{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T20:40:05Z","timestamp":1788900005042,"version":"build-2803163510"},"reference-count":61,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T00:00:00Z","timestamp":1752883200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T00:00:00Z","timestamp":1752883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Research Foundation - Flanders (FWO), Belgium","award":["11M2725N"],"award-info":[{"award-number":["11M2725N"]}]},{"name":"Research Foundation - Flanders (FWO), Belgium","award":["11M2725N"],"award-info":[{"award-number":["11M2725N"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Cardiovasc Imaging"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Around 30% of patients with type 2 diabetes(T2D) develop heart failure and this leads to poor prognosis. Treatment with exercise intervention can improve left cardiac function at rest in T2D, but its effects on subclinical HF markers, maximal cardiac function during exercise, and right cardiac function are unknown. This review aimed to synthesize the effects of exercise on cardiac structure and function in patients with T2D from prospective cardiac imaging trials. The secondary aim was to address the methodological shortcomings of previous studies and map future avenues. Our synthesis showed that exercise interventions can improve left ventricular structure and systolic and diastolic function at rest and during exercise, and right ventricular systolic function at rest in patients with T2D. Study shortcomings were inadequate reporting of randomization, concealment, between-group point estimates, intervention adherence, attendance and adverse events. Future studies should investigate sex- and phenotype-specific effects of exercise on the left and especially right heart during rest and peak exercise, determine the optimal exercise intensity, duration and volume for inducing cardiac changes, and determine if cardiac changes translate to a long-term prognosis.<\/jats:p>","DOI":"10.1007\/s10554-025-03457-z","type":"journal-article","created":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T06:54:20Z","timestamp":1752908060000},"page":"1851-1864","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of exercise on cardiac structure and function in patients with type 2 diabetes: a narrative review of prospective imaging studies"],"prefix":"10.1007","volume":"41","author":[{"given":"Tin","family":"Gojevic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe V. C.","family":"Machado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youri","family":"Bekhuis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Claessen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronique","family":"Cornelissen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"De Craemer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Dendale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"Falter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara M.","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lieven","family":"Herbots","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Hoedemakers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs","family":"Michielsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio","family":"Milani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Verwerft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,19]]},"reference":[{"issue":"6","key":"3457_CR1","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1016\/0002-9149(72)90595-4","volume":"30","author":"S Rubler","year":"1972","unstructured":"Rubler S, Dlugash J, Yuceoglu YZ, Kumral T, Branwood AW, Grishman A (1972) New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 30(6):595\u2013602","journal-title":"Am J Cardiol"},{"issue":"10","key":"3457_CR2","doi-asserted-by":"publisher","first-page":"490","DOI":"10.4239\/wjd.v10.i10.490","volume":"10","author":"L Athithan","year":"2019","unstructured":"Athithan L, Gulsin GS, McCann GP, Levelt E (2019) Diabetic cardiomyopathy: pathophysiology, theories and evidence to date. World J Diabetes 10(10):490\u2013510","journal-title":"World J Diabetes"},{"issue":"4","key":"3457_CR3","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1161\/CIRCRESAHA.117.311586","volume":"122","author":"G Jia","year":"2018","unstructured":"Jia G, Hill MA, Sowers JR (2018) Diabetic cardiomyopathy. Circ Res 122(4):624\u2013638","journal-title":"Circ Res"},{"issue":"19","key":"3457_CR4","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.1056\/NEJMoa1607141","volume":"375","author":"SP Marso","year":"2016","unstructured":"Marso SP, Bain SC, Consoli A, Eliaschewitz FG, J\u00f3dar E, Leiter LA et al (2016) Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 375(19):1834\u20131844","journal-title":"N Engl J Med"},{"issue":"22","key":"3457_CR5","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1056\/NEJMoa1504720","volume":"373","author":"B Zinman","year":"2015","unstructured":"Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S et al (2015) Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 373(22):2117\u20132128","journal-title":"N Engl J Med"},{"issue":"14","key":"3457_CR6","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1056\/NEJMoa1305889","volume":"369","author":"WB White","year":"2013","unstructured":"White WB, Cannon CP, Heller SR, Nissen SE, Bergenstal RM, Bakris GL et al (2013) Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med 369(14):1327\u20131335","journal-title":"N Engl J Med"},{"issue":"5","key":"3457_CR7","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1016\/j.ahj.2011.07.030","volume":"162","author":"D Castagno","year":"2011","unstructured":"Castagno D, Baird-Gunning J, Jhund PS, Biondi-Zoccai G, MacDonald MR, Petrie MC et al (2011) Intensive glycemic control has no impact on the risk of heart failure in type 2 diabetic patients: evidence from a 37,229 patient meta-analysis. Am Heart J 162(5):938\u2013948e2","journal-title":"Am Heart J"},{"issue":"11","key":"3457_CR8","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1093\/eurheartj\/ehn153","volume":"29","author":"MR MacDonald","year":"2008","unstructured":"MacDonald MR, Petrie MC, Varyani F, Ostergren J, Michelson EL, Young JB et al (2008) Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) programme. Eur Heart J 29(11):1377\u20131385","journal-title":"Eur Heart J"},{"issue":"9386","key":"3457_CR9","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/S0140-6736(03)14285-7","volume":"362","author":"S Yusuf","year":"2003","unstructured":"Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ et al (2003) Effects of Candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved trial. Lancet 362(9386):777\u2013781","journal-title":"Lancet"},{"key":"3457_CR10","unstructured":"Federici M, Sch\u00fctt K, M\u00fcller-Wieland D, Ajjan RA, Christodorescu RM, Crawford C et al 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes"},{"issue":"11","key":"3457_CR11","doi-asserted-by":"publisher","first-page":"2065","DOI":"10.2337\/dc16-1728","volume":"39","author":"SR Colberg","year":"2016","unstructured":"Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC et al (2016) Physical activity\/exercise and diabetes: A position statement of the American diabetes association. Diabetes Care 39(11):2065\u20132079","journal-title":"Diabetes Care"},{"issue":"2","key":"3457_CR12","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1249\/MSS.0000000000002800","volume":"54","author":"JA Kanaley","year":"2022","unstructured":"Kanaley JA, Colberg SR, Corcoran MH, Malin SK, Rodriguez NR, Crespo CJ et al (2022) Exercise\/Physical activity in individuals with type 2 diabetes: A consensus statement from the American college of sports medicine. Med Sci Sports Exerc 54(2):353","journal-title":"Med Sci Sports Exerc"},{"issue":"10","key":"3457_CR13","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1016\/S2213-8587(21)00203-5","volume":"9","author":"N Sattar","year":"2021","unstructured":"Sattar N, Lee MMY, Kristensen SL, Branch KRH, Prato SD, Khurmi NS et al (2021) Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials. Lancet Diabetes Endocrinol 9(10):653\u2013662","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"2","key":"3457_CR14","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1001\/jamacardio.2020.4511","volume":"6","author":"DK McGuire","year":"2021","unstructured":"McGuire DK, Shih WJ, Cosentino F, Charbonnel B, Cherney DZI, Dagogo-Jack S et al (2021) Association of SGLT2 inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes: A Meta-analysis. JAMA Cardiol 6(2):148\u2013158","journal-title":"JAMA Cardiol"},{"issue":"12","key":"3457_CR15","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1016\/j.amjcard.2005.02.029","volume":"95","author":"HJ Willens","year":"2005","unstructured":"Willens HJ, Chakko SC, Byers P, Chirinos JA, Labrador E, Castrillon JC et al (2005) Effects of weight loss after gastric bypass on right and left ventricular function assessed by tissue doppler imaging. Am J Cardiol 95(12):1521\u20131524","journal-title":"Am J Cardiol"},{"issue":"1","key":"3457_CR16","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/s10554-013-0302-y","volume":"30","author":"JT Jonker","year":"2014","unstructured":"Jonker JT, Snel M, Hammer S, Jazet IM, van der Meer RW, Pijl H et al (2014) Sustained cardiac remodeling after a short-term very low calorie diet in type 2 diabetes mellitus patients. Int J Cardiovasc Imaging 30(1):121\u2013127","journal-title":"Int J Cardiovasc Imaging"},{"issue":"2","key":"3457_CR17","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/s40279-018-1003-4","volume":"49","author":"M Verboven","year":"2019","unstructured":"Verboven M, Van Ryckeghem L, Belkhouribchia J, Dendale P, Eijnde BO, Hansen D et al (2019) Effect of exercise intervention on cardiac function in type 2 diabetes mellitus: A systematic review. Sports Med 49(2):255\u2013268","journal-title":"Sports Med"},{"issue":"6","key":"3457_CR18","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1097\/HCR.0000000000000353","volume":"38","author":"V Anand","year":"2018","unstructured":"Anand V, Garg S, Garg J, Bano S, Pritzker M (2018) Impact of exercise training on cardiac function among patients with type 2 diabetes: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 38(6):358\u2013365","journal-title":"J Cardiopulm Rehabil Prev"},{"issue":"1","key":"3457_CR19","doi-asserted-by":"publisher","first-page":"H113","DOI":"10.1152\/ajpheart.00440.2018","volume":"316","author":"Y Kang","year":"2019","unstructured":"Kang Y, Wang S, Huang J, Cai L, Keller BB (2019) Right ventricular dysfunction and remodeling in diabetic cardiomyopathy. Am J Physiol-Heart Circ Physiol 316(1):H113\u2013H122","journal-title":"Am J Physiol-Heart Circ Physiol"},{"issue":"36","key":"3457_CR20","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","volume":"42","author":"TA McDonagh","year":"2021","unstructured":"McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, B\u00f6hm M et al (2021) 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42(36):3599\u20133726","journal-title":"Eur Heart J"},{"issue":"9","key":"3457_CR21","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1093\/eurjpc\/zwad127","volume":"30","author":"Y Saito","year":"2023","unstructured":"Saito Y, Obokata M, Harada T, Kagami K, Wada N, Okumura Y et al (2023) Prognostic benefit of early diagnosis with exercise stress testing in heart failure with preserved ejection fraction. Eur J Prev Cardiol 30(9):902\u2013911","journal-title":"Eur J Prev Cardiol"},{"issue":"6","key":"3457_CR22","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.2337\/dc20-0129","volume":"43","author":"GS Gulsin","year":"2020","unstructured":"Gulsin GS, Swarbrick DJ, Athithan L, Brady EM, Henson J, Baldry E et al (2020) Effects of Low-Energy diet or exercise on cardiovascular function in Working-Age adults with type 2 diabetes: A prospective, randomized, Open-Label, blinded end point trial. Diabetes Care 43(6):1300\u20131310","journal-title":"Diabetes Care"},{"issue":"4","key":"3457_CR23","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1007\/s00421-022-04884-9","volume":"122","author":"L Van Ryckeghem","year":"2022","unstructured":"Van Ryckeghem L, Keytsman C, De Brandt J, Verboven K, Verbaanderd E, Marinus N et al (2022) Impact of continuous vs. interval training on oxygen extraction and cardiac function during exercise in type 2 diabetes mellitus. Eur J Appl Physiol 122(4):875\u2013887","journal-title":"Eur J Appl Physiol"},{"issue":"6","key":"3457_CR24","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1249\/MSS.0000000000001897","volume":"51","author":"GA Wilson","year":"2019","unstructured":"Wilson GA, Wilkins GT, Cotter JD, Lamberts RR, Lal S, Baldi JC (2019) HIIT improves left ventricular exercise response in adults with type 2 diabetes. Med Sci Sports Exerc 51(6):1099\u20131105","journal-title":"Med Sci Sports Exerc"},{"issue":"3","key":"3457_CR25","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1007\/s00592-018-1245-5","volume":"56","author":"J Suryanegara","year":"2019","unstructured":"Suryanegara J, Cassidy S, Ninkovic V, Popovic D, Grbovic M, Okwose N et al (2019) High intensity interval training protects the heart during increased metabolic demand in patients with type 2 diabetes: a randomised controlled trial. Acta Diabetol 56(3):321\u2013329","journal-title":"Acta Diabetol"},{"issue":"1","key":"3457_CR26","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","volume":"5","author":"M Ouzzani","year":"2016","unstructured":"Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan\u2014a web and mobile app for systematic reviews. Syst Rev 5(1):210","journal-title":"Syst Rev"},{"issue":"1","key":"3457_CR27","first-page":"9","volume":"13","author":"NA Smart","year":"2015","unstructured":"Smart NA, Waldron M, Ismail H, Giallauria F, Vigorito C, Cornelissen V et al (2015) Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. JBI Evid Implement 13(1):9","journal-title":"JBI Evid Implement"},{"issue":"16","key":"3457_CR28","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1136\/hrt.2009.165571","volume":"95","author":"MD Hordern","year":"2009","unstructured":"Hordern MD, Coombes JS, Cooney LM, Jeffriess L, Prins JB, Marwick TH (2009) Effects of exercise intervention on myocardial function in type 2 diabetes. Heart 95(16):1343\u20131349","journal-title":"Heart"},{"issue":"16","key":"3457_CR29","doi-asserted-by":"publisher","first-page":"1758","DOI":"10.1016\/j.jacc.2014.07.971","volume":"64","author":"SM Hollekim-Strand","year":"2014","unstructured":"Hollekim-Strand SM, Bj\u00f8rgaas MR, Albrektsen G, Tj\u00f8nna AE, Wisl\u00f8ff U, Ingul CB (2014) High-Intensity interval exercise effectively improves cardiac function in patients with type 2 diabetes mellitus and diastolic dysfunction. J Am Coll Cardiol 64(16):1758\u20131760","journal-title":"J Am Coll Cardiol"},{"issue":"5","key":"3457_CR30","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.echo.2016.01.005","volume":"29","author":"SM Hollekim-Strand","year":"2016","unstructured":"Hollekim-Strand SM, H\u00f8ydahl SF, Follestad T, Dalen H, Bj\u00f8rgaas MR, Wisl\u00f8ff U et al (2016) Exercise training normalizes timing of left ventricular untwist rate, but not peak untwist rate, in individuals with type 2 diabetes and diastolic dysfunction: A pilot study. J Am Soc Echocardiogr 29(5):421\u2013430e2","journal-title":"J Am Soc Echocardiogr"},{"issue":"4","key":"3457_CR31","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1161\/CIRCHEARTFAILURE.110.959312","volume":"4","author":"JL Hare","year":"2011","unstructured":"Hare JL, Hordern MD, Leano R, Stanton T, Prins JB, Marwick TH (2011) Application of an exercise intervention on the evolution of diastolic dysfunction in patients with diabetes mellitus: efficacy and effectiveness. Circ Heart Fail 4(4):441\u2013449","journal-title":"Circ Heart Fail"},{"issue":"12","key":"3457_CR32","doi-asserted-by":"publisher","first-page":"2223","DOI":"10.1249\/MSS.0b013e31829ab43c","volume":"45","author":"JF Schmidt","year":"2013","unstructured":"Schmidt JF, Andersen TR, Horton J, Brix J, Tarnow L, Krustrup P et al (2013) Soccer training improves cardiac function in men with type 2 diabetes. Med Sci Sports Exerc 45(12):2223\u20132233","journal-title":"Med Sci Sports Exerc"},{"issue":"11","key":"3457_CR33","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.1249\/mss.0b013e318145b642","volume":"39","author":"P Brassard","year":"2007","unstructured":"Brassard P, Legault S, Garneau C, Bogaty P, Dumesnil JG, Poirier P (2007) Normalization of diastolic dysfunction in type 2 diabetics after exercise training. Med Sci Sports Exerc 39(11):1896\u20131901","journal-title":"Med Sci Sports Exerc"},{"issue":"1","key":"3457_CR34","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1007\/s00125-015-3741-2","volume":"59","author":"S Cassidy","year":"2016","unstructured":"Cassidy S, Thoma C, Hallsworth K, Parikh J, Hollingsworth KG, Taylor R et al (2016) High intensity intermittent exercise improves cardiac structure and function and reduces liver fat in patients with type 2 diabetes: a randomised controlled trial. Diabetologia 59(1):56\u201366","journal-title":"Diabetologia"},{"issue":"1","key":"3457_CR35","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/1475-2840-10-47","volume":"10","author":"VB Schrauwen-Hinderling","year":"2011","unstructured":"Schrauwen-Hinderling VB, Meex RC, Hesselink MK, Van De Weijer T, Leiner T, Sch\u00e4r M et al (2011) Cardiac lipid content is unresponsive to a physical activity training intervention in type 2 diabetic patients, despite improved ejection fraction. Cardiovasc Diabetol 10(1):47","journal-title":"Cardiovasc Diabetol"},{"key":"3457_CR36","doi-asserted-by":"crossref","unstructured":"Cugusi L, Cadeddu C, Nocco S, Orr\u00f9 F, Bandino S, Deidda M et al (2015) Effects of an Aquatic-Based exercise program to improve cardiometabolic profile, quality of life, and physical activity levels in men with type 2. 7(2):141\u2013148 Diabetes Mellitus. PM&R","DOI":"10.1016\/j.pmrj.2014.09.004"},{"issue":"9","key":"3457_CR37","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1016\/j.metabol.2014.05.007","volume":"63","author":"JW Sacre","year":"2014","unstructured":"Sacre JW, Jellis CL, Jenkins C, Haluska BA, Baumert M, Coombes JS et al (2014) A six-month exercise intervention in subclinical diabetic heart disease: effects on exercise capacity, autonomic and myocardial function. Metabolism 63(9):1104\u20131114","journal-title":"Metabolism"},{"issue":"1","key":"3457_CR38","doi-asserted-by":"publisher","first-page":"10531","DOI":"10.1038\/s41598-017-10931-9","volume":"7","author":"MA Heiskanen","year":"2017","unstructured":"Heiskanen MA, Sj\u00f6ros TJ, Heinonen IHA, L\u00f6yttyniemi E, Koivum\u00e4ki M, Motiani KK et al (2017) Sprint interval training decreases left-ventricular glucose uptake compared to moderate-intensity continuous training in subjects with type 2 diabetes or prediabetes. Sci Rep 7(1):10531","journal-title":"Sci Rep"},{"issue":"11","key":"3457_CR39","first-page":"685","volume":"22","author":"J McGavock","year":"2004","unstructured":"McGavock J, Sandra Mandic R, Lewanczuk M, Koller IV, Muhll A, Quinney et al (2004) Cardiovascular adaptations to exercise training in postmenopausal women with type 2 diabetes mellitus. Cardiovasc Diabetol 22(11):685\u2013686","journal-title":"Cardiovasc Diabetol"},{"issue":"1","key":"3457_CR40","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/1476-7120-5-32","volume":"5","author":"A Loimaala","year":"2007","unstructured":"Loimaala A, Groundstroem K, Rinne M, Nenonen A, Huhtala H, Vuori I (2007) Exercise training does not improve myocardial diastolic tissue velocities in type 2 diabetes. Cardiovasc Ultrasound 5(1):32","journal-title":"Cardiovasc Ultrasound"},{"issue":"5","key":"3457_CR41","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1161\/CIRCULATIONAHA.118.039136","volume":"140","author":"JE Ho","year":"2019","unstructured":"Ho JE, Zern EK, Wooster L, Bailey CS, Cunningham T, Eisman AS et al (2019) Differential clinical profiles, exercise responses, and outcomes associated with existing HFpEF definitions. Circulation 140(5):353\u2013365","journal-title":"Circulation"},{"issue":"5","key":"3457_CR42","doi-asserted-by":"publisher","first-page":"e004750","DOI":"10.1161\/CIRCHEARTFAILURE.117.004750","volume":"11","author":"AS Eisman","year":"2018","unstructured":"Eisman AS, Shah RV, Dhakal BP, Pappagianopoulos PP, Wooster L, Bailey C et al (2018) Pulmonary capillary wedge pressure patterns during exercise predict exercise capacity and incident heart failure. Circ Heart Fail 11(5):e004750","journal-title":"Circ Heart Fail"},{"issue":"4","key":"3457_CR43","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1177\/8756479319836781","volume":"35","author":"A Kossaify","year":"2019","unstructured":"Kossaify A, Nasr M (2019) Diastolic dysfunction and the new recommendations for echocardiographic assessment of left ventricular diastolic function: summary of guidelines and novelties in diagnosis and grading. J Diagn Med Sonogr 35(4):317\u2013325","journal-title":"J Diagn Med Sonogr"},{"issue":"4","key":"3457_CR44","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","volume":"29","author":"SF Nagueh","year":"2016","unstructured":"Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 29(4):277\u2013314","journal-title":"J Am Soc Echocardiogr"},{"key":"3457_CR45","doi-asserted-by":"publisher","first-page":"814601","DOI":"10.3389\/fcvm.2022.814601","volume":"9","author":"J Verwerft","year":"2022","unstructured":"Verwerft J, Verbrugge FH, Claessen G, Herbots L, Dendale P, Gevaert AB (2022) Exercise systolic reserve and exercise pulmonary hypertension improve diagnosis of heart failure with preserved ejection fraction. Front Cardiovasc Med 9:814601","journal-title":"Front Cardiovasc Med"},{"issue":"9","key":"3457_CR46","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1161\/CIRCULATIONAHA.118.034646","volume":"138","author":"YNV Reddy","year":"2018","unstructured":"Reddy YNV, Carter RE, Obokata M, Redfield MM, Borlaug BA (2018) A simple, Evidence-Based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation 138(9):861\u2013870","journal-title":"Circulation"},{"issue":"40","key":"3457_CR47","doi-asserted-by":"publisher","first-page":"3297","DOI":"10.1093\/eurheartj\/ehz641","volume":"40","author":"B Pieske","year":"2019","unstructured":"Pieske B, Tsch\u00f6pe C, De Boer RA, Fraser AG, Anker SD, Donal E et al (2019) How to diagnose heart failure with preserved ejection fraction: the HFA\u2013PEFF diagnostic algorithm: a consensus recommendation from the heart failure association (HFA) of the European society of cardiology (ESC). Eur Heart J 40(40):3297\u20133317","journal-title":"Eur Heart J"},{"key":"3457_CR48","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1161\/01.CIR.101.3.336","volume":"101","author":"B Pluim","year":"2000","unstructured":"Pluim B, Zwinderman A, van der Laarse A, Wall E (2000) The athlete s heart: A Meta-Analysis of cardiac structure and function. Circulation 101:336\u2013344","journal-title":"Circulation"},{"issue":"7","key":"3457_CR49","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1249\/MSS.0000000000002899","volume":"54","author":"CE Marsh","year":"2022","unstructured":"Marsh CE, Thomas HJ, Naylor LH, Dembo LG, Scurrah KJ, Green DJ (2022) Left ventricular adaptation to exercise training via magnetic resonance imaging: studies of twin responses to understand exercise therapy. Med Sci Sports Exerc 54(7):1095\u20131104","journal-title":"Med Sci Sports Exerc"},{"key":"3457_CR50","doi-asserted-by":"publisher","unstructured":"Ekkekakis P, Swinton P, Tiller NB Extraordinary Claims in the Literature on High-Intensity Interval Training (HIIT): I. Bonafide Scientific Revolution or a Looming Crisis of Replication and Credibility? Sports Med [Internet]. 2023 Aug 10 [cited 2023 Aug 30]; Available from: https:\/\/link.springer.com\/https:\/\/doi.org\/10.1007\/s40279-023-01880-7","DOI":"10.1007\/s40279-023-01880-7"},{"issue":"1","key":"3457_CR51","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.1038\/s41467-019-09941-0","volume":"10","author":"C Albers","year":"2019","unstructured":"Albers C (2019) The problem with unadjusted multiple and sequential statistical testing. Nat Commun 10(1):1921","journal-title":"Nat Commun"},{"issue":"1","key":"3457_CR52","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1152\/physrev.00015.2022","volume":"103","author":"F Magkos","year":"2023","unstructured":"Magkos F, Reeds DN, Mittendorfer B (2023) Evolution of the diagnostic value of the sugar of the blood: hitting the sweet spot to identify alterations in glucose dynamics. Physiol Rev 103(1):7\u201330","journal-title":"Physiol Rev"},{"issue":"14","key":"3457_CR53","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1056\/NEJMoa1307684","volume":"369","author":"BM Scirica","year":"2013","unstructured":"Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B et al (2013) Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 369(14):1317\u20131326","journal-title":"N Engl J Med"},{"issue":"1","key":"3457_CR54","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1093\/eurjpc\/zwac153","volume":"30","author":"T Gojevic","year":"2023","unstructured":"Gojevic T, Van Ryckeghem L, Jogani S, Frederix I, Bakelants E, Petit T et al (2023) Pulmonary hypertension during exercise underlies unexplained exertional dyspnoea in patients with type 2 diabetes. Eur J Prev Cardiol 30(1):37\u201345","journal-title":"Eur J Prev Cardiol"},{"key":"3457_CR55","doi-asserted-by":"publisher","first-page":"831179","DOI":"10.3389\/fphys.2022.831179","volume":"13","author":"SR St. Pierre","year":"2022","unstructured":"St. Pierre SR, Peirlinck M, Kuhl E (2022) Sex matters: A comprehensive comparison of female and male hearts. Front Physiol 13:831179","journal-title":"Front Physiol"},{"issue":"11","key":"3457_CR56","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1016\/j.jacc.2009.09.065","volume":"55","author":"M Piro","year":"2010","unstructured":"Piro M, Della Bona R, Abbate A, Biasucci LM, Crea F (2010) Sex-Related differences in myocardial remodeling. J Am Coll Cardiol 55(11):1057\u20131065","journal-title":"J Am Coll Cardiol"},{"issue":"15","key":"3457_CR57","doi-asserted-by":"publisher","first-page":"1633","DOI":"10.1161\/CIRCULATIONAHA.106.613562","volume":"114","author":"BJ Maron","year":"2006","unstructured":"Maron BJ, Pelliccia A (2006) The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation 114(15):1633\u20131644","journal-title":"Circulation"},{"issue":"45","key":"3457_CR58","first-page":"1066","volume":"53","author":"Centers for Disease Control and Prevention (CDC)","year":"2004","unstructured":"Centers for Disease Control and Prevention (CDC) (2004) Prevalence of overweight and obesity among adults with diagnosed diabetes\u2013United states, 1988\u20131994 and 1999\u20132002. MMWR Morb Mortal Wkly Rep 53(45):1066\u20131068","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"6","key":"3457_CR59","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1002\/j.1550-8528.1998.tb00374.x","volume":"6","author":"K Karason","year":"1998","unstructured":"Karason K, Wallentin I, Larsson B, Sj\u00f6str\u00f6m L (1998) Effects of obesity and weight loss on cardiac function and valvular performance. Obes Res 6(6):422\u2013429","journal-title":"Obes Res"},{"issue":"1","key":"3457_CR60","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1007\/s11695-008-9645-1","volume":"19","author":"M Syed","year":"2009","unstructured":"Syed M, Rosati C, Torosoff MT, El-Hajjar M, Feustel P, Alger S et al (2009) The impact of weight loss on cardiac structure and function in obese patients. Obes Surg 19(1):36\u201340","journal-title":"Obes Surg"},{"key":"3457_CR61","doi-asserted-by":"crossref","unstructured":"Sargsyan N, Chen JY, Aggarwal R, Fadel MG, Fehervari M, Ashrafian H (2023) The effects of bariatric surgery on cardiac function: a systematic review and meta-analysis. Int J Obes 1\u201311","DOI":"10.1038\/s41366-023-01412-3"}],"container-title":["The International Journal of Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10554-025-03457-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10554-025-03457-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10554-025-03457-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T07:02:49Z","timestamp":1759388569000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10554-025-03457-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,19]]},"references-count":61,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["3457"],"URL":"https:\/\/doi.org\/10.1007\/s10554-025-03457-z","relation":{},"ISSN":["1875-8312"],"issn-type":[{"value":"1875-8312","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,19]]},"assertion":[{"value":"12 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Supplements 1\u20133. Methods, flowchart, lipid profile, and inclusion criteria of individual studies.Supplement 4. Tables\u00a01\u201313: The effects of exercise on cardiac structure and function in T2D.Supplement 5. Study quality assessment.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Additional materials"}}]}}