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Exercise in type 2 diabetes: genetic, metabolic and neuromuscular adaptations. A review of the evidence
  1. Silvano Zanuso1,
  2. Massimo Sacchetti2,
  3. Carl Johan Sundberg3,4,
  4. Giorgio Orlando2,
  5. Paolo Benvenuti5,
  6. Stefano Balducci6
  1. 1Centre for Applied Biological & Exercise Science, Coventry University Faculty of Health and Life Sciences, Coventry, UK
  2. 2Human Movement and Sport Science, University of Rome, Rome, Italy
  3. 3Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
  5. 5Departmentof Neurological and Movement Sciences, Universityof Verona, Verona, Italy
  6. 6Metabolic Fitness Association, Monterotondo (Rome), Italy
  1. Correspondence to Dr. Silvano Zanuso, Via Martiri d’Ungheria, 65 47521 Cesena (FC) Italy ; szanuso{at}


The biological responses to exercise training are complex, as almost all organs and systems are involved in interactions that result in a plethora of adaptations at the genetic, metabolic and neuromuscular levels.

To provide the general practitioner and the sports medicine professionals with a basic understanding of the genetic, metabolic and neuromuscular adaptations at a cellular level that occur with aerobic and resistance exercise in subjects with type 2 diabetes.

For each of the three domains (genetic, metabolic and neuromuscular), the results of the major systematic reviews and original research published in relevant journals, indexed in PubMed, were selected. Owing to limitations of space, we focused primarily on the role of skeletal muscle, given its pivotal role in mediating adaptations at all levels.

Generally, training-induced adaptations in skeletal muscle are seen as changes in contractile proteins, mitochondrial function, metabolic regulation, intracellular signalling, transcriptional responses and neuromuscular modifications. The main adaptation with clinical relevance would include an improved oxidative capacity derived from aerobic training, in addition to neuromuscular remodelling derived from resistance training. Both training modalities improve insulin sensitivity and reduce cardiovascular risk.

Taken together, the modifications that occur at the genetic, metabolic and neuromuscular levels, work correlatively to optimise substrate delivery, mitochondrial respiratory capacity and contractile function during exercise.

  • Exercise Training
  • Diabetes
  • Aerobics
  • Anaerobic

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  • Contributors CJS reviewed the literature and wrote the part related to ’Exercise,genetic and epigenetics'; SB and PB reviewed the literature and wrote the part related to ’Exercise modalities and metabolic modifications'; MS and GO reviewed the literature and wrote the part related to ’Neuromuscular dysfunction in type 2 diabetes'. SZ coordinated the overall process and wrote the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.