A Short-Bout Combined Aerobic and Resistance Exercise Program in Older Adults With Diabetes and Probable Sarcopenia

The Effect of a Short-Bout Combined Aerobic and Resistance Exercise Program on Physical Activity and Muscle Strength in Older Adults With Diabetes and Probable Sarcopenia: A Randomized Controlled Trial

Older adults with diabetes are at high risk of developing sarcopenia. A preclinical stage, known as "probable sarcopenia" (defined by low muscle strength), represents a critical window for early intervention. Physical activity is an effective strategy, but many patients struggle to maintain regular exercise. This parallel-group randomized controlled trial aims to evaluate the effectiveness of a 12-week home-based, short-bout combined aerobic and resistance exercise program on physical activity level and muscle strength among older adults with diabetes and probable sarcopenia.

The control group will receive usual community-based diabetes care. In addition to usual care, the intervention group will receive an individualized exercise program delivered in a short-bout, high-frequency format (resistance training: 3 days per week, three bouts per day at moderate intensity; aerobic training: 5 days per week, three bouts per day at moderate intensity). Primary outcomes are physical activity level and muscle strength. Assessments will be conducted at baseline, 12 weeks (post-intervention), and 24 weeks (follow-up).

Inclusion Criteria:

• Age ≥60 years, diagnosed with type 2 diabetes mellitus (T2DM) for ≥1 year.
• Meet the Asian Working Group for Sarcopenia (AWGS) 2025 criteria for probable sarcopenia.
• Physical activity <150 minutes per week of moderate-intensity aerobic activity.
• Conscious, able to communicate effectively in written or spoken language.
• Able to use a smartphone independently (or with minimal assistance).
• Voluntarily participate and provide written informed consent.

Exclusion Criteria:

• Confirmed sarcopenia based on AWGS 2025.
• History or current diagnosis of psychiatric disorders, or severe cognitive impairment.
• Severe acute or chronic diabetic complications (e.g., diabetic ketoacidosis, proliferative diabetic retinopathy, stage IV-V diabetic nephropathy).
• Severe congestive heart failure (NYHA class III-IV), or acute cardiac event, syncope, or loss of consciousness within the past year.
• Severe pulmonary, hepatic, or renal insufficiency, or active malignancy.
• Concurrent participation in another exercise intervention study.
• Severe joint or muscle disease that strictly limits exercise (e.g., severe osteoarthritis, fracture, or other significant functional impairment), or other absolute contraindications to exercise.
• Unintentional weight change >5% or major changes in medication regimen within the 3 months prior to enrollment.
• Classified as poor health status (Group 3) according to the Chinese Guideline for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2024 Edition).
• Implanted electronic medical device (e.g., cardiac pacemaker).