Journal of Diabetes and Metabolic Disorders · Mar 3, 2026

Effects of low-load blood flow restriction resistance training on Sirtuin-1 and endothelial-related biochemical markers in men with type 2 diabetes: a randomized controlled trial

By Fatehi M, Nayebifar S, Ghasemi E et al.

PURPOSE: The present study aimed to investigate the effects of a period of resistance training with blood flow restriction on serum levels of Sirtuin-1 (SIRT1), Nitric Oxide (NO), Endothelin-1 (ET-1), and blood pressure in individuals with type 2 diabetes. METHODS: In this randomized controlled clinical trial, 45 male patients with type 2 diabetes were purposefully selected and randomly assigned into three equal groups: high-resistance training (HRT), resistance training with blood flow restriction (RT + BFR), and control (CO). The HRT group performed resistance exercises at 70-80% of one-repetition maximum (1 RM), while the RT + BFR group trained at 20-30% of 1 RM using restrictive cuffs for 16 weeks. Before and after the training period, blood samples were taken to assess serum levels of SIRT1, NO, and ET-1. Data were analyzed using ANCOVA with post hoc Tukey tests, and significance was set at P < 0.05. FINDINGS: After the training intervention, serum levels of SIRT1 and NO significantly increased in both the HRT group (P = 0.001 and P = 0.001, respectively) and the RT + BFR group (P = 0.001 and P = 0.001, respectively) compared to the control group. Besides, ET-1 levels significantly decreased in the HRT group (P = 0.02) and the RT + BFR group (P = 0.01) compared to the control group. Systolic blood pressure significantly decreased only in the HRT group compared to the control (P = 0.03). Nevertheless, there were no significant differences between the two training groups in the mean values of SIRT1, NO, or systolic blood pressure (P > 0.05). CONCLUSION: Low-intensity resistance training with BFR, similar to high-intensity resistance training, can increase SIRT1 and NO levels, reduce ET-1 and blood pressure, and thereby exert a positive effect on biochemical markers associated with endothelial function in diabetic patients. TRIAL REGISTRATION: Registered retrospectively in the Iranian Registry of Clinical Trials (Registration Number: IRCT20241004063256N1) on November 24, 2024. Access at https://irct.behdasht.gov.ir/trial/79384.

doi.org/10.1007/s40200-026-01910-x Open access PubMed 41788318 Interventions