{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T06:27:51Z","timestamp":1786429671946,"version":"build-2736575974"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"\n Objectives<\/jats:title>\n This systematic review and three-level meta-analysis evaluated the effects of exercise interventions on glycemic control, lipid metabolism, body composition\/fat distribution, and liver function in patients with type 2 diabetes mellitus (T2DM) complicated by non-alcoholic fatty liver disease (NAFLD), and examined potential sources of heterogeneity relevant to individualized exercise prescription.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Randomized controlled trials were searched in Web of Science, PubMed, Cochrane Library, EBSCO, Embase, and CNKI from database inception to February 2026. The review followed PRISMA 2020 and used a three-level meta-analytic model to account for dependent effect sizes extracted from the same study. A priori subgroup analyses were conducted by exercise modality, and meta-regression was used to explore heterogeneity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Twenty-four studies involving 2,578 participants were included. Overall, exercise reduced BMI (Hedges\u2019\n g<\/jats:italic>\n = \u22120.36,\n p<\/jats:italic>\n &lt; 0.001), FPG (Hedges\u2019\n g<\/jats:italic>\n = \u22120.42,\n p<\/jats:italic>\n &lt; 0.001), HbA1c (Hedges\u2019\n g<\/jats:italic>\n = \u22120.52,\n p<\/jats:italic>\n &lt; 0.001), HOMA-IR (Hedges\u2019\n g<\/jats:italic>\n = \u22120.48,\n p<\/jats:italic>\n &lt; 0.001), LDL-C (Hedges\u2019\n g<\/jats:italic>\n = \u22120.36,\n p<\/jats:italic>\n = 0.001), TG (Hedges\u2019\n g<\/jats:italic>\n = \u22120.45,\n p<\/jats:italic>\n &lt; 0.001), ALT (Hedges\u2019\n g<\/jats:italic>\n = \u22120.41,\n p<\/jats:italic>\n &lt; 0.001), AST (Hedges\u2019\n g<\/jats:italic>\n = \u22120.38,\n p<\/jats:italic>\n &lt; 0.001), and GGT (Hedges\u2019\n g<\/jats:italic>\n = \u22120.40,\n p<\/jats:italic>\n &lt; 0.001), and increased HDL-C (Hedges\u2019\n g<\/jats:italic>\n = 0.28,\n p<\/jats:italic>\n = 0.009). Modality-specific analyses suggested that MICT may be more favorable for FPG, LDL-C, VAT, and HFC, whereas HIIT showed larger effects for HbA1c, HOMA-IR, TG, ALT, and GGT. Heterogeneity was substantial for TG, ALT, AST, HbA1c, and GGT in the primary analyses; however, sensitivity analyses reduced\n I<\/jats:italic>\n 2<\/jats:sup>\n below 50% without materially altering the pooled effects. Evidence for resistance training was limited by the small number of studies and should be interpreted cautiously. Meta-regression suggested that medication status and exercise frequency may be potential contributors to between-study heterogeneity.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Exercise, particularly aerobic exercise, appears to be a beneficial adjunctive strategy for improving metabolic and liver-related outcomes in patients with T2DM and NAFLD. Because clinical heterogeneity, medication use, dietary co-interventions, and study quality may influence the estimates, modality-specific conclusions should be applied cautiously and individualized according to patients\u2019 metabolic profile, comorbidities, and exercise tolerance.<\/jats:p>\n <\/jats:sec>\n \n Systematic review registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261327724<\/jats:ext-link>\n , identifier CRD420261327724.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fnut.2026.1907058","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T05:35:31Z","timestamp":1786426531000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of exercise intervention on glucose and lipid metabolism in patients with type 2 diabetes mellitus complicated by non-alcoholic fatty liver disease: a three-level 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