Impact of a 2-year structured program on physical fitness and physical activity in T2D patients with rapid renal...

Long-term structured physical activity (PA) programs remain insufficiently evaluated in real-life settings for individuals living with type 2 diabetes (T2D). We assessed the effects of a 2-year high-intensity physical activity (HIPA) program on physical fitness and spontaneous PA.

ACTIDIANE was a 21-center, open-label, randomized controlled trial comparing HIPA with standard PA recommendations (PAR) in 103 adults with T2D and rapid renal function decline. The HIPA intervention consisted of two supervised sessions per week delivered by certified adapted physical activity professionals over 24 months. Physical fitness and spontaneous PA were pre-specified secondary outcomes of the trial. Mixed models assessed group-by-time interactions over 24 months.

Baseline characteristics were similar between groups. Estimated $\dot{V}{O}_2\mathrm{peak}$ changed from 19.3 ± 3.1 to 22.0 ± 4.0 mL.min^-1.kg^-1 in the HIPA group vs. 19.9 ± 3.6 to 19.7 ± 3.7 mL.min^-1.kg^-1 in PAR (p for interaction <0.01). No group-by-time interaction was observed for sedentary time or moderate-to-vigorous PA, whether assessed by questionnaires or accelerometry. Adherence to HIPA was heterogeneous and declined over time.

In adults with T2D and rapid renal function decline, a 2-year structured HIPA program significantly improved estimated cardiorespiratory fitness, a clinically meaningful finding given the strong association between $\dot{V}{O}_2\mathrm{peak}$ and long-term cardiovascular and all-cause mortality, but did not modify spontaneous PA or sedentary behaviours. These findings highlight both the potential physiological benefit and the feasibility challenges of implementing long-term high-intensity PA in real-life clinical settings. Strategies enhancing adherence are needed to optimize clinical impact.