, supervised exercise was shown to have short-term efficacy. Possible explanations for the greater effect of supervised exercise are higher training intensity, greater adherence to exercise, and less anxiety about possible adverse effects of exercise Patients with an active lifestyle had less benefit from stimulating increased treatment adherence. It is suggested that patients with a less active lifestyle should be included in supervised exercise programmes.

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