Problem Is the problem a priority?
Judgment	Research evidence	Additional considerations
Probably yes	Aerobic exercise at least 3 days per week was recommended by most guidelines4−6. Resistance exercise alone or combined aerobic and resistance exercise was recommended only by a few guidelines36, 37. The identification of the best modality of physical exercise could be a relevant problem for the treatment of type 2 diabetes. Different types of exercise, which have differential effects on body composition, could theoretically determine different outcomes in diabetes control29
Desirable Effects How substantial are the desirable anticipated effects?
Judgment	Research evidence	Additional considerations
Small	Improvement of: HbA1c: − 0.1% (not significant reduction in favor of combined exercise) after updating the previous meta-analysis30
Undesirable Effects How substantial are the undesirable anticipated effects?
Judgment	Research evidence	Additional considerations
Trivial	No relevant risk associated with combined physical exercise was detected after updating the previous meta-analysis30	A post hoc analysis of the trials conducted for the present recommendation30 showed that combined exercise did not negatively affect blood pressure values at endpoint (systolic and diastolic blood pressure vs. aerobic exercise: − 6.1 [− 10.0, − 2.3] mmHg and − 2.8 [− 6.3, 0.63] mmHg, respectively)
Certainty of evidence What is the overall certainty of the evidence of effects?
Judgment	Research evidence	Additional considerations
Very low	Very low for HbA1c
Values Is there important uncertainty about or variability in how much people value the main outcomes?
Judgment	Research evidence	Additional considerations
No important uncertainty or variability	No evidence of variability or uncertainty HbA1c is already considered among critical outcomes of the treatment of type 2 diabetes by scientific societies4−6
Balance of effects Does the balance between desirable and undesirable effects favor the intervention or the comparison?
Judgment	Research evidence	Additional considerations
Neither favors the intervention nor comparison	Small and nonsignificant reduction of HbA1c
Resources required How large are the resource requirements (costs)?
Judgment	Research evidence	Additional considerations
Trivial	Similar overall expenditure between the two interventions, with a reported advantage on cost for QALY for combined training31
Certainty of evidence of required resources What is the certainty of the evidence of resource requirements (costs)?
Judgment	Research evidence	Additional considerations
Very low	No specific evidence is available on this issue31
Cost-effectiveness Does the cost-effectiveness of the intervention favor the intervention or the comparison?
Judgment	Research evidence	Additional considerations
Does not favor either the intervention or the comparison	No between-group differences for any of the critical outcomes were considered
Equity What would be the impact on health equity?
Judgment	Research evidence	Additional considerations
Probably no impact	No expected differences in costs and accessibility
Acceptability Is the intervention acceptable to key stakeholders?
Judgment	Research evidence	Additional considerations
Probably yes	No specific evidence is available on this issue
Feasibility Is the intervention feasible to implement?
Judgment	Research evidence	Additional considerations
Yes	No additional costs or resources are required