This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the effects of aerobic exercise on cardiometabolic health-related indices in patients with type 2 diabetes and concurrent overweight/obesity (diabesity). PubMed, Web of Science, Scopus, Science Direct, Cochrane Library, and Google Scholar databases were searched from inception to October 2024. The search strategy included the following keywords: diabetes, aerobic exercise, and endurance training. RCTs comparing aerobic exercise training ≥2 weeks in duration to standard treatment were considered eligible. Participants were adults with diabesity. A total of 1391 middle-aged/older adult patients (55 % females) were included in 34 RCTs. Body mass index [standardized mean differences (SMD) -0.18 kg/m², 95 % confidence intervals (CI) -0.36 to -0.01]. waist circumference (SMD -0.23 cm, 95 % CI -0.44 to -0.03), body fat (SMD -0.30 %, 95 % CI -0.59 to -0.01), fasting blood glucose (SMD -0.49 mmol/L, 95 % CI -0.72 to -0.27), glycated hemoglobin (SMD -0.79 %, 95 % CI -1.17 to -0.41), fasting insulin (SMD -0.44 mIU/L, 95 % CI -0.72 to -0.15), homeostatic model assessment for insulin resistance (SMD -0.72, 95 % CI -1.09 to -0.35), high-density lipoprotein cholesterol (SMD 0.32 mg/dL, 95 % CI 0.01 to 0.63), triglycerides (SMD -0.33 mg/dL, 95 % CI -0.63 to -0.04), and total cholesterol (SMD -0.28 mg/dL, 95 % CI -0.47 to -0.10) improved compared with standard treatment. These results underscore the beneficial role of aerobic exercise as a non-pharmacological intervention in managing and treating patients with diabesity when compared to standard treatment, despite the presence of considerable uncertainty in several outcomes.

Purpose: Heart rate (HR)-derived variables (HR reserve [HR_peak − HR_rest], chronotropic indices [attenuated HR response to exercise], HR recovery [attenuated HR response to exercise recovery], and peak HR index [HR_peak/HR_rest]) together with peak oxygen uptake (VO_2peak) are potential prognostic variables for cardiovascular and all-cause mortality. However, heart rate index (HRI) has not been established as a surrogate for VO_2peak, whether measured (Meas) or estimated (Est), during cycle ergometry (CE) and/or treadmill testing (TT). Methods: HR-derived prognostic variables to assess cardiovascular outcomes were identified from 150 studies obtained from MEDLINE and Google Scholar searches. The Meas CE/TT-VO_2peak was reported in 81 studies (21 773 participants) and Est CE/TT-VO_2peak in 69 studies (331 435 participants). Using the HRI equation with metabolic equivalent (METs) = 6 × HRI − 5 (where HRI = peak HR/resting HR), HRI-VO_2peak was calculated from HR data reported in the 150 studies. The HRI-VO_2peak was then compared against group mean data for both Meas CE/TT-VO_2peak and Est CE/TT-VO_2peak. Results: The difference between Meas CE/TT-VO_2peak and HRI-VO_2peak was 1% (7.15 ± 3.25 METs vs 7.08 ± 3.02 METs [P = .833], respectively). By comparison, the difference between Est CE/TT-VO_2peak and HRI-VO_2peak was 25.6% (8.94 ± 2.36 METs vs 7.12 ± 2.27 METs [P < .001], respectively). Moreover, HRI equation estimation of VO_2peak showed greater overprediction for TT, 26.6%, than for CE, 11.9%. Conclusions: The Meas-VO_2peak and HRI-VO_2peak agreed closely. When compared with HRI-VO_2peak, Est-VO_2peak from currently used exercise-based equations shows significant overprediction. Use of HRI and/or Fitness Registry and the Importance of Exercise National Database (FRIEND) registry equations warrant consideration for more accurately estimating VO_2peak.

Purpose: Personal Activity Intelligence (PAI) translates heart rate during physical activity (PA) into a weekly score, that credits vigorous over low- and moderate intensity PA. We prospectively investigated the association between PAI and fatal and non-fatal coronary heart disease (CHD) in self-reported healthy participants from Norway, with specific reference to improving the accuracy of conventional coronary risk assessment. Methods: We studied 40 961 healthy adults (56% women) from the population based Trøndelag Health Study (the HUNT study). Individual data were linked to hospital and cause of death registries. The weekly PAI score of each participant was divided into four groups (PAI scores of 0, ≤50, 51-99, or ≥ 100). Adjusted hazard ratios [aHRs] and 95% confidence intervals (CIs) for fatal and non-fatal CHD related to PAI were estimated using Cox proportional hazard regression analyses. Results: During a median follow-up period of 13.1 years (IQR, 12.7-13.6), 3303 (3109 non-fatal, 194 fatal) CHD events occurred. Compared with the inactive group (0 PAI), weekly PAI scores at baseline of 51-99 and ≥ 100 were associated with a lower risk of CHD [0.80 (0.71-0.91) and 0.86 (0.78-0.95), respectively]. By adding PAI to traditional risk factors, the net reclassification improvement of CHD was 0.472 (P < 0.001). Conclusions: PAI was inversely associated with CHD risk among healthy participants at baseline, and it’s cardioprotective effect persisted across diverse risk factor profiles. A PAI score > 50 was substantially associated with a reduced risk of CHD. These findings have implications for improving the accuracy of conventional coronary risk assessments with PAI.