Authors: Dr. B.R. Shaalini, Dr. K. Raja Senthil, Dr. E. Prema
Abstract: Background-Chronic Obstructive Pulmonary Disease (COPD) and Type 2 Diabetes Mellitus (T2DM) frequently coexist because of shared risk factors, including ageing, smoking, obesity, physical inactivity, and systemic inflammation. Their coexistence contributes to impaired pulmonary function, poor glycaemic control, reduced exercise capacity, diminished quality of life, and increased morbidity. Although exercise rehabilitation is recommended for both conditions individually, evidence regarding its effectiveness in patients with both COPD and T2DM has not been comprehensively synthesised. Objective- To systematically evaluate the effects of exercise interventions on clinical outcomes in adults with comorbid COPD and Type 2 Diabetes Mellitus. Methods- This systematic review was conducted according to the PRISMA 2020 guidelines. Electronic databases including PubMed/MEDLINE, Scopus, Embase, Web of Science, Cochrane Library-PEDro, and Google Scholar were searched for studies published between January 2015 and June 2026. Randomized controlled trials, controlled clinical trials, and prospective cohort studies evaluating structured exercise interventions in adults with comorbid COPD and T2DM were included. Methodological quality was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool and ROBINS-I. Due to clinical and methodological heterogeneity, a narrative synthesis was performed. Results- Twenty-five studies met the eligibility criteria. Exercise interventions, including aerobic training, resistance training, combined aerobic-resistance exercise, pulmonary rehabilitation, inspiratory muscle training, and high-intensity interval training, demonstrated consistent improvements in exercise capacity, pulmonary function, glycaemic control, respiratory muscle strength, dyspnoea, inflammatory markers, and health-related quality of life. Combined aerobic and resistance exercise delivered within pulmonary rehabilitation programmes showed the most consistent overall clinical benefits. Exercise interventions were generally safe and well tolerated, with no serious exercise-related adverse events reported. Conclusion- Current evidence supports structured exercise rehabilitation as a safe and effective non- pharmacological intervention for individuals with comorbid COPD and T2DM. Combined aerobic and resistance exercise within pulmonary rehabilitation appears to provide the greatest clinical benefit. However, larger multicentre randomized controlled trials with standardized exercise protocols and longer follow-up are needed to strengthen the evidence base.
DOI: http://doi.org/10.5281/zenodo.23102859
