Evidence Summary (Updated 2022)
Meta-analysis of 30 RCTs have shown that exercise in people with type 2 diabetes can reduce systolic blood pressure by up to 4mmHg and diastolic blood pressure by 2mmHg. Greater reductions are seen with increasing duration and intensity of exercise. Combined aerobic and resistance exercise is less effective in reducing blood pressure than aerobic or resistance exercise alone [1,2].
More recent high quality evidence is available on the ability of physical activity to reduce blood pressure in patients with T2DM. A network review and meta-analysis reviewed 37 RCTs employing different exercise modalities for patients with T2DM . They concluded that supervised resistance exercise showed more benefit than no exercise in lowering systolic blood pressure. Furthermore, combined aerobic and resistance intervention demonstrated significant decrease in diastolic blood pressure .
Quality of Evidence
Grade A – High Quality
Strength of recommendation
Grade 1 – Strong recommendation
High quality evidence exists supporting the role of physical activity in maintaining good blood pressure control in patients with Type 2 diabetes. Most patients would be best supported with this advice.
 Figueira FR, Umpierre D, Cureau FV, Zucatti AT, Dalzochio MB, Leitão CB, Schaan BD. Association between physical activity advice only or structured exercise training with blood pressure levels in patients with type 2 diabetes: a systematic review and meta-analysis. Sports Med. 2014 Nov;44(11):1557-72.
 Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010 Sep 27;170(17):1566-75.
 Pan, B., Ge, L., Xun, Yq. et al. Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Int J Behav Nutr Phys Act 15, 72 (2018). https://doi.org/10.1186/s12966-018-0703-3
 Zhao X, He Q, Zeng Y, Cheng L. Effectiveness of combined exercise in people with type 2 dia- betes and concurrent overweight/obesity: a systematic review and meta-analysis. BMJ Open. 2021 Oct 6;11(10):e046252. doi: 10.1136/bmjopen-2020-046252. PMID: 34615674; PMCID: PMC8496382