Journal of Diabetes and Its Complications · Oct 19, 2025

Impact of aerobic exercise on cardiometabolic health in patients with diabesity: A systematic review and meta-analysis of randomized controlled trials

By Al-Mhanna SB, Franklin BA, Jakicic JM et al.

PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

doi.org/10.1016/j.jdiacomp.2025.109203Open accessPubMed 41135244Interventions