The effect of exercise characteristics on HbA1c and other cardiovascular risk factors in adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 41457265 · doi:10.1186/s12933-025-03048-1
What was done
A systematic review and meta-analysis of randomized controlled trials across nine electronic databases (from inception to January 2025) evaluated the effects of various exercise modalities on HbA1c and concomitantly reported cardiovascular risk factors in adults with type 2 diabetes. Random-effects models pooled the outcomes, and subgroup analyses examined exercise characteristics such as supervision and volume.
What was found
The meta-analysis included 100 RCTs (7,195 participants, 136 interventions). All exercise types significantly reduced HbA1c, with the largest reductions seen in combined training (−0.74%, 95% CI [−0.91, −0.57], n=38) and high-intensity interval training (HIIT) (−0.71%, 95% CI [−1.07, −0.35], n=13), followed by continuous aerobic training (CAT) (−0.62%, 95% CI [−0.84, −0.41], n=57) and resistance training (−0.36%, 95% CI [−0.51, −0.20], n=38). Supervised sessions and weekly volumes of 150–210 min were most effective. VO2peak improved with CAT, combined training, and HIIT (+2.77 to +4.19 ml/kg/min); muscle strength improved with resistance and combined training (SMD: +0.44 to +0.66); all modalities reduced fasting plasma glucose (−0.60 to −1.13 mmol/L), LDL cholesterol (−0.18 to −0.31 mmol/L), and systolic blood pressure (−1.24 to −4.15 mmHg); body fat improved only after CAT, combined training, and HIIT (SMD: −0.36 to −0.59).
Why it matters
This review establishes the comparative effectiveness of different exercise regimens on glycemic control and comprehensive cardiovascular risk factors in type 2 diabetes, showing combined training offers the broadest benefits and HIIT is an effective time-efficient option.
Limits
The analysis evaluates surrogate biomarkers rather than hard clinical outcomes like cardiovascular events or mortality. Long-term intervention adherence, trial durations, adverse event rates, and between-study statistical heterogeneity metrics are not reported in the abstract.
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