---
title: "Exercise Modalities for Adults with Type 2 Diabetes and Obesity: Comparative Effects on Visceral F"
id: "frontiers-in-immunology-19-exercise-modalities-for-adults-with-type-2-diabetes-mellitus-and-obesity"
canonical_url: "https://medichelpline.com/clinical-feed/frontiers-in-immunology-19-exercise-modalities-for-adults-with-type-2-diabetes-mellitus-and-obesity"
content_type: "clinical_feed_article"
specialty: "Endocrinology"
source_name: "Frontiers in Immunology"
source_url: "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1825473"
published_at: "2026-08-25T00:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Exercise Modalities for Adults with Type 2 Diabetes and Obesity: Comparative Effects on Visceral F
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/frontiers-in-immunology-19-exercise-modalities-for-adults-with-type-2-diabetes-mellitus-and-obesity
- **Specialty:** [Endocrinology](https://medichelpline.com/clinical-feed/endocrinology.md)
- **Primary Source:** Frontiers in Immunology
- **Source URL:** [Original Journal Publication](https://www.frontiersin.org/articles/10.3389/fimmu.2026.1825473)
- **Published At:** 2026-08-25T00:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The provided source content consisted only of Frontiers in Immunology website navigation and journal section listings; the full article text was not included in the supplied source. - No study methods, results, sample sizes, exercise modalities, comparative findings, numeric outcomes, or author details were present in the material provided. - The original article title indicates a focus on exercise interventions for adults with **type 2 diabetes** and **obesity**, and aims to compare effects on **visceral fat**, metabolism, and **inflammatory markers** using a **network meta-analysis** approach. - Because the full article text was not available in the source, critical elements such as inclusion criteria, intervention definitions, outcome measures, statistical methods, and conclusions could not be extracted or summarized. - Readers seeking the complete evidence, specific comparative effects, or clinical recommendations should access the full article on the journal website; the supplied source did not report those details. - This summary preserves the original article intent but acknowledges that substantive content required for clinical interpretation was not reported in the provided source.
## Clinical Analysis & Structured Key Points
Frontiers | Exercise modalities for adults with type 2 diabetes mellitus and obesity: comparative effects on visceral fat, metabolism, and inflammatory markers from a network meta-analysis SYSTEMATIC REVIEW article Front. Immunol. , 25 August 2026 Sec. Inflammation Volume 17 - 2026 | https://doi.org/10.3389/fimmu.2026.1825473 Published in Frontiers in Immunology Inflammation 7 impact factor 11.3 citescore Editor & Reviewers Edited by M P Maria Pini Reviewed by O K Oran Kwon H A Hesham A Tawfeek Outline Figures and Tables Figure 1 View in article Figure 2 View in article Figure 3 View in article Table 1 Definitions of included interventions. View in article Table 2 Information related to 32 randomized controlled trials included in the network meta-analysis. View in article Table 3 SUCRA rankings of different exercise interventions by outcome indicators. View in article SYSTEMATIC REVIEW article Front. Immunol. , 25 August 2026 Sec. Inflammation Volume 17 - 2026 | https://doi.org/10.3389/fimmu.2026.1825473 Exercise modalities for adults with type 2 diabetes mellitus and obesity: comparative effects on visceral fat, metabolism, and inflammatory markers from a network meta-analysis J X Jinpeng Xu 1 S L Shuyue Luo 1 W G Wei Gao 2 * 1. Shenyang Sport University, Shenyang, Liaoning, China 2. Shenyang Sport University School of Marxism, Shenyang, Liaoning, China Article metrics View details Abstract Background: Obesity correlates closely with type 2 diabetes mellitus (T2DM), with central adiposity, dyslipidemia and chronic low-grade inflammation as typical pathological features. Physical exercise is recommended as a safe core non-pharmacological intervention, but the relative efficacy of different exercise modes for comprehensive metabolic improvement remains controversial and unclear. Objective: This network meta-analysis comprehensively compared the effects of diverse exercise interventions on abdominal fat distribution, glycolipid metabolism and inflammatory biomarkers in obese T2DM patients, aiming to determine the optimal exercise regimen for clinical individualized exercise prescription. Methods: We systematically searched five mainstream electronic databases for eligible RCTs published up to October 9, 2025. The Cochrane Risk of Bias Tool and GRADE system were used to assess study methodological quality and outcome evidence certainty. All statistical analyses were performed via Stata 16.0 and RevMan 5.4. Results: In total, 32 qualified RCTs involving 1519 obese T2DM participants were enrolled. No significant inconsistency was detected across all outcome indicators, so a consistency model was adopted for pooled analysis. Notably, exercise produced no significant change in total dietary energy intake. It significantly reduced BMI (MD = −1.78, 95% CI [−2.70, −0.85]), with combined aerobic-resistance training being optimal (SUCRA = 93%). Exercise also lowered TC (MD = −0.36, 95% CI [−0.59, −0.14], SUCRA = 94.2%), TG (MD = −0.28, 95% CI [−0.38, −0.19], SUCRA = 95%) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (MD = −0.92, 95% CI [−1.73, −0.10], SUCRA = 92.6%). LDL-C showed non-significant declining trend (SUCRA = 81.3%), while HDL-C increased markedly (MD = 0.12, 95% CI [0.05, 0.18], SUCRA = 97.5%). Aerobic exercise plus auxiliary treatments ranked first in reducing IL-6 (SUCRA = 99.9%). Walking and jogging worked best for reducing insulin level (SUCRA = 90.9%), and mind–body exercise maximized lean body mass (SUCRA = 93.7%). Conclusion: Regular exercise effectively ameliorates glycolipid metabolic disorders and chronic inflammatory status in obese T2DM patients. Combined aerobic-resistance training yields the most comprehensive metabolic benefits among all interventions. Importantly, these favorable metabolic improvements are independent of dietary energy restriction, which supports targeted individualized exercise prescriptions as an independent clinical intervention for this vulnerable population. Systematic review registration: https://www.crd.york.ac.uk/prospero/CRD420251272031 , identifier CRD420251272031. 1 Introduction In 2024, the global adult diabetes population reached 589 million, accounting for 11.1% of the global population in this age group. By 2045, this figure is projected to rise to 783 million ( 1 ). Type 2 diabetes mellitus (T2DM) is the predominant form of diabetes worldwide, accounting for over 90% of cases. Based on the 2024 global prevalence of 589 million people with diabetes, the number of T2DM patients is estimated at approximately 530 million ( 2 ). There are many factors contributing to the onset of T2DM, including obesity ( 3 ), prolonged sitting ( 4 ), Dietary habits ( 5 ) and unhealthy lifestyles ( 6 ) including factors such as Dietary adjustments and regular exercise are effective strategies for the prevention and management of T2DM ( 7 , 8 ). There exists a close bidirectional relationship between obesity and T2DM. Long-term excessive fat accumulation, particularly abdominal and visceral fat deposition, can promote the onset and progression of T2DM by exacerbating HOMA-IR and chronic low-grade inflammation ( 9 ). Diabetes itself can further exacerbate lipid metabolism disorders, creating a vicious metabolic cycle. Patients with T2DM and obesity typically exhibit abnormal abdominal fat accumulation, dyslipidemia, and elevated inflammatory factor levels. These alterations collectively contribute to the pathogenesis of glucose and lipid metabolism disorders ( 10 ). Patients with type 2 diabetes mellitus (T2DM) and obesity often require long-term energy restriction to improve glycemic and metabolic control, and their complications also significantly impact quality of life ( 11 , 12 ). This adds to the psychological burden of patients with T2DM and obesity to some extent, subsequently affecting their dietary quality and health status ( 13 ). Current diabetes interventions include lifestyle modifications, medication, and combined exercise and dietary interventions. International organizations typically recommend exercise as one of the primary management strategies for newly diagnosed T2DM patients. Exercise is a fundamental and primary element of diabetes and obesity prevention and management, underpinning lifestyle interventions alongside dietary and behavioral strategies ( 14 , 15 ). Currently, the International Diabetes Federation recommends moderate-intensity aerobic training and high-intensity resistance training for patients with type 2 diabetes mellitus (T2DM) who are also obese ( 16 ). However, different regional guidelines recommend different types of exercise, and there is yet to be a unified consensus on implementation methods and standardization ( 17 – 23 ). Previous studies have shown that aerobic exercise of varying intensities improves glycemic control, lipid levels, and functional activity scores in patients with type 2 diabetes mellitus ( 24 ). Resistance training exerts a significant impact on cardiovascular and metabolic health indicators in patients with type 2 diabetes mellitus (T2DM) and obesity ( 25 ). Aerobic combined with resistance training exercise under dietary control improved BMI, cardiovascular risk factors, and muscle strength in patients with type 2 diabetes mellitus and obesity ( 26 , 27 ). There is a relative lack of studies simultaneously measuring the effects of different exercise interventions on abdominal adipose tissue, obesity-induced lipid metabolism abnormalities, and chronic inflammation in populations with T2DM and obesity. Concurrently, constrained by study design limitations and the scarcity of direct comparisons, individual randomized controlled trials and traditional pairwise meta-analyses struggle to systematically evaluate the relative advantages of different physical activity modalities. Network meta-analysis integrates direct and indirect evidence to quantitatively compare the relative effectiveness of multiple interventions and rank their efficacy. Therefore, by examining the effects of different intervention approaches on patients with T2DM and obesity, we compare the efficacy and therapeutic outcomes of various exercise training regimens in improving lipid metabolism and reducing inflammatory markers within abdominal adipose tissue in this patient population. 2 Methods This study adheres to the recommendations of the PRISMA-NMA (see Supplementary Materials , Supplementary Table 1 ) and the Cochrane Handbook for Systematic Reviews of Interventions. It has been registered in the PROSPERO database (Registration ID: CRD420251272031). 2.1 Search strategy This study employed a three-stage literature retrieval strategy. First, an initial search was conducted in the PubMed database using a combination of MeSH terms and free-text keywords to establish a systematic retrieval vocabulary. Second, based on the established retrieval strategy, a comprehensive search was performed across PubMed, Embase, Web of Science, The Cochrane Library, and Scopus, systematically including randomized controlled trials published from the inception of our database through October 9, 2025. Finally, we supplemented the search by tracing the reference lists of all included studies to identify potentially overlooked relevant research. The keyword combinations used were: (“obesity” or “overweight”) AND (“exercise” or “training” or “physical activity”) AND (“type 2 diabetes” or “diabetes mellitus, type 2” or “non-insulin-dependent diabetes mellitus”). For specific search strategies, please refer to the attached document see ( Supplementary Materials , Supplementary Table 2 ). 2.2 Inclusion and exclusion criteria Inclusion criteria are as follows: ① Population: Adult patients (≥18 years old) with clinically confirmed type 2 diabetes mellitus (T2DM) and overweight or obesity, regardless of gender, disease duration, or severity. ② Intervention Measures: Included interventions must incorporate at least one exercise-based component, including but not limited to: Aerobic exercise alone, Resistance training alone, Combined aerobic and resistance training, Aerobic or resistance training combined with other effective interventions (e.g., standard care or health management), Structured exercise formats such as mind-body exercise, walking, or jogging. Specific details regarding the content, format, and combination of various exercise interventions are outlined in the Intervention Classification Description see Table 1 . ③ Comparison: The control group receives no exercise intervention, including routine care, health education, placebo intervention, or maintains their original lifestyle. ④ Outcomes: Studies must report at least one of the following outcome measures with extractable data. Outcomes were classified into primary and secondary outcomes based on reporting frequency across included studies and clinical evidence grade, consistent with standards for network meta-analysis. Table 1 Interventions Definition Blank Control Group no exercise intervention, usual care, diet-only intervention, or nutritional supplementation. Aerobic Exercise Only Group moderate-intensity aerobic exercise beach walking, MICT. Resistance Training Only Group This category comprised resistance training and high-intensity interval training (HIIT) interventions in which high-intensity muscular contractions constituted the dominant training stimulus. Aerobic Plus Resistance Training Group This intervention category included exercise programs that integrated aerobic exercise and resistance training within the same intervention period, either performed in the same session or on separate days. Aerobic exercise components consisted of activities such as walking, jogging, cycling, or other moderate-intensity continuous aerobic exercises, while resistance training comprised machine-based, free-weight, or body-weight resistance exercises. Aerobic Exercise Combined with Other Effective Treatments This category included aerobic exercise interventions combined with dietary modification or nutritional supplementation, such as aerobic exercise plus dietary intervention, aerobic exercise plus saffron supplementation, aerobic exercise plus green tea, and aerobic exercise plus zucchini supplementation. Resistance Training Combined with Other Effective Treatments This category included interventions in which resistance training was the core exercise modality, combined with specific nutritional or metabolic adjunctive treatments. Resistance training consisted of machine-based, free-weight, or body-weight exercises, while the co-interventions involved dietary carbohydrate modulation, protein supplementation, or other structured nutritional strategies (e.g., resistance training plus carbohydrate intake regulation or protein supplementation). Mind-Body Exercise Group This category included interventions characterized by integrated physical movement, breathing regulation, and mental focus, with Tai Chi as the primary modality. Walking and Jogging Group This category included structured walking-based interventions, such as continuous walking, intermittent walking, interval walking, and light jogging, performed at low-to-moderate intensity. Pharmacological or Psychological Intervention Group This category included non-exercise adjunctive interventions aimed at improving metabolic or psychological outcomes, such as nutritional supplementation (e.g., saffron, zucchini, green tea), macronutrient manipulation (e.g., carbohydrate-modified diets, high-protein diets), and structured dietary interventions. Aerobic Plus Resistance Training Combined with Other Effective Treatments This group integrates aerobic exercise, resistance training, and one or more additional effective therapeutic measures (e.g., dietary modification, nutritional supplementation, etc.) for patients with type 2 diabetes mellitus combined with obesity. Definitions of included interventions. Primary outcomes were defined as indicators with high reporting frequency (reported in ≥12 RCTs) and high clinical relevance to the core research question, reflecting key pathological characteristics in patients with type 2 diabetes and obesity. These included: BMI, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), HOMA-IR (Homeostatic Model Assessment of Insulin Resistanceis a widely validated mathematical index used to quantitatively evaluate peripheral insulin resistance, calculated from fasting plasma glucose and fasting insulin concentrations via the formula: HOMA-IR=Fasting glucose (mmol/L)×Fasting insulin (mIU/L)/22.5). Secondary outcomes were defined as indicators with lower reporting frequency ( 50, use random-effects models; if ≤ 50, use fixed-effects models. To further validate the robustness of the research conclusions, sensitivity analyses were conducted. During the meta-analysis process, randomized controlled trials with higher risk of bias were sequentially excluded to assess the stability of the results ( 30 ). Subsequently, a network meta-analysis was conducted. A network geometry diagram was used to visualize the evidence structure of different exercise interventions in patients with type 2 diabetes and obesity. In the network diagram, each node represents a distinct exercise intervention, with node area proportional to the number of participa
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