Psychophysiological Responses to Physical Activity, Exercise and/or Nutrition Interventions in Individuals with Cardiometabolic Health Impairments

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 30 September 2026 | Viewed by 70193

Editor


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Guest Editor
1. Department of Life Sciences, European University Cyprus, 2404 Nicosia, Cyprus
2. Department of Physical Education and Sport Science, Democritus University of Thrace, 89100 Komotini, Greece
Interests: clinical exercise physiology; exercise physiology; exercise biochemistry; strength and conditioning; high-intensity interval training; obesity; functional training; resistance training
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Special Issue Information

Dear Colleagues,

“Psychophysiological Responses to Physical Activity, Exercise and/or Nutrition Interventions in Individuals with Cardiometabolic Health Impairments” is a topic that affects a considerable proportion of the global adult population. In light of the growing prevalence in sedentary lifestyles and the alarming rise in chronic diseases associated with these habits, it is imperative to consider the potential benefits of regular physical activity. Further research is required to elucidate the crucial function of bodily movement and/or nutritional behavior among those impacted by the most common cardiometabolic health diseases.

Areas of interest for this Special Issue include, but are not limited to, the following areas: Physical activity, exercise, and/or nutrition, and:

  1. Anthropometric characteristics;
  2. Body composition;
  3. Glucose metabolism;
  4. Lipid metabolism;
  5. Blood pressure;
  6. Oxidative stress;
  7. Redox status;
  8. Liver function;
  9. Renal function;
  10. Physical fitness;
  11. Exercise behavioral regulation;
  12. Enjoyment;
  13. Affect valence;
  14. Quality of life;
  15. Mood state;
  16. Depression;
  17. Anxiety;
  18. Stress;
  19. Eating habits;
  20. Sleep.

I look forward to receiving your contributions.

Dr. Alexios Batrakoulis
Guest Editor

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Keywords

  • obesity
  • prediabetes
  • type 2 diabetes
  • dyslipidemia
  • hypertension
  • metabolic syndrome
  • chronic kidney disease
  • non-alcoholic fatty liver disease
  • cardiovascular diseases
  • exercise
  • physical activity
  • diet

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Published Papers (10 papers)

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Research

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16 pages, 278 KB  
Article
Mindful Eating and Healthy Lifestyle Behaviors Among Women with and Without Regular Exercise Habits
by Handan Isiklar, Meral Kucuk Yetgin and Zuhal Aydan Saglam
Healthcare 2026, 14(1), 67; https://doi.org/10.3390/healthcare14010067 - 26 Dec 2025
Viewed by 1067
Abstract
Background/Objectives: Eating mindfulness and healthy lifestyle behaviors play a key role in preventing unhealthy weight gain. Understanding how these behaviors differ according to exercise habits can guide interventions targeting women’s health. This study aimed to compare healthy lifestyle behaviors and eating mindfulness between [...] Read more.
Background/Objectives: Eating mindfulness and healthy lifestyle behaviors play a key role in preventing unhealthy weight gain. Understanding how these behaviors differ according to exercise habits can guide interventions targeting women’s health. This study aimed to compare healthy lifestyle behaviors and eating mindfulness between women with and without regular exercise habits. Methods: A cross-sectional, analytical, and descriptive study was conducted with 156 women: a Regular Exercise Group (REG, n = 68) and a Non-Exercise Group (NEG, n = 88). Data were collected through face-to-face interviews using the Mindful Eating Questionnaire (MEQ-30) and the Healthy Lifestyle Behavior Scale II (HLBS-II), along with dietary records and anthropometric measurements. Results: The REG scored significantly higher in eating discipline (p = 0.003) and in HLBS-II subscales of physical activity, nutrition, and stress management (p < 0.05). No significant differences were found in total MEQ scores, BMI-related nutrient intake, or other HLBS-II dimensions (p > 0.05). BMI values and smoking rates were lower in the REG (p < 0.05). Univariate logistic regression showed that BMI, eating discipline, physical activity, nutrition, stress management, and total HPLP-II scores were significantly associated with regular exercise (p < 0.05). In the multivariate model, BMI (OR = 1.114, 95% CI: 1.021–1.216) remained independently associated with regular exercise status. Conclusions: Although eating discipline was higher in the REG, overall mindful eating levels did not differ between groups. BMI were the strongest independent variables associated with regular exercise status, suggesting that while exercise supports positive lifestyle patterns, enhancing mindful eating may require additional targeted interventions. Full article
13 pages, 1400 KB  
Article
Development and Feasibility of a Smartphone Application for Promoting Healthy Heart Behaviors Following Open-Heart Surgery: A Mixed-Method Pilot Study
by Preeyaphorn Songsorn, Pawarat Nontasil, Kornanong Yuenyongchaiwat, Noppawan Charususin, Jitanan Laosiripisan, Sasipa Buranapuntalug and Khanistha Wattanananont
Healthcare 2025, 13(14), 1647; https://doi.org/10.3390/healthcare13141647 - 8 Jul 2025
Viewed by 1423
Abstract
Background/Objectives: Adherence to healthy behaviors after open-heart surgery is crucial for recovery and long-term health. Traditional patient education methods can be enhanced by using technology to improve engagement and self-care. This study aimed to develop and assess the feasibility of the “Term-Jai” smartphone [...] Read more.
Background/Objectives: Adherence to healthy behaviors after open-heart surgery is crucial for recovery and long-term health. Traditional patient education methods can be enhanced by using technology to improve engagement and self-care. This study aimed to develop and assess the feasibility of the “Term-Jai” smartphone application for promoting healthy heart behaviors in open-heart surgery patients. Methods: The “Term-Jai” psychological theory-based application was tested quantitatively and qualitatively over a 30-day period with 13 patients (age 44–78 years) following open-heart surgery between November 2023 and March 2024. Participant engagement, healthy behaviors, user experience, and usability were assessed using the System Usability Scale (SUS), satisfaction ratings, healthy behavior questionnaires, and semi-structured interviews. Results: The application was feasible, with 70% of participants remaining engaged during the intervention. The average SUS score was 80.2 ± 10.3, indicating good usability. Participants found the application’s information useful, clear, and easy to understand, showing improvements in health behaviors following application usage. The qualitative analysis highlighted the application’s intuitive design and potential for supporting cardiac rehabilitation. High satisfaction scores suggested its effectiveness despite some barriers to application usage around technical support and personalized exercise progression. Conclusions: The “Term-Jai” application is a promising tool for promoting healthy behaviors in patients following open-heart surgery. The application shows good usability and participant satisfaction, indicating its potential for broader implementation after further refinements. Full article
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13 pages, 2177 KB  
Article
Correlation Between Metabolic Score for Visceral Fat and Cardiovascular-Kidney-Metabolic Syndrome: Analysis of NHANES 2011–2020
by Xi Fang, Xuemin Yin, Qianfang Liu, Jing Liu and Ying Li
Healthcare 2025, 13(7), 694; https://doi.org/10.3390/healthcare13070694 - 21 Mar 2025
Cited by 6 | Viewed by 3495
Abstract
Background: Cardiovascular-kidney-metabolic (CKM) syndrome with high incidence and mortality rates is a prevalent health issue globally. The Metabolic Score for Visceral Fat (METS-VF), as a new index for valuating visceral adipose tissue, has been reported to be closely related to a variety of [...] Read more.
Background: Cardiovascular-kidney-metabolic (CKM) syndrome with high incidence and mortality rates is a prevalent health issue globally. The Metabolic Score for Visceral Fat (METS-VF), as a new index for valuating visceral adipose tissue, has been reported to be closely related to a variety of diseases. However, whether the METS-VF can be an indicator to predict the risk of CKM syndrome remains unclear. Methods: We selected National Health and Nutrition Examination Survey (NHANES) database data from the 2011–2020 year cycles and conducted analyses between the METS-VF and CKM syndrome utilizing weighted Cox regression models, subgroup and interaction analysis, and restricted cubic spline (RCS) analysis. We also used receiver operating characteristic (ROC) curves to analyze and compare the diagnostic predictive ability of the METS-VF, the BMI, and other indicators assessing adipose tissue, including the VAI, fat mass, and lean mass, in CKM syndrome. Results: In this study, the average age was 34.40 ± 0.61 years in the non-CKM patients, while the average age was over 40.38 ± 0.62 years in the CKM patients. Additionally, there was a greater proportion of male patients in the CKM patients (over 49.04%) in comparison with the non-CKM patients (37.94%). The average METS-VF was higher in the CKM patients (over 6.63 ± 0.02) compared with the non-CKM patients (5.62 ± 0.03). We found the METS-VF had a positive correlation with CKM syndrome and was hardly affected by other confounding factors. The METS-VF was more closely associated with CKM syndrome in the subgroup of age 20–59 and female patients. In addition, the METS-VF had better diagnostic ability for CKM syndrome than the body mass index (BMI) and other indicators. Conclusions: The METS-VF is a potentially actionable indicator that had a positive correlation with CKM risk. The METS-VF may be used as a possible reference in the management of CKM syndrome. Full article
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14 pages, 1251 KB  
Article
The Impact of Relaxation Massage Prior to Bedtime on Sleep Quality and Quantity in People with Symptoms of Chronic Insomnia: A Home-Based Sleep Study
by Ilias Ntoumas, Christina Karatzaferi, Christoforos D. Giannaki, Fotini Papanikolaou, Aggelos Pappas, Efthimios Dardiotis and Giorgos K. Sakkas
Healthcare 2025, 13(2), 180; https://doi.org/10.3390/healthcare13020180 - 17 Jan 2025
Cited by 5 | Viewed by 18006
Abstract
Background/Objectives: Manual massage is an effective treatment approach for reducing general stress and promoting an overall sense of well-being. Relaxation massage aims to alleviate psychophysiological tension, enhance both blood and lymphatic circulation, and promote mental and physical relaxation. It is particularly beneficial for [...] Read more.
Background/Objectives: Manual massage is an effective treatment approach for reducing general stress and promoting an overall sense of well-being. Relaxation massage aims to alleviate psychophysiological tension, enhance both blood and lymphatic circulation, and promote mental and physical relaxation. It is particularly beneficial for those with anxiety-related symptoms (such as generalized anxiety disorder and social anxiety) and sleep disorders, aiming to improve calmness and promote sleepiness. Aims: The purpose of the present study was to assess the effectiveness of a single session of relaxation massage prior to bedtime on sleep quality and quantity indices in individuals with symptoms of chronic insomnia. Methods: In total, 20 (N = 20) healthy individuals (aged 25.5 ± 12.0 years; 6F/14M) with a score on the Athens Insomnia Scale of ≥16 participated under three different conditions over one week apart: (1) a 45 min relaxation massage condition (REL), (2) a 45 min sham massage condition (PLA), and (3) a control condition with no massage. Sleep activity was monitored using a portable polysomnographic system. Results: A statistically significant effect was observed between sleep efficiency across the three sessions (p = 0.034), with a notable effect in the relaxation massage (REL) session (p = 0.045). Additionally, sustained sleep efficiency showed a statistically significant difference among the sessions (p = 0.005). Conclusions: Relaxation massage prior to bedtime could be used as an effective and safe non-pharmacological approach for improving sleep efficiency and potentially restoring the fragmented sleep of individuals with symptoms of insomnia. Trial registration number: The trial was registered at clinicaltrials.gov as NCT06781866. Full article
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Review

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23 pages, 1200 KB  
Review
Evolution of Exercise Training in Patients with Pulmonary Hypertension—A Comprehensive Review
by Ioannis Beis, Konstantina Dipla, Afroditi Boutou, Athanasios Zacharias, Athanasia Pataka, Evdokia Sourla, Andreas Zafeiridis and Georgia Pitsiou
Healthcare 2026, 14(12), 1796; https://doi.org/10.3390/healthcare14121796 - 22 Jun 2026
Viewed by 399
Abstract
Pulmonary hypertension (PH) is a progressive, multifactorial syndrome characterized by elevated pulmonary arterial pressure and right heart dysfunction, associated with significant morbidity, impaired quality of life, and poor prognosis. Advances in classification, hemodynamic definitions, and targeted pharmacotherapies have improved understanding and management, yet [...] Read more.
Pulmonary hypertension (PH) is a progressive, multifactorial syndrome characterized by elevated pulmonary arterial pressure and right heart dysfunction, associated with significant morbidity, impaired quality of life, and poor prognosis. Advances in classification, hemodynamic definitions, and targeted pharmacotherapies have improved understanding and management, yet therapeutic challenges persist across the five World Health Organization groups of PH. Historically, exercise was discouraged due to concerns about adverse hemodynamic effects, but growing evidence has suggested that structured, supervised training is safe and beneficial. Randomized trials and meta-analyses show improvements in six-minute walk distance, peak oxygen uptake, right ventricular function, ventilatory efficiency, and health-related quality of life, with a low incidence of adverse events. Physiological adaptations include favorable cardiac remodeling, enhanced endothelial function, improved skeletal and respiratory muscle performance, and improved neurohormonal activity. Despite this evidence, barriers such as patient fears, limited clinical expertise, and restricted access to specialized rehabilitation programs hinder widespread implementation. Current guidelines recommend supervised exercise as part of pulmonary rehabilitation for patients with stable PH, supporting its role as an adjunct to pharmacotherapy. This descriptive review briefly summarizes the pathophysiology of PH, phenotype-related differences and current therapeutic approaches, and the beneficial adaptations to exercise training, with the aim of informing exercise specialists and supporting safer, more effective integration of exercise-based rehabilitation into patient care. Full article
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27 pages, 2148 KB  
Review
Screening Tools for Early Identification of Adults at High Risk of Type 2 Diabetes: A Scoping Review
by Christos Christakis, Dimitra Saliari, Antonis Zampelas and Odysseas Androutsos
Healthcare 2026, 14(7), 839; https://doi.org/10.3390/healthcare14070839 - 25 Mar 2026
Viewed by 959
Abstract
Background/Objectives: Global estimates suggest that approximately 43% of individuals living with diabetes remain undiagnosed, underscoring the need for early identification of adults at high risk of type 2 diabetes mellitus (T2DM) to support timely preventive interventions. This scoping review aimed to map and [...] Read more.
Background/Objectives: Global estimates suggest that approximately 43% of individuals living with diabetes remain undiagnosed, underscoring the need for early identification of adults at high risk of type 2 diabetes mellitus (T2DM) to support timely preventive interventions. This scoping review aimed to map and summarize existing non-invasive screening tools for identifying adults at high risk of T2DM. Methods: PubMed (MEDLINE), Web of Science, ScienceDirect, and Scopus were searched in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR). Studies published between 1995 and 2026 that described screening tools for adult populations were included. Results: A total of 58 studies describing screening tools were identified. The tools were developed and applied across diverse populations and ethnic groups. Most were questionnaire-based, easy to administer, and low cost. Commonly included variables comprised demographic characteristics, anthropometric measures, lifestyle factors, and clinical indicators associated with increased T2DM risk. Substantial heterogeneity was observed in tool structure and reported predictive components. Conclusions: This scoping review provides an overview of available screening tools for the early identification of adults at high risk of T2DM. The mapped evidence may inform future validation studies and support context-specific implementation in public health and clinical practice settings, including integration into digital platforms. Full article
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28 pages, 1689 KB  
Review
Translational Lifestyle Medicine Approaches to Cardiovascular–Kidney–Metabolic Syndrome
by Zacharias Papadakis
Healthcare 2026, 14(1), 51; https://doi.org/10.3390/healthcare14010051 - 24 Dec 2025
Cited by 2 | Viewed by 2033
Abstract
Cardiovascular–Kidney–Metabolic (CKM) syndrome arises from interrelated cardiovascular, renal, and metabolic pathways that require coordinated therapeutic strategies. This narrative review synthesizes recent systematic reviews, meta-analyses, and original studies to evaluate the translational application of lifestyle medicine (LM) for CKM management. Evidence indicates that LM [...] Read more.
Cardiovascular–Kidney–Metabolic (CKM) syndrome arises from interrelated cardiovascular, renal, and metabolic pathways that require coordinated therapeutic strategies. This narrative review synthesizes recent systematic reviews, meta-analyses, and original studies to evaluate the translational application of lifestyle medicine (LM) for CKM management. Evidence indicates that LM interventions targeting the six pillars of practice (nutrition, physical activity, stress management, sleep, social support, and avoidance of risky substances) can improve blood pressure, lipid profiles, glycemic control, and weight, with benefits that complement or at times rival pharmacotherapy. We outline opportunities at the LM–drug interface, including sodium-glucose cotransporter-2 inhibitors and nutrient-stimulated hormone agents such as GLP-1 and GIP, and highlight the need to test synergy and sequencing with LM. Persistent implementation barriers include prioritization of drug-centric care and limited protocolized delivery; the AHA 5A model and digital health tools, including wearables that enable real-time feedback, provide practical routes for integration. Marginalized populations carry a disproportionate burden of CKM, underscoring the need for equitable, culturally tailored approaches. Sex-specific gaps, particularly in post-menopausal lipid metabolism and insulin sensitivity, point to the promise of genomic and nutraceutical personalization. Future work should use preregistered, adequately powered multimodal trials to establish durable, scalable pathways for CKM care. Full article
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Other

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18 pages, 347 KB  
Systematic Review
The Effect of Intradialytic Exercise on Cognition in Renal Patients Undergoing Hemodialysis: An Updated Systematic Review of Randomized Controlled Trials
by Andreas Mavrommatis, Nicos Mitsides, Myrtani Pieri, Eleni P. Andreou, Giorgos K. Sakkas, Kyproula Dimitriou, Michalis Spartalis, Maria Arsali, Themis Christofi, Theophanis Theophanous, Bettina Wollesen, Georgios M. Hadjigeorgiou and Christoforos D. Giannaki
Healthcare 2025, 13(23), 3016; https://doi.org/10.3390/healthcare13233016 - 21 Nov 2025
Cited by 1 | Viewed by 1669
Abstract
Background/Objectives: Hemodialysis patients are disproportionately affected by impaired cognitive function in comparison to the general population. This systematic review aims to update and expand the current evidence regarding the effects of IET interventions on global cognition and specific cognitive domains, such as [...] Read more.
Background/Objectives: Hemodialysis patients are disproportionately affected by impaired cognitive function in comparison to the general population. This systematic review aims to update and expand the current evidence regarding the effects of IET interventions on global cognition and specific cognitive domains, such as executive function, processing speed, and attention. Methods: A comprehensive search was conducted across three databases (PubMed, Scopus, and EBSCO) from database inception to 24 August 2025 for randomized controlled trials examining the effects of intradialytic exercise training on cognitive function, using combinations of the following search terms: hemodialysis, dialysis, dialy*, physical exercise, physical activity, exercise, activity, activit*, cognition, cognitive, and cognit*. Included studies were assessed for risk of bias and methodological quality using the Jadad Scale and NHLBI tools. Results: Seven studies were included in this review, encompassing (n = 332; 60.4% male) hemodialysis patients aged from 48 to 74.9 years. In comparison to standard care, IET significantly improved global cognition and specific cognitive domains. Regarding global cognitive function, interventions regardless of exercise type, which were performed thrice weekly over 12 to 16 weeks, significantly improved scores in (n = 4; 57%) studies using the Montreal Cognitive Assessment (MoCA) and in (n = 1; 14%) study using the Mini Mental State Examination. Regarding specific cognitive domains, aerobic exercise performed thrice weekly for 12 weeks were associated with statistically significant improvements in the following: executive function scores (n = 2; 29%), studied using the Trail Making Test (TMT) Part-B and TMTB-A; psychomotor processing speed (n = 1; 14%), studied using TMT-A and Symbol Digit Modality Test (SDMT); and alertness (n = 1; 14%), studied using the Test of Attentional Performance (TAP) test. Conclusions: The collective evidence confers that IET is an effective intervention that may moderately improve global and domain-specific cognitive function or, at the very least, serve in a protective capacity to stem potential future cognitive decline in this population. However, further large-scale randomized controlled trials that place emphasis on standardized reporting of exercise intervention characteristics and cognitive outcome measures are necessary to inform clinical practice. Full article
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43 pages, 2146 KB  
Systematic Review
The Effects of Concurrent Training Versus Aerobic or Resistance Training Alone on Body Composition in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis
by Mousa Khalafi, Shokoufeh Kheradmand, Aref Habibi Maleki, Michael E. Symonds, Sara K. Rosenkranz and Alexios Batrakoulis
Healthcare 2025, 13(7), 776; https://doi.org/10.3390/healthcare13070776 - 31 Mar 2025
Cited by 24 | Viewed by 33771
Abstract
Introduction and Aim: The beneficial effects of aerobic training (AT) on preventing excess fat mass, and of resistance training (RT) on skeletal muscle adaptation, are well established. However, the effects of concurrent training (CT) compared to AT or RT alone on body composition [...] Read more.
Introduction and Aim: The beneficial effects of aerobic training (AT) on preventing excess fat mass, and of resistance training (RT) on skeletal muscle adaptation, are well established. However, the effects of concurrent training (CT) compared to AT or RT alone on body composition in middle-aged and older adults are less understood, and therefore, the focus of this meta-analysis. Methods: Three databases, including PubMed, Web of Science, and Scopus, were searched from inception to March 2024. Randomized trials were included if they compared CT versus either AT or RT, and included body composition measures such as fat mass, body fat percentage, waist circumference, visceral fat mass, lean body mass (LBM), muscle mass/volume, or muscle or muscle fiber cross-sectional area (CSA), in middle-aged (50 to <65 years) and older adults (≥65 years). Weighted mean differences (WMD) or standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated using random effects models. Results: A total of 53 studies involving 2873 participants were included. Overall, CT increased body weight and LBM significantly more, trending toward significantly larger increases in muscle mass and CSA, compared with AT alone. However, there were no significant differences between CT and RT alone, for body weight, BMI, body fat percentage, fat mass, waist circumference, or visceral fat mass. Conclusions: CT is as effective as AT for decreasing body fat measures and as effective as RT for increasing muscle mass in middle-aged and older adults, and it should be recommended accordingly. Full article
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16 pages, 2330 KB  
Systematic Review
The Effects of Exercise Training on Body Composition and Cardiometabolic Risk Factors in Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis
by Mousa Khalafi, Farnaz Dinizadeh, Sara K. Rosenkranz, Michael E. Symonds and Saeid Fatolahi
Healthcare 2025, 13(3), 246; https://doi.org/10.3390/healthcare13030246 - 26 Jan 2025
Cited by 5 | Viewed by 5676
Abstract
Introduction and Aim: We performed a systematic review and meta-analysis to investigate the effects of exercise training on body composition and cardiometabolic health in patients with Type 1 diabetes (T1D). Method: A search in three main databases including PubMed, Web of Science, and [...] Read more.
Introduction and Aim: We performed a systematic review and meta-analysis to investigate the effects of exercise training on body composition and cardiometabolic health in patients with Type 1 diabetes (T1D). Method: A search in three main databases including PubMed, Web of Science, and Scopus was conducted from the inception of this review until June 2024 to identify randomized control trials investigating the effects of exercise training compared to a control on body composition and cardiometabolic risk factors in patients with T1D. The data were pooled using random effects models to calculate weighted mean differences (WMDs), standardized mean differences (SMDs), and 95% confidence intervals (CIs). Results: Overall, 25 studies involving 1120 patients with T1D were included in the meta-analysis. Exercise training decreased body mass index (BMI) [WMD: −0.18 kg.m2, p = 0.02], fasting glucose [WMD: −14.97 mg/dl, p = 0.01], and HbA1c [WMD: −0.49%, p = 0.003], and increased VO2max/peak [WMD: 2.76 mL/kg/min, p = 0.001] as compared with controls. Exercise training had no effect on body fat percentage or lean body mass, lipid profiles, or blood pressure. Subgroup analysis indicated that age, exercise mode, and intervention duration were the main moderators for the beneficial effects of exercise training. Conclusions: In patients with T1D, exercise training is effective for decreasing body weight and cardiometabolic risk factors. Full article
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