Sex Differences in the Feasibility of Aerobic Exercise Training for Improving Cardiometabolic Health Outcomes in Adults with Type 2 Diabetes

Females with type 2 diabetes (T2D) have a 25-50% greater risk of developing cardiovascular disease compared with males. While aerobic exercise training is effective for improving cardiometabolic health outcomes, there is limited sex-segregated evidence on the feasibility of aerobic training in adults with T2D. A secondary analysis of a 12-week randomized controlled trial examining aerobic training in inactive adults with T2D was conducted. Feasibility outcomes were recruitment, retention, treatment fidelity, and safety. Sex differences and intervention effects were assessed using two-way analyses of variances. Thirty-five participants (14 females) were recruited. The recruitment rate was significantly lower among females (9% versus 18%; p = 0.022). Females in the intervention were less adherent (50% versus 93%; p = 0.016), and experienced minor adverse events more frequently (0.08% versus 0.03%; p = 0.003). Aerobically trained females experienced clinically meaningful reductions in pulse wave velocity (-1.25 m/s, 95%CI [-2.54, 0.04]; p = 0.648), and significantly greater reductions in brachial systolic pressure (-9 mmHg, 95%CI (3, 15); p = 0.011) and waist circumference (-3.8 cm, 95%CI (1.6, 6.1); p < 0.001) than males. To enhance the feasibility of future trials, targeted strategies to improve female recruitment and adherence are needed. Females with T2D may experience greater cardiometabolic health improvements from aerobic training than males.