Aerobic exercise induces beneficial cardiometabolic health changes compared with standard treatment in patients with diabesity.

Aerobic exercise provides a complementary non-pharmacological management intervention, even without concomitant weight loss.

Future investigations should focus on longitudinal real-world aerobic exercise interventions and the dose-response effects.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the effects of aerobic exercise on cardiometabolic health-related indices in patients with type 2 diabetes and concurrent overweight/obesity (diabesity).

PubMed, Web of Science, Scopus, Science Direct, Cochrane Library, and Google Scholar databases were searched from inception to October 2024. The search strategy included the following keywords: diabetes, aerobic exercise, and endurance training. RCTs comparing aerobic exercise training ≥2 weeks in duration to standard treatment were considered eligible. Participants were adults with diabesity.

A total of 1391 middle-aged/older adult patients (55 % females) were included in 34 RCTs. Body mass index [standardized mean differences (SMD) -0.18 kg/m2, 95 % confidence intervals (CI) -0.36 to −0.01]. waist circumference (SMD -0.23 cm, 95 % CI -0.44 to −0.03), body fat (SMD -0.30 %, 95 % CI -0.59 to −0.01), fasting blood glucose (SMD -0.49 mmol/L, 95 % CI -0.72 to −0.27), glycated hemoglobin (SMD -0.79 %, 95 % CI -1.17 to −0.41), fasting insulin (SMD -0.44 mIU/L, 95 % CI -0.72 to −0.15), homeostatic model assessment for insulin resistance (SMD -0.72, 95 % CI -1.09 to −0.35), high-density lipoprotein cholesterol (SMD 0.32 mg/dL, 95 % CI 0.01 to 0.63), triglycerides (SMD -0.33 mg/dL, 95 % CI -0.63 to −0.04), and total cholesterol (SMD -0.28 mg/dL, 95 % CI -0.47 to −0.10) improved compared with standard treatment.

These results underscore the beneficial role of aerobic exercise as a non-pharmacological intervention in managing and treating patients with diabesity when compared to standard treatment, despite the presence of considerable uncertainty in several outcomes.

Exercise

Endurance training

Type 2 diabetes

Obesity

Body composition

Blood pressure

Glucose metabolism

Lipid metabolism

Chronic inflammation

Physical function

The data are available from the corresponding author upon reasonable request.

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