Comparison between different types of exercise training in patients with type 2 diabetes mellitus: A systematic review and network metanalysis of randomized controlled trials
Abstract
Aim Aim of the present meta-analysis and network metanalysis (NMA) is the assessment of the effects of physical exercise on glucose control and cardiovascular risk factors in type 2 diabetes. Data synthesis This metanalysis includes all available trials exploring the effects of different exercise modalities in type 2 diabetes, with a duration of ≥3 months. The standardized difference in means (SDM) with 95% Confidence Intervals were calculated. Data were analyzed using MetaXL and Rev Man 5.0. Primary endpoint was the effect of exercise versus no exercise on HbA1c and fasting plasma glucose (FPG) at endpoint. Secondary endpoints were body weight and fat, waist circumference, and blood pressure. A comparison of different exercise training modalities (aerobic, resistance and combined) for the same endpoints was also performed, choosing 'no exercise' as the reference for indirect comparisons. We included 25 trials fulfilling all inclusion criteria. Physical exercise versus no exercise produced a small, but significant, improvement of HbA1c, body fat, and systolic blood pressure at endpoint (-0.3 [-0.1;-0.4]%, -1.44 [-2.22, -0.66]%, and -5.6 [-9.5, -1.6] mmHg, respectively). Combined, supervised aerobic and resistance exercise were associated with a significantly greater reduction of HbA1c (SDM, -0.4 [-0.6;-0.3], -0.2 [-0.4;-0.1], and -0.2 [-0.3;-0.1]%, respectively), but not of FPG, in comparison with no exercise. Conclusions Physical exercise produces small, but detectable, advantages on glycemic control and cardiovascular risk factors and should be suggested in type 2 diabetes. Combined aerobic/resistance training seems to be superior to aerobic training alone, but differences are small and the reliability of supporting evidence limited.
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No previous meta-analysis has found the optimal type or dose of physical activity to control HbA1c in type 2 diabetes.
“none found the optimal type or dose of physical activity to verify the validity and reliability of these recommendations”
From Optimal Dose and Type of Physical Activity to Improve Glycemic Control in People Diagnosed With Type 2 Diabetes: A Systematic Review and Meta-analysis (2024) · cites this paper as [13]
Two meta-analyses of 12 and 25 studies showed trivial or no differences in A1c between aerobic and resistance exercise groups.
“two meta-analyses of 12 (595 participants) and 25 studies (2578 participants), respectively, showed trivial or no differences in A1c between aerobic and resistance exercise groups.”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [36]
A meta-analysis of 25 studies found combined aerobic and resistance training decreased A1c by 0.4%, while aerobic and resistance training individually decreased A1c by 0.2%.
“a metaanalysis of 25 studies identified a decrease in A1c of 0.4% with combined aerobic and resistance training and a decrease of 0.2% for aerobic and resistance training individually.”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [36]
Multiple studies show hemoglobin A1c improvements of 0.5% to 0.7% with combined aerobic and resistance training.
“Multiple studies have shown significant improvements in hemoglobin A1c (0.5-0.7%) of patients with T2DM through a combination of aerobic and resistance training.”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [36]
Resistance training can demand more equipment, facilities, and trainer involvement, potentially reducing its accessibility.
“Resistance training may require more equipment, facilities, and involvement of professional trainers, which could impact accessibility.36”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [36]
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- Authors
- Mannucci, E., Bonifazi, A., & Monami, M.
- Affiliations
- Azienda Ospedaliero-Universitaria Careggi (IT)
- University of Florence (IT)
- Corresponding author
- Monami, Matteo
- Venue
- Nutrition, Metabolism and Cardiovascular Diseases
- Publisher
- Elsevier BV
- Published
- 2021-06
- Volume
- 31
- Issue
- 7
- Pages
- 1985-1992
- ISSN
- 0939-4753 (ISSN-L)
- OpenAlex
- W3139466974
- Cited by
- 64
- References
- 42
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 13 · 2023: 11 · 2022: 12 · 2021: 2
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nutrition Metabolism and Cardiovascular Diseases (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion)
- Funders
- Merck
- Novartis
- Boehringer Ingelheim
- Bristol-Myers Squibb
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- type 2 diabetes, exercise training, aerobic exercise, resistance training, concurrent training, glycemic control, HbA1c, fasting blood glucose, cardiovascular risk factors, fat mass, waist circumference, blood pressure, supervised exercise
- MeSH terms
- Network Meta-Analysis, Glycemic Control, Blood Glucose, Diabetes Mellitus, Type 2, Exercise Therapy, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Biomarkers, Randomized Controlled Trials as Topic, Treatment Outcome, Resistance Training
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