Combined Exercise Training and Supervision: Impact on Cardiometabolic Risk Factors,Adherence,and Quality of Life in Adults With Type 2 Diabetes

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a major global and national public-health challenge. Most adults do not meet the aerobic and strength guidelines necessary for the prevention and management of the disease. Purpose: To synthesize evidence on how combined exercise training (CET: aerobic + resistance) affects cardiometabolic risk factors, adherence, and quality of life (QoL) in adults with T2DM; identify the impact of supervision features, and produce equity-focused, practice-ready recommendations. Methods: Narrative synthesis reporting CET effects on cardiometabolic risk factors, adherence, and QoL, emphasizing intervention parameters and supervision models. Results: CET consistently yields modest to clinically meaningful reductions in HbA1c and fasting glucose and improves body composition, lipids, blood pressure, vascular function, inflammatory markers (CRP, IL-6), myokine responses, and VO2max. Supervised CET produces larger effect sizes, greater adherence, better technique and safety, and stronger psychosocial benefits (self-efficacy, social support, QoL) than unsupervised/usual-care programs. Heterogeneity in modalities (MICT, HIIT), resistance intensity/equipment, scheduling, supervision models, outcome metrics, and underrepresentation of diverse populations limit definitive guidance. Conclusions: Supervised CET effectively improves cardiometabolic health and QoL in adults with T2DM. Standardized reporting, head-to-head trials of scheduling and supervision, and pragmatic studies in diverse settings are needed to support scalable implementation.

Keywords

combined exercise training type 2 diabetes supervision adherence quality of life

“Supervised combined aerobic-plus-resistance training (CET) yields larger cardiometabolic benefits than unsupervised or usual-care programs.”

Introduction

Type 2 diabetes mellitus (T2DM) is a rapidly expanding global public health problem. An estimated 589 million adults (11.1%) currently live with diabetes, the majority (90 - 95%) being T2DM. Prevalence, morbidity, and mortality are projected to rise to 853 million by 2050.^1–3 In the United States, in 2023, an estimated 40.1 million people (12%) had diabetes in 2023, of whom 90-95% had T2DM.^4,5 Globally, diabetes accounted for more than 1.6 million deaths in 2021 and contributed substantially to premature cardiovascular mortality.^2,3

T2DM is characterized by hyperglycemia, insulin resistance, and progressive β-cell dysfunction, which, if uncontrolled, can damage the heart, vasculature, eyes, kidneys, and nerves.⁶ Adults with T2DM are commonly overweight, obese, or have remarkable abdominal adiposity. These characteristics, which drive the increasing prevalence of the disease, are inextricably linked to obesogenic diets, physical inactivity, and population aging.^6,7 Regular physical activity (PA) remains a cornerstone strategy for the prevention and management of T2DM.^7,8 Current guidance recommends combined aerobic and resistance training (e.g., ≥150 minutes/week of moderate aerobic activity across ≥3 days plus resistance training on ≥2 nonconsecutive days). Higher targets of 200-300 minutes/week are recommended by the ACSM and the ADA for overweight/obese adults with T2DM.^5,9

Despite clear recommendations, adherence is poor: only about 24%–32% of adults with diabetes meet aerobic targets, about 11%–20% meet muscle-strengthening guidelines, and only 6%–12% meet both, with rates lower in nonmetropolitan and underserved communities.^4,10 Barriers include limited access to supervised programs, unclear clinical referral pathways, socioeconomic constraints, comorbidity, low motivation, and insufficient community resources.^11,12

Current evidence indicates that combined exercise training (CET) may exert a larger effect in improving glycated hemoglobin (HbA1c), body composition, lipid profiles, blood pressure BP), vascular function, and cardiorespiratory fitness (VO2max) more consistently than single-modality programs.^13–16 Additionally, there is evidence to suggest that supervision of exercise may play a critical role in mitigating these cardiometabolic effects and improving motivation, physical literacy, self-efficacy, social support, and quality of life,^17–20 which in turn could facilitate sustained behavior change and long-term adherence to exercise.

This synthesis will evaluate how supervised CET influences cardiometabolic outcomes, adherence, and QoL in adults with T2DM, identifying supervision features as effect modifiers, and will translate findings into equity-focused, practice-ready recommendations for clinicians, exercise professionals, and community program leaders.

Methods

We searched PubMed Central, ScienceDirect, and Google Scholar for English-language studies published from 2017 to 2026. Search terms combined synonyms for the clinical population, intervention, and outcomes using Boolean operators (e.g., “diabetes” OR “type 2 diabetes” AND “exercise” OR “physical activity” AND “combined” OR “combined training” AND “aerobic” AND “resistance” AND “adherence” AND “quality of life” AND “supervision”). Searches were limited to human studies of adults (≥18 years). Titles and abstracts were screened for relevance; full texts were retrieved when eligibility was uncertain.

Inclusion Criteria

We included studies of combined aerobic and resistance training in adults with T2DM that reported cardiometabolic outcomes (e.g., HbA1c, fasting glucose, lipids, blood pressure), adherence, or quality-of-life measures, with baseline and post-intervention data included. We prioritized randomized controlled trials (RCTs), controlled clinical trials, and high-quality observational and synthesis studies (systematic reviews/meta-analyses).

Exclusion Criteria

We excluded studies of type 1 or gestational diabetes, interventions that did not combine aerobic and resistance exercise, pediatric populations, non-human studies, and non-English reports.

Results

Twenty-three studies met the inclusion criteria. Designs comprised 12 RCTs, (13, 15, 16, 20, 22, 23, 24, 27, 28, 31, 32, 34), 5 systematic reviews/meta-analyses (14, 19, 25, 33, 35), 4 observational/epidemiologic or cohort analyses (1, 3, 4, 10), and 2 qualitative/adherence studies (17, 36). The RCTs were mainly short to medium-duration (8-52 weeks), with sample sizes ranging from ∼20-60 to ∼100-500. The largest pragmatic trials (e.g., STRRIDE-related) had the largest cohorts (15). The 5 syntheses pooled 6-20 trials each and reported pooled effects on HbA1c, fasting glucose, lipids, inflammatory markers, fitness, and body composition (14, 19, 25, 33, 35). Most RCTs enrolled mixed-sex samples (9 of 12: 15, 20-24, 28, 31, 32); 2 trials primarily recruited men, and one focused on postmenopausal women (34). Several syntheses conducted subgroup analyses by sex and other moderators when data allowed (19, 25).

Impact of Supervised CET on Cardiometabolic Risk Factors

CET involves aerobic + resistance training. Recent pooled evidence indicates that aerobic and resistance training can be performed in the same session, with dramatic cardiometabolic effects.²¹ However, this synthesis will focus on separate-day training for aerobic and resistance training. The cardiometabolic outcomes reported include glycemic control, body composition, lipid profile, insulin sensitivity/resistance, systemic inflammation, cardiovascular factors, and VO2max.

Glycemic Control (HbA1c & FBG)

Five randomized trials, one systematic review, and one meta-analysis report that CET reduces HbA1c and FBG in adults with T2DM. A community-based trial found no HbA1c change with once-weekly CET but demonstrated frequency-dependent benefits (≥3×/week, ∼50% adherence) in the higher-frequency arm.²² A 12-week trial showed significant reductions in fasting/postprandial glucose and HbA1c vs usual care,²⁰ and a 4-arm RCT reported lower FBG after CET vs controls.¹³ An 8-week supervised CET program (HIIT or MICT) produced comparable 8-week HbA1c improvements, though gains largely regressed at 12 months when adherence fell.²³ In normal-weight adults, CET and strength training yielded similar HbA1c declines.²⁴ A meta-analysis of 20 studies (n = 1192) found significant HbA1c reductions in overweight/obese adults,¹⁹ while a smaller meta-analysis reported no pooled HbA1c difference but greater FBG reductions vs aerobic training alone.²⁵ Overall, CET improves glycemia, but effect size and durability depend on dose, intensity, supervision, adherence, and study design; accompanying body-composition changes may partly mediate these benefits.²⁶

Body Composition

Four randomized controlled trials and one meta-analysis report meaningful improvements in body composition following CET. Banitalebi et al²⁷ found that sprint-interval and CET produced similar BMI reductions vs usual-care controls. Ambelu and Teferi’s head-to-head trial showed greater mean reductions in BMI and body-fat percentage in exercise groups after adjusting for diet, age, and sex.¹³ Francois et al²⁸ demonstrated that body-fat declines following HIIT plus once-weekly resistance were attributable to training and not augmented by post-exercise protein supplementation. Supervision emerged as a key modifier: fully supervised interventions and supervised-to-home hybrid programs (e.g., Gajanand et al²³) produced significant fat-mass decreases at 8 weeks, whereas gains often regressed by 12 months when supervision and adherence waned; brief supervised-then-home protocols also improved body fat vs HIIT or standard care while supervision persisted.²⁰ A meta-analysis of 20 CET studies (n = 1192) reported a pooled significant reduction in BMI.¹⁹ Collectively, evidence indicates that CET reliably reduces adiposity and BMI, which likely mediates improvements in insulin resistance and lipid profiles, and that sustained supervision/support enhances effect magnitude and durability.

Lipid Profile

Lipid abnormalities have been shown to contribute to insulin resistance, a metabolic component of T2DM, through multiple mechanisms. Conversely, insulin resistance can lead to lipid abnormalities.²⁹ The cluster of lipid abnormalities (Dyslipidemia)- includes high LDL cholesterol, low HDL cholesterol, and high triglycerides.³⁰ Of the included studies, one long-term RCT and 2 pooled analyses evaluated CET’s effects on lipids in adults with T2DM. In a 1-year trial comparing moderate-intensity continuous training + resistance (MCT + RT) vs high-intensity interval training + resistance training (HIIT + RT), Magalhães et al³¹ found significant improvements in HDL, LDL, and total cholesterol only in the HIIT + RT arm. A meta-analysis of 6 RCTs (n = 366) likewise reported that combined aerobic-resistance programs produced significant reductions in LDL-C and triglycerides, and increases in HDL-C, compared with aerobic training alone.²⁵ A larger comparative systematic review of 15 studies (≈1794 participants) concluded that CET yielded the most pronounced cardiovascular lipid benefits, including an approximate 10% reduction in LDL cholesterol.¹⁴ Collectively, supervised, adequately dosed CET, particularly when combined with higher-intensity aerobic work, appears to offer modest but clinically relevant improvements in lipid profiles among adults with T2DM.

Insulin Sensitivity/Insulin Resistance

Improvements in lipid metabolism frequently accompany enhanced insulin sensitivity. In a 10-week trial, Banitalebi et al³² reported significant HOMA-IR reductions for both sprint-interval and combined training vs control. Other RCTs found CET with high-intensity aerobic plus resistance lowered circulating insulin and inflammatory mediators linked to insulin resistance.^16,33 A comparative trial also showed greater HOMA-IR improvement for CET vs HIIT or usual care.²⁰ In a large 8-month RCT (n = 508) evaluating ten exercise modalities, Ross et al¹⁵ identified CET among the 3 modes that significantly improved LP-IR and diabetes-risk scores. Two meta-analyses^19,25 pooled multiple trials and confirmed combined training’s benefits on insulin-resistance biomarkers. Studies using supervised or supervised-to-home delivery generally reported larger, more durable improvements than unsupervised interventions, indicating supervision and adherence support are important effect modifiers. Improved lipid profile and insulin sensitivity are mechanistically linked to reduced systemic inflammation, better vascular function, and lower blood pressure in adults with T2DM.

Inflammatory Markers

CET reduces systemic inflammation in adults with T2DM across RCTs and meta-analyses. AL-Mhanna et al¹⁹ reported significant reductions in CRP, IL-6, and related markers after CET, with larger effects for interventions >12 weeks. In their 12-week RCT (n = 59), Sabouri et al¹⁶ demonstrated significant declines in IL-6 and CRP following CET and high-intensity protocols. A systematic review and meta-analysis³³ similarly found that CET programs improved inflammation markers in middle-aged and older adults with T2DM, supporting the anti-inflammatory effects of CET. The comparative systematic analysis by Mousavi Zadeh et al¹⁴ corroborates these findings across multiple studies, showing greater reductions in inflammatory markers with CET vs single modalities. Additionally, one study reported lower circulating apolipoprotein J after CET intervention in postmenopausal women.³⁴ Collectively, RCTs and pooled analyses indicate that supervised, adequately dosed CT meaningfully lowers systemic inflammation in T2DM.

Cardiac Vasculature and Blood Pressure

CET yields consistent vascular and blood-pressure benefits in adults with T2DM across randomized trials and pooled analyses. A 1-year RCT reported vascular remodeling and improved arterial stiffness indices after CET.³¹ Smaller intervention studies also show reductions in systolic and diastolic BP following combined training.¹³ Meta-analyses and systematic reviews corroborate these findings: Al-Mhanna et al¹⁹ found significant BP improvements after CET and a comparative review likewise reported larger cardiovascular gains, including 9/6 mmHg systolic/diastolic improvement in BP with CET vs single-modality training.¹⁴ Overall, supervised, adequately dosed CET over months reliably improves vascular function and lowers BP in T2DM. These findings underscore the importance of CET in reducing cardiovascular risk in adults with T2DM.

Cardiorespiratory Fitness (VO2max)

Combined evidence from 4 randomized trials and one recent meta-analysis shows CET reliably increases VO2max in adults with T2DM. RCTs^23,27,28 and related trials enrolled small-to-moderate samples (typically 20-150 participants per study) and ran from short (8-12 weeks) up to 1 year, reporting significant post-intervention VO2max gains following supervised CET protocols. The low-volume HIIT-style CET trial,²³ demonstrated meaningful improvements in VO2max with time-efficient sessions. Meta-analysis,¹⁹ pooling multiple trials confirms pooled VO2max increases, with larger effects linked to greater total weekly volume, adequate resistance intensity, and supervised delivery.

The high level of evidence examined and synthesized demonstrates that supervised CET yields consistent cardiometabolic benefits in adults with T2DM, including improvements in glycemic control, insulin sensitivity, body composition, lipid profiles, blood pressure/vascular function, inflammation, and VO2max. Effects were consistently larger and more durable when delivered with supervision. The results of the synthesis are summarized in Table 1.

Table 1.

Summary of Cardiometabolic Effects of Supervised CET in T2DM.

Outcome	Supervision level	Representative Studies (by reference number)
Glycemic control (HbA1c, FBG)	Mostly supervised (some community-based supervised; a few hybrid supervised→home	RCTs: 13,32, 20, 22, 23, 24, 28; MAs: 19,25,
Body composition (weight, BMI, % body fat, waist)	Predominantly supervised; hybrid models show short-term gains that regress if supervision lapses	RCTs: 13,32,27,28,23, 34 MAs: 19, 25
Lipid profile (LDL, HDL, TG, TC)	Supervised interventions, higher intensity or HIIT + RT, show larger changes	RCTs: 31,28,13; MAs: 14, 19, 25
Insulin resistance/sensitivity (fasting insulin, HOMA-IR, LP-IR)	Supervised CET yields consistent improvements; dose/intensity and supervision moderate effect size	RCTs: 13,32,28,15, 20; MAs: 19, 25, 33
Inflammatory markers (CRP, IL-6, myokines)	Supervised CET reduces inflammatory markers; effects are stronger in longer, supervised programs	RCTs: 16,13,28; MAs: 33, 19
Cardiac vasculature & blood pressure (arterial stiffness, BP, HRV)	Supervised, longer-duration trials (≥12 months) documented vascular remodeling and BP reductions; supervised HIIT + RT favorable	RCTs: 31); 27, 13; MAs: (14), (19)
Cardiorespiratory fitness (VO2max)	Supervised CET consistently increases VO2max; low-volume supervised HIIT + RT has been shown to be effective	RCTs: 13,32, 28, 23, 22; Mas: 19, 25

Exercise Prescription: Modalities, Intensity, Frequency, Duration

Strength Component

Across trials, resistance modalities included free weights, machines, resistance bands, and bodyweight. Intensity was typically moderate–high (60-80% 1-RM), with 2-4 sets of 8-15 repetitions per major muscle group, performed 2-3 nonconsecutive days per week. Programs incorporated progressive overload and were supervised to ensure technique and safe load progression, aligning with ACSM guidance for adults with T2DM.⁹ Study durations ranged from 8 weeks to 12 months (commonly 12 weeks to 1 year).

Aerobic Component

Aerobic modalities included treadmill, cycling, and brisk walking, usually delivered ∼3 sessions/week (range 2-5). Continuous aerobic training was prescribed at moderate intensity (≈50-75% HRmax or 60-70% VO2max) for 30-60 minutes per session; HIIT protocols used brief high-intensity intervals (80-95% HRmax) with lower-intensity recovery. Programs were generally supervised or partly supervised with progressive overload to maintain targets. These combined, supervised prescriptions (aerobic + resistance) consistently produced the most reliable cardiometabolic improvements in adults with T2DM.^5,9

Impact of Supervised CET on Adherence and Quality of Life

Supervised CET improves adherence and QoL in adults with T2DM across randomized trials and syntheses. Community-based supervised programs report superior engagement, retention, and greater cardiometabolic gains compared with less structured approaches.²² Low-volume supervised HIIT + Resistance CET produced strong short-term adherence and clinically meaningful improvements in fitness and glycemic control during the coached phase, though benefits diminished at 12-month follow-up as supervision and adherence declined, underscoring the need for sustained support.²³ Supervision enhances psychosocial mediators of long-term adherence: structured, coached interventions increase self-efficacy and perceived social support, correlating with greater ongoing activity.¹⁸ Qualitative analyses highlight that safe, supportive supervised settings foster competence and relatedness, transforming motivation and intrinsic engagement.¹⁷ Group-based supervised formats further boost peer accountability and persistence.

Quality of life improves alongside adherence and physiologic gains. Systematic reviews and RCTs report clinically meaningful improvements in QoL and physical function in supervised CET arms, especially in longer programs with behavioral supports.^19,21,25 Meta-analytic evidence identifies supervision, program dose, and intensity as consistent effect modifiers—supervised or partially supervised CET yields larger pooled effects on metabolic, fitness, and patient-reported outcomes than unsupervised care.^19,25,35 Overall, supervision substantially strengthens CET’s behavioral and health impacts in adults with T2DM. The psychosocial, adherence and Qol effects of supervised CET are summarized in Table 2.

Table 2.

Effects of Supervised Combined Exercise Training on Psychosocial Factors, Adherence, Qol, and Safety Outcomes in Adults With Type 2 Diabetes.

Outcome	Impact of Supervised CET	Representative studies (reference numbers)
Adherence (attendance, retention)	Higher session attendance, lower dropout, frequency-dependent benefits; supervision sustains short-term engagement	22, 23, 21
Self-efficacy, exercise fidelity & intensity control	Significant increases in confidence to exercise and manage activity routines following coached programs	18, 17, 21, 23, 22, 24
Self-efficacy, exercise fidelity & intensity control	Improved technique, ability to reach target intensities, progressive overload adherence	18, 17, 21, 23, 22, 24
Perceived social support/group cohesion	Enhanced peer support and accountability in supervised/group formats, aiding persistence	17, 18, 26
Quality of life (QoL)	Statistically and clinically meaningful gains (physical function, diabetes specific domains) when supervised and of sufficient duration	19, 21, 26
Psychological well-being (anxiety/depression)	Reductions in anxiety/depressive symptoms reported post-supervised CET	23, 26
Safety/adverse events	Lower technique-related injury risk when supervised; supervision facilitates safe progression for comorbid participants	22, 23, 24
Sustainability (maintenance post supervision)	Benefits often attenuate when supervision ceases; hybrid transition models improve longer-term maintenance	23, 22, 21

Conclusion

Supervised combined aerobic-plus-resistance training (CET) yields larger cardiometabolic benefits than unsupervised or usual-care programs. Randomized trials report greater reductions in HbA1c, fasting insulin/HOMA-IR, and blood pressure, as well as larger gains in VO2max and body composition with structured, supervised CET compared with routine or unsupervised exercise. Meta-analyses corroborate these findings, showing pooled improvements in glycemia, lipids, inflammatory markers, and BP for combined supervised training compared with comparators. Supervision consistently enhances adherence, exercise fidelity, and the magnitude and durability of metabolic gains.¹³ ^– 27

Supervised CET also strengthens psychosocial mediators of long-term activity: supervised programs increase attendance, self-efficacy, perceived social support, and quality of life, which reinforce sustained exercise behavior and health gains. Key limitations include heterogeneity in CET composition, scheduling, supervision model, intensity, frequency, duration, and outcome/adherence metrics, limiting comparability and meta-analytic precision. Many trials are small, single-site, short-term, and underrepresent older adults, racial/ethnic minorities, and low-resource settings, and the reliance on self-report for psychosocial outcomes raises measurement concerns.

Clinical Implication

Clinicians, exercise professionals, and community program leaders should prioritize supervised or hybrid CET (∼30-60 min of moderate aerobic ≈ activity 3×/week plus resistance training 2-3×/week at moderate–high intensity with progressive overload and embedded behavioral supports (group sessions, coached feedback, scheduled accountability).

Research Priorities

Future research in adults with T2DM should aim to conduct head-to-head RCTs comparing scheduling and supervision, undertake larger pragmatic trials across diverse settings, and evaluate implementation and cost-effectiveness to inform policy and scale up supervised CET in diabetes care. For scalability, hybrid supervision models (community-led groups, telehealth coaching, structured tapering) can retain accountability and feedback while reducing resource needs; embedding behavior-change techniques (goal setting, feedback, self-monitoring) and community linkages during supervised phases support transition to self-management and sustain activity post-supervision.

Footnotes

ORCID iDs

Ava T. Donaldson

Brian F. Foster

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

Ong

Stafford

McLaughlin

GBD 2021 Collaborators . Global, regional, and national burden of diabetes from 1990 to 2021, with projections to 2050: GBD 2021. Lancet. 2023;402(10397):203-234. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01301-6/fulltext#. Accessed February 14, 2026.

World Health Organization . Diabetes. Published November 14, 2024. https://www.who.int/news-room/fact-sheets/detail/diabetes. Accessed February 14, 2026.

International Diabetes Federation . Diabetes around the world in 2024: facts & figures. Published 2024. https://idf.org/about-diabetes/diabetes-facts-figures/. Accessed February 14, 2026.

Centers for Disease Control and Prevention . National diabetes statistics report. Published 15 May 2024. https://www.cdc.gov/diabetes/php/data-research/index.html

American Diabetes Association Professional Practice Committee . Diagnosis and classification of diabetes: standards of care in Diabetes—2025. Diabetes Care. 2025;48(Suppl 1):S27-S49. doi:10.2337/dc25-S008.

Jebari

Siddiqi

Uribe

Ostolaza

Martín

. Pathophysiology of type 2 diabetes mellitus. Int J Mol Sci. 2020;21(17):6275. doi:10.3390/ijms21176275.

Chan

Lim

Wareham

, et al. The lancet commission on diabetes: using data to transform diabetes care and patient lives. Lancet. 2020;396(10267):2019-2082. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32374-6/fulltex

Centers for Disease Control and Prevention . National diabetes statistics report - diabetes. 2024. https://www.cdc.gov/diabetes/php/data-research/index.html

Kanaley

Colberg

Corcoran

, et al. Exercise/physical activity in individuals with T2DM: ACSM consensus. Med Sci Sports Exerc. 2022;54(2):353-368. doi:10.1249/MSS.0000000000002800.

10.

Mortensen

Kristensen

Grøntved

Ried-Larsen

Lau

Skou

. Determinants of physical activity among 6,856 individuals with diabetes: a nationwide cross-sectional study. BMJ Open Diabetes Res Care. 2022;10(4):e002935. doi:10.1136/bmjdrc-2022-002935.

11.

Onufrak

Saelee

Zaganjor

, et al. Physical activity according to diabetes and metropolitan status, U.S., 2020 and 2022. Am J Prev Med. 2024;66(6):1008-1016. doi:10.1016/j.amepre.2024.01.023.

12.

Yao

Han

De Vito

, et al. Physical activity and glycemic control in Chinese patients with T2DM: secondary analysis of an RCT. Int J Environ Res Publ Health. 2021;18(8):4292. doi:10.3390/ijerph18084292.

13.

Ambelu

Teferi

. Impact of exercise modalities on blood glucose, BP, and body composition in T2DM. BMC Sports Sci Med Rehabil. 2023;15:153. doi:10.1186/s13102-023-00762-9.

14.

Mousavi Zadeh

Caminiti

Aracri

, et al. Comparative analysis of cardiovascular outcomes in T2DM patients engaging in aerobic, resistance, and combined training: systematic review. Diabetology. 2025;6(5):38. doi:10.3390/diabetology6050038.

15.

Ross

Slentz

Zidek

, et al. Effects of amount, intensity, and mode of exercise training on insulin resistance and type 2 diabetes risk in the STRRIDE randomized trials. Front Physiol. 2021;12:626142. doi:10.3389/fphys.2021.626142.

16.

Sabouri

Hatami

Pournemati

Shabkhiz

. Inflammatory, antioxidant and glycemic status to different mode of high-intensity training in T2DM. Mol Biol Rep. 2021;48:5291-5304. doi:10.1007/s11033-021-06539-y.

17.

Nielsen

Danielsen

Grønbæk

Molsted

Jacobsen

Varming

. Transforming motivation for exercise in a safe and kind environment—a qualitative study of experiences among individuals with type 2 diabetes. Int J Environ Res Publ Health. 2022;19(10):6091. doi:10.3390/ijerph19106091.

18.

Al-Ghafri

Al-Harthi

Al-Farsi

Craigie

Bannerman

Anderson

. Changes in self-efficacy and social support after an intervention to increase physical activity among adults with type 2 diabetes in Oman: 12-month follow-up of the MOVEdiabetes trial. Sultan Qaboos Univ Med J. 2021;21(1):e42-e49. doi:10.18295/squmj.2021.21.01.006.

19.

Al-Mhanna

Batrakoulis

Wan Ghazali

, et al. Effects of combined aerobic and resistance training: systematic review and meta-analysis. PeerJ. 2024;12:e17525. doi:10.7717/peerj.17525.

20.

Amaravadi

Ferreira

Vigário

. Comparative effects of combined aerobic and resistance training versus high-intensity interval training on insulin resistance, glycaemic control, body composition and quality of life in type 2 diabetes: a 12-week randomised controlled trial. PLoS One. 2025;20(12):e0336898. doi:10.1371/journal.pone.0336898.

21.

Zaki

Sharma

Vats

. Effectiveness of concurrent exercise training in people with T2DM: systematic review and meta-analysis. Physiother Theory Pract. 2024;40(9):2094-2115. doi:10.1080/09593985.2023.2225717.

22.

Mukherji

Qin

, et al. Effectiveness of a community-based structured physical activity program for adults with type 2 diabetes: randomized clinical trial. JAMA Netw Open. 2022;5(12):e2247858. doi:10.1001/jamanetworkopen.2022.47858.

23.

Gajanand

Cox

Keating

, et al. Low-volume combined aerobic and resistance high-intensity interval training in type 2 diabetes: a randomized controlled trial. BMJ Open Sport Exerc Med. 2024;10(4):e002046. doi:10.1136/bmjsem-2024-002046.

24.

Kobayashi

Long

Dan

, et al. Strength training is more effective than aerobic exercise for improving glycemic control and body composition in people with normal-weight type 2 diabetes: a randomized controlled trial. Diabetologia. 2023;66:1897-1907. doi:10.3389/fphys.2017.00528.

25.

Shu

Chen

Bai

Yang

Ding

. Intervention effect of combined resistance and aerobic exercise on type 2 diabetes: a meta-analysis. World J Diabetes. 2025;16(7):108121. doi:10.4239/wjd.v16.i7.108121.

26.

Igarashi

Akazawa

Maeda

. Effects of changes in body fat mass as a result of regular exercise on hemoglobin A1c in patients with type 2 diabetes mellitus: a meta-analysis. Int J Sport Nutr Exerc Metabol. 2023;33(4):209-221. doi:10.1123/ijsnem.2022-0217.

27.

Banitalebi

Kazemi

Faramarzi

Mardaniyan Ghahfarrokhi

Nasiri

Haghighi

. Effects of sprint interval or combined aerobic and resistance training on myokines in overweight women with type 2 diabetes: a randomized controlled trial. Life Sci. 2019;217:101-109. doi:10.1016/j.lfs.2018.11.062.

28.

François

Durrer

Pistawka

Halperin

Chang

Little

. Combined interval training and post-exercise nutrition in type 2 diabetes: a randomized controlled trial. Front Phys. 2017;8:528. doi:10.3389/fphys.2017.00528.

29.

Jahdkaran

Sistanizad

. From lipids to glucose: role of dyslipidemia in insulin resistance. J Steroid Biochem Mol Biol. 2025;250:106744. doi:10.1016/j.jsbmb.2025.106744.

30.

Bjornstad

Eckel

. Pathogenesis of lipid disorders in insulin resistance: a brief review. Curr Diabetes Rep. 2018;18(12):127. doi:10.1007/s11892-018-1101-6.

31.

Magalhães

Melo

Correia

, et al. Effects of combined training with different intensities on vascular health in patients with type 2 diabetes: a 1-year randomized controlled trial. Cardiovasc Diabetol. 2019;18:34. doi:10.1186/s12933-019-0840-2.

32.

Banitalebi

Mardaniyan Ghahfarrokhi

Faramarzi

Earnest

. Sprint interval training vs combined aerobic + resistance training in overweight women with type 2 diabetes. J Sports Med Phys Fitness. 2021;61(5):712-724. doi:10.23736/S0022-4707.20.11105-8.

33.

Xing

Yoong

Tan

Kusuyama

. Effect of aerobic and resistance exercise intervention on inflammaging in type 2 diabetes mellitus in middle-aged and older adults: a systematic review and meta-analysis. J Am Med Dir Assoc. 2022;23:823-830.e13. doi:10.1016/j.jamda.2022.01.055.

34.

Jeon

Kim

, et al. Combined aerobic and resistance exercise training reduces circulating apolipoprotein J levels and improves insulin resistance in postmenopausal diabetic women. Diabetes Metab J. 2020;44(1):103-112. doi:10.4093/dmj.2018.0160.

35.

Pan

Xun

, et al. Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Int J Behav Nutr Phys Activ. 2018;15:72. doi:10.1186/s12966-018-0703-3.