Background: Adults with type 2 diabetes mellitus (T2DM), excess adiposity, and knee osteoarthritis (OA) require exercise prescriptions that address cardiometabolic risk without unnecessarily increasing joint symptoms.Aims: This randomized controlled trial evaluated whether 12 weeks of home-based hybrid multicomponent exercise training (HMET) altered metabolic (FBG), hemodynamic (SBP/DBP), anthropometric (BMI), and walking-capacity (6MWD) outcomes in adults with diabesity and radiographic knee OA.Methods: Forty-two adults aged >50 years with T2DM, BMI ≥23 kg/m², and Kellgren-Lawrence grade 2–3 knee OA were randomized 1:1 to HMET (n = 21) or control (n = 21). HMET was performed three times weekly. Prespecified co-outcomes were BMI, fasting blood glucose (FBG), systolic and diastolic blood pressure (SBP/DBP), and 6-minute walk distance (6MWD). Group × time effects were evaluated using repeated-measures ANOVA; Holm-adjusted p-values were used as a multiplicity sensitivity analysis. Results: The group × time interaction was strongest for FBG [F(1,40) = 8.83, nominal p = .005, Holm p = .025, partial η² = .18], with an HMET-versus-control difference in change of −82.0 mg/dL (95% CI −137.7 to −26.2). DBP showed a nominal interaction [F(1,40) = 4.31, p = .044, Holm p = .176, partial η² = .10; difference in change −4.9 mmHg, 95% CI −9.7 to −0.1], but did not remain statistically significant after multiplicity adjustment. Interactions for BMI, SBP, and 6MWD were not statistically significant. All 42 participants completed follow-up; HMET adherence was ≥90%, and no adverse events were recorded.Conclusion: Twelve-week home-based HMET produced a statistically significant FBG group × time effect after Holm adjustment and a more tentative DBP signal, without statistically significant evidence of parallel change in BMI, SBP, or 6MWD. These findings support further confirmatory trials with a prespecified primary endpoint and longer follow-up.

To evaluate the effects of aerobic exercise (AE) versus resistance training (RT) on cardiometabolic health-related outcomes in patients with type 2 diabetes mellitus and concurrent obesity (diabesity). Systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, Web of Science, Scopus, ScienceDirect, Cochrane Library, and Google Scholar databases were searched from inception up to April 2026. RCTs comparing AE and RT for a minimum duration of two weeks. Participants were adults with diabesity. A total of 23 RCTs qualified, involving 1, 184 patients (58/42 women/men ratio; age range: 30-70 years; body mass index: 32.1 ± 6.6 kg/m2). AE appears to be more efficacious than RT in reducing fasting blood glucose (mean differences (MD) = -0.89 mmol/L, 95% CI: -1.62 to -0.16; I2 = 0%) and increasing cardiorespiratory fitness (MD = 1.78 mL/kg/min, 95% CI: 0.38 to 3.18; I2 = 66%). However, AE led to a greater increase in body fat (MD = 0.34%, 95% CI: 0.10 to 0.57; I2 = 1%) and less fat-free mass retention (MD = -0.86 kg, 95% CI: -1.46 to -0.26; I2 = 37%) compared with RT. For selected cardiometabolic health-related outcomes, including anthropometrics, blood lipids, and hemodynamics, no statistically significant between-group difference was detected. The overall certainty of the evidence across outcomes ranged from high to very low, with most being moderate. In adults with diabesity, AE appears to provide greater benefits for FBG and CRF, whereas RT appears more favorable for preserving FFM and improving BF. For the majority of cardiometabolic outcomes, the two modalities exhibit analogous effects. The present findings support a goal-directed and complementary approach to exercise prescription, as opposed to a one-modality-fits-all model, for the improvement of cardiometabolic health in patients with diabesity.