Meta-analysis: Resistance training improves vascular function in type 2 diabetes

ObjectiveTo systematically evaluate and meta-analytically quantify the effects of RT-based interventions—defined as resistance training alone or resistance training combined with aerobic training—on vascular function in adults with T2DM.MethodsFollowing PRISMA guidelines, we systematically searched PubMed, Embase, Web of Science, the Cochrane Library, Ovid, CNKI, Wanfang Data, VIP, and CBM from inception to August 2025 for randomised controlled trials evaluating resistance training alone or combined with aerobic training on vascular function in adults with T2DM. Random-effects meta-analyses were conducted using Hedge’ s g and 95% confidence intervals (CIs). Heterogeneity was assessed with I², and prespecified subgroup analyses and meta-regression were performed to explore potential moderators.ResultsCompared with non-exercise controls, RT-based interventions significantly reduced arterial stiffness (Hedge’ s g = −0.24, 95% CI −0.39 to −0.09; p = 0.0015) and improved endothelial function, as reflected by flow-mediated dilation (Hedge’ s g = 0.61, 95% CI 0.32 to 0.89; p  0.05). No significant effects were observed for wave reflection indices (Hedge’ s g = −0.10, 95% CI −0.45 to 0.25; p = 0.58), and effects on peripheral haemodynamics remained inconclusive (Hedge’ s g = 0.44, 95% CI −0.00 to 0.88; p = 0.05). These pooled findings should therefore be interpreted as reflecting RT-based interventions overall, rather than isolated RT per se.ConclusionsRT-based interventions, particularly when delivered as combined RT+AT, may improve vascular function in adults with T2DM, especially arterial stiffness and endothelial function, with moderate-certainty evidence supporting these benefits. However, because the pooled estimates reflect RT-based programmes overall and the evidence for RT alone was more limited for several outcomes, conclusions regarding isolated RT should remain cautious. Evidence for wave reflection indices remains inconclusive (moderate certainty), and evidence for peripheral haemodynamics remains inconclusive (low certainty). Further well-designed, adequately powered RCTs with standardised vascular assessments are needed to define optimal exercise prescriptions in adults with T2DM.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261323648.