Latest advances and controversies of exercise therapy in the management of type 2 diabetes

Exercise therapy is a recognized cornerstone in the management of type 2 diabetes, offering broad benefits that extend beyond simple glycemic control to include cardiovascular and quality-of-life improvements. This mini-review synthesizes recent evidence on the efficacy of various exercise modalities, dosage optimization, and the ongoing tension between ideal clinical efficacy and real-world effectiveness. Recent meta-analyses indicate that high-intensity interval training (HIIT) is highly time-efficient and yields superior reductions in glycated hemoglobin (HbA1c). Meanwhile, concurrent training, which combines aerobic and resistance exercise, provides the most comprehensive metabolic and physiological benefits. Emerging research also emphasizes a paradigm shift toward personalized exercise prescriptions, suggesting an optimal physical activity dose of approximately 1100 MET-min/week that must be tailored to a patient's baseline glycemic status. Despite clear physiological advantages, such as enhanced cardiorespiratory fitness and reduced chronic inflammation, long-term patient adherence remains a significant barrier to sustained effectiveness in real-world settings. Future clinical and research strategies must prioritize behavioral innovations to improve adherence, explore the synergistic effects of exercise with novel pharmacological treatments like GLP-1 receptor agonists, and foster sustainable, active lifestyles for patients with type 2 diabetes.