Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2025; 16(7): 108121
Published online Jul 15, 2025. doi: 10.4239/wjd.v16.i7.108121
Intervention effect of combined resistance and aerobic exercise on type 2 diabetes: A meta-analysis
Jiang-Chen Ma, Song Shu, Tian-Xiao Chen, Hui-Jing Bai, Ya Yang, Xiao-Wei Ding
Jiang-Chen Ma, Department of Geriatrics, The Affiliated Hangzhou First People's Hospital Chengbei Campus, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
Jiang-Chen Ma, Department of Geriatrics, Hangzhou Geriatric Hospital, Hangzhou 310000, Zhejiang Province, China
Song Shu, Xiao-Wei Ding, Department of Rehabilitation Medicine, Hangzhou Geriatric Hospital, Hangzhou 310000, Zhejiang Province, China
Tian-Xiao Chen, Department of Rehabilitation Medicine, The Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
Hui-Jing Bai, Department of Nutrition, Huadong Hospital, Fudan University, Shanghai 200040, China
Ya Yang, Department of Geriatrics, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an 223003, Jiangsu Province, China
Xiao-Wei Ding, Department of Rehabilitation Medicine, The Affiliated Hangzhou First People's Hospital Chengbei Campus, School of Medicine, Westlake University, Hangzhou 310088, Zhejiang Province, China
Co-first authors: Jiang-Chen Ma and Song Shu.
Author contributions: Ma JC and Shu S designed the research; Ma JC, Shu S and Chen TX performed the research and contributed to the methodology; Ma JC, and Bai HJ contributed new reagents or analytic tools; Bai HJ, and Yang Y analyzed the data; Ma JC, Shu S, and Ding XW wrote the paper; Ma JC and Shu S equally contributed to this work as co-first authors; Ding XW reviewed and edited the manuscript.
Supported by Research Project of Zhejiang Provincial Science and Technology Plan for Traditional Chinese Medicine, No. 2024ZL753; and Research Project of Zhejiang Provincial Medical and Health Science and Technology Plan, No. 2024KY1406.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Wei Ding, MD, Director, Department of Rehabilitation Medicine, The Affiliated Hangzhou First People's Hospital Chengbei Campus, School of Medicine, Westlake University, No. 88 Bolang Street, Xiasha Street, Qiantang District, Hangzhou 310088, Zhejiang Province, China. 13758120616@163.com
Received: April 15, 2025
Revised: May 19, 2025
Accepted: June 23, 2025
Published online: July 15, 2025
Processing time: 90 Days and 23.5 Hours
Abstract
BACKGROUND

Type 2 diabetes mellitus (T2DM), a chronic metabolic disease with a high global incidence, has become a serious public health challenge. China has the largest number of T2DM patients worldwide, imposing a significant economic burden on the healthcare system. T2DM is closely associated with insulin resistance, impaired pancreatic B cell function, and disordered glucose and lipid metabolism, which can lead to various complications, reducing patients' quality of life and increasing the risk of disability and death. Thus, finding effective preventive and intervention measures is crucial. Exercise therapy, a key part of diabetes management, has gained attention in recent years, with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.

AIM

To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.

METHODS

Systematic searches were conducted using PubMed, EMBASE, Cochrane Library, and Chinese databases for relevant randomized controlled trials (RCTs). The inclusion criteria were participants aged ≥ 18 years with T2DM and the intervention involved combined resistance and aerobic exercise for ≥ 8 weeks. The primary outcome indicators were fasting blood glucose, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), glycated hemoglobin A1c (HbA1c), and total cholesterol (TC) levels. Data analysis was performed using RevMan software, and the interventional effects were assessed using weighted mean differences or standardized mean differences (SMD).

RESULTS

Six RCTs meeting the inclusion criteria were included, with a total sample size of 366 participants. The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM. Specific results were as follows: (1) For fasting blood glucose, combined exercise was more effective than aerobic exercise alone [SMD = 1.22; 95% confidence interval (95%CI): 0.70, 1.74; P < 0.00001]; (2) LDL-C levels were significantly reduced by the combined intervention (SMD = 1.45; 95%CI: 1.18-1.72; P < 0.00001); (3) The combined intervention significantly increased HDL-C levels (SMD = 1.42; 95%CI: 0.98-1.87; P < 0.00001); (4) The combined intervention significantly reduced TG levels (SMD = 1.12; 95%CI: 0.85-1.39; P < 0.00001; (5) No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group (SMD = −0.03; 95%CI: -1.09 to 1.04; P < 0.00001); and (6) The combined exercise intervention group significantly reduced TC levels (SMD = 2.66; 95%CI: 1.93-3.38; P < 0.00001). The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors, including the patient's age, baseline blood glucose levels, and exercise intensity.

CONCLUSION

Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose, LDL-C, HDL-C, TG, and TC levels in patients with T2DM, especially in terms of blood glucose control and cardiovascular risk, demonstrating better outcomes than aerobic exercise alone.

Keywords: Type 2 diabetes; Combined resistance exercise; Aerobic exercise; Meta-analysis; Blood glucose control; Metabolic indicators

Core Tip: Combined resistance and aerobic exercise significantly improves glycemic control and metabolic indicators in patients with type 2 diabetes, including fasting blood glucose, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and total cholesterol levels. Although no significant improvement was observed in glycated hemoglobin A1c levels, combined exercise remains a promising therapeutic strategy for diabetes management.