Objective:

To assess the effects of exercise modality and dose on glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and 2-hour postprandial glucose (2hPG) in older adults with type 2 diabetes mellitus (T2DM).

Approach:

• Study Design: Systematic review and network meta-analysis of randomized controlled trials (RCTs) involving adults with T2DM aged 60 years or older.
• Data Sources: Searched seven databases from inception to August 18, 2025.
• Analysis Method: Conducted a random-effects network meta-analysis combined with dose-response modeling using MET-min/week as the standardized metric for exercise dose.

Key Findings:

• Thirty-four RCTs involving 2461 participants were included.
• Combined aerobic and resistance exercise (CE) showed the greatest reduction in HbA1c (MD = −1.05%; 95% CrI: −1.43, −0.64).
• Significant reductions in FBG were observed for CE (MD = −1.44 mmol/L; 95% CrI: −2.16, −0.66) and continuous aerobic exercise (CAE) (MD = −0.98 mmol/L; 95% CrI: −1.52, −0.41).
• Improvements in HbA1c and FBG began at approximately 520 MET-min/week and 500 MET-min/week, respectively.
• Only CE showed a significant reduction in 2hPG (MD = −3.15 mmol/L; 95% CrI: −5.42, −0.83).

Interpretation:

Exercise interventions improved glycemic control in older adults with T2DM.

Limitations:

• Evidence for 2hPG was limited, and no dose-response analysis was performed for this outcome.
• Further studies are needed to confirm dose-response patterns and refine exercise recommendations.

Conclusion:

Exercise interventions can enhance glycemic control in older adults with T2DM, with CE appearing particularly effective.

Sources:

• Systematic Review Registration