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Physiological and glycaemic responses to exercise and recovery were monitored during an exercise test at baseline and following the intervention. This secondary analysis focuses on a subgroup (\n                      <jats:italic>n<\/jats:italic>\n                      =21), in which plasma samples were collected before and after exercise, and after 30 min of recovery, and lipid profiles were analysed using mass spectrometry-based lipidomics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Glycaemic management during and after the exercise test improved similarly in both groups, whereas only the PD+E group showed improvements in cardiometabolic fitness. In plasma samples obtained at rest before exercise, the intervention reduced levels of triacylglycerols in both groups, with additional reductions of very-long-chain ceramides (&gt;C22 acyl chains) in the PD+E group. During the exercise test, sphingomyelins and ceramides\u00a0increased in both groups, but only PD+E resulted in improved clearance of these bioactive lipids from circulation during recovery. The specific lipid response during recovery from exercise was associated with improvements in fat oxidation during exercise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>Concurrent training during PD-induced weight loss improves cardiometabolic fitness and is associated with an enhanced ability to clear bioactive sphingomyelins and ceramides from the circulation in the recovery phase after an exercise test. The improved lipid response during recovery and its association with the capacity for fat oxidation suggest that concurrent training during PD-induced weight loss may augment lipid handling beyond diet-induced changes, although causal mechanisms cannot be established.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06820-4","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T15:27:49Z","timestamp":1785943669000},"page":"3288-3300","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Concurrent training is associated with enhanced post-exercise ceramide clearance and fat oxidation capacity in individuals with type 2 diabetes following lifestyle intervention"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7743-9295","authenticated-orcid":false,"given":"Mikael","family":"Flockhart","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4972-4416","authenticated-orcid":false,"given":"Michael","family":"Svensson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3807-0990","authenticated-orcid":false,"given":"Emad","family":"Ehtesham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3851-1132","authenticated-orcid":false,"given":"Mats","family":"Ryberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9169-1059","authenticated-orcid":false,"given":"Andreas","family":"Stomby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0214-596X","authenticated-orcid":false,"given":"Torbj\u00f6rn","family":"\u00c5kerfeldt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9016-1139","authenticated-orcid":false,"given":"Julia","family":"Otten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7768-1076","authenticated-orcid":false,"given":"Tommy","family":"Olsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8057-1684","authenticated-orcid":false,"given":"Elin","family":"Chorell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"issue":"10120","key":"6820_CR1","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/s0140-6736(17)33102-1","volume":"391","author":"ME Lean","year":"2018","unstructured":"Lean ME, Leslie WS, Barnes AC et al (2018) Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. 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The Swedish Metabolomics Centre (\n                      \n                      ) is acknowledged for access to instrumentation and technical support, and the Sports Medicine Master's and PhD students for their dedicated coaching and instruction of the participants during their training. The graphical abstract and Figs\n                      \n                      ,\n                      \n                      a were created with BioRender.com.","order":1,"name":"Ethics","label":"Acknowledgements","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The datasets generated during and\/or analysed during the current study are available from the corresponding author (elin.chorell@umu.se) upon reasonable request. The data are not publicly available because public sharing is restricted under the EU General Data Protection Regulation (GDPR) and applicable Swedish data-protection legislation.","order":2,"name":"Ethics","label":"Data availability","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Open access funding provided by Umea University. This study was funded by the Swedish Research Council (2021-01091), the Swedish Diabetes Research Foundation (2014-096, 2017-215 and 2022-726), the Swedish Heart and Lung Foundation (20150553), King Gustav V and Queen Victorias Foundation, the County Council of V\u00e4sterbotten, and Ume\u00e5 University, Sweden and the Kempe Foundation (JCK-1725).","order":3,"name":"Ethics","label":"Funding","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"TO is a member of the Diabetologia editorial board. The other authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","label":"Authors\u2019 relationships and activities","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"EC, MS, TO, MF, AS and JO conceptualised the study. EC and TO acquired the funding. EC, MS, TO, JO, EE, AS and MR were responsible for the method of the intervention, which was carried out by JO, AS, EE, T\u00c5, MR and MS. TO supervised the intervention. EC, EE, MS, JO and MF curated and analysed the data presented in this manuscript. MF and EC created the figures. MF and EC wrote the original draft, and edited it with TO. All authors critically revised the manuscript and agreed to the published version. EC is responsible for the integrity of the work as a whole.","order":5,"name":"Ethics","label":"Contribution statement","group":{"name":"EthicsHeading","label":"Ethics"}}]}}