Obesity is a worldwide epidemic affecting adults and children, regardless of their socioeconomic status. Significant progress has been made in understanding the genetic causes contributing to obesity, shedding light on a portion of cases worldwide. In young children with severe obesity however, recessive mutations, i.e., leptin or leptin receptor deficiency should be sought. Much more has been learned about the far-reaching impact of obesity on complications, including cardiovascular disease, liver and kidney dysfunction, diabetes, inflammation, hypertension, sleep, cancer, and the eye. Preventive strategies, particularly in children, are crucial for reducing obesity rates and mitigating its long-term complications. While dietary modifications and lifestyle changes remain the cornerstone of obesity prevention or treatment, recent advancements have introduced highly effective pharmacological options complementing weight-reduction surgery. Newer medications, like incretin-based therapies including glucagon-like peptide-1 agonists (GLP-1RA), have demonstrated remarkable efficacy in promoting weight loss, offering new insights into margining obesity-related conditions. Primary care providers, whether treating adults or children, play a pivotal role in preventing obesity, initiating treatment, and making onward referrals to specialists to assist in managing obesity and obesity-related complications.

Obesity adversely impacts musculoskeletal health, contributing to functional limitations and an increased risk for falls, fractures and disability. Weight loss can mitigate these effects, but strategies that neglect to incorporate evidence-based dietary and/or exercise approaches can exacerbate musculoskeletal and functional declines. Sustainable weight loss requires a personalised approach that prioritises adequate protein intake and essential nutrients to preserve musculoskeletal health. To enhance adherence and long-term success, dietary strategies should be practical, nutritionally balanced and cost-effective. Similarly, exercise programmes should be individually tailored and progressive, with resistance training central to any program prescribed in the context of weight loss, due to its critical role in maintaining muscle and bone mass and strength. When prescribing weight loss strategies involving lifestyle behaviour changes, clinicians must consider their patient's readiness to change. We have used the transtheoretical model of change framework as an example to identify a patient's level of readiness and provided associated motivational interviewing-based strategies to enhance adherence and engagement. This review outlines evidence-based, practical diet and exercise recommendations and behavioural strategies that can facilitate effective and sustainable weight loss, which is particularly important for at-risk populations such as older adults.

This study aims to assess the effects of different exercise types and their specific doses on glycemic control among individuals with prediabetes.

Multiple databases were subjected to a comprehensive search for randomized controlled trials (RCTs) published until 15 July 2024. The study protocol was prospectively registered with PROSPERO (CRD42024573186). The exercise interventions analyzed included aerobic exercise (AE), resistance training (RT), and combined aerobic-resistance training (AE+RT). Outcomes were quantified using standardized mean difference (SMD) with 95% credible intervals (CrIs), employing the confidence in network meta-analysis (CINeMA) framework for network meta-analysis to confirm the outcome reliability.

According to the network meta-analysis, irrespective of dose, AE+RT led to the largest decrease in fasting blood glucose (FBG) (-0.44, [-0.62 to -0.26]). AE alone resulted in the largest reductions in 2-hour post-meal blood glucose (2hPG) (-0.71, [-0.97 to -0.45]) and glycosylated hemoglobin A1c (HbA1c) (-0.30, [-0.37 to -0.22]). Dose-response (DR) analysis identified optimal doses for each exercise type: 880 metabolic equivalent of task minutes per week (METs-min/week) for both AE and RT and 800 METs-min/week for AE+RT to reduce FBG. The optimal dose for 2hPG improvement via AE was 1,100 METs-min/week, and for HbA1c reduction via RT, it was 870 METs-min/week.

Given the variety of impaired glucose regulation (IGR), we recommend that people with prediabetes engage in RT at 1,100 METs-min/week to improve 2hPG and at 870 METs-min/week to reduce HbA1c. For FBG control, a dose of 800 METs-min/week is optimal for all exercise modalities. These evidence-based recommendations provide practical guidance for designing personalized exercise prescriptions to manage prediabetes.

Enhanced Drp1 activity mediates excessive mitochondrial fission, contributing to the onset and progression of various chronic diseases, including neurodegenerative, cardiovascular, and metabolic disorders. Studies indicate that exercise mitigates mitochondrial dysfunction by modulating Drp1-related signaling targets, thereby inhibiting Drp1 activity and reducing excessive mitochondrial fission. This, in turn, enhances mitochondrial function and cellular metabolism. This review synthesizes the current understanding of Drp1 structure and activation mechanisms, and analyzes the effects of exercise interventions on Drp1-mediated mitochondrial fission in different disease models to improve common chronic conditions. This research deepens our insight into the specific mechanisms of Drp1-induced excessive mitochondrial fission in chronic disease pathogenesis, offering new theoretical support and practical guidance for exercise as a non-pharmacological intervention strategy.

Regular physical activity is a key, patient-centred therapy for people with diabetes to manage their glycemia. The International Working Group on the Diabetic Foot recommends optimization of glycemic control for people with/at risk of diabetes-related foot ulcer (DFU); however, people with DFU are commonly instructed by clinicians to avoid physical activity so as not to worsen the ulcer. The effects of exercise on glycemia, fitness, and wound healing in people with active DFU are not clear. In this study we examined the effects of regular exercise (training) on glycemia, cardiorespiratory fitness, muscular strength, metabolic health, and ulcer healing in adults with diabetes and an active foot ulcer.

Online databases and reference lists of included studies were searched from earliest records to December 2023. Studies involving adult populations with DFU and incorporating interventions of exercise training were included. Data were extracted independently by 2 reviewers.

Of the 5,592 studies screened, 8 were included, with a total of 213 participants. Exercise interventions involved foot range-of-movement exercises and/or aerobic and/or resistance-type exercise. None of the studies reported on cardiorespiratory fitness or anthropometry and limited data were available for glycemic and muscular strength outcomes. Interpretation of data on safety, wound healing, and adherence to exercise were limited due to inconsistent reporting.

Despite some data that exercise may have a positive impact on wound healing, evidence regarding its benefits and safety is significantly lacking, despite metabolic (particularly glycemic) and fitness outcomes being core to the rationale for exercise therapy in diabetes. Given the importance of exercise in current management guidelines for diabetes, and the plausibility of positive health effects of exercise training for people with DFU, there is a need for research to move from foot-focussed to person-centred outcomes to better inform the implementation of exercise therapy for people with DFU.

Diabetes mellitus is a chronic disorder that progressively induces complications, compromising daily independence. Among these, diabetic neuropathy is particularly prevalent and contributes to substantial neuromuscular impairments in both types 1 and 2 diabetes. This condition leads to structural damage affecting both the central and peripheral nervous systems, resulting in a significant decline in sensorimotor functions. Alongside neuropathy, diabetic myopathy also contributes to muscle impairment and reduced motor performance, intensifying the neuromuscular decline. Diabetic neuropathy typically implicates neurogenic muscle atrophy, motoneuron loss and clustering of muscle fibres as a result of aberrant denervation-reinervation processes. These complications are associated with compromised neuromuscular junctions, where alterations occur in pre-synaptic vesicles, mitochondrial content and post-synaptic signalling. Neural damage is intensified by chronic hyperglycaemia and oxidative stress, exacerbating vascular dysfunction and reducing oxygen delivery. These complications imply a severe decline in neuromuscular performance, evidenced by reductions in maximal force and power output, rate of force development and muscle endurance. Furthermore, diabetes-related complications are compounded by age-related degenerative changes in long-term patients. Aerobic and resistance training offer promising approaches for managing blood glucose levels and neuromuscular function. Aerobic exercise promotes mitochondrial biogenesis and angiogenesis, supporting metabolic and cardiovascular health. Resistance training primarily enhances neural plasticity, muscle strength and hypertrophy, which are crucial factors for mitigating sarcopenia and preserving functional independence. This topical review examines current evidence on the physiological mechanisms underlying diabetic neuropathy and the potential impact of physical activity in counteracting this decline.

A total of 37.3 million Americans have diabetes, and 96 million more have prediabetes. Hyperglycemia, the hallmark of diabetes, increases the risk for diabetes-related complications, including skin breakdown and cardiovascular disease. Many clinical practice guidelines exist, but there are gaps regarding the best approaches to assess physical fitness and mobility in adults with diabetes; incorporate exercise into the care plan; and reload the diabetic foot after ulcer closure has occurred to avoid ulcer reoccurrence. The purpose of this clinical practice guideline was to review and assess previously published guidelines and address gaps within the guidelines specific to the following: best screening tools/tests and interventions to prevent a future reulceration, best screening tools and interventions to assess and address mobility impairments, best tools to measure and interventions to address reduced physical fitness and activity, best approach to reloading the foot after ulceration closure and, finally, whether improvement in physical fitness will positively change quality of life and health care costs. The Guidelines Development Group performed a systematic literature search and review of the literature. A total of 701 studies were identified. Following duplicate removal and exclusion for irrelevance, 125 studies underwent full-text review, and 38 studies were included. Recommendations were developed using a software assistant created specifically for guideline recommendation development. Recommendations resulted for physical fitness and activity inclusion and measurement for adults with diabetes and with or without foot ulceration. Exercise and physical activity should be prescribed according to the physiologic response of an adult with diabetes to exercise and preferences for optimizing long-term quality of life and reduce health care costs. Reloading following diabetic foot ulcer closure should include maximal offloading, especially during the first 3 months; loading should be titrated using a footwear schedule. Further research is necessary in the areas of exercise in the wound healing process and the assessment of methods to reload a newly reepithelialized ulcer to prevent recurrence.

Most cases of type 2 diabetes (T2D) can be prevented by adopting a healthy lifestyle, highlighting that lifestyle modifications should be the primary defence against developing T2D. Although accumulating evidence suggests that exercise can be an efficacious therapy for T2D, especially in conjunction with pharmacological interventions, its long-term effectiveness remains controversial owing to significant adherence challenges. In this narrative review, we combine an evolutionary perspective with epidemiological and prospective interventional studies to examine the efficacy versus effectiveness of varying volumes of exercise prescriptions for treating T2D. Commonly prescribed and recommended volumes of moderate-intensity physical activity (150 min/week) have demonstrated low-to-moderate efficacy in improving glycaemic control, reflected by improvements in glycated haemoglobin levels. Higher exercise volumes have been shown to enhance efficacy. While exercise can be moderately efficacious under the optimal circumstances of short-term exercise interventions (≤1 year), there is little evidence of its long-term effectiveness, primarily due to poor adherence. To date, no study has demonstrated long-term adherence to exercise programmes in individuals with T2D (>1 year). From an evolutionary perspective, the finding that exercise interventions are often ineffective over time is unsurprising. Although often overlooked, humans never evolved to exercise. Exercise is a counter-instinctive behaviour that can be difficult to maintain, even in healthy populations and can be especially challenging for individuals who are unfit or have T2D morbidities. We conclude by presenting several considerations informed by evolutionary logic that may be useful for practitioners, policymakers and advocates of exercise as medicine to improve exercise adherence.

Both glucagon-like peptide-1 receptor (GLP1R) agonists and lifestyle modifications are widely adopted in managing glycemia. However, the joint effects of GLP1R agonists with lifestyle on glycemic traits have not been evaluated.

This gene-environment study tested the interaction between GLP1R-rs10305492 variant, consistent with the effect of GLP1R agonist therapies, and four lifestyle factors (diet, physical activity, sleep duration, and chronotype) for glucose and glycated hemoglobin (HbA1c) levels among 263,846 UK Biobank participants. Linear regression models were conducted to evaluate the effects of the rs10305492 and lifestyle factors on glucose and HbA1c levels.

GLP1R-rs10305492-AA/AG genotype combined a healthy diet, regular physical activity, adequate sleep duration, or morning chronotype were associated with lower glucose and HbA1c levels (all P for trend < 0.001). A synergistic effect was found between rs10305492 and sleep duration on HbA1c, suggesting a recommended adequate sleep duration (7-8 h/day) may amplify the HbA1c lowering effect of GLP1R agonists. Joint effects of the rs10305492 and adequate sleep were associated with a 26 % reduced risk of hyperglycemia (>7.8 mmol/L) risk and a 22 % lower of high HbA1c (>39 mmol/mol or 5.7 %).

Combining GLP1R agonists with adequate sleep may provide additional benefits for glycemic control in clinical practice.

Exercise is a non-pharmacological intervention for type 2 diabetes mellitus (T2DM), including moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT). Despite diverse exercise protocol variations, the impact of these variations in HIIT on T2DM anthropometrics, glycemic control, and cardiorespiratory fitness (CRF) remains unclear.

The aim was to examine the influence of HIIT protocol characteristics on anthropometrics, glycemic control, and CRF in T2DM patients and compare it to control (without exercise) and MICT.

This review is registered in PROSPERO (CRD42021281398) and follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search, employing "high-intensity interval training" and "diabetes mellitus" in PubMed and Web of Science databases, with a "randomized controlled trial" filter, spanned articles up to January 2023.

Of 190 records, 29 trials were included, categorized by HIIT interval duration, training volume, and intervention period. Long-duration, high-volume, and long-term HIIT yields superior outcomes compared to control conditions for body mass, waist circumference, fasting plasma glucose, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), glycosylated hemoglobin (%HbA1c), and CRF. The findings favored HIIT over MICT for body mass in long-duration, high-volume, and short-term intervals (mean difference [MD] - 3.45, - 3.13, and - 5.42, respectively, all p < 0.05) and for CRF in long and medium work intervals and high volume (MD 1.91, 2.55, and 2.43, respectively, all p < 0.05), as well as in medium and long-term intervention (MD 2.66 and 2.21, respectively, all p < 0.05). Regardless of specific HIIT characteristics, no differences were found in the HIIT versus MICT comparison for glycemic control.

Specific HIIT protocol characteristics influence changes in anthropometrics, glycemic control, and CRF compared to control groups. However, compared to MICT, only longer duration, higher volume, and short-term HIIT improved body mass, waist circumference, and CRF in individuals with T2DM.

Higher prevalence rates of diabetes and its complications have been reported among individuals with poor physical activity and a sedentary lifestyle. This study explored the influence of six months of moderate-intensity supervised aerobic training on the serum lipid profile, hs-CRP level, and variable-related correlations in prediabetic and type 2 diabetes patients (T2DM).

The study was based on a two-arm parallel group pretest‒posttest comparative design.

A total of 50 subjects who were diagnosed with diabetes for more than five years and aged 30-70 years were included in this study. The subjects were classified into two groups on the basis of their glycated haemoglobin (HbA1c%) values: Group 1 (patients with the prediabetes; HbA1c % ≤ 6.5, n = 25) and Group 2 (patients with the T2DM; HbA1c % ≥ 6.5, n = 25). Blood sugar, HbA1c %, insulin, lipid profile, and highly sensitive CRP (hs-CRP) were measured via colorimetric and immunoassay techniques at baseline and six months postintervention with moderate aerobic exercise.

The results revealed that participation in moderate aerobic training interventions for six months resulted in a significant reduction in BMI, fasting blood sugar, glycosylated haemoglobin, hs-CRP, and lipid profile parameters such as T-Cholest, TG, and LDL-C as well as significant improvement in the level of insulin with a reduction in the values of HOMA-IR towards normal values in the patients with prediabetes (P < 0.01) in group 1 and patients with diabetes in group 2 (P < 0.001). The change in VO2max with good physical fitness significantly improved with the exercise program after six months. The reduced levels of hs-CRP, HOMA-IR, and lipid profile and improved levels of insulin were significantly positively correlated with the levels of glycated haemoglobin (HbA1c%) in the patients with prediabetes (P < 0.01) and those with diabetes (P < 0.001) following six months of moderate aerobic training interventions. Moreover, hs-CRP was positively correlated with T-Cholest, TG, and LDL-C (p = 0.01) and negatively correlated with HDL-C. The data revealed improved glycemic control factors, lipid profiles, and hs-CRP levels as cardio-predictive markers in patients with both prediabetes and diabetes as well. These findings suggest that the anti-inflammatory effect of physical activity gained from moderate exercise training for six months may counteract increased cardiovascular complications associated with increased CRP levels and lipid profiles in prediabetes and T2DM patients.

Moderate aerobic training for six months favourably affects glycemic parameters, lipid profiles, and inflammatory hs-CRP indicators and improves VO2max, an indicator of physical fitness, in prediabetic and diabetic patients. The data obtained suggest the positive effect of moderate exercise training as a protective modulator of cardiovascular disorders, including the dyslipidaemic profile, glycaemic control, and hs-CRP inflammatory markers, in prediabetes and T2DM patients. Thus, regular exercise, owing to its anti-inflammatory effects and ability to improve cardiorespiratory fitness, lipid profiles, blood glucose levels, and insulin resistance, may help reduce the severity of cardiovascular diseases in prediabetes and T2DM patients and healthy controls.

Retrospectively registered with ClinicalTrials.gov PRS under trial identifier ID: NCT06246435 dated 30/01/2024.

The purpose of this study is to investigate changes in gut microbiota related to metabolic diseases after moderate and high-intensity exercise. A total of 24 participants were divided into three groups: Non-Exercise Group (NEG, n = 8, 28.6 ± 5.3 years, 176.0 ± 7.8 cm, 81.3 ± 14.6 kg), Moderate Intensity Exercise Group (MIEG, n = 8, 26.5 ± 3.3 years, 176.9 ± 5.0 cm, 75.4 ± 9.5 kg), and Vigorous Intensity Exercise Group (VIEG, n = 8, 30.6 ± 5.9 years, 174.2 ± 3.5 cm, 77.8 ± 12.2 kg).

The participants were selected by assessing physical activity, gut health status, presence of diseases, recent disease diagnoses, and dietary disorders. Those who reported any presence disease or recent disease diagnosis were excluded from the current study. Stool samples were collected after a 10-h fast for gut microbiome analysis. MIEG participants trained at 40-59 % heart rate reserve (HRR) for at least 150 min per week, while VIEG participants trained at ≥ 60 % HRR for at least 90 min per week. After 4 weeks, all participants provided stool samples for gut microbiome analysis.Data analysis was conducted using the Wilcoxon test, with statistical significance set at ≤ 0.05.

The results indicated an increase in Prevotella in MIEG, while Veillonella, Dorea_formicigenerans, and Dorea_longicatena exhibited a decrease (p < 0.05). In VIEG, there was an increase in Bacteroides, Butyricimonas, Odoribacter, and Alistipes (p < 0.05).

These modified microbial groups were associated with factors related to metabolic diseases, including inflammatory bowel disease, obesity, colorectal cancer, diabetes, hypertension, metabolic liver diseases, and ischemic heart diseases. Additional research is essential to delve into the relationship between exercise and these alterations in the microbiome.

The purpose of this study was to compare different intensities of aerobic exercise for patients with knee osteoarthritis (KOA) and type 2 diabetes mellitus (T2DM) in terms of glycemic control, pain relief, and functional outcomes.

A prospective randomized open-label parallel multicenter clinical trial conducted at two hospitals in Shanghai and Sichuan that included 228 patients with type 2 diabetes mellitus (T2DM) and knee osteoarthritis (KOA). Enrollment occurred between January 2021 and February 2023, and follow-up was completed in September 2023. Participants were randomized to threshold training/high-intensive stationary cycling training (n=76), intensive endurance/moderate-intensive stationary cycling training (n=77), and regular rehabilitation programs (n=75). The primary outcome at the 6-month follow-up was the HbA1c level. Key secondary outcomes included the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale of pain and quality of life.

Of 228 patients, 212 (93%) completed the trial. The mean adjusted (sex, baseline BMI, and baseline outcome measures) HbA1c level at the 6-month follow-up decreased significantly in the high-intensive training group compared with other groups (high-intensity group vs. control group; difference, 0.51%, 95% confidence interval, 0.05% to 1.15%). Mean KOOS subscales of pain and quality of life were statistically significantly different between the control group and moderate-intensity or high-intensity groups, but no statistical differences were noted between the different intensities of aerobic exercise. Patients in all groups achieved a greater reduction in BMI but no significant differences were observed between groups.

In KOA and T2DM patients, high-intensity stationary cycling can significantly improve glycemic control compared with moderate-intensity and regular rehabilitation programs. However, high-intensity stationary cycling does not exert a superior effect on pain relief and functional improvement for KOA compared with moderate-intensity and regular rehabilitation programs.

Concurrent Exercise Training (CET) is defined as an exercise training mode in which aerobic and resistance exercises are performed in the same session.

The effects of CET in type 2 diabetes mellitus (T2DM) are inconclusive. Therefore, the objective of the present systematic review with a meta-analysis is to evaluate the effects of CET on metabolic markers, body composition, lipid profile, inflammation, and cardiorespiratory fitness (CRF) in people with T2DM.

Five electronic databases were searched from inception up to January 2023. The eligibility criteria included prospective studies that had T2DM participants aged between 35 and 65 years who performed CET at least 2 times/week for a minimum duration of 8 weeks with a control group.

Seven studies were identified for qualitative review. Sufficient data were not available for one study, therefore, meta-analysis was performed in six studies. A significant effect was observed in glucose level (p < .01); glycated hemoglobin (p = .02); Homeostatic Model Assessment for Insulin Resistance (p = .02); body mass index (p = .02); %body fat (p < .01); %fat-free mass (p < .01); waist circumference (p = .03); triglyceride (p < .01); peak oxygen uptake (p < .01); and tumor necrotic factor -α (p < .01).

The CET is effective in improving metabolic markers, body composition, lipid profile, inflammation, and CRF in people with T2DM and can be included in the management of T2DM. The overall evidence for this conclusion may be influenced by bias in included studies.

We aimed to assess the effect of exercise training on heart rate variability (HRV) in hypertensive patients and to provide practical recommendations. We systematically searched seven databases for randomized controlled trials (RCTs) comparing the efficacy of exercise interventions vs. non-exercise control for HRV in adults with hypertension. HRV parameters, blood pressure (BP), and heart rate (HR) from the experimental and control groups were extracted to carry out meta-analysis. To explore the heterogeneity, we performed sensitivity analysis, sub-analysis, and meta-regression. Twelve RCTs were included, and the main results demonstrated exercise produced improvement in root mean square of successive RR-intervals differences (RMSSD) and high frequency (HF), and reductions in LF/HF, resting systolic blood pressure (SBP), and HR. The sub-analysis and meta-regression showed that AE improved more HRV indices and was effective in reducing BP compared with RE. Follow-up duration was also an important factor. Data suggests exercise training has ameliorating effects on HRV parameters, resting SBP, and HR in hypertensive patients, showing enhanced autonomic nervous system function and vagal activity. This effect may be better realized with exercise interventions of 4 weeks or more. Considering our results and the hypertension practice guidelines, we tend to recommend patients choose supervised AE.

Impaired glucose control & Insulin resistance are reported to be risk factors for the development of cardiovascular diseases. To find the effects of a structured exercise program on insulin resistance, glycaemic control, functional capacity, and quality of life in patients with Type 2 diabetes mellitus.

Randomized, controlled trial.

Diabetic Foot Clinic, Department of Physiotherapy & Department of General Medicine, Kasturba Hospital in Manipal, Karnataka, India.

160 participants aged between 30-65 years with Type 2 diabetes mellitus.

A set of structured exercise programs (aerobic, resistance, and combined) along with the standard hospital care was performed 3-5 times weekly for 12 weeks.

Fasting Insulin Level, Homa-IR, Six-minute walk test (6MWT), and WHOQOL-BREF questionnaire at baseline and 12th week.

Body composition analysis, Fasting Blood Sugar, Postprandial Blood Sugar, Glycated Haemoglobin (HbA1c), and GPAQ questionnaire at baseline and 12th week.

Significant differences have been observed in Homeostasis model assessment for insulin resistance (Homa-IR) (F (1, 144) = 89.29, p < 0.001); Fasting insulin (FI) (F (1, 144) = 129.10, p < 0.001); Fasting blood sugar (FBS) (F (1, 144) = 12.193, p< 0.001); Post prandial blood sugar (PPBS) (F (1, 144) = 53.015, p< 0.001); glycated haemoglobin (HbA1c) (F (1, 144) = 80.050, p < 0.001); WHOQOL-Physical health (F (1, 144) = 20.008, p< 0.001), Psychological (F (1, 144) = 77.984, p< 0.001), Social relationship (F (1, 144) = 44.866, p< 0.001); Environmental (F (1, 144) = 69.974, p< 0.001); Six minute walk test (6MWT) (F (1, 144) = 84.135, p< 0.001) in the study group when compared with the control group from baseline to 12th week.

The study reveals that a 12-week structured exercise training program effectively reduces insulin resistance, improves quality of life, enhances functional capacity, and improves glycaemic control in type 2 diabetes mellitus.

In the field of eye health, the profound impact of exercise and physical activity on various ocular diseases has become a focal point of attention. This review summarizes and elucidates the positive effects of exercise and physical activities on common ocular diseases, including dry eye disease (DED), cataracts, myopia, glaucoma, diabetic retinopathy (DR), and age-related macular degeneration (AMD). It also catalogues and offers exercise recommendations based on the varying impacts that different types and intensities of physical activities may have on specific eye conditions. Beyond correlations, this review also compiles potential mechanisms through which exercise and physical activity beneficially affect eye health. From mitigating ocular oxidative stress and inflammatory responses, reducing intraocular pressure, enhancing mitochondrial function, to promoting ocular blood circulation and the release of protective factors, the complex biological effects triggered by exercise and physical activities reveal their substantial potential in preventing and even assisting in the treatment of ocular diseases. This review aims not only to foster awareness and appreciation for how exercise and physical activity can improve eye health but also to serve as a catalyst for further exploration into the specific mechanisms and key targets through which exercise impacts ocular health. Such inquiries are crucial for advancing innovative strategies for the treatment of eye diseases, thereby holding significant implications for the development of new therapeutic approaches.

To investigate the relationship of moderate physical activity (MPA), vigorous physical activity (VPA), and muscle strengthening activity (MSA), independently and jointly, with all-cause, cardiovascular disease (CVD), and non-CVD mortality in individuals with type 2 diabetes (T2D).

This cohort study included 47,538 adults with T2D and 561,963 adults without T2D from the National Health Interview Survey 1997-2018 who provided data on self-reported physical activity (PA). Mortality data were obtained from the National Death Index through 2019. Cox regression was used to estimate hazard ratio (HR) and 95% confidence interval (CI).

In analyses mutually adjusted, versus no MPA adults with T2D, performing the recommendations of MPA (150-299 min/week) associated with lower all-cause mortality (HR, 0.72; 95% CI, 0.66-0.78), CVD mortality (HR, 0.68; 95% CI, 0.58-0.79), and non-CVD mortality (HR, 0.72; 95% CI, 0.65-0.79). Similar benefits were observed in those meeting recommendations for VPA and MSA. Higher levels of PA beyond current recommendations may provide a few additional benefits without adverse effects on mortality risk, regardless of diabetes onset age, duration of diabetes, and medication status. The joint analysis indicates that combining MSA with aerobic PA could further lower mortality risk, and lowest all-cause mortality was observed among individuals engaging in either 75-150 min/week of VPA and 1 time/week of MSA (HR, 0.30; 95% CI, 0.13-0.70) or 150-299 min/week of MPA and 1 time/week of MSA (HR, 0.33; 95% CI, 0.20-0.55).

Our study supports the current PA guidelines and suggests that there may be limited benefits gained from exercising beyond recommended levels in adults with T2D, combining recommended levels of aerobic and resistance exercises could yield the greatest benefits.

In type 2 diabetes control, self-management is an effective way to minimize the risk of developing complications and improve the quality of life. Self-determination theory (SDT) proposed a promising explanatory framework to predict self-regulated behavior which was particularly relevant for self-management. This study aimed to investigate whether SDT constructs can affect the self-management and controlling glycated hemoglobin A1c (HbA1c) levels in type 2 diabetic patients or not.

This cross-sectional study was conducted from August to December 2022 at two diabetes clinics in Zahedan. The study included 300 patients with type 2 diabetes. Data collection was done using a researcher-administrated questionnaire that included demographic data, diabetes self-care activities, and self-determination constructs including autonomous support, autonomous motivation, and perceived competence.

The mean of the overall score of self-care activities was 34.62 ± 11.86 out of a maximum of 70. Patients in the fourth quarter (wealthiest) of the socioeconomic status had the highest mean self-care score (P = 0.003). There was a significant relationship between diet score with perceived competence (P = 0.009). Perceived competence (P<0.001) and controlled self-regulation (P<0.001) were the predictors of exercise score in diabetes patients. Independent self-regulation (P<0.001, r = 0.21) and overall self-regulation (P = 0.001, r = 0.19) were significantly related to blood-glucose testing score. There was a significant relationship between foot care score with perceived competence (P = 0.048, r = 0.11) and autonomous support (P = 0.013, r = 0.14). Multiple regression showed that exercise was the predictor of HbA1c (P = 0.014).

Exercise is crucial for achieving good individualized glycemic control and reducing the risk of diabetes complications. The findings provided valuable insights into the determinants of self-care activities in patients with type 2 diabetes and underscore the need for interventions that address socioeconomic disparities, enhance perceived competence, and provide autonomy support to improve diabetes self-care.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Metabolic-associated fatty liver disease (MAFLD) is the most prevalent chronic liver disease worldwide, affecting 25% of people globally and up to 80% of people with obesity. MAFLD is characterised by fat accumulation in the liver (hepatic steatosis) with varying degrees of inflammation and fibrosis. MAFLD is strongly linked with cardiometabolic disease and lifestyle-related cancers, in addition to heightened liver-related morbidity and mortality. This position statement examines evidence for exercise in the management of MAFLD and describes the role of the exercise professional in the context of the multi-disciplinary care team. The purpose of these guidelines is to equip the exercise professional with a broad understanding of the pathophysiological underpinnings of MAFLD, how it is diagnosed and managed in clinical practice, and to provide evidence- and consensus-based recommendations for exercise therapy in MAFLD management. The majority of research evidence indicates that 150-240 min per week of at least moderate-intensity aerobic exercise can reduce hepatic steatosis by ~ 2-4% (absolute reduction), but as little as 135 min/week has been shown to be effective. While emerging evidence shows that high-intensity interval training (HIIT) approaches may provide comparable benefit on hepatic steatosis, there does not appear to be an intensity-dependent benefit, as long as the recommended exercise volume is achieved. This dose of exercise is likely to also reduce central adiposity, increase cardiorespiratory fitness and improve cardiometabolic health, irrespective of weight loss. Resistance training should be considered in addition to, and not instead of, aerobic exercise targets. The information in this statement is relevant and appropriate for people living with the condition historically termed non-alcoholic fatty liver disease (NAFLD), regardless of terminology.

Behavioral interventions targeted at managing Type 2 diabetes mellitus (T2DM) may have a positive effect on quality of life (QOL). Limited reviews have synthesized this effect in low- and middle-income countries (LMICs). This review and meta-analysis synthesised available evidence on the effect of behavioral interventions to manage T2DM on the QOL of people with T2DM in LMICs.

Electronic databases PUBMED/MEDLINE, SCOPUS, CINAHL, Embase, Web of Science and PsycINFO were searched from May to June 2022. Studies published between January 2000 and May 2022, conducted in LMICs using randomized controlled trial design, using a health behavior intervention for T2DM management, and reporting QOL outcomes were included. Difference in QOL change scores between the intervention and control group was calculated as the standardized mean difference (SMD) of QOL scores observed between the intervention and control groups. Random-effects model was used for meta-analysis.

Of 6122 studies identified initially, 45 studies met the inclusion criteria (n = 8336). Of them, 31 involved diabetes self-management education and 14 included dietary and/or physical activity intervention. There was moderate quality evidence from the meta-analysis of mean QOL (n = 25) that health behavior intervention improved the QOL of people with T2DM (SMD = 1.62, 95%CI = 0.65-2.60 I2 = 0.96, p = 0.001). However, no significant improvements were found for studies (n = 7) separately assessing the physical component summary (SMD = 0.76, 95%CI = -0.03-1.56 I2 = 0.94, p = 0.060) and mental component summary (SMD = 0.43, 95%CI = -0.30-1.16 I2 = 0.94, p = 0.249) scores. High heterogeneity and imprecise results across studies resulted in low to moderate quality of evidence.

The findings suggest that health behavior interventions to manage T2DM may substantially improve the QOL of individuals with T2DM over short term. However, due to low to moderate quality of evidence, further research is required to corroborate our findings. Results of this review may guide future research and have policy implications for T2DM management in LMICs.

Type 2 diabetes mellitus (T2DM) is a leading cause of disability-adjusted life years (DALY). Physical exercise is an effective non-pharmacological intervention to promote glycaemic control in T2DM. However, the optimal exercise parameters for glycemic control in individuals with T2DM remain unclear.

This study aimed to analyze the relationship between physical training variables - frequency, intensity, type, duration, volume, and progression - and glycemic control in individuals with T2DM.

A rapid systematic literature review was conducted on PubMed and LILACS databases. The PICOT strategy was employed to define the inclusion criteria. Eligible studies had to assess the impact of exercise parameters (frequency, intensity, type, duration, volume, and progression) on glycemic control indicators, primarily glycosylated hemoglobin (HbA1c). Randomized and non-randomized clinical trials were included in the review. The methodological quality of each study was assessed using the PEDro scale (PROSPERO - CRD 42021262614).

Out of 1188 papers initially identified, 18 reports met the inclusion criteria and were included in the analysis. A total of 1,228 participants with T2DM (1086 in exercise groups) were included in the selected studies. Among these studies, 16 (88.9%) were RCTs and 2 (11.1%) were nRCTs. The age of participants ranged from 43.1 and 68.9 years, and the average intervention duration was 16.8 weeks. Data on adherence to the intervention, adverse events, detailed intervention protocol, and its impacts on glycaemic control, lipid profile, blood pressure, anthropometric measures, medication, body composition, and physical fitness are reported.

The evidence supports the safety and effectiveness of physical exercises as non-pharmacological interventions for glycemic control. Aerobic, resistance and combined training interventions were associated with reductions in HbA1c and fasting glucose. The diversity of the physical exercise intervention protocols investigated in the studies included in this review is an important limitation to generalizing evidence-based practice. The call for action is mandatory to implement large-scale education programs on the prevention of diabetes and public health policies aimed to include well-planned and supervised exercise programs as an essential part of the primary prevention of type 2 diabetes.

PROSPERO, identifier (CRD42021262614).

Sarcopenia generally refers to the age-related reduction in muscle strength, functional ability, and muscle mass. Sarcopenia is a multifactorial condition associated with poor glucose disposal, insulin resistance, and subsequently type 2 diabetes (T2D). The pathophysiological connection between sarcopenia and T2D is complex but likely involves glycemic control, inflammation, oxidative stress, and adiposity.

Resistance exercise and aerobic training are two lifestyle interventions that may improve glycemic control in older adults with T2D and counteract sarcopenia. Further, there is evidence that dietary protein, Omega-3 fatty acids, creatine monohydrate, and Vitamin D hold potential to augment some of these benefits from exercise.

The purpose of this narrative review is: (1) discuss the pathophysiological link between age-related sarcopenia and T2D, and (2) discuss lifestyle interventions involving physical activity and nutrition that may counteract sarcopenia and T2D.

Physical activity is important for type 2 diabetes treatment, yet the underlying mechanisms for these beneficial effects of exercise are not fully understood. Here, we investigated the effects of exercise training on biphasic β-cell insulin secretory function, a key factor regulating blood glucose. Adults with type 2 diabetes (7F/3M, age 49 ± 5 years, BMI 30 ± 3 kg/m²) completed a 10-week moderate-intensity exercise program and multiple components of glucose homeostasis were measured. Training improved glycemic control, insulin sensitivity, and processing of proinsulin-to-insulin. Training increased late phase β-cell function by 38% (p = 0.01), which was correlated with changes in VO_2peak suggesting training response-dependent effects. Ras-Responsive Element Binding Protein 1 (RREB1) concentrations, a protein postulated to increase type 2 diabetes risk, were inversely correlated with increases in training-induced late-phase disposition index, consistent with an inhibitory role of RREB1 on insulin secretion. Moderate-intensity exercise training improves late-phase β-cell function and glycemic control in adults with type 2 diabetes.

The aim of this study was to evaluate the effectiveness of a real-life clinical physical activity program (DIAfit) on improving physical fitness, body composition, and cardiometabolic health in an unselected population with type 2 diabetes mellitus, and to compare the effects of two variants a different exercise frequencies on the same outcomes.

This was a cluster randomized-controlled assessor-blind trial conducted in 11 clinical centres in Switzerland. All participants in the clinical program with type 2 diabetes were eligible and were randomized to either standard (3 sessions/week for 12 weeks) or alternative (1 session/week for the first four weeks, then 2 sessions/week for the rest of 16 weeks) physical activity program each consisting of 36 sessions of combined aerobic and resistance exercise. Allocation was concealed by a central office unrelated to the study. The primary outcome was aerobic fitness. Secondary outcome measures included: body composition, BMI, HbA_1c, muscle strength, walking speed, balance, flexibility, blood pressure, lipid profile.

All 185 patients with type 2 diabetes (mean age 59.7 +-10.2 years, 48% women) agreed to participate and were randomized in two groups: a standard group (n=88) and an alternative group (n=97)). There was an 11% increase in aerobic fitness after the program (12.5 Watts; 95% CI 6.76 to 18.25; p<0.001). Significant improvements in physical fitness, body composition, and cardiometabolic parameters were observed at the end of the DIAfit program (improvements between 2-29%) except for lean body mass, triglycerides and cholesterol. No differences were observed between both programs, except for a larger weight reduction of -0.97kg (95% CI -0.04 to -1.91; p=0.04) in the standard program.

Both frequency variants of the nation-wide DIAfit program had beneficial effects on physical fitness, HbA_1c, body composition, and blood pressure in type 2 diabetes patients and differences were negligible.

clinicaltrials.gov, identifier NCT01289587.

Diabetes mellitus (DM) is a chronic disease and one of the oldest known disorders. It is characterized by dysglycemia, dyslipidemia, insulin resistance (IR), and pancreatic cell dysfunction. Although different drugs, metformin (MET), glipizide, glimepiride, etc., have been introduced to treat type 2 DM (T2DM), these drugs are not without side effects. Scientists are now seeking natural treatments such as lifestyle modification and organic products known with limited side effects. Thirty-six male Wistar rats were randomized into six groups (n = 6 per group): control, DM untreated rats, DM+orange peel extract (OPE), DM+exercise (EX), DM+OPE +EX, and DM+MET. The administration was once daily through the oral route and lasted for 28 days. EX and OPE synergistically ameliorated the diabetic-induced increase in fasting blood sugar, homeostatic model assessment for insulin resistance (HOMA IR), total cholesterol (TC) and triglyceride (TG), TC/high-density lipoprotein (HDL), TG/HDL, triglyceride glucose (TyG) index, and hepatic lactate dehydrogenase, alanine transaminase, malondialdehyde, c-reactive protein, and tumour necrosis factor α when compared with the diabetic untreated group. Also, EX+OPE blunted DM-induced decrease in serum insulin, homeostasis model assessment of β-cell function (HOMA-B), homeostasis model assessment of insulin sensitivity (HOMA S), quantitative insulin-sensitivity check index (QUICK 1), HDL, total antioxidant capacity, superoxide dismutase, and hepatic glycogen. Furthermore, EX+OPE ameliorated the observed DM-induced decrease in glucose transporter type 4 (GLUT 4), expression. This study showed that OPE and EX synergistically ameliorate T2DM-induced dysglycaemia, dyslipidaemia, and down-regulation of GLUT4 expression.

To assess the effects of exercise training parameters on cardiorespiratory fitness of individuals with type 2 diabetes mellitus (T2DM).

This systematic review was registered on PROSPERO (CRD42020210470). Searches were performed on PubMed, PEDro EMBASE, MEDLINE (Ovid), LILACS, PsycINFO, SCIELO, CINAHL, and Cochrane Library. The primary outcome was cardiorespiratory fitness, defined as maximal oxygen uptake (VO2max) during a maximal or submaximal exercise test. Two independent reviewers extracted data and assessed the risk of bias. Data were pooled using a random effects model and expressed as mean difference (MD) and 95% confidence interval (95%CI). Heterogeneity (I2) was assessed using Cochran's Q test. The risk of bias and quality of evidence was assessed using the Cochrane risk of bias tool and GRADE.

Twenty-two studies comparing exercise and control groups were included. The risk of bias indicated some concerns in most studies, and the quality of evidence was rated very low. Interventions with moderate (MD = 1.91, 95%CI = .58 to 3.34) and progressive exercise intensity (MD = 2.70, 95%CI = 2.43 to 2.96) and volume (MD = 1.72, 95%CI = .59 to 2.85) showed greater improvements in VO2max.

Protocols that progressively increased exercise training parameters improved the cardiorespiratory fitness response. Progressive exercise might be more suitable for individuals with T2DM. Our conclusion may be limited due to the very low quality of evidence.

The online version contains supplementary material available at 10.1007/s40200-023-01205-5.

Diabetes mellitus (DM) is a chronic illness with an increasing global prevalence. More than 537 million cases of diabetes were reported worldwide in 2021, and the number is steadily increasing. The worldwide number of people suffering from DM is projected to reach 783 million in 2045. In 2021 alone, more than USD 966 billion was spent on the management of DM. Reduced physical activity due to urbanization is believed to be the major cause of the increase in the incidence of the disease, as it is associated with higher rates of obesity. Diabetes poses a risk for chronic complications such as nephropathy, angiopathy, neuropathy and retinopathy. Hence, the successful management of blood glucose is the cornerstone of DM therapy. The effective management of the hyperglycemia associated with type 2 diabetes includes physical exercise, diet and therapeutic interventions (insulin, biguanides, second generation sulfonylureas, glucagon-like peptide 1 agonists, dipeptidyl-peptidase 4 inhibitors, thiazolidinediones, amylin mimetics, meglitinides, α-glucosidase inhibitors, sodium-glucose cotransporter-2 inhibitors and bile acid sequestrants). The optimal and timely treatment of DM improves the quality of life and reduces the severe burden of the disease for patients. Genetic testing, examining the roles of different genes involved in the pathogenesis of DM, may also help to achieve optimal DM management in the future by reducing the incidence of DM and by enhancing the use of individualized treatment regimens.

Both cardiorespiratory fitness (CRF) and muscular strength are reported to decrease with age and menopause, which considered to be risk for cardiovascular diseases (CVDs). Previous relevant meta-analyses are inconclusive on the beneficial effects of exercise, particularly in post-menopausal women. In this systematic review and meta-analysis, we investigated the effects of exercise modalities on CRF and muscular strength in post-menopausal women, and identified the effective exercise type and duration.

A comprehensive search was conducted on PubMed, Web of Science, CINAHL, and Medline to identify the randomized controlled trials, which evaluated exercise effect on CRF, lower- and upper-body muscular strength, and/or handgrip strength in post-menopausal women and compared the results with control. Standardized mean differences (SMD), weighted mean differences (WMD), and 95% confidence intervals (95% CIs) were calculated using random effects models.

A total of 129 studies comprising 7,141 post-menopausal women with mean age and BMI ranging from ∼53 to 90 years and 22 to 35 kg/m2, respectively, were included in the meta-analysis. Overall, exercise training effectively increased CRF (SMD: 1.15; 95% CI: 0.87, 1.42; p = 0.001), lower-body muscular strength (SMD: 1.06; 95% CI: 0.90, 1.22; p = 0.001), upper-body muscular strength (SMD: 1.11; 95% CI: 0.91, 1.31; p = 0.001), and handgrip strength (WMD: 1.78 kg; 95% CI: 1.24, 2.32; p = 0.001) in post-menopausal women. These increments were found to be irrespective of ages and intervention durations. Regarding exercise type, aerobic, resistance, and combined training significantly increased CRF and lower-body muscular strength, while resistance and combined training effectively increased handgrip strength. However, only resistance training increased the upper-body muscular strength in women.

Our findings suggest that exercise training is effective in increasing CRF and muscular strength in post-menopausal women, which might be cardioprotective. Both aerobic and resistance training alone or in combination increased CRF and lower-body muscular strength, but only resistance training increased upper-body strength in women.

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283425, identifier: CRD42021283425.

Knee osteoarthritis (OA) may be comorbid with diabetes mellitus (DM), and physical activity is a recommended lifestyle strategy for both diseases. The present study investigated the physical activity differences by intensity between knee OA patients with or without DM, and evaluated if physical activity was associated with the presence of DM in knee OA patients.

A total of 183 patients (mean age 74.9 ± 6.4 years) with moderate-to-severe knee OA underwent evaluation of knee function (i.e., knee flexion/extension range-of-motion, knee-extension muscle strength, and knee pain), the timed up-and-go (TUG) test, and physical activity measurement using an accelerometer. Physical activity by intensity was compared between knee OA patients with and without DM. The association between physical activity, including knee function and the TUG test time, and DM was assessed.

The 2 groups (with or without DM) did not differ significantly in knee OA severity or age. Compared to knee OA patients without DM, knee OA patients with DM had a significantly lower average daily step count (p < 0.001), and significantly shorter times spent performing light-intensity physical activity (LPA; p < 0.001) and moderate-to-vigorous-intensity physical activity (MVPA; p = 0.006). After adjusting for age, sex, and body mass index, we found that a lower average daily step count and shorter LPA time significantly correlated with DM (β = -0.200, p = 0.006; β = -0.216, p = 0.004, respectively) and a longer TUG test time (β = -0.196, p = 0.014; β = -0.208, p = 0.011, respectively). A shorter MVPA time significantly correlated with lower contralateral knee-extension muscle strength (β = 0.187, p = 0.032).

Knee OA patients with DM had significantly lower physical activity levels than those without DM. Furthermore, the presence of DM correlated with a lower step count and a shorter LPA time in knee OA patients.

The mental health of adults with ADHD was compared to neurotypical controls, and associations between cardiorespiratory fitness (CRF) and mental health were examined.

Seventy-two participants (n = 36 with ADHD) completed demographic questions assessing ADHD and mental health symptoms. CRF was estimated using the 6-Minute Walk Test and a self-perception question.

Those with ADHD had significantly poorer mental health outcomes than controls (p < .001), with 50% of adults with ADHD reporting moderate to extremely severe symptoms of depression, anxiety, and stress. Critically, lower CRF was associated with worse depression, anxiety, and stress (all p ≤ .03) across both groups. Within the ADHD group, those with higher estimated CRF had significantly lower stress. Among participants with less severe ADHD symptoms, those with higher perceived CRF had significantly lower depressive symptoms.

In our cross-sectional study, participants with ADHD had poorer mental health than neurotypical controls, and higher fitness was associated with better mental health.

This study aimed to summarize the effects of aquatic training on the health outcomes of type 2 diabetes (T2D) patients.

This is a systematic review with meta-analysis that followed the PRISMA recommendations. Searches were performed in four databases in April 2021. The following eligibility criteria were adopted: adults with T2D; aquatic training (AT) intervention in an upright position; pre- and post-intervention assessments of the following outcomes: HbA1c, SBP and DBP, functional capacity, VO_2peak. The random-effects meta-analysis results are presented as mean differences and 95% confidence intervals.

Of the 375 studies, 12 studies were eligible and included in the meta-analysis. Favorable effects of AT post-intervention were observed in HbA1c (-0.62 %), VO_2peak (2.16 mL.Kg^-1.min^-1), SBP (-5.55 mmHg), DBP (-4.99 mmHg), and the 6-minute walk test (76.64 m). AT also revealed superior effects when compared to the control group (CG) and similar effects to land training (LT) in HbA1c (AT vs CG = -0.67 % and AT vs LT = -0.40 %), VO_2peak (AT vs CG = 3.78 mL.Kg^-1.min^-1; AT vs LT = -0.12 mL/Kg-1.min^-1), SBP (AT vs LT = -0.85 mmHg), and DBP (AT vs LT = 2.12 mmHg).

AT improves HbA1c, VO_2peak, SBP, DBP, and functional capacity in T2D patients. Beneficial effects favored AT over CG, while similar effects were verified between AT and LT on HbA1c, VO_2peak, and blood pressure.

In recent years, various physical exercise interventions have been developed with a view to reducing comorbidity and morbidity rates among patients with chronic diseases. Regular physical exercise has been shown to reduce hypertension and mortality in patients with type 2 diabetes. Diabetes and obesity are often associated with the development of nonalcoholic fatty liver disease, which can lead to liver fibrosis and then (in some cases) nonalcoholic steatohepatitis cirrhosis. We searched the literature for publications on personalized physical exercise programs in cirrhotic patients before and after liver transplantation. Eleven studies in cirrhotic patients and one study in liver transplant recipients were included in the systematic review, the results of which were reported in compliance with the preferred reporting items for systematic reviews and meta-analyses guidelines. The personalized physical exercise programs lasted for 6 to 16 weeks. Our review evidenced improvements in peak oxygen consumption and six-minute walk test performance and a reduction in the hepatic venous pressure gradient. In cirrhotic patients, personalized physical exercise programs improve quality of life, are not associated with adverse effects, and (for transplant recipients) might reduce the 90-day hospital readmission rate. However, none of the literature data evidenced reductions in the mortality rates before and after transplantation. Further prospective studies are needed to evaluate the benefit of long-term physical exercise programs in cirrhotic patients before and after liver transplantation.

Muscle glucose transport activity increases with an acute bout of exercise, a process that is accomplished by the translocation of glucose transporters to the plasma membrane. This process remains intact in the skeletal muscle of individuals with insulin resistance and type 2 diabetes mellitus (T2DM). Exercise training is, therefore, an important cornerstone in the management of individuals with T2DM. However, the acute systemic glucose responses to carbohydrate ingestion are often augmented during the early recovery period from exercise, despite increased glucose uptake into skeletal muscle. Accordingly, the first aim of this review is to summarize the knowledge associated with insulin action and glucose uptake in skeletal muscle and apply these to explain the disparate responses between systemic and localized glucose responses post-exercise. Herein, the importance of muscle glycogen depletion and the key glucoregulatory hormones will be discussed. Glucose uptake can also be stimulated independently by hypoxia; therefore, hypoxic training presents as an emerging method for enhancing the effects of exercise on glucose regulation. Thus, the second aim of this review is to discuss the potential for systemic hypoxia to enhance the effects of exercise on glucose regulation.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

High-intensity and sprint interval training (HIIT and SIT, respectively) enhance insulin sensitivity and glycemic control in both healthy adults and those with cardiometabolic diseases. The beneficial effects of intense interval training on glycemic control include both improvements seen in the hours to days following a single session of HIIT/SIT and those which accrue with chronic training. Skeletal muscle is the largest site of insulin-stimulated glucose uptake and plays an integral role in the beneficial effects of exercise on glycemic control. Here we summarize the skeletal muscle responses that contribute to improved glycemic control during and following a single session of interval exercise and evaluate the relationship between skeletal muscle remodelling and improved insulin sensitivity following HIIT/SIT training interventions. Recent evidence suggests that targeting skeletal muscle mechanisms via nutritional interventions around exercise, particularly with carbohydrate manipulation, can enhance the acute glycemic benefits of HIIT. There is also some evidence of sex-based differences in the glycemic benefits of intense interval exercise, with blunted responses observed after training in females relative to males. Differences in skeletal muscle metabolism between males and females may contribute to sex differences in insulin sensitivity following HIIT/SIT, but well-controlled studies evaluating purported muscle mechanisms alongside measurement of insulin sensitivity are needed. Given the greater representation of males in muscle physiology literature, there is also a need for more research involving female-only cohorts to enhance our basic understanding of how intense interval training influences muscle insulin sensitivity in females across the lifespan.

There are few established easy-to-perform exercise protocols with evidence-based effects for individuals with type 2 diabetes (T2D). A unique exercise regimen, interval walking training (IWT), has been reported to be beneficial for improving metabolic function, physical fitness and muscle strength in adults of overall health. This pilot study aims to demonstrate descriptive statistics of IWT adherence and changes in various data before and after the intervention of IWT in adults with T2D, perform statistical hypothesis testing, and calculate effect sizes. We performed a single-arm interventional pilot study with IWT for 20 weeks. We enrolled 51 participants with T2D aged 20-80 years with glycohemoglobin (HbA1c) levels of 6.5-10.0% (48-86 mmol/mol) and a body mass index of 20-34 kg/m2, respectively. The target was 60 min/week of fast walking for 20 weeks. The participants visited the hospital and were examined at 4-week intervals during this period. Between the start of IWT and after 20 weeks, we measured and evaluated changes in glucose and lipid metabolism data, body composition, physical fitness, muscle strength, dietary calorie intake, and daily exercise calories. All included participants completed IWT, with 39% of them reaching the target length of fast walking over 1,200 minutes in 20 weeks. In the primary outcome, HbA1c levels, and in the secondary, lipid metabolism and body composition, no significant changes were observed except for high-density lipoprotein cholesterol (HDL-C) (from 1.4 mmol/L to 1.5 mmol/L, p = 0.0093, t-test). However, in the target achievement group, a significant increase in VO2 peak by 10% (from 1,682 mL/min to 1,827 mL/min, p = 0.037, t-test) was observed. Effect sizes were Cohen's d = 0.25 of HDL-C, -0.55 of triglyceride, and 0.24 of VO2 peak in the target achievement group, which were considered to be of small to medium clinical significance. These results could be solely attributed to IWT since there were no significant differences in dietary intake and daily life energy consumption before and after the study. IWT could be highly versatile and was suggested to have a positive effect on lipid metabolism and physical fitness. In future randomized controlled trial (RCT) studies, the detailed effects of IWT, focusing on these parameters, will be examined. Trial registration: This trial was registered with the Japanese University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR: Usefulness on interval walking training in patients with type 2 diabetes. 000037303).

We aimed to determine the prevalence and risk factors for diabetic retinopathy (DR) in a multi-primary healthcare facilities-based DR screening project by analyzing single-field fundus photographs among patients with diabetes in Rafsanjan City, Iran, based on the Rafsanjan Cohort Study, as a part of the prospective epidemiological research studies in IrAN (PERSIAN).

Of all participants in the Rafsanjan Cohort Study (performed in four primary healthcare facilities across Rafsanjan City from August 2015 to December 2017), patients with diabetes were recruited in this study. All participants underwent a standardized interview and clinical and paraclinical examinations for demographic characteristics, and medical conditions according to the PERSIAN's protocols. In addition, digital fovea-centered and single-field fundus photography was performed for DR identification and grading. For assessment of agreement, a subgroup of participants underwent fundus examination, randomly. DR was graded as nonproliferative (NPDR) or proliferative (PDR).

Of 8414 screened participants, 1889 had diabetes. The total prevalence of DR was 6.93% [131 individuals including 110 (5.82%) with NPDR, and 21 (1.11%) with PDR] based on single-field fundus photographs, with almost perfect agreement with fundus examinations (κ = 0.82). On adjusted multivariate analysis, duration of diabetes (OR 1.16, 95% CI 1.13-1.19), positive family history for diabetes (OR 1.73, 95% CI 1.09-2.75), fasting plasma glucose (FPG) ≥ 126 mg/dL (OR 1.98, 95% CI 1.16-3.39), and serum creatinine level (OR 1.79, 95% CI 1.08-2.98) were associated with DR. Factors including age, education level, physical activity, body mass index, hypertension, and cardiovascular and renal diseases did not have association with DR on adjusted multivariate analysis.

Single-field fundus photography can be used for screening of DR in primary healthcare facilities. In individuals with diabetes, duration of diabetes, positive family history for diabetes, FPG ≥ 126 mg/dL, and serum creatinine level may be associated with DR.

Patients with type 2 diabetes mellitus (T2DM) have reduced exercise capacity, indexed by lower maximal oxygen consumption (V̇o2max) and achievement of the gas exchange threshold (GET) at a lower % V̇o2max. The ubiquitous signaling molecule nitric oxide (NO) plays a multifaceted role during exercise and, as patients with T2DM have poor endogenous NO production, we investigated if inorganic nitrate/nitrite supplementation (an exogenous source of NO) improves exercise capacity in patients with T2DM. Thirty-six patients with T2DM (10F, 59 ± 9 yr, 32.0 ± 5.1 kg/m2, HbA1c = 7.4 ± 1.4%) consumed beetroot juice containing either inorganic nitrate/nitrite (4.03 mmol/0.29 mmol) or a placebo (0.8 mmol/0.00 mmol) for 8 wk. A maximal exercise test was completed before and after both interventions. V̇o2max was determined by averaging 15-s data, whereas the GET was identified using the V-slope method and breath-by-breath data. Inorganic nitrate/nitrite increased both absolute (1.96 ± 0.67 to 2.07 ± 0.75 L/min) and relative (20.7 ± 7.0 to 21.9 ± 7.4 mL/kg/min, P < 0.05 for both) V̇o2max, whereas no changes were observed following placebo (1.94 ± 0.40 to 1.90 ± 0.39 L/min, P = 0.33; 20.0 ± 4.2 to 19.7 ± 4.6 mL/kg/min, P = 0.39). Maximal workload was also increased following inorganic nitrate/nitrite supplementation (134 ± 47 to 140 ± 51 W, P < 0.05) but not placebo (138 ± 32 to 138 ± 32 W, P = 0.98). V̇o2 at the GET (1.11 ± 0.27 to 1.27 ± 0.38L/min) and the %V̇o2max in which GET occurred (56 ± 8 to 61 ± 7%, P < 0.05 for both) increased following inorganic nitrate/nitrite supplementation but not placebo (1.10 ± 0.23 to 1.08 ± 0.21 L/min, P = 0.60; 57 ± 9 to 57 ± 8%, P = 0.90) although the workload at GET did not achieve statistical significance (group-by-time P = 0.06). Combined inorganic nitrate/nitrite consumption improves exercise capacity, maximal workload, and promotes a rightward shift in the GET in patients with T2DM. This manuscript reports data from a registered Clinical Trial at ClinicalTrials.gov ID: NCT02804932.NEW & NOTEWORTHY We report that increasing nitric oxide bioavailability via 8 wk of inorganic nitrate/nitrite supplementation improves maximal aerobic exercise capacity in patients with type 2 diabetes mellitus. Similarly, we observed a rightward shift in the gas exchange threshold. Taken together, these data indicate inorganic nitrate/nitrite may serve as a means to improve fitness in patients with type 2 diabetes mellitus.