Impact of high-intensity interval training on cardiometabolic health in patients with diabesity: a systematic review and meta-analysis of randomized controlled trials

Sameer Badri Al-Mhanna^{1

2

3}, Barry A Franklin^{4

5}, Mark A Tarnopolsky⁶, John A Hawley⁷, John M Jakicic⁸, Emmanuel Stamatakis^{9

10}, Jonathan P Little¹¹, Linda S Pescatello¹², Deborah Riebe¹³, Walter R Thompson¹⁴, James S Skinner¹⁵, Sheri R Colberg¹⁶, Jonathan K Ehrman¹⁷, George S Metsios¹⁸, Helen T Douda¹⁹, Norsuhana Omar²⁰, Abdullah F Alghannam²¹, Alexios Batrakoulis^{22

23}

Affiliations

¹ Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India.
² Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
³ Department of Higher Studies, Al-Qasim Green University, Babylon, Iraq.
⁴ Preventive Cardiology and Cardiac Rehabilitation, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.
⁵ Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
⁶ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁷ Exercise and Nutrition Research Program, The Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
⁸ Department of Internal Medicine, Division of Physical Activity and Weight Management, Medical Center, University of Kansas, Kansas City, KS, USA.
⁹ Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
¹⁰ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
¹¹ School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada.
¹² Department of Kinesiology, University of Connecticut, Storrs, CT, USA.
¹³ College of Health Sciences, University of Rhode Island, Kingston, RI, USA.
¹⁴ College of Education and Human Development, Georgia State University, Atlanta, GA, USA.
¹⁵ Department of Kinesiology, Indiana University Bloomington, Bloomington, IN, USA.
¹⁶ Human Movement Sciences Department, Old Dominion University, Norfolk, VA, USA.
¹⁷ Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health, Detroit, MI, USA.
¹⁸ Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece.
¹⁹ Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece.
²⁰ Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. suhanakk@usm.my.
²¹ Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint Abdulrahman, University, Riyadh, Saudi Arabia.
²² Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece. abatrakoulis@uth.gr.
²³ Department of Physical Education and Sport Science, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece. abatrakoulis@uth.gr.

PMID: 41137077
PMCID: PMC12553184
DOI: 10.1186/s13098-025-01974-4

Review

Impact of high-intensity interval training on cardiometabolic health in patients with diabesity: a systematic review and meta-analysis of randomized controlled trials

Sameer Badri Al-Mhanna et al. Diabetol Metab Syndr. 2025.

. 2025 Oct 24;17(1):406.

doi: 10.1186/s13098-025-01974-4.

Authors

Affiliations

¹ Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India.
² Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
³ Department of Higher Studies, Al-Qasim Green University, Babylon, Iraq.
⁴ Preventive Cardiology and Cardiac Rehabilitation, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.
⁵ Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
⁶ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁷ Exercise and Nutrition Research Program, The Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
⁸ Department of Internal Medicine, Division of Physical Activity and Weight Management, Medical Center, University of Kansas, Kansas City, KS, USA.
⁹ Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
¹⁰ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
¹¹ School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada.
¹² Department of Kinesiology, University of Connecticut, Storrs, CT, USA.
¹³ College of Health Sciences, University of Rhode Island, Kingston, RI, USA.
¹⁴ College of Education and Human Development, Georgia State University, Atlanta, GA, USA.
¹⁵ Department of Kinesiology, Indiana University Bloomington, Bloomington, IN, USA.
¹⁶ Human Movement Sciences Department, Old Dominion University, Norfolk, VA, USA.
¹⁷ Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health, Detroit, MI, USA.
¹⁸ Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece.
¹⁹ Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece.
²⁰ Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. suhanakk@usm.my.
²¹ Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint Abdulrahman, University, Riyadh, Saudi Arabia.
²² Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece. abatrakoulis@uth.gr.
²³ Department of Physical Education and Sport Science, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece. abatrakoulis@uth.gr.

PMID: 41137077
PMCID: PMC12553184
DOI: 10.1186/s13098-025-01974-4

Abstract

Aims: This systematic review and meta-analysis aimed to evaluate the effects of high-intensity interval training (HIIT) on cardiometabolic health-related outcomes in patients with type 2 diabetes and obesity (diabesity).

Methods: PubMed, Web of Science, Scopus, Science Direct, Cochrane Library, and Google Scholar databases were searched from inception up to November 2024. The search strategy encompassed the following keywords: diabetes, obesity, and HIIT. Randomized controlled trials (RCTs) recruiting adult participants with diabesity and comparing HIIT per se for ≥ 2 weeks in duration with non-exercise standard treatment were included.

Results: A total of 18 RCTs qualified involving 504 patients (52/48 women/men ratio; 55.0 ± 11.8 years; 31.0 ± 6.9 kg/m2). Body mass [standardized mean differences (SMD) -0.36 kg, 95% confidence intervals (CI) -0.71 to -0.01], body mass index (SMD -0.57 kg/m2, 95% CI -0.92 to -0.21), waist-to-hip ratio (SMD -1.68, 95% CI -2.50 to -0.86), fasting blood glucose (SMD -0.64 mmol/L, 95% CI -1.03 to -0.24), glycated hemoglobin (SMD -1.08%, 95% CI -1.68 to -0.47), fasting insulin (SMD -0.79 mIU/L, 95% CI -1.28 to -0.31), homeostatic model assessment for insulin resistance (SMD -0.95, 95% CI -1.43 to -0.47), low-density lipoprotein cholesterol (SMD -0.64 mg/dL, 95% CI -1.23 to -0.06), triglycerides (SMD -0.64 mg/dL, 95% CI -1.02 to -0.26), and total cholesterol (SMD -0.66 mg/dL, 95% CI -1.23 to -0.08) improved compared to standard treatment without exercise.

Conclusions: The present findings suggest that HIIT improves several markers of metabolic health and cardiovascular risk, even without significant body composition improvements in patients with diabesity. OPEN SCIENCE FRAMEWORK REGISTRY.: https://osf.io/rtb42.

Keywords: Aerobic capacity; Blood pressure; Body composition; Exercise; Glucose metabolism; Intermittent training; Lipid metabolism; Obesity; Type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Provenance and peer review: Not commissioned; externally peer-reviewed. Patient consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

**Fig. 2**
Summary of the risk of bias assessment

**Fig. 3**
Graphic overview of results. BF: Body fat, BM: Body mass, BMI: Body mass index, DBP: Diastolic blood pressure, FBG: Fasting blood glucose, FFM: Fat-free mass, FI: Fasting insulin, FM: Fat mass, HbA1c: Glycated hemoglobin, HC: Hip circumference, HDL-C: High-density lipoprotein cholesterol, HIIT: High-intensity interval training, HOMA-IR: Homeostatic Model Assessment for Insulin Resistance, HRmax: Maximum Heart Rate, LDL-C: Low-density lipoprotein cholesterol, RHR: Resting heart rate, SBP: Systolic blood pressure,TC: Total cholesterol, TG: Triglycerides, VO₂max: Maximum oxygen consumption, WC: Waist circumference, WHR: Waist-to-hip ratio

See this image and copyright information in PMC

References

1. Bhupathiraju SN, Hu FB. Epidemiology of obesity and diabetes and their cardiovascular complications. Circ Res. 2016;118(11):1723–35. 10.1161/CIRCRESAHA.115.306825. - DOI - PMC - PubMed
1. Ng ACT, Delgado V, Borlaug BA, Bax JJ. Diabesity: the combined burden of obesity and diabetes on heart disease and the role of imaging. Nat Rev Cardiol. 2021;18(4):291–304. 10.1038/s41569-020-00465-5. - DOI - PubMed
1. Liu J-J, Liu S, Wang J, Lee J, Tang JI-S, Gurung RL, et al. Risk of incident heart failure in individuals with early-onset type 2 diabetes. J Clinical Endocrinol & Metabolism. 2022;107(1):e178–87. - DOI - PubMed
1. Moore KJ, Shah R. Introduction to the obesity, metabolic syndrome, and CVD compendium. Circ Res. 2020;126(11):1475–6. 10.1161/CIRCRESAHA.120.317240. - DOI - PMC - PubMed
1. Pataky Z, Armand S, Muller-Pinget S, Golay A, Allet L. Effects of obesity on functional capacity. Obesity (Silver Spring). 2014;22(1):56–62. 10.1002/oby.20514. - DOI - PubMed

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Impact of high-intensity interval training on cardiometabolic health in patients with diabesity: a systematic review and meta-analysis of randomized controlled trials

Affiliations

Impact of high-intensity interval training on cardiometabolic health in patients with diabesity: a systematic review and meta-analysis of randomized controlled trials

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources