May the force be with you: Why resistance training is essential for subjects with type 2 diabetes mellitus without complications

Codella, Roberto; Ialacqua, Marta; Terruzzi, Ileana; Luzi, Livio

doi:10.1007/s12020-018-1603-7

Cited by 72Physical Activity and HealthDiabetes Treatment and ManagementDiabetes Management and Research

May the force be with you: Why resistance training is essential for subjects with type 2 diabetes mellitus without complications

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Codella, Roberto, Ialacqua, Marta, Terruzzi, Ileana, Luzi, Livio·2018·Endocrine

DOI 10.1007/s12020-018-1603-7

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Abstract

Physical activity, together with diet and pharmacological therapy, represents one of the three cornerstones in type 2 diabetes mellitus treatment and care. The therapeutic appeal of regular physical activity stems from: (i) its non-pharmacological nature; (ii) its beneficial effects on the metabolic risk factors associated with diabetes complications; (iii) its low costs. Evidence accumulated in the last years suggests that aerobic training-endurance training-constitutes a safe modality of intervention, achievable, and effective in diabetes treatment, whenever it is not limited by comorbidities. Aerobic training exerts insulin-mimetic effects and has been shown to lower mortality risk too. Anaerobic, intense physical activity, such as that of strength or power sports disciplines, is not univocally recognized as safe and simple to realize, however, it is important in stimulating energy and glucose metabolism. According to recent evidence, high-intensity training may be prescribed even in the face of cardiovascular diseases, peripheral vascular disease, or osteoarthritis. Some studies have shown resistance training to be more efficient than aerobic exercise in improving glycemic control. This review explores the most up-to-date indications emerging from literature in support of the beneficial effects of strength stimulation and resistance training in patients with type 2 diabetes without complications.

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Resistance exercise can increase muscle mass quantity and quality through the IGF-1/phosphatidylinositol-3 kinase/protein kinase-B pathways.
“An important effect of resistance exercise is that in can increase muscle mass quantity but also quality through the IGF-1/phosphatidylinositol-3 kinase/protein kinase-B pathways [227].”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [227]

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Osterberg, K. L., & Melby, C. L. (2000) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.10.1.71 · Cited by 87 · cited 2× · see citing works
“RT augments excess oxygen delivery post-training (EPOC, Excess Postexercise Oxygen Consumption) [59].”
Background
Resistance Training Improves Cardiovascular Risk Factors in Obese Women Despite a Significative Decrease in Serum Adiponectin Levels
Ibáñez, J., Izquierdo, M., Martínez‐Labari, C., Ortega, F. J., Grijalba, A., Forga, L., Idoate, F., García‐Unciti, M., Fernández‐Real, J. M., & Gorostiaga, E. M. (2009) · Obesity · doi:10.1038/oby.2009.277 · Cited by 80 · see citing works
Effects of Long-Term Exercise Interventions on Glycaemic Control in Type 1 and Type 2 Diabetes: a Systematic Review
Röhling, M., Herder, C., Roden, M., Stemper, T., & Müssig, K. (2016) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/s-0042-106293 · Cited by 75 · see citing works
Skeletal Muscle Microvascular-Linked Improvements in Glycemic Control From Resistance Training in Individuals With Type 2 Diabetes
Russell, R., Hu, D., Greenaway, T. M., Blackwood, S. J., Dwyer, R. M., Sharman, J. E., Jones, G., Squibb, K. A., Brown, A. A., Otáhal, P., et al. (2017) · Diabetes Care · doi:10.2337/dc16-2750 · Cited by 64 · see citing works
Impact of intensive lifestyle intervention on disability-free life expectancy: the Look AHEAD study
Gregg, E. W., Lin, J., Bardenheier, B., Chen, H., Rejeski, W. J., Zhuo, X., Hergenroeder, A. L., Kritchevsky, S. B., Peters, A. L., Wagenknecht, L. E., et al. (2018) · Diabetes Care · doi:10.2337/dc17-2110 · Cited by 64 · see citing works
Impact of Metformin on Exercise-Induced Metabolic Adaptations to Lower Type 2 Diabetes Risk
Malin, S. K., & Braun, B. (2016) · Exercise and Sport Sciences Reviews · doi:10.1249/jes.0000000000000070 · Cited by 56 · see citing works
Whole-body skeletal muscle mass is not related to glucose tolerance or insulin sensitivity in overweight and obese men and women
Kuk, J. L., Kilpatrick, K., Davidson, L. E., HUDSON, R. W., & Ross, R. L. (2008) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/h08-060 · Cited by 51 · see citing works
Impact of diabetes on muscle mass, muscle strength, and exercise tolerance in patients after coronary artery bypass grafting
Nishitani, M., Shimada, K., Sunayama, S., Masaki, Y., Kume, A., Fukao, K., Sai, E., Yamashita, H., Ohmura, H., Onishi, T., et al. (2011) · Journal of Cardiology · doi:10.1016/j.jjcc.2011.05.001 · Cited by 49 · see citing works
Effects of Aerobic Training, Resistance Training, or Both on Glycemic Control in Type 2 Diabetes: A Randomized Trial
Sigal, R. J., Kenny, G. P., Boulé, N. G., Wells, G. A., Prud'homme, D., Fortier, M., Reid, R. D., Tulloch, H., Coyle, D., Phillips, P., et al. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-6-200709180-00005 · Cited by 48 · see citing works
Resistance Training Improves Insulin Signaling and Action in Skeletal Muscle
Yaspelkis, B. B. (2006) · Exercise and Sport Sciences Reviews · doi:10.1097/00003677-200601000-00009 · Cited by 42 · see citing works
Active Subjects with Autoimmune Type 1 Diabetes have Better Metabolic Profiles than Sedentary Controls
Adamo, M., Codella, R., Casiraghi, F., Ferrulli, A., Macrì, C., Bazzigaluppi, E., Terruzzi, I., Inverardi, L., Ricordi, C., & Luzi, L. (2016) · Cell Transplantation · doi:10.3727/096368916x693022 · Cited by 34 · see citing works
Exercise as Medicine: Key Concepts in Discussing Physical Activity with Patients who have Type 2 Diabetes
Armstrong, M. J., & Sigal, R. J. (2015) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2015.09.081 · Cited by 29 · see citing works
“Dempsey's Trainer”
Beck, C. S. (2000) · Mayo Clinic Proceedings · doi:10.4065/75.1.3 · Cited by 27 · see citing works
Structured therapeutic education in diabetes: is it time to re-write the chapter on the prevention of diabetic complications?
Gazzaruso, C., Fodaro, M., & Coppola, A. (2016) · Endocrine · doi:10.1007/s12020-016-0947-0 · Cited by 27 · see citing works
Exercise recommendations for patients with type 2 diabetes
Dugan, J. A. (2015) · JAAPA · doi:10.1097/01.jaa.0000475460.77476.f6 · Cited by 25 · see citing works
Associations of Low-Intensity Resistance Training with Body Composition and Lipid Profile in Obese Patients with Type 2 Diabetes
Hamasaki, H., Kawashima, Y., Tamada, Y., Furuta, M., Katsuyama, H., Sako, A., & Yanai, H. (2015) · PLoS ONE · doi:10.1371/journal.pone.0132959 · Cited by 22 · see citing works
Hyperinsulinemia Inhibits Hepatic Peroxisomal β-Oxidation in Rats
Xu, L., Ash, M., Abdel‐aleem, S., Lowe, J. E., & Badr, M. (1995) · Hormone and Metabolic Research · doi:10.1055/s-2007-979912 · Cited by 17 · see citing works
Ultra-marathon 100 km in an islet-transplanted runner
Codella, R., Adamo, M., Maffi, P., Piemonti, L., Secchi, A., & Luzi, L. (2016) · Acta Diabetologica · doi:10.1007/s00592-016-0938-x · Cited by 13 · see citing works
Comparative Effectiveness of Patient Education Methods for Type 2 Diabetes
Sperl‐Hillen, J. M., Beaton, S. J., Fernandes, O. D., Worley, A. V., Vazquez‐Benitez, G., Parker, E. D., Lavin-Tompkins, J. M., Glasrud, P. H., Davis, H., Adams, K., et al. (2016) · Cited by 7 · see citing works
Treatment of Diabetes with Lifestyle Changes: Physical Activity
Codella, R., Terruzzi, I. M., & Luzi, L. (2018) · Endocrinology · doi:10.1007/978-3-319-27317-4_25-1 · Cited by 1 · see citing works

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Sorted by citations

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness
Firth, J., Siddiqi, N., Koyanagi, A., Siskind, D., Rosenbaum, S., Galletly, C., Allan, S., Caneo, C., Carney, R., Carvalho, A. F., et al. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30132-4 · Cited by 1,531 · see citing works
“…that strength and resistance training or so-called high-intensity interval training can have beneficial effects for both metabolic and mental health 349–351 • Given that enjoyment and satisfaction are key factors in determining exercise adherence, 352 offering a range of exercise options that…”
Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance
Papakonstantinou, E., Oikonomou, C., Nychas, G., & Dimitriadis, G. D. (2022) · Nutrients · doi:10.3390/nu14040823 · Cited by 199 · see citing works
Impaired skeletal muscle regeneration in diabetes: From cellular and molecular mechanisms to novel treatments
Espino-González, E., Dalbram, E., Mounier, R., Gondin, J., Farup, J., Jessen, N., & Treebak, J. T. (2024) · Cell Metabolism · doi:10.1016/j.cmet.2024.02.014 · Cited by 132 · see citing works
The Interplay between Oxidative Stress, Exercise, and Pain in Health and Disease: Potential Role of Autonomic Regulation and Epigenetic Mechanisms
Hendrix, J., Nijs, J., Ickmans, K., Godderis, L., Ghosh, M., & Polli, A. (2020) · Antioxidants · doi:10.3390/antiox9111166 · Cited by 74 · see citing works
“For instance, resistance exercises and aerobic physical activity are beneficial for patients with diabetes mellitus type 1 or 2 [16,17]—which are both conditions where oxidative stress plays a major role (for a review, see [18]).”
Background
Effects of exercise training on serum preptin, undercarboxylated osteocalcin and high molecular weight adiponectin in adults with metabolic syndrome
Rahimi, G. R. M., Bijeh, N., & Rashidlamir, A. (2019) · Experimental Physiology · doi:10.1113/ep088036 · Cited by 69 · see citing works
“Our results are consistent with findings of Kim et al. (2015), Dieli-Conwright et al. (2018) and Levinger et al. (2014), but differ from Colleluori et al. (2017).”
Result
Diabetic sarcopenia: metabolic and molecular appraisal
Giha, H., Alamin, O. A. O., & Sater, M. S. (2022) · Acta Diabetologica · doi:10.1007/s00592-022-01883-2 · Cited by 52 · see citing works
Higher Risk of Sarcopenia in Older Adults with Type 2 Diabetes: NHANES 1999–2018
Dai, S., Shu, D., Meng, F., Chen, Y., Wang, J., Liu, X., Xiao, X., Guo, W., & Chen, F. (2023) · Obesity Facts · doi:10.1159/000530241 · Cited by 63 · see citing works
“Regular moderate physical exercise (mostly 150 min per week) has been suggested for T2DM [40].”
Background
Pathogenesis and comprehensive treatment strategies of sarcopenia in elderly patients with type 2 diabetes mellitus
Hou, Y., Xiang, J., Wang, B., Duan, S., Song, R., Zhou, W., Tan, S., & He, B. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1263650 · Cited by 72 · see citing works
“Aerobic exercise can especially enhance insulin sensitivity, while resistance training and strength training can also signi ﬁ cantly improve insulin resistance (163, 164).”
Background
Beyond general resistance training. Hypertrophy versus muscular endurance training as therapeutic interventions in adults with type 2 diabetes mellitus: A systematic review and meta-analysis
Acosta‐Manzano, P., Rodriguez‐Ayllon, M., Acosta, F. M., Niederseer, D., & Niebauer, J. (2020) · Obesity Reviews · doi:10.1111/obr.13007 · Cited by 59 · see citing works
Exercise training to reduce cardiovascular risk in patients with metabolic syndrome and type 2 diabetes mellitus: How does it work?
Kränkel, N., Bahls, M., Craenenbroeck, E. M. V., Adams, V., Serratosa, L., Solberg, E. E., Hansen, D., Dörr, M., & Kemps, H. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318805158 · Cited by 56 · see citing works
Effectiveness of Resistance Training and Associated Program Characteristics in Patients at Risk for Type 2 Diabetes: a Systematic Review and Meta-analysis
Qadir, R., Sculthorpe, N. F., Todd, T., & Brown, E. C. (2021) · Sports Medicine - Open · doi:10.1186/s40798-021-00321-x · Cited by 45 · see citing works
“RT is an effective intervention to manage T2D and offers a valid alternative to AT, which can be more difficult to perform in individuals with certain comorbidities associated with T2D, such as obesity, osteoarthritis, peripheral vascular disease, and other physical disabilities [33, 34].”
Background
Resistance Training Safety during and after the SARS‐Cov‐2 Outbreak: Practical Recommendations
Gentil, P., de Lira, C. A. B., Souza, D., Jiménez, A., Mayo, X., Gryschek, A. L. D. F. P. L., Pereira, É. G., Alcaráz, P. E., Bianco, A., Paoli, A., et al. (2020) · BioMed Research International · doi:10.1155/2020/3292916 · Cited by 40 · see citing works
“Its benefits, largely mediated by strength gains, culminate in reductions in mortality rates in different populations [3–7] and expand to several areas such as blood pressure control [8], improved bone mineral density [9], depression management [10], cancer treatment [11], blood glucose management [12], and weight man…”
Background
Effect of Exercise Training on Some Anti-Inflammatory Adipokines, High Sensitivity C-Reactive Protein, and Clinical Outcomes in Sedentary Adults With Metabolic Syndrome
Gao, K.-L., Su, Z.-G., Meng, J., Yao, Y., Li, L.-G., Su, Y.-P., & Rahimi, G. M. M. (2023) · Biological Research for Nursing · doi:10.1177/10998004231195541 · Cited by 26 · see citing works
“When conducted correctly, resistance training can offer numerous functional bene ﬁ ts such as improved glucose tolerance and insulin sensitivity in type 2 diabetes (Codella et al., 2018), as well as enhancement of metabolism and ﬁ tness in sedentary individuals (Shaw & Shaw, 2005).”
Background
Resistance Exercise Improves Glycolipid Metabolism and Mitochondrial Biogenesis in Skeletal Muscle of T2DM Mice via miR-30d-5p/SIRT1/PGC-1α Axis
Zheng, L., Rao, Z., Wu, J., Ma, X., Jiang, Z., & Xiao, W. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252212416 · Cited by 25 · see citing works
Resistance Training in Face of the Coronavirus Outbreak: Time to Think Outside the Box
Gentil, P., Ramírez‐Campillo, R., & Souza, D. (2020) · Frontiers in Physiology · doi:10.3389/fphys.2020.00859 · Cited by 25 · see citing works
“, 2018), controlling blood glucose (Codella et al., 2018), weight management (Paoli et al.”
Background
Metabolic and hormonal responses to chronic blood-flow restricted resistance training in chronic kidney disease: a randomized trial
Deus, L. A., Corrêa, H. D. L., Neves, R. V. P., Reis, A. L., Honorato, F. S., de Araújo, T. B., Souza, M. K., Haro, A. S., Silva, V. L., Barbosa, J. M. D. S., et al. (2022) · Applied Physiology Nutrition and Metabolism · doi:10.1139/apnm-2021-0409 · Cited by 25 · see citing works
Acute exercise increases syndecan-1 and -4 serum concentrations
Lee-Ødegård, S., Kolset, S. O., Birkeland, K. I., Drevon, C. A., & Reine, T. M. (2019) · Glycoconjugate Journal · doi:10.1007/s10719-019-09869-z · Cited by 24 · see citing works
Fat‐Free Mass: Friend or Foe to Metabolic Health?
Oliver, C. J., Climstein, M., Rosic, N. N., Bosy‐Westphal, A., Tinsley, G. M., & Myers, S. P. (2025) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.13714 · Cited by 26 · see citing works
Fast walking is a preventive factor against new-onset diabetes mellitus in a large cohort from a Japanese general population
Iwasaki, M., Kudo, A., Asahi, K., Machii, N., Iseki, K., Satoh, H., Moriyama, T., Yamagata, K., Tsuruya, K., Fujimoto, S., et al. (2021) · Scientific Reports · doi:10.1038/s41598-020-80572-y · Cited by 23 · see citing works
The non-modifiable factors age, gender, and genetics influence resistance exercise
Viecelli, C., & Ewald, C. Y. (2022) · Frontiers in Aging · doi:10.3389/fragi.2022.1005848 · Cited by 23 · see citing works
Association between domain-specific physical activity and diabetes in Korean adults
Lee, E.-B., Hong, S., Min, J., Park, D., Cho, W., Suh, S., Lee, H., Lee, H., Kimm, H., Lee, D. H., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-92560-x · Cited by 20 · see citing works
Resistance Exercise Training Improves Metabolic and Inflammatory Control in Adipose and Muscle Tissues in Mice Fed a High-Fat Diet
Effting, P. S., Thirupathi, A., Muller, A. P., Pereira, B. D. C., Sepa-Kishi, D. M., Marqueze, L. F., Vasconcellos, F. F., Nesi, R. T., Pereira, T. C. B., Kist, L. W., et al. (2022) · Nutrients · doi:10.3390/nu14112179 · Cited by 20 · see citing works
“Thus, although imposing distinct metabolic demands on skeletal muscles, both AE and RT can favor weight loss and glycemic control [10,11].”
Background
Physical activity as a proxy to ameliorate inflammation in patients with type 2 diabetes and periodontal disease at high cardiovascular risk
Codella, R., Guardia, L. D., Terruzzi, I. M., Solini, A., Folli, F. B., Varoni, E. M., Carrassi, A., & Luzi, L. (2021) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2021.04.022 · Cited by 19 · see citing works
Strength training improves insulin resistance and differently affects mitochondria in skeletal muscle and visceral adipose tissue in high-fat fed mice
Costa, J. S. R., Fonseca, G. F. A. C., Ottone, N. C. D. S., Silva, P. A., Antonaccio, R. F., Silva, G., Rocha, M. D. S. A., Coimbra, C. C., Esteves, E. A., Mang, Z. A., et al. (2021) · Life Sciences · doi:10.1016/j.lfs.2021.119639 · Cited by 17 · see citing works
Mechanisms of endurance and resistance exercise in type 2 diabetes mellitus: A Narrative review
Zhao, X., Huang, F., Sun, Y., & Li, L. (2025) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2025.151731 · Cited by 14 · see citing works
May the Force and Mass Be With You—Evidence-Based Contribution of Mechano-Biological Descriptors of Resistance Exercise
Viecelli, C., & Aguayo, D. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2021.686119 · Cited by 14 · see citing works
“, 2016), improved insulin sensitivity controlling blood glucose (Codella et al., 2018), weight management (Paoli et al.”
Background
Exercise, Nutrition, and Supplements in the Muscle Carnitine Palmitoyl-Transferase II Deficiency: New Theoretical Bases for Potential Applications
Negro, M., Cerullo, G., Parimbelli, M., Ravazzani, A., Feletti, F., Berardinelli, A. L., Cena, H., & D’Antona, G. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.704290 · Cited by 15 · see citing works
Is Physical Exercise in Hypoxia an Interesting Strategy to Prevent the Development of Type 2 Diabetes? A Narrative Review
Groote, E. D., & Deldicque, L. (2021) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s322249 · Cited by 14 · see citing works
Short-term Resistance Training Increases APPL1 Content in the Liver and the Insulin Sensitivity of Mice Fed a Long-term High-fat Diet
Minuzzi, L. G., Kuga, G. K., Breda, L., Gaspar, R. C., Muñoz, V. R., Pereira, R. M., Botezelli, J. D., da Silva, A. S. R., Cintra, D. E., de Moura, L. P., et al. (2019) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-0885-9872 · Cited by 13 · see citing works
One Bout of Resistance Training Does Not Enhance Metformin Actions in Prediabetic and Diabetic Individuals
Moreno‐Cabañas, A., ORTEGA, J. F., Morales‐Palomo, F., Ramírez-Jiménez, M., Álvarez-Jiménez, L., & Mora‐Rodríguez, R. (2022) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002889 · Cited by 12 · see citing works
Photobiomodulation Therapy on the Treatment of Insulin Resistance: A Narrative Review
Magalhães, F. D. C., & Ferraresi, C. (2022) · Photobiomodulation Photomedicine and Laser Surgery · doi:10.1089/photob.2022.0031 · Cited by 12 · see citing works
Proof of Concept of a 6-Month Person-Oriented Exercise Intervention ‘MultiPill-Exercise’ among Patients at Risk of or with Multiple Chronic Diseases: Results of a One-Group Pilot Trial
Schweda, S., Munz, B., Burgstahler, C., Niess, A. M., Roesel, I., Sudeck, G., & Krauß, I. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159469 · Cited by 10 · see citing works
Different eccentric‐based power training volumes improve glycemic, lipidemic profile and body composition of females in a dose‐dependent manner: Associations with muscle fibres composition adaptations
Methenitis, S. K., Nomikos, T., Mpampoulis, T., Kontou, E., Kiourelli, K., Evaνgelidou, E., Papadopoulos, C., Papadimas, G. K., & Terzis, G. D. (2022) · European Journal of Sport Science · doi:10.1080/17461391.2022.2027024 · Cited by 9 · see citing works
“Manzano, Rodriguez-Ayllon, Acosta, Niederseer, & Niebauer, 2020; Ashton et al., 2020; Codella et al., 2018; Costa et al., 2019).”
BackgroundMethodResultInfluential
Exploring molecular mechanisms of exercise on metabolic syndrome: a bibliometric and visualization study using CiteSpace
Wan, K., Jin, Y., Fan, R., Xu, Q., Li, X., Yan, H., & Wang, R. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1408466 · Cited by 8 · see citing works
“Consequently, research has shown that therapies combining endurance and resistance training are more effective in improving glycemic control, anti-in ﬂ ammatory responses, and body composition (23 – 28).”
Background
Effects of aerobic exercise training on mental health and arterial stiffness in middle-aged and older adults
Akazawa, N., Tanahashi, K., Kosaki, K., Oikawa, S., Kumagai, H., & Maeda, S. (2021) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.20.11751-1 · Cited by 8 · see citing works
Resistance Training before, during, and after COVID-19 Infection: What Have We Learned So Far?
Gentil, P., de Lira, C. A. B., Vieira, C. A., Ramírez‐Campillo, R., Haghighi, A. H., Clemente, F. M., & Souza, D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19106323 · Cited by 7 · see citing works
“In this regard, previous evidence shows that RT can help to control blood pressure [43,44], blood glucose [45], body weight [46], and blood lipids [47]; therefore, it can mitigate complications in cases of contamination.”
Method
Diabetes and sarcopenia: A bibliometric exploration of mechanisms, comorbidities, and therapeutic frontiers—an evidence mapping study
Chen, L., Zheng, J., Ye, B., Huang, Y., & Wang, Z. (2025) · Experimental Gerontology · doi:10.1016/j.exger.2025.112874 · Cited by 6 · see citing works
Gut related inflammation and cardiorespiratory fitness in patients with CAD and type 2 diabetes: a sub-study of a randomized controlled trial on exercise training
Aune, S. K., Byrkjeland, R., Solheim, S., Arnesen, H., Trøseid, M., Awoyemi, A., Seljeflot, I., & Helseth, R. (2021) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-021-00655-2 · Cited by 6 · see citing works
“Abbreviations CAD: Coronary artery disease; CVD: Cardiovascular disease; T2DM: Type 2 diabetes mellitus; VO2peak: Peak oxygen uptake; sCD14: Soluble cluster of differentiation 14; LPS: Lipopolysaccharide; LBP: LPS-binding protein; I-FABP: Intestinal fatty-acid binding protein; TLR4: Toll-like receptor 4; GOLD: Global…”
BackgroundInfluential
Effects of a 12-week lower limb resistance training with breathing regulation in patients with diabetes-related foot ulcers: A randomized controlled trial
Wu, J.-L., Yeh, M., & Liao, J. (2025) · Applied Nursing Research · doi:10.1016/j.apnr.2025.151911 · Cited by 5 · see citing works
The Significant Role of Physical Activity and Exercise in Health and Metabolic Diseases
Dimitriadis, G., Chryssanthopοulos, C., Philippou, Α., & Koutsilieris, M. (2025) · Physiologia · doi:10.3390/physiologia5040057 · Cited by 9 · see citing works
“A key effect of resistance exercise is its ability to enhance both the quantity and quality of muscle mass through the IGF-1/phosphatidylinositol 3-kinase/protein kinase B pathways [96,97].”
Muscular Adaptations to Concurrent Resistance Training and High-Intensity Interval Training in Adults with Type 2 Diabetes: A Pilot Study
Orlando, G., Pugh, J. K., Faulkner, S. H., Balducci, S., Sacchetti, M., Pugliese, G., Bazzucchi, I., Haxhi, J., Martinez‐Valdes, E., Falla, D., et al. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20186746 · Cited by 4 · see citing works
Photobiomodulation Enhances the Effect of Strength Training on Insulin Resistance Regardless of Exercise Volume in Mice Fed a High‐Fat Diet
Costa, J. S. R., Silva, G., Guimarães, I. C., Silva, L. F. R., da Silva, S. S., Almeida, J. P. D. P., Coimbra, C. C., Parizotto, N. A., Gripp, F., Dias‐Peixoto, M. F., et al. (2024) · Journal of Biophotonics · doi:10.1002/jbio.202400274 · Cited by 4 · see citing works
“Specifically, improvement in glucose metabolism has been observed in response to ST in individuals living with T2DM [10, 12, 13], with prediabetes [14], with obesity [15, 16], with overweight [17], and in healthy individuals [11].”
Brief periods of resistance training enhance insulin sensitivity in humans
Katz, A. (2019) · Experimental Physiology · doi:10.1113/ep087607 · Cited by 4 · see citing works
“mitochondrial function and glycogenesis in skeletal muscle (Codella et al., 2018).”
Background
A Metabolic Profile of Peripheral Heart Action Training
Mang, Z. A., Moriarty, T. A., Realzola, R. A., Millender, D. J., Wells, A. D., Houck, J. M., Bellissimo, G. F., Fennel, Z. J., Beam, J. R., Mermier, C. M., et al. (2021) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2020.1856315 · Cited by 4 · see citing works
“Aerobic fitness and muscular strength are both independently associated with longevity and metabolic health (Codella et al., 2018; Kim et al., 2018) and CRT can help improve both parameters over time.”
Background
Impact of the COVID-19 pandemic on the physical and mental health of the elderly
Silişteanu, S. C. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-85174-9.00012-1 · Cited by 6 · see citing works
Effects of the association of different volumes of strength training with photobiomodulation therapy on insulin resistance: A protocol for a randomized, triple-blind, placebo-controlled trial
Ferreira, P. P. R., Silva, L. F. R., Dias‐Peixoto, M. F., Cassilhas, R. C., Gripp, F., Amorim, F. T., Mang, Z. A., Esteves, E. A., Tricoli, V., Ferraresi, C., et al. (2022) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2022.100984 · Cited by 4 · see citing works
“previously sedentary or physically inactive insulin-resistant, obese individuals, performing aerobic exercise can be difficult, uncomfortable, even painful [55], and for these subjects, strength training might be a viable option [12].”
Background
Do assessments of cardiorespiratory and muscular fitness influence subsequent reported physical activity? A randomized controlled trial
Langland, J. T., Sathnur, N., Wang, Q., & Olson, A. P. J. (2021) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-021-00295-z · Cited by 4 · see citing works
Impacts of a 12-week aerobic, resistance, and combined exercise training on serum FAM19A5, glucose homeostasis, and novel cardiovascular risk factors among adults with obesity
Mir, E., Shamseddini, A., Rahimi, N., & Bazgir, B. (2024) · International Journal of Diabetes in Developing Countries · doi:10.1007/s13410-024-01315-7 · Cited by 3 · see citing works
“Neverthe-less, it has been reported that resistance training can afford valuable benefits, including ameliorating glucose tolerance and insulin sensitivity in type 2 diabetes patients [24] and enhancing fitness in sedentary individuals [25] when correctly performed.”
Effects of short-term resistance training on oxidative stress, lipid panel, liver and kidney function in patients with and without type 2 diabetes
Sousa, C. V., Filho, A. S. S., Aguiar, S. D. S., Souza, G. V. E., Guerra, M. F., Ernesto, C., Guido, M., Cantão, E. W., Bezerra, M. L. D. D., Inácio, P. A., et al. (2024) · Manual Therapy Posturology & Rehabilitation Journal · doi:10.17784/mtprehabjournal.2024.22.1335 · Cited by 3 · see citing works
Impact of resistance exercise program on muscle strength, cardiopulmonary function and glycolipid metabolism of bedridden population aged 80 years and above: A randomized controlled trial
Wang, Y., Huo, X., Wang, X.-J., Zhu, H., Lai, X., & Yu, T. (2024) · Medicine · doi:10.1097/md.0000000000038412 · Cited by 3 · see citing works
“Codella et al [49] found that resistance exercise with exercise time ≥ 12 weeks and intensity of 60% to 80% 1RM significantly improved the blood lipid metabolism of patients, but the resistance movement mode in their study was with the help of sports equipment, so this conclusion could not be…”
Background
Sarcopenia
Bloomgarden, Z. T. (2024) · Journal of Diabetes · doi:10.1111/1753-0407.70025 · Cited by 2 · see citing works
“…resistance training, reduce visceral fat, increase fat-free mass, increase strength, and reduce inflammatory cytokine levels, with reduction in triglyceride and HbA1c levels among persons with diabetes, 27 leading to consensus statements suggesting that exercise therapy be more widely utilized.”
Microcirculatory Responses to Muscle and Tendon Exercises in Individuals With and Without Type 2 Diabetes Mellitus and the Association Between Microcirculatory and Exercise Performance
Lai, Y.-C., Chao, Y.-H., Kuo, C.-Y., Lee, W.-N., Chuang, L., Shih, T. T., Rolf, C., & Wang, H. (2021) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2020.0111 · Cited by 2 · see citing works
“11 However, high-intensity resistance or isometric exercises are observed to be accompanied by acute cardiovascular hemodynamic changes consisting of increases in systolic, diastolic, and mean arterial pressure, 11 as well as, decreases of soft tissue oxygen saturation ( SpO 2 ) ( i.e. , the oxygen…”
Resistance Exercise and Cardiovascular Disease in Diabetes Mellitus
Yoon, J.-H. (2022) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes22038 · Cited by 2 · see citing works
The role of resistance training in improving beta-cell function in type 2 diabetes: a systematic review and meta-analysis
Li, H., Fang, Y., & Zhang, W. (2026) · BMC Endocrine Disorders · doi:10.1186/s12902-026-02286-y · Cited by 1 · see citing works
“Strategies that preserve β-cell function are therefore essential for slowing disease progression and reducing long-term complications [2, 5, 7].”
Is there a different rating of perceived exertion in men with type 2 diabetes mellitus?
Schwensfeier, L., Kreutz, T., & Brinkmann, C. K. (2023) · Journal of Diabetes & Metabolic Disorders · doi:10.1007/s40200-023-01261-x · Cited by 1 · see citing works
The Effect of Effort During a Resistance Exercise Session on Glycemic Control in Individuals Living With Prediabetes or Type 2 Diabetes: Protocol for a Crossover Randomized Controlled Trial
Ramirez, M., Gebauer, M., Mermier, C. M., Little, J. P., Lin, L., Palley, G., Hsiao, Y., Mota, R. I., Mang, Z. A., Amorim, F. T., et al. (2024) · JMIR Research Protocols · doi:10.2196/63598 · Cited by 1 · see citing works
“Although aerobic exercise is usually the default choice for T2D treatment and prevention [7], resistance exercise is also a viable option for physically inactive individuals living with prediabetes and T2D [12,13].”
Background
The Effects of Turmeric Intake Alone or in Combination with Resistance Training on Liver Enzymes in Adult Men
Paek, S.-J., Lee, S.-H., Park, J. S., Kim, J.-S., & Park, D. (2021) · Exercise Science · doi:10.15857/ksep.2021.30.2.183
“당 조절에 있어서 유산소 운동 효과보다도 저항성 운동이 효과적이라 고 제안하고 있다[41].”
Exercise Training Alleviates Cognitive Functions in Diabetic Rats through HMGB1/RAGE/NF-kB PathwayPreprint
Wang, Y., & Wang, C. (2021) · Research Square · doi:10.21203/rs.3.rs-605807/v1
Efeitos de um programa de exercício físico sobre a aptidão física relacionada à saúde em mulheres com diabetes tipo 2: um estudo experimental
Aragão, R. A. C., de Vasconcelos, A. R., do Nascimento, M. E. Q. H., Ribeiro, J. N. D. S., Costa, K. B., & Vancea, D. M. M. (2022) · Revista de Educação Física / Journal of Physical Education · doi:10.37310/ref.v90i4.2809
Research Progress on the Effect of Exercise Rehabilitation on Functional Level and Physical Fitness
Yin, L., Zheng, Y. P., Lijuan, W. U., Ni, X., & Chen, L. (2021) · Rehabilitation Medicine · doi:10.3724/sp.j.1329.2021.05013
Exercício físico e sistema purinérgico
Falqueto, H., Júnior, J. L. R., Cardoso, A. M., & Manfredi, L. H. (2021) · Editora UFFS eBooks · doi:10.7476/9786586545494.0004
Specific Physical Exercises Adapt to Patients with Obesity or with Diabetes Mellitus (Type 1 and Type 2)
Codella, R. (2023) · Springer eBooks · doi:10.1007/978-3-031-27192-2_16
Therapeutic Boxing: Narrative Review About Boxing as Therapeutic Tool
Molina, J. S., & Mahecha, S. M. (2024) · SVOA Orthopaedics · doi:10.58624/svoaor.2024.04.074
Metabolik Sendrom, Modern Yaşam ve Enerji Mekanizması
Çetin, B. (2024) · Özgür Yayınları eBooks · doi:10.58830/ozgur.pub499.c2104
Pathophysiology of diabetes-induced complications: A systematic review concerning the preventive role of dietary polyphenols, probiotics and physical activity
Miran, M., Kamandloo, F., Salami, M., Buttar, H. S., Dahiya, R., Télessy, I. G., & Wilson, D. W. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-22300-6.00007-3
Additional file 2 of Gut related inflammation and cardiorespiratory fitness in patients with CAD and type 2 diabetes: a sub-study of a randomized controlled trial on exercise training
Aune, S. K., Byrkjeland, R., Solheim, S., Arnesen, H., Trøseid, M., Awoyemi, A., Seljeflot, I., & Helseth, R. (2021) · Figshare · doi:10.6084/m9.figshare.14361701
Additional file 1 of Gut related inflammation and cardiorespiratory fitness in patients with CAD and type 2 diabetes: a sub-study of a randomized controlled trial on exercise training
Aune, S. K., Byrkjeland, R., Solheim, S., Arnesen, H., Trøseid, M., Awoyemi, A., Seljeflot, I., & Helseth, R. (2021) · Figshare · doi:10.6084/m9.figshare.14361698
Additional file 3 of Effectiveness of Resistance Training and Associated Program Characteristics in Patients at Risk for Type 2 Diabetes: a Systematic Review and Meta-analysis
Qadir, R., Sculthorpe, N. F., Todd, T., & Brown, E. C. (2021) · Figshare · doi:10.6084/m9.figshare.14702623
Additional file 1 of Effectiveness of Resistance Training and Associated Program Characteristics in Patients at Risk for Type 2 Diabetes: a Systematic Review and Meta-analysis
Qadir, R., Sculthorpe, N. F., Todd, T., & Brown, E. C. (2021) · Figshare · doi:10.6084/m9.figshare.14702617
Additional file 2 of Effectiveness of Resistance Training and Associated Program Characteristics in Patients at Risk for Type 2 Diabetes: a Systematic Review and Meta-analysis
Qadir, R., Sculthorpe, N. F., Todd, T., & Brown, E. C. (2021) · Figshare · doi:10.6084/m9.figshare.14702620
Optimal exercise dose for resistance training to improve HbA1c levels in overweight and obese patients with type 2 diabetes: a systematic review of randomized controlled trials and a Bayesian network meta-analysis
Li, H., Yang, S., Wang, X., Wang, Z., Zhang, W., Zhang, X., & Shouliang, H. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1867073
“…is because the abnormal glucose metabolism in patients with T2DM primarily manifests as changes in peripheral glucose metabolism; since skeletal muscle is the main peripheral site where insulin stimulates glucose uptake, skeletal muscle mass becomes a key in ﬂ uencing factor (Codella et al., 2018).”

Authors: Codella, R., Ialacqua, M., Terruzzi, I., & Luzi, L.
Affiliations: University of Milan (IT)
IRCCS Ospedale San Raffaele (IT)
Corresponding author: Codella, Roberto
ORCID: Codella, Roberto
Terruzzi, Ileana
Luzi, Livio
Venue: Endocrine
Publisher: Springer Science and Business Media LLC
Published: 2018-05-05
Volume: 62
Issue: 1
Pages: 14-25
ISSN: 0969-711X (ISSN-L)
1355-008X
1559-0100
DOI: 10.1007/s12020-018-1603-7
OpenAlex: W2799876477
Cited by: 72
References: 97
Citations by year: 2026: 2 · 2025: 6 · 2024: 12 · 2023: 5 · 2022: 16 · 2021: 21 · 2020: 4 · 2019: 5 · 2018: 1
FWCI: 1.02
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Endocrine (publishedVersion)
PubMed (publishedVersion)
Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords: type 2 diabetes, resistance training, high-intensity training, aerobic exercise, glycemic control, physical activity, insulin sensitivity, exercise safety, diabetes complications
MeSH terms: Blood Glucose, Diabetes Mellitus, Type 2, Humans, Insulin Resistance, Physical Fitness, Exercise, Resistance Training

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May the force be with you: Why resistance training is essential for subjects with type 2 diabetes mellitus without complications

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