Background and Purpose
Type 2 diabetes mellitus (T2DM) ranks among the century's most prevalent metabolic disorders, defined by chronic hyperglycemia, insulin resistance, and profound dyslipidemia that burdens global healthcare systems. Middle-aged and elderly women face escalating prevalence, compounded by obesity, hypertension, and premature cardiovascular mortality. Central to T2DM pathology is dyslipidemia: hypertriglyceridemia, hypercholesterolemia, reduced high-density lipoprotein (HDL), and low apolipoprotein A-1 (ApoA-1)—HDL's principal structural protein essential for reverse cholesterol transport, anti-inflammatory effects, and endothelial protection. Exercise emerges as a cornerstone non-pharmacological therapy. Resistance training (RT) targets muscular hypertrophy and metabolic rate elevation, whereas endurance training (ET) optimizes aerobic efficiency and lipid oxidation. Notwithstanding supportive literature, comparative RT versus ET efficacy on TG, CHOL, and ApoA-1 remains contentious in female T2DM cohorts. This randomized controlled trial systematically compared 8-week RT and ET protocols' influence on lipidomic, anthropometric, and glycemic indices in sedentary T2DM women, elucidating optimal exercise prescriptions for dyslipidemia mitigation and cardiovascular risk stratification.
Materials and Methods
This randomized pretest-posttest controlled clinical trial enrolled 60 sedentary women diagnosed with type 2 diabetes mellitus (T2DM; mean age: 50.87 ± 7.63 years; BMI ≈30 kg/m²) from Ardabil, Iran. Participants were randomly allocated (simple randomization via random number generator) to three equal groups (n=20 each): resistance training (RT), endurance training (ET), or control. Strict inclusion criteria ensured homogeneity: age 45-60 years, T2DM duration >1 year, HbA1c 6.5-9%, no cardiovascular/respiratory/musculoskeletal disorders, sedentary (<150 min/week moderate activity), normotensive (<140/90 mmHg), non-smokers, stable oral antidiabetic monotherapy, no skin lesions, and voluntary informed consent. Exclusions: pregnancy, insulin therapy, recent infections, or orthopedic limitations. Medical clearance obtained via physician evaluation and ECG.Baseline assessments (24h pre-intervention) encompassed anthropometrics (stature: Seca stadiometer; mass: digital scale; BMI; WHR via tape measure), hemodynamics (sphygmomanometer), and fasting venous blood (8-10h) for FBS, insulin (ELISA), TG, CHOL, ApoA-1 (commercial kits, calibrated spectrophotometry/ELISA reader). 8-week intervention: 3 supervised sessions/week (48h apart), 45-60 min duration. RT: 10min warm-up (cycling/stretching), 6 multi-joint exercises (leg press, bench press, lat pulldown, seated row, leg curl/extension, shoulder press) at 40%1RM (week1) progressing to 75%1RM (weeks7-8; 3sets×8-12reps, 60-90s rest), 10min cool-down. 1RM estimated Brzycki formula. ET: treadmill (10min warm-up), continuous moderate intensity 40-75% maxHR (220-age), duration 20-45min progressive, 10min cool-down. Controls maintained habitual lifestyle sans exercise. Adherence >85%; progression monitored RPE (6-8/10). Post-testing: 48h post-final session (counterbalanced order). Statistical analysis: SPSS v26. Normality (Shapiro-Wilk), homogeneity (Levene). Primary: MANOVA (group×time), univariate ANOVA, Bonferroni post-hoc (p<0.05). Partial η² effect sizes. Power analysis (G*Power): 0.80, α=0.05, f=0.40.
Results
Post-intervention analysis revealed substantial improvements across anthropometric, glycemic, and lipid variables in both exercise cohorts versus sedentary controls. Resistance training (RT) induced pronounced weight loss (75.67 ± 11.66 kg pre-intervention to 65.91 ± 8.14 kg post-intervention; absolute reduction 9.76 kg, -12.89%, p<0.001), accompanied by significant BMI decline (30.41 ± 3.80 to 27.94 ± 3.13 kg/m²; -8.12%, p<0.001). Waist-hip ratio (WHR) improved from 0.91 ± 0.04 to 0.86 ± 0.05 (p=0.01), signifying reduced central adiposity. Fasting blood sugar (FBS) decreased 12.85 mg/dL (149.14 ± 26.32 to 136.29 ± 15.62 mg/dL, p<0.005), indicating enhanced glycemic control.Endurance training (ET) demonstrated moderate but clinically meaningful reductions: weight declined 5.11 kg (69.99 ± 13.26 to 64.88 ± 10.23 kg; -7.3%, p=0.002), BMI decreased (29.10 ± 6.01 to 28.04 ± 5.64 kg/m²; -3.4%, p=0.04), WHR improved (0.88 ± 0.07 to 0.58 ± 0.01, p=0.03), and FBS reduced 15.58 mg/dL (147.29 ± 27.57 to 131.71 ± 22.26 mg/dL, p=0.003). Notably, ET achieved greater absolute FBS reduction than RT, suggesting superior glycemic responsiveness. Conversely, control participants exhibited stasis: weight (70.93 ± 7.80 to 70.81 ± 7.63 kg, p=0.85), BMI (30.01 ± 3.89 to 29.82 ± 4.11 kg/m², p=0.40), WHR (0.87 ± 0.37 to 0.86 ± 0.03, p=0.67), and FBS (194.29 ± 37.79 to 178.14 ± 32.61 mg/dL, p=0.07) remained statistically unchanged.Multivariate analysis of variance (MANOVA) confirmed significant between-group differences for primary outcomes: FBS post-intervention (F=4.02, p=0.01, η²=0.44, large effect), BMI post-intervention (F=3.45, p=0.03, η²=0.34, moderate-large effect), and triglycerides post-intervention (F=3.62, p=0.03, η²=0.35), with both RT and ET reducing triglycerides by approximately 20-25% from baseline. However, secondary lipid markers showed no significant intergroup differences: total cholesterol (F=1.93, p=0.15, η²=0.22), insulin (F=0.97, p=0.42), HbA1c (F=0.61, p=0.61, η²=0.61), and apolipoprotein A-1 (ApoA-1; F=0.59, p=0.62, η²=0.08). Controls remained biochemically stable across all measured variables, thereby highlighting training-specific metabolic improvements. Post-hoc Bonferroni tests confirmed RT and ET equivalence for significant outcomes, with both superior to controls (p<0.05).
Conclusion
Eight weeks of resistance and endurance training substantially improved anthropometric, glycemic, and triglyceridemic indices in women with type 2 diabetes, corroborating Miller et al. (2017) and Ghodrat et al. (2022) on exercise-induced metabolic amelioration. Both modalities yielded comparable benefits: RT excelled in weight/BMI reduction (-12.89%/-8.12%), whereas ET matched glycemic improvements (FBS ↓15.58 mg/dL). Triglyceride reductions (~20-25%) underscore favorable lipid modulation. However, absent total cholesterol, apolipoprotein A-1 (ApoA-1), and HbA1c improvements suggest 8-week duration insufficiency; longer protocols may enhance apolipoprotein dynamics and long-term glycemic control. Exercise intensity, population heterogeneity, and medication confounders warrant consideration. These findings reinforce structured exercise's pivotal role in non-pharmacological T2DM management, supporting personalized training prescription based on individual preferences, comorbidities, and fitness levels. Future investigations should examine extended interventions (>12 weeks), combined RT+ET protocols, and sex-stratified responses for optimized cardiovascular risk reduction.
Article Message
Type 2 diabetes mellitus imposes substantial metabolic and cardiovascular burdens, particularly in women. This study demonstrates that structured resistance and endurance training interventions, implemented systematically over eight weeks, effectively ameliorate anthropometric (weight, BMI, WHR), glycemic (FBS), and lipid (triglycerides) dysfunctions in sedentary diabetic women. Both exercise modalities yielded comparable benefits, with resistance training demonstrating superior body composition reductions and endurance training matching glycemic improvements. These findings underscore exercise's pivotal non-pharmacological role in T2DM management. Clinicians should prescribe personalized exercise protocols aligned with individual patient preferences, functional capacity, and comorbidities to enhance adherence and therapeutic efficacy. Structured exercise integration into diabetes care pathways optimizes metabolic control and reduces premature cardiovascular mortality.
Ethical Considerations
The present study was approved by the Research Ethics Committee of Mohaghegh Ardabili University with ethical code IR.UMA.REC.1403.061. The clinical trial registration number at the Iranian Registry of Clinical Trials (IRCT) is IRCT20250405065220N1.  
Authors’ Contributions
Conceptualization: Reza Farzizadeh
Data Collection: Bagher Shoja Anzabi
Data Analysis: Farnaz Seifi-askishahr
Manuscript Writing: Bagher Shoja Azabi
Review and Editing: Reza Farzizadeh
Literature Review: Afshin Nejati-afkham
Project Manager: Reza Farzizadeh
Conflict of Interest
In this study, the authors declare that they have no financial, personal, or professional conflicts of interest, and all stages of the research were conducted in full compliance with ethical principles and without any influence from secondary interests.
Acknowledgments
We sincerely acknowledge all individuals who contributed to the successful completion of this research, particularly our esteemed study participants and the respected laboratory specialists. Your invaluable collaboration and unwavering support played a crucial role in advancing and accomplishing this investigation. We express our heartfelt gratitude for your dedication and commitment throughout this research endeavor.