SynthesisBMC endocrine disorders2026
Comparative effects of different exercise types on inflammatory markers in type 2 diabetes mellitus patients with overweight and obesity: a systematic review and network meta-analysis.
Synthesis in BMC endocrine disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFor patients with type 2 diabetes mellitus (T2DM) living with overweight or obesity, systemic chronic low-grade inflammation induced by excessive fat accumulation not only exacerbates insulin resistance but also serves as a pivotal driver of disease progression and cardiovascular complications. As a vital component of non-pharmacological therapy, exercise has demonstrated the potential to modulate immune responses and improve metabolic status, holding positive significance for combating this inflammatory process and delaying disease progression.
objectiveThis study aims to compare the effects of aerobic exercise (AE), resistance training (RT), and combined aerobic and resistance training (CE) on inflammatory marker levels in T2DM patients living with overweight and obesity through a network meta-analysis (NMA).
methodLiterature searches were conducted up to November 2025 across Cochrane, Embase, PubMed, and Web of Science databases to identify English-language randomized controlled trials (RCTs) meeting the inclusion criteria.
resultsA random-effects NMA was performed within a frequentist framework using Stata 17.0. 71 RCTs (N=4,266) were included. Results indicated that AE exhibits the highest probability of effectiveness in reducing high-sensitivity C-reactive protein (hs-CRP) (SUCRA = 81.7; SMD = -1.18; 95% CI: -1.81, -0.55; P < 0.001) and leptin (SUCRA = 91.5; SMD = -0.71; 95% CI: -1.05, -0.37; P < 0.001) levels as well as increasing adiponectin (SUCRA = 76.7; SMD = 1.13; 95% CI: 0.42, 1.84; P = 0.002) levels. At the same time, CE appears to offer the greatest potential in lowering IL-6 (SUCRA=76.6; SMD=-0.93; 95% CI: -1.63, -0.23; P=0.01) levels. RT did not significantly affect most inflammatory markers. TNF-α levels were not significantly modulated across any of the exercise interventions.
conclusionThis NMA based on RCTs confirms that different exercise types exhibit varying efficacy on distinct inflammatory markers in T2DM patients with overweight or obesity. These findings provide an evidence-based reference for clinicians when selecting exercise modalities based on a patient’s specific inflammatory profile, thereby more effectively managing their chronic inflammatory state. Given the holistic nature of lifestyle interventions, future research may integrate lifestyle control measures such as calorie restriction or anti-inflammatory diets. The current study was registered with the International Prospective Register of Systematic Reviews (PROSPERO), ID: CRD420251218729. CLINICAL TRIAL NUMBER: Not applicable.
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