Intervention effect of combined resistance and aerobic exercise on type 2 diabetes: A meta-analysis

Table 1 Search strategy

Type of database	Search term combination	Screening conditions
English databases	"Resistance training" OR "Strength training" OR "Resistance exercise" OR "Strength exercise" OR "Aerobic exercise" OR "Aerobic training" OR "Combined training" OR "Combined exercise" OR "Resistance-aerobic exercise" OR "Aerobic-resistance exercise" OR "Exercise intervention" OR "Physical activity" AND ("Type 2 Diabetes Mellitus" OR "Diabetes Mellitus Type 2" OR "T2DM" OR "Non-insulin-dependent diabetes mellitus" OR "NIDDM" OR "Type II Diabetes") AND ("Effectiveness" OR "Efficacy" OR "Clinical effect" OR "Therapeutic effect" OR "Glycemic control" OR "Blood glucose control" OR "HbA1c" OR "Glucose metabolism") AND ("Safety" OR "Adverse events" OR "Adverse effects" OR "Side effects" OR "Safety profile") AND ("RCT" OR "Randomized controlled trial" OR "Clinical trial" OR "Randomized trial")	(1) Randomized controlled trials; (2) Patients with T2DM aged 18 or older; (3) Compare resistance exercise with aerobic exercise lasting at least 8 weeks, with preset frequency, intensity, and duration; and (4) Primary outcome indicators include at least one of the following and provide usable data: Fasting blood glucose level; low-density lipoprotein cholesterol level; high-density lipoprotein cholesterol level; triglycerides level; HbA1c level; total cholesterol level
Chinese databases	"Resistance training”, "aerobic exercise”, "combined exercise”, "exercise intervention”, "T2DM”, "diabetes”, "efficacy”, "effectiveness”, "safety”, and "randomized controlled trials"

T2DM: Type 2 diabetes mellitus; HbA1c: Glycated hemoglobin A1c.

Table 2 Characteristics of the included studies

Ref.	Sample (male/female)	Age	Outcome	Exercise method			Duration exercise program (month)	Resistance exercise-aerobic exercise combination (year)	Value of reference
				Treatment group (resistance exercise-aerobic exercise combination)		Control group
Yavari et al[12], 2012	52/46	56-75	(1), (2), (4), (5)	Resistance band exercises, including 10 different movements, with 3 sets of 15-20 repetitions per movement	Gait training at an intensity of 3.6-5.2 metabolic equivalents	Simple exercise: Slow walking	12	2-19/1-6	B
Church et al[13], 2010	69/68	≥ 34	(1), (2), (5), (6)	5 resistance training machines, with 3 sets of 8 repetitions per machine, resistance ranging from 60% of baseline to approximately 2.5 kg	Cycling ergometer at an intensity of 50%-85% of VO2 peak	Jogging for 30 minutes	12	2-3/1-6	A
Reid et al[14], 2010	60/62	30-55	(1), (2), (3)	9 exercises using machines and free weights, with 3 sets of 10 repetitions per exercise	Treadmill, upright stationary bike, recumbent stationary bike, and elliptical trainer at an intensity of 65%-70% of predicted heart rate	Treadmill for 20 minutes	12	2-25/1-6	A
Eskandary et al[15], 2017	37/37	≥ 30	(1), (2), (4), (5), (6)	7 exercises using weight machines, with 2-3 sets of 7-9 repetitions at maximum weight	Cycling or treadmill at an intensity of 60%-75% of maximum heart rate	Simple exercise: Slow walking	12	1-6	A
Al-Mhanna et al[16], 2024	63/63	< 43	(1), (2), (3), (5)	8 exercises using weight machines, with 2-3 sets of 6-8 repetitions per exercise	Cycling ergometer at an intensity of 65%-85% of heart rate reserve	Simple aerobic exercise for 20 minutes + 10 minutes of slow walking	12	2-19	A
Fatone et al[17], 2010	42/37	≥ 32	(1), (2), (4), (5), (6)	No machine-based exercises, with 3 sets of 8-10 repetitions per exercise	Treadmill, elliptical machine, or cycle ergometer at an intensity of 60%-75% of maximum heart rate	Simple exercise: Slow walking	12	1-4/1-5	B

(1): Fasting blood glucose level; (2): Low-density lipoprotein cholesterol level; (3): High-density lipoprotein cholesterol level; (4): Triglycerides level; (5): Glycated hemoglobin A1c level; (6): Total cholesterol level.

Table 3 Subgroup analysis

Factor	Fasting blood glucose	LDL-C	HDL-C	TG	HbA1c	TC
Age (years)
30-50	1.35 (0.75, 1.95)	1.60 (1.25, 1.95)	1.50 (1.05, 1.95)	1.25 (0.80, 1.70)	-0.10 (-1.10, 0.90)	2.80 (2.05, 3.55)
> 50	1.00 (0.50, 1.50)	1.30 (1.05, 1.55)	1.30 (0.90, 1.70)	1.00 (0.70, 1.30)	0.05 (-0.95, 1.05)	2.40 (1.75, 3.05)
Fasting blood glucose
> 8 mmol/L	1.50 (1.00, 2.00)	1.75 (1.40, 2.10)	1.40 (1.00, 1.80)	1.15 (0.85, 1.45)	-0.05 (-1.10, 1.00)	2.90 (2.30, 3.50)
< 8 mmol/L	0.95 (0.40, 1.50)	1.10 (0.80, 1.40)	1.25 (0.80, 1.70)	1.05 (0.70, 1.40)	0.05 (-0.95, 1.05)	2.50 (1.85, 3.15)
Exercise intensity
High	1.25 (0.80, 1.70)	1.50 (1.25, 1.75)	1.55 (1.10, 2.00)	1.10 (0.80, 1.40)	-0.05 (-1.05, 0.95)	2.75 (2.10, 3.40)
Low-to moderate	1.10 (0.50, 1.70)	1.25 (1.00, 1.50)	1.10 (0.70, 1.50)	1.05 (0.70, 1.40)	0.00 (-1.00, 1.00)	2.50 (1.85, 3.15)

The data were presented as standardized mean differences. LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; TG: Triglyceride; HbA1C: Glycated hemoglobin A1C; TC: Total cholesterol.