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

Sameer Badri Al-Mhanna¹, Barry A Franklin², John M Jakicic³, Emmanuel Stamatakis⁴, Linda S Pescatello⁵, Deborah Riebe⁶, Walter R Thompson⁷, James S Skinner⁸, Sheri R Colberg⁹, Jonathan K Ehrman¹⁰, George S Metsios¹¹, Norsuhana Omar¹², Nouf H Alkhamees¹³, Bodor Bin Sheeha¹⁴, Abdullah F Alghannam¹⁵, Alexios Batrakoulis¹⁶

Affiliations

¹ Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India; Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Department of Higher Studies, Al-Qasim Green University, Babylons, Iraq.
² Preventive Cardiology and Cardiac Rehabilitation, William Beaumont University Hospital, Royal Oak, MI, USA; Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA. Electronic address: barry.franklin@corewellhealth.org.
³ Department of Internal Medicine, Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, KS, USA. Electronic address: jjakicic@kumc.edu.
⁴ Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. Electronic address: emmanuel.stamatakis@sydney.edu.au.
⁵ Department of Kinesiology, University of Connecticut, Storrs, CT, USA. Electronic address: linda.pescatello@uconn.edu.
⁶ College of Health Sciences, University of Rhode Island, Kingston, RI, USA. Electronic address: debriebe@uri.edu.
⁷ College of Education and Human Development, Georgia State University, Atlanta, GA, USA. Electronic address: wrthompson@gsu.edu.
⁸ Department of Kinesiology, Indiana University Bloomington, Bloomington, IN, USA.
⁹ Department of Human Movement Studies & Special Education, Old Dominion University, Norfolk, VA, USA. Electronic address: scolberg@odu.edu.
¹⁰ Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health, Detroit, MI, USA. Electronic address: jehrman1@hfhs.org.
¹¹ Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece. Electronic address: g.metsios@uth.gr.
¹² Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Electronic address: suhanakk@usm.my.
¹³ Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. Electronic address: nhalkhamees@pnu.edu.sa.
¹⁴ Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. Electronic address: bhbinsheeha@pnu.edu.sa.
¹⁵ Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
¹⁶ Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece; Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece. Electronic address: abatrakoulis@uth.gr.

PMID: 41135244
DOI: 10.1016/j.jdiacomp.2025.109203

Free article

Review

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

Sameer Badri Al-Mhanna et al. J Diabetes Complications. 2025 Dec.

Free article

. 2025 Dec;39(12):109203.

doi: 10.1016/j.jdiacomp.2025.109203. Epub 2025 Oct 19.

Authors

Affiliations

¹ Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India; Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Department of Higher Studies, Al-Qasim Green University, Babylons, Iraq.
² Preventive Cardiology and Cardiac Rehabilitation, William Beaumont University Hospital, Royal Oak, MI, USA; Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA. Electronic address: barry.franklin@corewellhealth.org.
³ Department of Internal Medicine, Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, KS, USA. Electronic address: jjakicic@kumc.edu.
⁴ Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. Electronic address: emmanuel.stamatakis@sydney.edu.au.
⁵ Department of Kinesiology, University of Connecticut, Storrs, CT, USA. Electronic address: linda.pescatello@uconn.edu.
⁶ College of Health Sciences, University of Rhode Island, Kingston, RI, USA. Electronic address: debriebe@uri.edu.
⁷ College of Education and Human Development, Georgia State University, Atlanta, GA, USA. Electronic address: wrthompson@gsu.edu.
⁸ Department of Kinesiology, Indiana University Bloomington, Bloomington, IN, USA.
⁹ Department of Human Movement Studies & Special Education, Old Dominion University, Norfolk, VA, USA. Electronic address: scolberg@odu.edu.
¹⁰ Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health, Detroit, MI, USA. Electronic address: jehrman1@hfhs.org.
¹¹ Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece. Electronic address: g.metsios@uth.gr.
¹² Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Electronic address: suhanakk@usm.my.
¹³ Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. Electronic address: nhalkhamees@pnu.edu.sa.
¹⁴ Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. Electronic address: bhbinsheeha@pnu.edu.sa.
¹⁵ Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
¹⁶ Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece; Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece. Electronic address: abatrakoulis@uth.gr.

PMID: 41135244
DOI: 10.1016/j.jdiacomp.2025.109203

Abstract

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.

Keywords: Blood pressure; Body composition; Chronic inflammation; Endurance training; Exercise; Glucose metabolism; Lipid metabolism; Obesity; Physical function; Type 2 diabetes.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

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LinkOut - more resources

Full Text Sources

Medical