Table 1. Characteristics of the included studies according to population, intervention, comparator, and outcomes.

Study	C	P	N (AE/RT)	Weeks	Age (yrs)	BMI (kg/m2)	Intervention (AE)	Comparator (RT)	Primary outcomes	Dropout (%) (AE/RT)
Ranasinghe et al., 2021	Sri Lanka	Adults with diabesity	28 / 28	12	~50	NR	60-75% HRmax, walking/ cycling/stepper, 60-75 min, 2×/wk	50-60% 1RM, 7 exercises, 3×8 reps, 2×/wk; supervised	BW, BF, WC, FBG, FI, HbA1c, SBP, DBP	26 / 26
Bacchi et al., 2012	Italy	Adults with diabesity	19 / 19	16	40-70	~29	cycling 60% VO2max, 60 min, 3×/wk	70-80% 1RM, 9 exercises, progressive, 3×/wk; supervised	BMI, WC, FBG, HbA1c, HDL, LDL, TC, TG, SBP, DBP, CRF	5 / 5
Cauza et al., 2005	Austria	Adults with diabesity	17 / 22	16	~58-60	~31-34	~60-80% VO2peak, 3×/wk	~70-80% 1RM, 3×/wk	BW, BF, FFM, FBG, FI, HbA1c, HDL, LDL, TC, TG, SBP, DBP, CRF	14 / 13
Church et al., 2010	USA	Adults with diabesity	72 / 73	36	NR	~35	12 kcal/kg/wk, 50-80% VO2max, 3×/wk	7 machine exercises, progressive, 3×/wk	BMI, HbA1c	4 / 7
Jorge et al., 2011	Brazil	Adults with diabesity	12 / 12	12	~54	~29-32	cycling at lactate threshold, 60 min, 3×/wk	60-80% 1RM, 8 exercises, circuit, 3×/wk	BMI, WHR, FBG, HbA1c, HOMA-IR, HDL, TC, TG, CRF	0 / 0
Kadoglou et al., 2013	Greece	Adults with diabesity	21 / 23	24	AE 58 ± 5 RT 56 ± 5	AE 32 ± 3 RT 33 ± 3	60-75% HRmax, 60 min, 4×/wk	60-80% 1RM, supervised	BF, WHR, FBG, FI, HOMA-IR, HbA1c, HDL, LDL, TC, TG, SBP, DBP, CRF	16 / 8
Ku et al., 2010	South Korea	Adults with diabesity	15 / 13	12	NR	NR	walking 60 min, 3.6-5.2 METs, 5×/wk	elastic band, 40-50% max, 5×/wk	BW, BMI, WHR, FBG, HbA1c	0 / 0
Moe et al., 2011	Norway	Adults with diabesity	13 / 13	12	~56-58	~29-31	75-85% VO2peak, 3×/wk	~60% 1RM, 3×/wk	BMI, FBG, HbA1c, HC, WC, WHR, SBP, DBP, CRF	0 / 0
Ng et al., 2010	Singapore	Adults with diabesity	30 / 30	8	58 ± 7	28 ± 5	similar volume aerobic exercise; 8 wk	progressive resistance training of similar volume; 8 wk	BW, BF, BMI, FBG, HbA1c, WC, WHR, SBP, DBP	20 / 17
Shenoy et al., 2009	India	Adults with diabesity	10 / 10	16	NR	~26-27	moderate intensity, 3×/wk	60↓100% 1RM progressive, 2×/wk	BMI, FBG, HbA1c, SBP, DBP	0 / 0
Sigal et al., 2007	Canada	Adults with diabesity	60 / 64	22	NR	~34-36	treadmill/ cycling, 60-75% HRmax, 3×/wk	8-9RM progressive, 3×/wk	BW, BF, FFM, BMI, WC, HbA1c, HDL, LDL, TC, TG, SBP, DBP	0 / 0
Yavari et al., 2012	Iran	Adults with diabesity	15 / 15	52	51 ± 9	NR	60↓75% HRmax, 20↓60 min, 3×/wk	60↓80% 1RM, 10 exercises, 3×8-10 reps, 3×/wk	BW, BF, FBG, HbA1c, HDL, LDL, TC, TG, SBP, DBP, RHR, CRF	25 / 25
Kobayashi et al., 2023	Japan	Adults with diabesity	63 / 61	36	~60	NR	moderate-to-vigorous target HR zone, 3×/wk	8-12RM progressive, 3×/wk	BF, FFM, FBG, HbA1c	28 / 27
Duan and Lu, 2024	China	Adults with diabesity	12 / 12	12	40-45	≥ 30	60-75% HRR, 4×/wk	60-80% 1RM, 3×/wk	FBG, FI, HOMA-IR, HbA1c, HDL, LDL, TC, TG, CRF	0 / 0
Shahzadi et al., 2025	Pakistan	Adults with diabesity	20 / 20	12	~50-55	NR	~60-70% HRmax, 3×/wk	~60-70% 1RM, 3×/wk	HbA1c, CRF	9 / 4
Piralaiy et al., 2025	Thailand	Adults with diabesity	11 / 11	12	~50-55	NR	~60-70% HRR, 3×/wk	~60-70% 1RM, 3×/wk	BMI	15 / 15
Kwon et al., 2011	South Korea	Adults with diabesity	13 / 12	12	57 ± 7	27 ± 2.3	walking 60 min, 3.6-6.0 METs, 5 ×/wk	bands, 3×10-15, progressive, 3×/wk	BW, FBG, HbA1c, HDL, LDL, TC, TG, SBP, DBP, CRF	0 /0
Sukala et al., 2012	New Zealand	Adults with diabesity	9 / 9	16	49 ± 5	44 ± 10	supervised, 3×/wk, 16 wk	supervised, 3×/wk, 16 wk	BW, BF, BMI, WC, FBG, FI, HbA1c, HDL, LDL, TC, TG, SBP, DBP	31 / 31
Elsayed et al., 2024	Egypt	Adults with diabesity	20 / 20	12	~mid-50s	≥ 25	~60-70% HRmax, 3×/wk	~60-70% 1RM, 3×/wk	FI, TC	0 / 0
Arora et al., 2009	India	Adults with diabesity	10 / 9	8	NR	NR	walking 30 min, 3×/wk	60↓100% 1RM, 7 exercises, 3×10, 2×/wk	BMI, HbA1c, HDL, TC, TG, SBP, DBP, RHR	0 / 10
Oliveira et al., 2012	Brazil	Adults with diabesity	11 / 10	12	AT 52 ± 9 RT 54 ± 9	AT 29 ± 2 RT 31 ± 4	cycling at lactate threshold, progressed to 50 min, 3×/wk	circuit 7 exercises, 4×8-12 to failure, 3×/wk	BW, BF, WC, WHR, FBG, HbA1c, HDL, LDL, TC, TG, SBP, DBP, CRF	0 / 0
Swift et al., 2012	USA	Adults with diabesity	50 / 58	~36	AE 56 ± 8 RT 59 ± 8	AE 34 ± 6 RT 34 ± 5	12 kcal/kg/wk (HART-D)	3×/wk, 2-3 sets, 10-12 reps, progressive	BF, FFM, FBG, HbA1c, WC, CRF	8 / 5
Reid et al., 2010	Canada	Adults with diabesity	51 / 58	22	39-70	AE 34 ± 6 RT 33 ± 6	treadmill/cycling to 45 min at 75% HRmax, 3×/wk	8 machine exercises, 2-3 sets, ~8RM, 3×/wk	BMI, RHR	0 / 0

C: country, P: Population, AE: Aerobic exercise, RT: Resistance training, BMI: Body mass index, BW: Body weight, BF: Body fat, WC: Waist circumference, WHR: Waist-to-hip ratio, FBG: Fasting blood glucose, FI: Fasting insulin, HbA1c: Glycated hemoglobin, HOMA-IR: Homeostatic model assessment of insulin resistance, HDL=High-density lipoprotein cholesterol, LDL: Low-density lipoprotein cholesterol, TC: Total cholesterol, TG: Triglycerides, SBP: Systolic blood pressure, DBP: Diastolic blood pressure, CRF: Cardiorespiratory fitness.