Impact of resistance, endurance, and combined exercise training on lipid profile, apolipoprotein A-1, and nitric oxide synthase expression in women with type 2 diabetes: A randomized controlled trial

Type 2 diabetes mellitus (T2DM) involves metabolic disturbances and endothelial dysfunction, raising cardiovascular risk. To compare the effects of 8 weeks of resistance, endurance, and combined exercise on serum apolipoprotein A-1 (ApoA1), lipid profile, nitric oxide (NO) levels, nitric oxide synthase (NOS) expression, and metabolic parameters in women with T2DM. Sixty women with T2DM (aged 48–58) were randomized into resistance, endurance, combined training, or control groups. Interventions occurred thrice weekly for eight weeks. Pre- and post-intervention measures included anthropometrics (weight, BMI, WHR), fasting blood glucose (FBS), HbA1c, lipid profile (TG, LDL, HDL, total cholesterol), ApoA1, NO levels, and NOS expression (iNOS, eNOS). All exercise groups showed significant metabolic improvements versus controls. Endurance training notably reduced FBS, triglycerides, and BMI, with greatest improvements in FBS and TG (p < 0.05). Resistance training yielded the largest decreases in weight (12.89%) and BMI (8.12%), while combined training most effectively lowered FBS (19.23%). The endurance group had the greatest HbA1c reduction (18.15%). No significant changes were found in ApoA1, LDL, HDL, or total cholesterol. NO levels increased significantly in all exercise groups, especially combined and resistance groups (p < 0.001), but iNOS and eNOS expression remained unchanged. Controls showed minimal change. Eight weeks of resistance, endurance, or combined exercise improve metabolic markers in women with T2DM, each with distinct benefits. Increased NO without NOS expression changes suggests alternative pathways for NO bioavailability. Tailored exercise regimens are recommended for optimal T2DM management and cardiovascular risk reduction. • Randomized controlled trial comparing resistance, endurance, and combined exercise training in women with type 2 diabetes. • Endurance training led to the greatest reductions in fasting blood sugar, triglycerides, BMI, and HbA1c. • Resistance training resulted in the largest decreases in body weight and BMI. • Combined training was most effective for lowering fasting blood sugar. • No significant changes were observed in ApoA1, LDL, HDL, or total cholesterol in any exercise group. • All exercise groups showed significant increases in nitric oxide (NO) levels, especially combined and resistance groups. • No significant changes in iNOS or eNOS expression were detected after exercise interventions. • Increased NO levels without changes in NOS expression suggest alternative pathways for NO bioavailability.