Table 1.
Participant and intervention characteristics.
| Study | Sample Size (Sex) | Health Condition | Groups | Outcomes | Age [Years] Mean ± SD |
BMI [kg/m2] Mean ± SD |
Exercise Intervention |
Follow Up (Week) | Diet Intervention |
|---|---|---|---|---|---|---|---|---|---|
| Abdelbassett et al. (2019) [30] | 32 (M and F) | T2DM NAFLD Obesity |
Con HIIT |
VFA (cm2) Liver fat (%) |
Con: ccc HIIT: 54.4 ± 5.8 |
Con: 35.9 ± 5.3 HIIT: 36.3 ± 4.5 |
5 min warm-up and 3 sets of 4 min cycling sessions at 80% to 85% of the VO2max with 2 min intervals at 50% of the VO2max between sets and 5 min cool-down × 3 d/w | 8 weeks | Medical treatment Each patient was instructed to not eat for 2 h before the exercise session to avoid exercise-induced airway obstruction |
| Abdelbasset et al. (2020) [1] | 42 (M and F) | T2DM NAFLD Obesity |
Con HIIT MICT |
VFA (cm2) Liver fat (%) |
Con: 55.2 ± 4.3 HIIT: 54.4 ± 5.8 MICT: 54.9 ± 4.7 |
Con: 35.9 ± 5.3 HIIT: 36.3 ± 4.5 MICT: 36.7 ± 3.4 |
HIIT: 5 min warm-up and 3 sets of 4 min cycle Ergometer at 80% to 85% of the VO2max with 2 min interval at 50% of the VO2max between sets and 5 min cool-down × 3 d/w MICT: 5 min warming up followed by 40–50 min cycle ergometer with continuous intensity at 60% to 70% max HR and 5 min cooling down × 3 d/w |
8 weeks | NR |
| Barone et al. (2012) [31] | 112 (M and F) | T2DM Obesity |
Con Combined Exe (A-Exe + R-Exe) |
VFA (cm2) | Con: 56 ± 6 Combined Exe: 58 ± 5 |
Con: 33.5 ± 4.3 Combined Exe: 32.35.3 |
A-Exe: 60 min of 60–90% MHR × 3 d/w R-Exe: 2 sets of 12–15 reps at 50% 1RM of machine weights × 3 d/w |
26 weeks | NR |
| Bonekamp et al. (2008) [32] | 45 (M and F) | T2DM Obesity |
Con Combined Exe (A-Exe + R-Exe) |
Liver fat (%) | 58 | 31.4 | A-Exe: 45 min of 80% MHR R-Exe: lifting 7 weights at 2 sets of 12–15 reps at 50% 1RM × 3 d/w |
26 weeks | NR |
| Botton et al. (2018) [33] | 26 (M and F) | T2DM | Con R-Exe |
VFA (mm) | Con: 68.6 ± 7.06 R-Exe: 70.6 ± 6.7 |
Con: 28.64 ± 3.26 R-Exe: 28.2 ± 3.6 |
R-Exe: whole-body exercise; 2–3 sets with 10–15 reps and 60–90 s rest between each set × 3 d/w | 12 weeks | NR |
| Bouchi et al. (2021) [34] | 141 (M and F) | T2DM | Con: DAPA Con R-Exe: DAPA + R-Exe |
Trunk fat mass (kg) Body weight (kg) |
Con: 57 ± 11 R-Exe: 59 ± 10 |
Con: 25.5 ± 4 R-Exe: 25.7 ± 3.5 |
30 min walking and resistance training of three sets of 10 repetitions of six items × daily | 24 weeks | DAPA was administered from a starting dose of 5 mg to both groups, and participants were allowed to increase the dose up to 10 mg after ≥4 weeks if they failed to achieve the target HbA1c of <7.0% |
| Boudou et al. (2001) [23] | 16 (M) | T2DM | Con A-Exe (A-Exe1 + A-Exe2) |
VFA (cm2) SAT (cm2) Body weight (kg) |
Con: 45.4 ± 7.2 A-Exe: 45.4 ± 7.2 |
Con: 29.6 ± 4.6 A-Exe: 29.6 ± 4.6 |
A-Exe1: 40 min of continuous cycle ergometer exercise was performed at 75% VO2peak × 2 d/w A-Exe2: cycle ergometer exercise was performed 20 min with 5 × 2 min 85% VO2peak work periods and 3 min 50% VO2peak rest periods × 1 d/w |
8 weeks | NR |
| Bozzetto et al. (2012) [35] | 17 (M and F) | T2DM Obesity |
Con1: MUFA diet Con A-Exe1: MUFA diet + A-Exe Con2: CHO/fiber Diet A-Exe2: CHO/fiber Diet + A-Exe |
Liver fat (%) Body weight (kg) |
Con1: 57 ± 8 A-Exe1: 57 ± 9 Con2: 58 ± 5 A-Exe2: 57 ± 9 |
Con1: 28 ± 3 A-Exe1: 30 ± 4 Con2: 30 ± 2 A-Exe2: 31 ± 3 |
A-Exe: 45 min treadmill or cycle ergometer at 70% baseline VO2peak + warm-up and cool-down × 2 d/w | 8 weeks | High-MUFA diet for both groups enforced by calls from dietician every 2–3 days |
| Cassidy et al. (2016) [36] | 23 (M and F) | T2DM Obesity |
Con HIIT |
VFA (cm2) Liver fat (%) Body weight (kg) |
Con: 59 ± 9 HIIT: 61 ± 9 |
Con: 32 ± 6 HIIT: 31 ± 5 |
HIIT: cycle ergometer and passive recovery at RPE 9–13 during warm-up and 5 intervals at an RPE 16–17 during high-intensity interval. Interval duration started at 2 min and progressed to 3 min and 50 s by week 12 × 3 d/w | 12 weeks | NR |
| Celli et al. (2022) [26] | 100 (M and F) | T2DM Obesity |
Con Combined Exe (A-Exe + R-Exe) |
VFA (cm3) Body weight (kg) |
Con: 71.4 ± 3.7 Combined Exe: 72.3 ± 4.01 |
Con: 34.5 ± 5.4 Combined Exe: 35.7 ± 5.1 |
15 min warm-up flexibility exercises followed by, 30 min aerobic exercises (65–85% PHR), 30 min resistance exercises (1–2 sets, 8–12 repetitions at 65–85% of 1RM), and 15 min balance exercises | 52 weeks | calcium and vitamin D intaketo 1500 mg/day and 1000 IU/day, respectively |
| Choi et al. (2012) [48] | 75 (F) | T2DM | Con MICT |
VFA (cm2) SAT (cm2) Body weight (kg) |
Con: 55 ± 6.0 MICT: 53.8 ± 7.2 |
26.8 ± 2.4 | MICT: 60 min walking of 3.6–6.0 METs × 5 d/w | 12 weeks | NR |
| Cuff et al. (2003) [49] | 28 (F) | T2DM Obesity Postmenopausal |
Con A-Exe Combined Exe (A-Exe + R-Exe) |
VFA (cm2) IMCL (cm2) SAT (cm2) Body weight (kg) |
Con: 60 ± 7.9 A-Exe: 63.4 ± 6.9 Combined Exe: 59.4 ± 5.7 |
Con: 36.7 ± 6.0 A-Exe: 33.3 ± 4.7 Combined Exe: 32.5 ± 4.2 |
A-Exe: 75 min of treadmill, cycle ergometers, recumbent steppers and elliptical trainers at 60–75% HRR R-Exe: 5 exercises of stack weight equipment. 2 sets of 12 reps A-Exe + R-Exe 75 min × 3 d/w |
16 weeks | NR |
| Dobrosielski et al. (2012) [37] | 140 (M and F) | T2DM Obesity |
Con Combined Exe (A-Exe + R-Exe) |
VFA (cm2) SAT (cm2) Body weight (kg) |
Con: 56 ± 6 Combined Exe: 57 ± 6 |
Con: 33.6 ± 0.5 Combined Exe: 33.0 ± 0.6 |
A-Exe = 45 min of treadmill, stationary cycle, or stair stepper at 60–90% MHR R-Exe = multistation machine 2 sets of 10–15 reps at 50% 1RM × 3 d/w |
26 weeks | All participants were given dietary advice from the American Heart Association |
| Giannopoulou et al. (2005) [50] | 33 (F) | T2DM Obesity Postmenopausal |
Con: HMF Diet HMF Diet + A-Exe A-Exe |
VFA (cm3) SAT (cm3) Body weight (kg) |
Con: 58.5 ± 1.7 Diet + A-Exe: 57.5 ± 1.7 A-Exe: 55.5 ± 1.7 |
Con: 34.3 ± 1.9 Diet + A-Exe: 33.7 ± 1.9 A-Exe: 35.9 ± 1.9 |
A-Exe: walking at 60–70% VO2peak × 3–4 d/w | 10 weeks | High-monounsaturated-fat diet composed of 40% fat (30% monounsaturated, 5% polyunsaturated, and 5% saturated), 40% carbohydrates (15% simple and 25% complex carbohydrates), and 20% protein = ~ 2510 kJ/day on non-exercise days and ~1460 kJ deficit where applicable |
| Jiang et al. (2020) [38] | 49 (M and F) | T2DM | Con (M) Con (F) A-Exe (M) A-Exe (F) |
VFA (cm2) SAT (cm2) Body weight (kg) |
Con (M): 62.6 ± 3.8 Con (F): 62.6 ± 3.8 A-Exe (M): 63.9 ± 6.1 A-Exe (F): 63.9 ± 6.1 |
Con (M): 26.5 ± 2.1 Con (F): 26.7 ± 3.2 A-Exe (M): 26.9 ± 2.1 A-Exe (F): 26.6 ± 2.2 |
30–60 min walking/running at FATmax HR × 3 d/w | 16 weeks | All participants were required to record a five-weekday dietary diary at the beginning and the end of the experimental period. The weight of the food and percentages of carbohydrate, fat, and protein in the food were estimated from the records |
| Jung et al. (2012) [51] | 28 (F) | T2DM | Con A-Exe1 A-Exe2 |
VFA (cm2) SAT (cm2) Body weight (kg) |
Con: 55.5 ± 7.6 A-Exe1: 56.8 ± 8.2 A-Exe2: 48.4 ± 6.1 |
Con: 27.7 ± 3.4 A-Exe1: 25.5 ± 1.5 A-Exe2: 25.9 ± 1.6 |
MICT: 60 min moderate intensity walking exercise at 3.5–5.2 METs A-Exe: 30 min vigorous intensity walking exercise at >5.3 METs × 5 d/w |
12 weeks | NR |
| Jung et al. (2014) [52] | 35 (F) | T2DM | Con A-Exe |
VFA (cm2) SAT (cm2) Body weight (kg) |
Con: 57.6 ± 3.5 A-Exe: 55.4 ± 3.5 |
Con: 27.2 ± 2.1 A-Exe: 26.0 ± 1.5 |
A-Exe: 60 min of walking exercise at 3.6–5.2 METs × 3 d/w | 12 weeks | Both groups received one dietary education program at the beginning of the intervention |
| Karstoft et al. (2013) [39] | 32 (M and F) | T2DM | Con A-Exe1 A-Exe2 |
VFA (L) Body weight (kg) |
Con: 57.1 ± 3.0 A-Exe1: 60.8 ± 2.2 A-Exe2: 57.5 ± 2.4 |
Con: 29.7 ± 1.9 A-Exe1: 29.9 ± 1.6 A-Exe2: 29.0 ± 1.3 |
A-Exe1: 60 min of interval walking exercise 3 min at 70% of the peak energy expenditure rate during intense interval and 3 min at A-Exe2: 60 min of Continuous walking exercise 55% of the peak energy expenditure rate × 5 d/w |
16 weeks | NR |
| Kong et al. (2022) [40] | 86 (M and F) | T2DM | Con A-Exe |
VFA (cm2) Body weight (kg) |
Con: 50 ± 8 A-Exe: 50 ± 10 |
Con: 29 ± 4 A-Exe: 28 ± 5 |
Low intensity to 70% of maximum heart rate- 60–90 min each time × 3–5 d/w |
16 weeks | 1 week before the experiment, fat, rice or noodleswere minimized to about 250 g per day |
| Koo et al. (2010) [53] | 64 (F) | T2DM | Con1 A-Exe1 Con2: Diet A-Exe2: Diet + A-Exe |
VFA (cm2) SAT (cm2) Body weight (kg) |
Con1: 57 ± 8 A-Exe1: 59 ± 4 Con2: 57 ± 8 A-Exe2: 53 ± 8 |
Con1: 28.5 A-Exe1: 25.5 Con2: 27.1 A-Exe2: 29.4 |
A-Exe and Diet + A-Exe: 120 min brisk walking × 7 d/w | 12 weeks | C and A-Exe: received conventional education for a mildly hypocaloric diet (30 kcal per kg of ideal body weight per day) at the beginning of the study Diet and Diet + A-Exe: reduced their usual energy intake to 1200 kcal/day for weight reduction and were educated individually every 2 weeks based on the self-recorded 3-day diet diary |
| Ku et al. (2010) [54] | 44 (F) | T2DM | Con R-Exe A-Exe |
VFA (g) IMCL (g) SAT (cm2) Body weight (kg) |
Con: 57.8 ± 8.1 R-Exe: 55.7 ± 6.2 A-Exe: 55.7 ± 7.0 |
Con: 27.4 ± 2.8 R-Exe: 27.1 ± 2.3 A-Exe: 27.1 ± 2.4 |
R-Exe: 3 sets of 15–20 repetitions at 40–50% 1RM A-Exe: 60 min walking at 3.6–5.2 METs × 5 d/w |
12 weeks | NR |
| Kwon et al. (2010) a [55] | 28 (F) | T2DM | Con R-Exe |
VFA (mm2) SAT (mm2) Body weight (kg) |
Con: 57.0 ± 8.0 R-Exe: 55.7 ± 6.2 |
Con: 27.6 ± 2.8 R-Exe: 27.1 ± 2.3 |
R-Exe: 40 min 3 sets of 10–15 reps at 40–50%1RM and 20 min collectively of warm-up and cool-down × 3 d/w | 12 weeks | Three-day diet record (two weekdays and one weekend day) and visited the hospital every four weeks to have their dietary record reviewed |
| Kwon et al. (2010) b [56] | 27 (F) | T2DM | Con A-Exe |
VFA (mm2) SAT (mm2) |
Con: 57.5 ± 8.6 A-Exe: 55.5 ± 7.5 |
Con: 27.5 ± 3.0 A-Exe: 27.0 ± 2.5 |
A-Exe: performed 60 min moderate intensity walking × 5 d/w | 12 weeks | Three-day diet record (two weekdays and one weekend day) and visited the clinic every four weeks to have their dietary record reviewed |
| Li et al. (2022) [27] | 82 (M and F) | T2DM | Con A-Exe |
VFA (cm2) SAT (cm2) |
Con: 67.62 ±5.91 A-Exe: 65.15 ± 5.00 |
Con: 24.77 ± 3.02 A-Exe: 24.27 ± 2.76 |
A-Exe: 5 min warm-up, 50 minaerobic dancing, 5 min cool-down (60%–70% ofMHR) × 3 d/w | 24 weeks | All participants follow ahealthy diet (55–60% carbohydrate, 15–20% protein, and 25–30% fat |
| Lyngbæk et al. (2023) [41] | 44 (M and F) | T2DM Obesity |
Con: Diet Diet + Combined Exe1 Diet + Combined Exe2 |
VFA (cm3) SAT (cm3) Body weight (kg) |
Con: 55.9 ± 10.0 Combined Exe1: 60.9 ± 7.6 Combined Exe2: 57.3 ± 11.8 |
Con: 33.2 ± 3.8 Combined Exe1: 33.2 ± 4.1 Combined Exe2: 33.4 ± 3.5 |
Combined Exe1: two aerobic training sessions and one combined aerobic andresistance training session/per week in total of 150–165 min. Combined Exe2: four aerobic training sessions/per week and two sessions/per week with combined aerobic in total of 300–330 min. training and resistance training. 60–100% HRmax. 8–12 repetitions. |
16 weeks | DI: ~25–30% energy deficit/day (45–60E% carbohydrate, 15–20E% protein, and 20–35E% fat (<7E% saturatedfat). |
| Mavros et al. (2013) [42] | 83 (M and F) | T2DM Obesity |
Con R-Exe |
VFA (cm2) IMCL (cm2) Body weight (kg) |
Con: 68.9 ± 6.0 R-Exe: 67.1 ± 4.8 |
Con: 31.5 ± 6.3 R-Exe: 31.0 ± 4.6 |
R-Exe: 80% 1RM power training, quick concentric phase and slow eccentric phase × 3 d/w | 52 weeks | NR |
| Mourier et al. (1997) [25] | 21 (M and F) | T2DM Obesity |
Con A-Exe |
VFA (cm2) SAT (cm2) Body weight (kg) |
Con: 46 ± 9.9 A-Exe: 45 ± 6.3 |
Con: 30.1 ± 5.3 A-Exe: 30.4 ± 2.5 |
A-Exe: 55 min continuous cycling at 75% VO2peak; ×2 d/w, 35 min intermittent exercise was performed 5×2 min at 85% VO2peak and 3 min of 50% VO2peak recovery periods× 1 d/w |
12 weeks | Half of the participants from both groups were given BCAA capsules (46% leucine, 24% isoleucine, and 30% valine) |
| Otten et al. (2018) [43] | 26 (M and F) | T2DM Obesity |
Con: Paleolithic diet Combined Exe: Paleolithic diet + Exe |
Liver fat (%) IMCL (%) Body weight (kg) |
Con: 59.33 ± 9.30 Combined Exe: 62 ± 7.47 |
Con: 31.5 ± 3.57 Combined Exe: 31.6 ± 4.65 |
Aerobic exercise and resistance training in 60 min sessions × 3 d/w | 12 weeks | The Paleolithic diet included lean meat, eggs, fish, seafood, nuts, fruits and vegetables. Dairy products, cereals, legumes and added sugar and salt were excluded. Energy intake was ad libitum |
| Sabag et al. (2020) [28] | 35 (M and F) | T2DM Obesity |
Con MICT HIIT |
Liver fat (%) Body weight (kg) |
Con: 54.8 ± 8.3 MICT: 56.9 ± 7.2 HIIT: 51.9 ± 4.6 |
Con: 35.8 ± 5.6 MICT: 34.3 ± 3.8 HIIT: 37.5 ± 5.5 |
MICT: 30–55 min of Continuous cycling at 60% VO2peak × 3 d/w HIIT: 1–4 min of cycling at a 90% VO2peak and a 10 min warm-up and 5 min cool-down at a 50% VO2peak and 5 min warm-up and cool-down at 50% VO2peak × 3 d/w |
12 weeks | NR |
| Sigal et al. (2007) [24] | 251 (M and F) | T2DM Obesity |
Con A-Exe R-Exe Combined Exe (A-Exe + R-Exe) |
VFA (cm2) SAT (cm2) Body weight (kg) |
Con: 54.8 ± 7.2 A-Exe: 53.9 ± 6.6 R-Exe: 54.7 ± 7.5 Combined Exe: 53.5 ± 7.3 |
Con: 35.0 ± 9.5 A-Exe: 35.6 ± 10.1 R-Exe: 34.1 ± 9.6 Combined Exe: 35.0 ± 9.6 |
A-Exe: 15–45 min treadmill or bicycle exercise at 60–75% MHR× 3 d/w R-Exe: 2–3 sets of 7–9 RM machine weights × 3 d/w A-EXE + PRT: completed the full exercise programs for A-Exe and PRT × 3 d/w |
26 weeks | Standardized diet counseling given to all participants at the beginning of the trial based on the Canadian Diabetes Diet recommendations |
| Snel et al. (2012) [29] | 27 (M and F) | T2DM Obesity |
VLCD VLCD + A-Ex |
IMCL (cm2) Body weight (kg) |
Con: 56.1 ± 2.4 A-Exe: 53.0 ± 2.5 |
Con: 37.9 ± 1.4 A-Exe: 36.4 ± 1.1 |
AEx: 60 min cycle ergometer at 3.6–5.2 METs × 3 d/w | 16 weeks | All patients started a 16 wk VLCD (Modifast, Nutrition & Sante, Antwerpen, Belgium). Modifast provides a total of approximately 450 kcal/d and all necessary vitamins and micronutrients, divided over three meals of liquid shakes |
| Stomby et al. (2020) [44] | 28 (M and F) | T2DM Obesity |
Con: Paleolithic diet Combined Exe: Paleolithic diet + Exe |
Liver fat (%) | Con: 60 ± 11 Combined Exe: 61 ± 8 |
Con: 31.4 ± 4.3 Combined Exe: 31.4 ± 6.1 |
60 min aerobic and resistance exercise at 50% × 3 d/w | 12 weeks | The Paleolithic-type diet included recommendations of a high intake of vegetables, fruit, lean meat, nuts, eggs, fish and seafood. The intake of grains, sugar, salt, dairy products and refined fats was reduced |
| Szilagyi et al. (2019) [45] | 208 (M and F) | T2DM Obesity |
Con Combined Exe (A-Exe + R-Exe) |
VFA (cm2) Body weight (kg) |
Con: 60.10 ± 7.32 Combined Exe: 61.83 ± 6.86 |
Con: 33.64 ± 4.31 Combined Exe: 33.63 ± 4.09 |
10 min warm-up and 40 min aerobic exercise MAX. Pulse 60–75% and 10 min resistance training and 10 min cool-down × 3–4 d/w | 24 weeks | Exercise diary (concentration of glucose in blood pressure, pulse, ketone body) was kept regularly. |
| Tan et al. (2018) [57] | 31 (F) | T2DM | Con A-Exe |
Visceral trunk fat (%) Body weight (kg) |
Con: 62.9 ± 2.6 A-Exe: 63.0 ± 2.3 |
Con: 26.5 ± 3.2 A-Exe: 26.6 ± 3.1 |
40–60 min at fat maxHR of walking or running × 3 d/w | 12 weeks | Daily energy intake was then calculated by multiplying the proportions of carbohydrate, fat and protein consumed with their respective energy values (carbohydrate provides 4 kcal/g of energy, fat 9 kcal/g and protein 4 kcal/g) |
| Winding et al. (2018) [46] | 32 (M and F) | T2DM | Con A-Exe HIIT |
VFA (kg) Body weight (kg) |
Con: 57 ± 7 A-Exe: 58 ± 8 HIIT: 54 ± 6 |
Con: 28.0 ± 3.5 A-Exe: 27.4 ± 3.1 HIIT: 28.1 ± 3.5 |
A-Exe: 5 min warm-up, 40 min of cycling at 50% of Wpeak × 3 d/w HIIT: 5 min warm-up, 20 min of cycling consisting of cycles of 1 min at 95% Wpeak and 1 min of active recovery (20% Wpeak) × 3 d/w |
11 weeks | On experimental days, participants refrained from taking their anti-diabetic medication and arrived in a fasting state (≥10 h). Participants refrained from alcohol and caffeine intake for at least 24 h prior to any of the testing days and from exercise for 24 or 48 h before test days A and B, respectively |
| Yamaguchi et al. (2011) [47] | 19 (M and F) | T2DM | Con A-Exe |
VFA (cm2) SAT (cm2) Body weight (kg) |
Con: 50 ± 2.7 A-Exe: 50 ± 3.1 |
Con: 27.8 ± 5.6 A-Exe: 27.9 ± 6.0 |
A-Exe: 2 × 30 min bouts each day of walking exercise at 3.6–5.2 METs × 7 d/w | 12 weeks | Both groups received one dietary education program at the beginning of the intervention |
Abbreviations: M: male; F: female; BMI: body mass index; mg: milligram; kcal: kilocalorie; kJ: kilojoule; min: minutes; T2DM: type 2 diabetes mellitus; RPE: rate of perceived exertion; Con: control; D: diet; HMF: high monounsaturated fat; SAT: subcutaneous adipose tissue; VFA: visceral fat area; AVFA: abdomen visceral adipose tissue; A-Exe: aerobic exercise; R-Exe: resistance exercise; Exe: exercise; HIIT: high-intensity interval training; MICT: moderate-intensity aerobic exercise; SIT: sprint interval training; PLA: placebo; PD: Paleolithic diet; VLCD: very-low-calorie diet; NR: not reported; VO2peak: peak rate of oxygen consumption; Wpeak: peak power output; HRR: heart rate reserve; HR: heart rate; MHR: maximum heart rate; METs: metabolic equivalent; AT: anaerobic threshold; RM: repetition maximum; CHO: carbohydrates; MUFAs: monounsaturated fatty acids; BCAAs: branched-chain amino acids; VO2peak: peak oxygen consumption; Kg: kilogram; g: gram; DAPA: dapagliflozin.