Exercise Interventions for Type 2 Diabetes: Why Strength Training May Be Superior to Aerobic Exercise

If you’ve been told that aerobic exercise—like jogging, cycling, or swimming—is the best way to manage type 2 diabetes (T2DM), it’s time to rethink the conventional wisdom. While cardio certainly helps, recent research suggests that strength training (also called resistance training) may actually be more effective for blood sugar control, particularly for certain subgroups of patients.

For the 537 million people worldwide living with type 2 diabetes, exercise is a key pillar of management, alongside medication and diet. But what if lifting weights could lower your HbA1c more than a brisk walk? And what if it also improved muscle mass, insulin sensitivity, and metabolic health in ways that cardio alone cannot?

In this article, we’ll break down:

✅ The science behind strength training and its impact on blood glucose control
✅ Why it may be particularly beneficial for normal-weight type 2 diabetes (NWT2D)
✅ Key findings from the STRONG-D trial, which compared strength training to aerobic exercise
✅ How resistance training improves insulin sensitivity, metabolism, and muscle function
✅ Practical tips to get started safely and build an effective workout routine

Understanding Type 2 Diabetes and Exercise

The Role of HbA1c in Diabetes Management

Hemoglobin A1c (HbA1c) is the gold standard biomarker for long-term glycemic control. It reflects average blood glucose levels over approximately 2-3 months by measuring the percentage of hemoglobin proteins in red blood cells that have glucose attached to them. For individuals with type 2 diabetes, maintaining HbA1c levels below 7% is typically recommended to reduce the risk of complications.

Exercise has long been known to improve insulin sensitivity and reduce HbA1c levels. Traditionally, aerobic exercise has been the primary recommendation, but emerging research suggests that resistance training (strength training) may be equally or more effective, particularly for certain populations.

Normal-Weight Type 2 Diabetes: A Unique Challenge

While type 2 diabetes is commonly associated with obesity, approximately 15% of patients have normal-weight type 2 diabetes (NWT2D), defined as a BMI below 25 kg/m². These individuals often present with different physiological characteristics compared to their overweight counterparts:

• Lower insulin production rather than insulin resistance

• Different fat distribution patterns (more visceral fat despite normal BMI)

• Often more pronounced muscle mass deficiency (sarcopenia)

• Sometimes more aggressive disease progression

These unique characteristics suggest that exercise interventions may need to be tailored differently for normal-weight patients with type 2 diabetes.

The STRONG-D Trial: Strength Training vs. Aerobic Exercise

The STRONG-D trial (Strength Training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes) represents a significant advancement in our understanding of exercise interventions for NWT2D.

Study Design and Methodology

The STRONG-D trial was a randomized controlled trial that enrolled 289 individuals with normal-weight type 2 diabetes. Participants were randomly assigned to one of three intervention groups:

1. Strength Training (ST): Progressive resistance exercises targeting major muscle groups

2. Aerobic Training (AER): Moderate-intensity cardiovascular exercise

3. Combined Training (COMB): A combination of both strength and aerobic training

The intervention lasted 9 months, with exercise sessions occurring 2-3 times per week. The primary outcome measure was change in HbA1c, with secondary outcomes including body composition changes.

Key Findings

The results of the STRONG-D trial were striking:

• Greater HbA1c Reduction: The strength training group experienced significantly greater reductions in HbA1c compared to the aerobic training group. The mean difference in HbA1c between ST and AER groups was 2.51 mmol/mol (0.23%) for the intention-to-treat analysis and 3.06 mmol/mol (0.28%) for the per-protocol analysis.

• Improved Body Composition: Strength training led to increases in lean muscle mass and decreases in fat mass, creating a more favorable appendicular lean mass index (ALMI) to fat mass index (FMI) ratio.

• Effect Size: The effect size for ST vs. AER was 0.77 for the intention-to-treat analysis (moderate to large) and 0.88 for the per-protocol analysis (large).

• No Additional Benefit from Combined Training: Interestingly, the combined training group did not show additional benefits over strength training alone, suggesting that focusing on strength training might be more advantageous for this population.

Why Strength Training Works Better for Blood Sugar Control

Several physiological mechanisms likely explain why strength training may be particularly effective for improving glycemic control in individuals with normal-weight type 2 diabetes:

• Muscle Mass Development

  Strength training directly addresses one of the key issues in NWT2D: insufficient muscle mass. By increasing lean muscle tissue, strength training creates:

  • Larger glucose storage capacity through expanded muscle glycogen reserves

  • More active tissue for glucose uptake and utilization

  • Enhanced glucose transport protein (GLUT4) expression and translocation

• Enhanced Insulin Sensitivity

  Resistance exercise improves insulin sensitivity through multiple pathways:

  • Activation of AMP-activated protein kinase (AMPK), a key regulator of cellular energy

  • Increased expression of insulin receptor substrate (IRS) proteins

  • Reduction in muscle lipid content, which can interfere with insulin signaling

• Metabolic Improvements

  Strength training induces favorable metabolic adaptations:

  • Increased resting metabolic rate due to greater muscle mass

  • Enhanced mitochondrial function and density

  • Improved glucose oxidation capacity

  • Reduced inflammatory markers associated with insulin resistance

• Hormonal Changes

  Resistance exercise triggers beneficial hormonal responses:

  • Increased growth hormone and testosterone production, which promote muscle development and fat reduction

  • Reduced cortisol-to-testosterone ratio, improving metabolic health

  • Enhanced adiponectin levels, which improve insulin sensitivity

Beyond Blood Sugar: Additional Benefits of Strength Training

The benefits of strength training for individuals with type 2 diabetes extend well beyond glycemic control:

• Improved Cardiovascular Health

  Despite being traditionally associated with aerobic exercise, cardiovascular benefits from strength training include:

  • Reduced systolic and diastolic blood pressure

  • Improved blood lipid profiles, particularly increased HDL cholesterol

  • Reduced triglyceride levels

  • Decreased inflammatory markers associated with cardiovascular disease

• Enhanced Functional Capacity

  Strength training provides functional benefits particularly important for aging individuals with diabetes:

  • Increased bone mineral density, reducing fracture risk

  • Improved balance and coordination, preventing falls

  • Enhanced mobility and independence in daily activities

  • Reduced risk of disability and frailty

• Psychological Well-being

  Mental health benefits associated with strength training include:

  • Reduced symptoms of depression and anxiety

  • Improved sleep quality

  • Enhanced self-efficacy and confidence

  • Better overall quality of life

Recent Meta-Analysis Findings on Exercise Interventions

Recent meta-analyses provide additional context for understanding the role of different exercise modalities in diabetes management.

Resistance Training and Metabolic Syndrome Markers

A meta-analysis synthesizing evidence from 50 randomized controlled trials (including 2,271 participants) investigated the impact of resistance exercise training (RET) on metabolic syndrome markers in patients with type 2 diabetes. Key findings included:

• Significant reductions in fasting blood glucose (-7.09 mg/dl)

• Decreased triglyceride levels (-14.05 mg/dl)

• Reduced systolic (-4.13 mmHg) and diastolic (-2.03 mmHg) blood pressure

• Decreased waist circumference (-2.18 cm)

• Increased high-density lipoprotein levels (+1.86 mg/dl)

These improvements occurred consistently across varying intervention durations and participant genders, underscoring the broad applicability of resistance training for diverse T2DM populations.

Comparing Multiple Exercise Modalities

A comprehensive network meta-analysis of 158 studies involving 17,059 participants compared the efficacy of different exercise modalities on glycemic control. This analysis ranked intervention effectiveness as follows:

• High-Intensity Interval Training (HIIT): HbA1c reduction of 0.61%

• Combined Training (CT): HbA1c reduction of 0.58%

• Aerobic Training (AT): HbA1c reduction of 0.58%

• Resistance Training (RT): HbA1c reduction of 0.40%

• Physical Activity Advice: HbA1c reduction of 0.35%

Using the Surface Under the Cumulative Ranking Curve (SUCRA) methodology, HIIT emerged as the most effective treatment (SUCRA = 82%), followed by combined training (77%), aerobic training (76%), resistance training (37%), and physical activity advice (29%).

This meta-analysis suggests that while all exercise modalities are beneficial, the intensity and combination of exercise types play important roles in determining effectiveness. The relatively lower ranking of resistance training in this analysis compared to the STRONG-D findings highlights the importance of considering patient-specific factors (such as weight status) when prescribing exercise interventions.

Creating an Effective Strength Training Routine for Type 2 Diabetes

Based on the STRONG-D protocol and other research findings, here are practical guidelines for implementing strength training for type 2 diabetes management:

Getting Started Safely

• Consult healthcare providers: Before beginning any new exercise program, consult with your physician and, if possible, a certified exercise professional with experience in diabetes management.

• Start gradually: Begin with lower weights and fewer sets, gradually increasing intensity as strength and confidence improve.

• Focus on proper form: Correct technique prevents injuries and ensures maximum benefit from each exercise.

• Monitor blood glucose: Check blood glucose before, sometimes during, and after exercise sessions, especially when starting a new program.

Recommended Training Parameters

• Frequency: 2-3 sessions per week on non-consecutive days

• Intensity: 8-12 repetitions per set (approximately 65-75% of one-repetition maximum)

• Volume: 2-3 sets per exercise

• Exercise selection: 8-10 exercises targeting major muscle groups (legs, back, chest, shoulders, arms, core)

• Progression: Gradually increase resistance when current weight becomes manageable

Sample Strength Training Routine

Workout A (Lower Body Focus)

• Squats: 3 sets × 10-12 reps

• Leg press: 3 sets × 10-12 reps

• Seated leg extension: 2 sets × 10-12 reps

• Seated leg curl: 2-3 sets × 10-12 reps

• Standing calf raises: 2-3 sets × 15-20 reps

• Abdominal crunches: 2-3 sets × 15-20 reps

Workout B (Upper Body Focus)

• Chest press: 3 sets × 10-12 reps

• Seated row: 3 sets × 10-12 reps

• Shoulder press: 2-3 sets × 10-12 reps

• Lat pulldown: 2-3 sets × 10-12 reps

• Bicep curls: 2 sets × 10-12 reps

• Tricep extensions: 2 sets × 10-12 reps

Special Considerations for Diabetes

• Proper footwear: Essential for individuals with peripheral neuropathy

• Hydration: Maintain adequate fluid intake before, during, and after exercise

• Timing with medication: Coordinate exercise with medication timing to avoid hypoglycemia

• Recovery: Allow 48 hours of recovery between strength training sessions for the same muscle groups

Key Takeaways

• Strength training is particularly effective for normal-weight type 2 diabetes: The STRONG-D trial demonstrates superior HbA1c reductions with strength training compared to aerobic exercise for individuals with normal-weight type 2 diabetes.

• Muscle mass matters: Strength training increases lean muscle mass, which improves glucose metabolism and insulin sensitivity.

• Multiple benefits beyond glycemic control: Strength training improves cardiovascular health, functional capacity, and psychological well-being.

• Exercise type should be tailored to individual needs: While meta-analyses suggest HIIT and combined training may be most effective overall, specific subgroups like normal-weight diabetics may benefit more from focused strength training.

• Consistency is crucial: Regular, progressive strength training (2-3 times weekly) produces the best results.

• Professional guidance improves outcomes: Working with healthcare providers and exercise specialists ensures safe and effective implementation.

Frequently Asked Questions

Is strength training safe for all individuals with type 2 diabetes?

Most people with type 2 diabetes can safely engage in strength training, but certain complications require precautions. Individuals with proliferative retinopathy, severe neuropathy, or uncontrolled hypertension should consult healthcare providers before starting and may need modified programs.

How soon can I expect to see improvements in blood glucose after starting strength training?

Acute improvements in insulin sensitivity can occur after a single session of strength training. However, meaningful reductions in HbA1c typically require 8-12 weeks of consistent training. Individual results vary based on initial fitness level, diabetes duration, medication use, and dietary habits.

Can I do strength training if I'm currently only doing aerobic exercise?

Yes, adding strength training to an existing aerobic routine is beneficial. Research suggests that combining both forms of exercise provides complementary benefits. Begin by incorporating 1-2 strength sessions weekly while maintaining your aerobic activity.

Do I need special equipment or a gym membership for effective strength training?

While gym equipment offers variety, effective strength training can be performed at home using resistance bands, dumbbells, or even bodyweight exercises. The key is progressive overload—gradually increasing resistance as strength improves.

Will strength training cause hypoglycemia?

Strength training typically causes less pronounced drops in blood glucose compared to extended aerobic exercise. However, monitoring blood glucose before and after sessions is recommended, especially when beginning a new program. Having a fast-acting carbohydrate source available during exercise is advisable.

How does strength training affect diabetes medications?

As strength training improves insulin sensitivity, some individuals may require adjustments to diabetes medications. Regular communication with healthcare providers is essential to monitor and adjust medication dosages as needed.

Final Takeaway: Strength Training Is a Game-Changer for Type 2 Diabetes

For years, aerobic exercise has been the go-to recommendation for managing type 2 diabetes, but the latest research—especially the STRONG-D trial—makes it clear: strength training deserves a top spot in diabetes care, particularly for those with normal-weight type 2 diabetes (NWT2D).

By building muscle mass, improving insulin sensitivity, and enhancing metabolic health, strength training goes beyond just lowering HbA1c—it supports long-term vitality, functional independence, and even mental well-being.

So, if you’ve never considered adding resistance exercises to your routine, now’s the time. Lifting weights, using resistance bands, or even doing bodyweight exercises just 2-3 times per week can make a significant difference in your diabetes management.

The Bottom Line?

💪 Strength training isn't just for athletes—it’s for anyone who wants better blood sugar control, stronger muscles, and a healthier life.

🔥 Don’t underestimate the power of muscle—your body (and your blood sugar) will thank you.

Now, are you ready to pick up those weights? 🚀

Related

Conquer Sarcopenia: Your Guide to Strength Training for a Strong and Active Life

Move More, Lose More: Exercise Dose-Response trumps Calorie Counting for Belly Fat

Journal References

Garcia, S. P., Cureau, F. V., Iorra, F. Q., Bottino, L. G., R C Monteiro, L. E., Leivas, G., Umpierre, D., & Schaan, B. D. (2025). Effects of exercise training and physical activity advice on HbA1c in people with type 2 diabetes: A network meta-analysis of randomized controlled trials. Diabetes research and clinical practice, 221, 112027. https://doi.org/10.1016/j.diabres.2025.112027

Han, C., Xue, H., Yang, S., & Gao, B. (2025). Resistance exercise training and its impact on metabolic syndrome in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes research and clinical practice, 222, 112077. Advance online publication. https://doi.org/10.1016/j.diabres.2025.112077

Kobayashi, Y., Long, J., Johannsen, N.M. et al. Is strength training more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes? Reply to Pontes‑Silva A, Santos‑de‑Araujo AD, Teixeira BC et al [letter]. Diabetologia 67, 1721–1722 (2024). https://doi.org/10.1007/s00125-024-06181-w

Kobayashi, Y., Long, J., Dan, S., Johannsen, N. M., Talamoa, R., Raghuram, S., Chung, S., Kent, K., Basina, M., Lamendola, C., Haddad, F., Leonard, M. B., Church, T. S., & Palaniappan, L. (2023). Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes: a randomised controlled trial. Diabetologia, 66(10), 1897–1907. https://doi.org/10.1007/s00125-023-05958-9

Disclaimer

The information on this website is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

About the Author:

Dr.T.S. Didwal, MD, is an experienced Internal Medicine Physician with over 30 years of practice. Specializing in internal medicine, he is dedicated to promoting wellness, preventive health, and fitness as core components of patient care. Dr. Didwal’s approach emphasizes the importance of proactive health management, encouraging patients to adopt healthy lifestyles, focus on fitness, and prioritize preventive measures. His expertise includes early detection and treatment of diseases, with a particular focus on preventing chronic conditions before they develop. Through personalized care, he helps patients understand the importance of regular health screenings, proper nutrition, exercise, and stress management in maintaining overall well-being.