Resistance Training in Type 2 Diabetes: Mechanisms and Clinical Translation

Zhifei Wu

doi:10.54254/2753-8818/2025.AU25518

Theoretical and Natural ScienceOpen access

Resistance Training in Type 2 Diabetes: Mechanisms and Clinical Translation

Research Article

Open Access

Resistance Training in Type 2 Diabetes: Mechanisms and Clinical Translation

Zhifei Wu ^1*

¹ School of Physical Education and Health, Guangxi Medical University, Nanning, Guangxi, China

^*Corresponding author: 20224273544@sr.gxmu.edu.cn

Published on 30 July 2025

TNS Vol.133

ISSN (Print): 2753-8826

ISSN (Online): 2753-8818

ISBN (Print): 978-1-80590-303-1

ISBN (Online): 978-1-80590-304-8

Download Cover

Abstract

Type 2 diabetes (T2D) is a global pandemic imposing substantial health and economic burdens, highlighting the critical need for effective non-pharmacological management strategies beyond medication. This paper comprehensively examines the biological mechanisms underpinning the therapeutic effects of resistance training (RT) in T2D and translates this evidence into clinical applications. The results of this paper demonstrate that RT enhances glycemic control by upregulating skeletal muscle GLUT4 expression through AMPK/HDAC5-MEF2 and Akt/AS160 pathways, and activates mTORC1 signaling to promote protein anabolism. Clinically, structured RT significantly reduces HbA1c, attenuates postprandial glucose fluctuations, and mitigates major complications. The rationale is to improve the prognosis of diabetic foot by enhancing plantar pressure distribution and endothelial function, which is expected to reduce renal inflammation and oxidative stress in a preclinical diabetic nephropathy model, and in combination with aerobic exercise, improve nerve conduction velocity and pain in diabetic peripheral neuropathy. Critically, RT demonstrates a unique "strength-metabolism coupling" effect, concurrently improving muscle strength and glycemic control, especially in elderly T2D patients with sarcopenia. This paper underscores RT as a potent, evidence-based cornerstone intervention for T2D management. It provides a crucial theoretical foundation for developing personalized RT prescriptions and integrating RT within multidisciplinary care models to optimize outcomes and reduce complication risks.

Keywords:

Resistance training, Type 2 diabetes, Glycemic control, Diabetic complications.

View PDF

References

[1]. American Diabetes Association. (2023). Standards of Care in Diabetes—2023. Diabetes Care, 46(Suppl 1), S1–S291.

[2]. Wan, Y., & Su, Z. (2024). The Impact of Resistance Exercise Training on Glycemic Control Among Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Biological research for nursing, 26(4), 597–623.

[3]. Egan, B., Carson, B. P., Garcia-Roves, P. M., Chibalin, A. V., Sarsfield, F. M., Barron, N., McCaffrey, N., Moyna, N. M., Zierath, J. R., & O'Gorman, D. J. (2010). Exercise intensity-dependent regulation of peroxisome proliferator-activated receptor coactivator-1 mRNA abundance is associated with differential activation of upstream signalling kinases in human skeletal muscle. The Journal of physiology, 588(Pt 10), 1779–1790.

[4]. Holten, M. K., Zacho, M., Gaster, M., Juel, C., Wojtaszewski, J. F., & Dela, F. (2004). Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes, 53(2), 294–305.

[5]. Al-Mhanna, S. B., Batrakoulis, A., Wan Ghazali, W. S., Mohamed, M., Aldayel, A., Alhussain, M. H., Afolabi, H. A., Wada, Y., Gülü, M., Elkholi, S., Abubakar, B. D., & Rojas-Valverde, D. (2024). Effects of combined aerobic and resistance training on glycemic control, blood pressure, inflammation, cardiorespiratory fitness and quality of life in patients with type 2 diabetes and overweight/obesity: a systematic review and meta-analysis. PeerJ, 12, e17525.

[6]. Liu, Y., Ye, W., Chen, Q., Zhang, Y., Kuo, C. H., & Korivi, M. (2019). Resistance Exercise Intensity is Correlated with Attenuation of HbA1c and Insulin in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. International journal of environmental research and public health, 16(1), 140.

[7]. Dempsey, P. C. et al. (2016). Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities. Diabetes Care, 39(6), 964–972.

[8]. Armstrong, D. G., Tan, T. W., Boulton, A. J. M., & Bus, S. A. (2023). Diabetic Foot Ulcers: A Review. JAMA, 330(1), 62–75.

[9]. Aagaard, T. V., Moeini, S., Skou, S. T., Madsen, U. R., & Brorson, S. (2022). Benefits and Harms of Exercise Therapy for Patients With Diabetic Foot Ulcers: A Systematic Review. The international journal of lower extremity wounds, 21(3), 219–233.

[10]. Saberi, S., Askaripour, M., Khaksari, M., Amin Rajizadeh, M., Abbas Bejeshk, M., Akhbari, M., Jafari, E., & Khoramipour, K. (2024). Exercise training improves diabetic renal injury by reducing fetuin-A, oxidative stress and inflammation in type 2 diabetic rats. Heliyon, 10(6), e27749.

[11]. Seyedizadeh, S. H., Cheragh-Birjandi, S., & Hamedi Nia, M. R. (2020). The Effects of Combined Exercise Training (Resistance-Aerobic) on Serum Kinesin and Physical Function in Type 2 Diabetes Patients with Diabetic Peripheral Neuropathy (Randomized Controlled Trials). Journal of diabetes research, 2020, 6978128.

[12]. Shabkhiz, F., Khalafi, M., Rosenkranz, S., Karimi, P., & Moghadami, K. (2021). Resistance training attenuates circulating FGF-21 and myostatin and improves insulin resistance in elderly men with and without type 2 diabetes mellitus: A randomised controlled clinical trial. European journal of sport science, 21(4), 636–645.

[13]. Lee, J., Kim, D., & Kim, C. (2017). Resistance Training for Glycemic Control, Muscular Strength, and Lean Body Mass in Old Type 2 Diabetic Patients: A Meta-Analysis. Diabetes therapy: research, treatment and education of diabetes and related disorders, 8(3), 459–473.

References

[1]. American Diabetes Association. (2023). Standards of Care in Diabetes—2023. Diabetes Care, 46(Suppl 1), S1–S291.

[7]. Dempsey, P. C. et al. (2016). Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities. Diabetes Care, 39(6), 964–972.

[8]. Armstrong, D. G., Tan, T. W., Boulton, A. J. M., & Bus, S. A. (2023). Diabetic Foot Ulcers: A Review. JAMA, 330(1), 62–75.

Cite this article

Wu,Z. (2025). Resistance Training in Type 2 Diabetes: Mechanisms and Clinical Translation. Theoretical and Natural Science,133,43-49.

Data availability

The datasets used and/or analyzed during the current study will be available from the authors upon reasonable request.

About volume

Volume title: Proceedings of ICBioMed 2025 Symposium: AI for Healthcare: Advanced Medical Data Analytics and Smart Rehabilitation

ISBN: 978-1-80590-303-1(Print) / 978-1-80590-304-8(Online)

Editor: Alan Wang

Conference website: https://2025.icbiomed.org/auckland.html

Conference date: 17 October 2025

Series: Theoretical and Natural Science

Volume number: Vol.133

ISSN: 2753-8818(Print) / 2753-8826(Online)

© 2024 by the author(s). Licensee EWA Publishing, Oxford, UK. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. Authors who publish this series agree to the following terms:

1. Authors retain copyright and grant the series right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this series.

2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the series's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this series.

3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See Open access policy for details).