Aerobic-resistance training and high-intensity interval training may improve metabolic and functional outcomes in adults with type 2 diabetes

1. 12 weeks of aerobic–resistance training and high-intensity interval training improved metabolic, functional, and quality-of-life outcomes in adults with type 2 diabetes mellitus compared with standard care.

2. HIIT was superior for fasting glucose reduction and muscle mass gains, while aerobic–resistance training produced greater improvements in HbA1c, fat reduction, and quality of life.

Evidence Rating Level: 1 (Excellent)

Aerobic exercise training, resistance exercise training, and high-intensity interval training (HIIT) each provide unique physiological benefits for the management of type 2 diabetes mellitus (T2DM). However, direct comparison between aerobic–resistance training (A + R) and high-intensity interval training (HIIT) in T2DM management is lacking. This study thus compared the effects of A + R and HIIT on clinical outcomes in adults with T2DM, relative to standard care. This randomised controlled trial included participants aged 30–65 years with T2DM who were recruited from a hospital in Ajman, United Arab Emirates, between 2 June 2021 and 30 November 2022. Participants were randomised 1:1:1 to either the combined aerobic and resistance exercise training (A + R) group, HIIT training group, or control group (usual care without structured exercise). Both A+R and HIIT programs were delivered 3–5 times weekly for 12 weeks. All 90 participants randomised completed the intervention and follow-up, with 30 participants in each group (A+R group: mean [SD] age = 55.1 [6.2] years, HIIT group: mean [SD] age = 45.9 [10.3] years, control group: mean [SD] age = 50.4 [8.5] years). Compared to the control group at 12-weeks, both the HIIT and A+R group showed greater reduction in fasting glucose (HIIT: Mean Difference [MD] −29.1 mg/dL; 95% CI −41.2 to −17.0; A+R: MD −20.6 mg/dL; 95% CI −31.0 to −10.2), HbA1c (HIIT: MD −3.35%; 95% CI −4.11 to −2.5; A+R: MD −3.33%; 95% CI −4.03 to −2.62), and fasting insulin (HIIT: MD −7.16 mIU/L; 95% CI −10.04 to −4.28; A+R MD −8.87 mIU/L; 95% CI −11.77 to −5.97). Compared to the control group, the Homeostatic Model Assessment of Insulin Resistance improved in the A+R group (MD −2.33; 95% CI −3.63 to −1.03) but not in the HIIT group. Functional capacity (6-minute walk distance) also increased in both the HIIT group (MD +178.9 m; 95% CI 130.5 to 227.4) and A+R group (MD +233.6 m; 95% CI 191.8 to 275.5) compared to the control. Additionally, in both HIIT and A+R groups, fat-free mass increased (HIIT MD +7.54 kg; 95% CI 4.71 to 10.36; A+R MD +5.96 kg; 95% CI 3.06 to 8.86) while subcutaneous fat (HIIT: MD −7.16%; 95% CI −9.33 to −4.99; A+R: MD −8.37%; 95% CI −10.65 to −6.09) and visceral fat (HIIT: MD −4.70%; 95% CI −5.93 to −3.47; A+R: MD −4.58%; 95% CI −5.86 to −3.31) were reduced. Finally, quality of life improved across domains in both groups (e.g., physical domain: HIIT MD +10.29; 95% CI 4.06 to 16.51; A+R MD +13.77; 95% CI 6.62 to 20.91) compared to the control group. Overall, this study found that aerobic–resistance training (A + R) and high-intensity interval training (HIIT) improved metabolic, functional, and quality-of-life outcomes in adults with type 2 diabetes mellitus compared with standard care. HIIT was superior for fasting glucose reduction and muscle mass gains, while A + R produced greater improvements in HbA1c, fat reduction, and quality of life. These findings support tailoring exercise interventions to therapeutic goals. Future longitudinal studies are needed to confirm these findings.

Click here to read this study in PLOS One

Image: PD

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