EXERCISE TRAINING could support the management of diabetic cardiomyopathy, particularly in its early stages, but stronger evidence is needed to establish the most effective programmes and their long-term cardiovascular benefits, a new review suggests.
The the narrative review brings together experimental and clinical research on exercise for diabetes-associated heart muscle dysfunction. It highlights promising biological mechanisms and improvements in selected clinical measures, while identifying substantial gaps between laboratory findings and routine care.
Diabetic cardiomyopathy involves changes in heart muscle metabolism, fibrosis, disrupted calcium handling and ventricular remodelling. Strategies capable of reversing established cardiac injury remain limited.
The review examined how exercise might influence these processes. Experimental studies suggest that training can support mitochondrial function and the heart’s ability to use different energy sources, while reducing oxidative stress and inflammatory signalling associated with fibrosis.
Other proposed mechanisms include improved calcium regulation and changes in pathways involved in cell death. Together, these findings provide a biological rationale for exercise-based management.
However, experimental evidence cannot establish the size or durability of benefits in patients. The distinction between a plausible mechanism and a proven clinical effect remains central to interpreting the review.
The clinical evidence came predominantly from people with Type 2 diabetes who had subclinical or early cardiac abnormalities, rather than clearly characterised populations with established diabetic cardiomyopathy.
Within this evidence base, combined aerobic and resistance training showed potential to improve cardiorespiratory fitness, insulin sensitivity, vascular function and selected measures of left ventricular performance.
High-intensity interval training may offer additional benefits for appropriately selected patients. Nevertheless, the review emphasises that its safety and effectiveness require individual assessment, limiting the case for a uniform exercise prescription.
Differences between intervention protocols and inconsistent reporting of exercise dose also make programmes difficult to compare.
The authors call for more consistent reporting of exercise intensity using physiologically comparable measures. They also recommend assessing treatment response across several domains, including cardiac imaging, functional capacity, biomarkers, glycaemic control and adverse events.
This broader assessment would help distinguish improvements in fitness or metabolic health from changes in cardiac function, while ensuring that safety receives appropriate attention.
Adequately powered trials in clearly defined patient populations are still needed to establish optimal exercise dose and long-term cardiovascular benefit.
The review positions exercise as a promising adjunct to management, particularly in early disease. Its precise role in established diabetic cardiomyopathy remains to be determined. Wiley Online Library
Reference: Li X et al. Exercise-based management of diabetic cardiomyopathy: preclinical mechanisms, clinical evidence, and translational strategies. Journal of Diabetes. 2026;18(11):e70292. doi:10.1111/1753-0407.70292.
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