Exercise as targeted therapy in type 2 diabetes: a phenotype-informed clinical prioritisation framework for adapted...

Area of Science:

• Endocrinology and Metabolism
• Exercise Physiology
• Geriatrics

Background:

• Type 2 diabetes (T2D) is a complex metabolic disease with overlapping comorbidities like obesity, sarcopenia, frailty, and cardiorenal issues.
• International guidelines highlight physical activity's benefits for T2D, yet personalized exercise prescription remains challenging due to patient complexity.

Purpose of the Study:

• To introduce a phenotype-informed clinical prioritization framework for Adapted Physical Activity (APA) in T2D.
• To guide clinicians in identifying dominant clinical complexity domains and therapeutic priorities for exercise prescription.

Main Methods:

• Synthesized evidence from guidelines, consensus statements, systematic reviews, and meta-analyses.
• Integrated functional status, frailty, sarcopenia, and cardiorenal risk into a conceptual model for exercise prescription.
• Developed a six-step clinical algorithm for assessment, risk stratification, and dynamic reassessment.

Main Results:

• Identified four overlapping domains of clinical complexity in T2D: adiposopathic insulin-resistant, muscle failure (frailty-sarcopenia), cardiorenal-metabolic, and complication-driven.
• Defined therapeutic priorities, exercise modalities, intensity, and safety considerations for each domain.
• The algorithm facilitates multidimensional assessment and prioritized, dynamic exercise prescription.

Conclusions:

• Adapted Physical Activity (APA) prescription in T2D requires multidimensional assessment, prioritization, monitoring, and adaptation, mirroring pharmacotherapy principles.
• This approach supports the evolving role of diabetologists in managing complex patients through precision exercise medicine.
• A structured framework enhances the clinical application of exercise for T2D management.