Impact of resistance, endurance, and combined exercise training on lipid profile, apolipoprotein A-1, and nitric oxide synthase expression in women with type 2 diabetes: A randomized controlled trial

Background: Type 2 diabetes mellitus (T2DM) involves metabolic disturbances and endothelial dysfunction, raising cardiovascular risk. Objective: To compare the effects of 8 weeks of resistance, endurance, and combined exercise on serum apolipoprotein A-1 (ApoA1), lipid profile, nitric oxide (NO) levels, nitric oxide synthase (NOS) expression, and metabolic parameters in women with T2DM. Methods: Sixty women with T2DM (aged 48–58) were randomized into resistance, endurance, combined training, or control groups. Interventions occurred thrice weekly for eight weeks. Pre- and post-intervention measures included anthropometrics (weight, BMI, WHR), fasting blood glucose (FBS), HbA1c, lipid profile (TG, LDL, HDL, total cholesterol), ApoA1, NO levels, and NOS expression (iNOS, eNOS). Results: All exercise groups showed significant metabolic improvements versus controls. Endurance training notably reduced FBS, triglycerides, and BMI, with greatest improvements in FBS and TG (p < 0.05). Resistance training yielded the largest decreases in weight (12.89 %) and BMI (8.12 %), while combined training most effectively lowered FBS (19.23 %). The endurance group had the greatest HbA1c reduction (18.15 %). No significant changes were found in ApoA1, LDL, HDL, or total cholesterol. NO levels increased significantly in all exercise groups, especially combined and resistance groups (p < 0.001), but iNOS and eNOS expression remained unchanged. Controls showed minimal change. Conclusion: Eight weeks of resistance, endurance, or combined exercise improve metabolic markers in women with T2DM, each with distinct benefits. Increased NO without NOS expression changes suggests alternative pathways for NO bioavailability. Tailored exercise regimens are recommended for optimal T2DM management and cardiovascular risk reduction.