Review article - (2026)25, 637 - 655
DOI: https://doi.org/10.52082/jssm.2026.637
Comparative Effectiveness of Aerobic Exercise versus Resistance Training on Cardiometabolic Health in Patients with Diabesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Sameer Badri Al-Mhanna1,2,3, Barry A. Franklin4,5, Zacharias Papadakis6, Stuart M. Phillips7, John M. Jakicic8, Emmanuel Stamatakis9,10,11, Brad J. Schoenfeld12, Yongming Li13,14,15, Linda S. Pescatello16, Deborah Riebe17, Walter R. Thompson18, Mingyue Yin13,14, Nouf H. Alkhamees19, Bodor Bin Sheeha19, Norsuhana Omar2,, Abubakar Ibrahim20, Ain' Sabreena Mohd Noh2, Yusuf Lukman21, Mohd Shahrulsalam Mohd Shah22, Alexios Batrakoulis23,24
1Department of Physiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
10Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, Australia
11School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
12Department of Exercise Science and Recreation, Lehman College, Bronx, NY, USA
13School of Athletic Performance, Shanghai University of Sport, Shanghai, China
14School of Coaching, Shanghai University of Sport, Shanghai, China
15China Institute of Sport Science, Beijing, China
16Department of Kinesiology, University of Connecticut, Storrs, CT, USA
17College of Health Sciences, University of Rhode Island, Kingston, RI, USA
18College of Education and Human Development, Georgia State University, Atlanta, GA, USA
19Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Saudi Arabia
2Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
20Amino Teaching Hospital, Bayero University, Kano Nigeria
21Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
22Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
23Department of Life Sciences, European University Cyprus, Nicosia, Cyprus
24Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
3Department of Higher Studies, Al-Qasim Green University, Babylon, Iraq
4Preventive Cardiology and Cardiac Rehabilitation, William Beaumont University Hospital, Royal Oak, MI, USA
5Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
6Department of Health Sciences and Clinical Practice, College of Health Professions and Medical Sciences, Barry University, Miami Shores, FL, USA
7Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
8Department of Internal Medicine, Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, KS, USA
9Turner Institute for Brain and Mind Health, School of Psychological Sciences, Monash University, Melbourne, Australia

Norsuhana Omar
✉ Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Email: suhanakk@usm.my
Received: 30-05-2026 -- Accepted: 26-06-2026
Published (online): 01-09-2026
Narrated in English
ABSTRACT

To evaluate the effects of aerobic exercise (AE) versus resistance training (RT) on cardiometabolic health-related outcomes in patients with type 2 diabetes mellitus and concurrent obesity (diabesity). Systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, Web of Science, Scopus, ScienceDirect, Cochrane Library, and Google Scholar databases were searched from inception up to April 2026. RCTs comparing AE and RT for a minimum duration of two weeks. Participants were adults with diabesity. A total of 23 RCTs qualified, involving 1, 184 patients (58/42 women/men ratio; age range: 30-70 years; body mass index: 32.1 ± 6.6 kg/m2). AE appears to be more efficacious than RT in reducing fasting blood glucose (mean differences (MD) = -0.89 mmol/L, 95% CI: -1.62 to -0.16; I2 = 0%) and increasing cardiorespiratory fitness (MD = 1.78 mL/kg/min, 95% CI: 0.38 to 3.18; I2 = 66%). However, AE led to a greater increase in body fat (MD = 0.34%, 95% CI: 0.10 to 0.57; I2 = 1%) and less fat-free mass retention (MD = -0.86 kg, 95% CI: -1.46 to -0.26; I2 = 37%) compared with RT. For selected cardiometabolic health-related outcomes, including anthropometrics, blood lipids, and hemodynamics, no statistically significant between-group difference was detected. The overall certainty of the evidence across outcomes ranged from high to very low, with most being moderate. In adults with diabesity, AE appears to provide greater benefits for FBG and CRF, whereas RT appears more favorable for preserving FFM and improving BF. For the majority of cardiometabolic outcomes, the two modalities exhibit analogous effects. The present findings support a goal-directed and complementary approach to exercise prescription, as opposed to a one-modality-fits-all model, for the improvement of cardiometabolic health in patients with diabesity.
Key words: Exercise, type 2 diabetes, obesity, body composition, glucose metabolism, lipid metabolism, blood pressure, cardiorespiratory fitness

Key Points
  • Aerobic exercise appears more effective than resistance training for improving fasting blood glucose in adults with diabesity.
  • Aerobic exercise also produces greater improvements in cardiorespiratory fitness compared with resistance training.
  • Resistance training appears superior for body composition, leading to better fat-free mass preservation and less body fat gain than aerobic exercise.
  • Aerobic exercise and resistance training show broadly no statistically significant between-group difference on anthropometric indices, blood lipids, and hemodynamic outcomes.
  • These findings support a goal-directed, complementary exercise prescription strategy rather than a one-modality-fits-all approach for cardiometabolic health in patients with diabesity.








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Comparative Effectiveness of Aerobic Exercise versus Resistance Training on Cardiometabolic Health in Patients with Diabesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Sameer Badri Al-Mhanna, Barry A. Franklin, Zacharias Papadakis, Stuart M. Phillips, John M. Jakicic, Emmanuel Stamatakis, Brad J. Schoenfeld, Yongming Li, Linda S. Pescatello, Deborah Riebe, Walter R. Thompson, Mingyue Yin, Nouf H. Alkhamees, Bodor Bin Sheeha, Norsuhana Omar, Abubakar Ibrahim, Ain' Sabreena Mohd Noh, Yusuf Lukman, Mohd Shahrulsalam Mohd Shah, Alexios Batrakoulis
2026(25), 637 - 655.
DOI: https://doi.org/10.52082/jssm.2026.637