Exercise modalities for adults with type 2 diabetes mellitus and obesity: comparative effects on visceral fat, metabolism, and inflammatory markers from a network meta-analysis.

Obesity correlates closely with type 2 diabetes mellitus (T2DM), with central adiposity, dyslipidemia and chronic low-grade inflammation as typical pathological features. Physical exercise is recommended as a safe core non-pharmacological intervention, but the relative efficacy of different exercise modes for comprehensive metabolic improvement remains controversial and unclear. This network meta-analysis comprehensively compared the effects of diverse exercise interventions on abdominal fat distribution, glycolipid metabolism and inflammatory biomarkers in obese T2DM patients, aiming to determine the optimal exercise regimen for clinical individualized exercise prescription. We systematically searched five mainstream electronic databases for eligible RCTs published up to October 9, 2025. The Cochrane Risk of Bias Tool and GRADE system were used to assess study methodological quality and outcome evidence certainty. All statistical analyses were performed via Stata 16.0 and RevMan 5.4. In total, 32 qualified RCTs involving 1519 obese T2DM participants were enrolled. No significant inconsistency was detected across all outcome indicators, so a consistency model was adopted for pooled analysis. Notably, exercise produced no significant change in total dietary energy intake. It significantly reduced BMI (MD = -1.78, 95% CI [-2.70, -0.85]), with combined aerobic-resistance training being optimal (SUCRA = 93%). Exercise also lowered TC (MD = -0.36, 95% CI [-0.59, -0.14], SUCRA = 94.2%), TG (MD = -0.28, 95% CI [-0.38, -0.19], SUCRA = 95%) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (MD = -0.92, 95% CI [-1.73, -0.10], SUCRA = 92.6%). LDL-C showed non-significant declining trend (SUCRA = 81.3%), while HDL-C increased markedly (MD = 0.12, 95% CI [0.05, 0.18], SUCRA = 97.5%). Aerobic exercise plus auxiliary treatments ranked first in reducing IL-6 (SUCRA = 99.9%). Walking and jogging worked best for reducing insulin level (SUCRA = 90.9%), and mind-body exercise maximized lean body mass (SUCRA = 93.7%). Regular exercise effectively ameliorates glycolipid metabolic disorders and chronic inflammatory status in obese T2DM patients. Combined aerobic-resistance training yields the most comprehensive metabolic benefits among all interventions. Importantly, these favorable metabolic improvements are independent of dietary energy restriction, which supports targeted individualized exercise prescriptions as an independent clinical intervention for this vulnerable population. https://www.crd.york.ac.uk/prospero/CRD420251272031, identifier CRD420251272031.