***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Physical fitness is inversely related to mortality in the general population and in subjects with type 2 diabetes . Here , we present data concerning the relationship between changes in physical fitness and modifiable cardiovascular risk factors in subjects with type 2 diabetes from the Italian Diabetes and Exercise Study . RESEARCH DESIGN AND METHODS Sedentary patients with type 2 diabetes ( n = 606 ) were enrolled in 22 outpatient diabetes clinics and r and omized to twice-a-week supervised aerobic and resistance training plus exercise counseling versus counseling alone for 12 months . Baseline to end-of- study changes in cardiorespiratory fitness , strength , and flexibility , as assessed by Vo2max estimation , a 5–8 maximal repetition test , and a hip/trunk flexibility test , respectively , were calculated in the whole cohort , and multiple regression analyses were applied to assess the relationship with cardiovascular risk factors . RESULTS Changes in Vo2max , upper and lower body strength , and flexibility were significantly associated with the variation in the volume of physical activity , HbA1c , BMI , waist circumference , high-sensitivity C-reactive protein ( hs-CRP ) , coronary heart disease ( CHD ) risk score , and inversely , HDL cholesterol . Changes in fitness predicted improvements in HbA1c , waist circumference , HDL cholesterol , hs-CRP , and CHD risk score , independent of study arm , BMI , and in case of strength , also waist circumference . CONCLUSIONS Physical activity/exercise-induced increases in fitness , particularly muscular , predict improvements in cardiovascular risk factors in subjects with type 2 diabetes independently of weight loss , thus indicating the need for targeting fitness in these individuals , particularly in subjects who struggle to lose weight Objective : We have previously reported insignificant changes in HbA1c after exercise in patients with both type 2 diabetes and coronary artery disease . In this study , we investigated the effect of exercise on endothelial function and possible associations between changes in endothelial function and HbA1c . Methods : Patients with type 2 diabetes and coronary artery disease ( n = 137 ) were r and omised to 12 months exercise or st and ard follow-up .  Endothelial function was assessed by circulating biomarkers ( E-selectin , intercellular adhesion molecule-1 , vascular cell adhesion molecule-1 , von Willebr and factor , tissue plasminogen activator antigen , asymmetric dimethylarginine and L-arginine/asymmetric dimethylarginine ratio ) . Differences between the r and omised groups were analysed by analysis of covariance and correlations by Spearman ’s rho or Pearson ’s correlation . Results : No effect of exercise on endothelial function was demonstrated . The changes in HbA1c in the exercise group correlated with changes in E-selectin ( r = 0.56 , p < 0.001 ) , intercellular adhesion molecule-1 ( r = 0.27 , p = 0.052 ) , vascular cell adhesion molecule-1 ( r = 0.32 , p = 0.022 ) and tissue plasminogen activator antigen ( r = 0.35 , p = 0.011 ) . HbA1c decreased significantly more in patients with versus without a concomitant reduction in E-selectin ( p = 0.002 ) , intercellular adhesion molecule-1 ( p = 0.011 ) , vascular cell adhesion molecule-1 ( p = 0.028 ) and tissue plasminogen activator antigen ( p = 0.009 ) . Conclusion : Exercise did not affect biomarkers of endothelial function in patients with both type 2 diabetes and coronary artery disease . However , changes in biomarkers of endothelial activation correlated with changes in HbA1c , and reduced endothelial activation was associated with improved HbA1c after exercise Importance It is unclear whether a lifestyle intervention can maintain glycemic control in patients with type 2 diabetes . Objective To test whether an intensive lifestyle intervention results in equivalent glycemic control compared with st and ard care and , secondarily , leads to a reduction in glucose-lowering medication in participants with type 2 diabetes . Design , Setting , and Participants R and omized , assessor-blinded , single-center study within Region Zeal and and the Capital Region of Denmark ( April 2015-August 2016 ) . Ninety-eight adult participants with non – insulin-dependent type 2 diabetes who were diagnosed for less than 10 years were included . Participants were r and omly assigned ( 2:1 ; stratified by sex ) to the lifestyle group ( n = 64 ) or the st and ard care group ( n = 34 ) . Interventions All participants received st and ard care with individual counseling and st and ardized , blinded , target-driven medical therapy . Additionally , the lifestyle intervention included 5 to 6 weekly aerobic training sessions ( duration 30 - 60 minutes ) , of which 2 to 3 sessions were combined with resistance training . The lifestyle participants received dietary plans aim ing for a body mass index of 25 or less . Participants were followed up for 12 months . Main Outcomes and Measures Primary outcome was change in hemoglobin A1c ( HbA1c ) from baseline to 12-month follow-up , and equivalence was prespecified by a CI margin of ±0.4 % based on the intention-to-treat population . Superiority analysis was performed on the secondary outcome reductions in glucose-lowering medication . Results Among 98 r and omized participants ( mean age , 54.6 years [ SD , 8.9 ] ; women , 47 [ 48 % ] ; mean baseline HbA1c , 6.7 % ) , 93 participants completed the trial . From baseline to 12-month follow-up , the mean HbA1c level changed from 6.65 % to 6.34 % in the lifestyle group and from 6.74 % to 6.66 % in the st and ard care group ( mean between-group difference in change of −0.26 % [ 95 % CI , −0.52 % to −0.01 % ] ) , not meeting the criteria for equivalence ( P = .15 ) . Reduction in glucose-lowering medications occurred in 47 participants ( 73.5 % ) in the lifestyle group and 9 participants ( 26.4 % ) in the st and ard care group ( difference , 47.1 percentage points [ 95 % CI , 28.6 - 65.3 ] ) . There were 32 adverse events ( most commonly musculoskeletal pain or discomfort and mild hypoglycemia ) in the lifestyle group and 5 in the st and ard care group . Conclusions and Relevance Among adults with type 2 diabetes diagnosed for less than 10 years , a lifestyle intervention compared with st and ard care result ed in a change in glycemic control that did not reach the criterion for equivalence , but was in a direction consistent with benefit . Further research is needed to assess superiority , as well as generalizability and durability of findings . Trial Registration clinical trials.gov Identifier : OBJECTIVE To investigate the associations between changes in body composition and fitness after exercise training and changes in hemoglobin A1c ( HbA1c ) in individuals with type 2 diabetes . RESEARCH DESIGN AND METHODS Participants ( n = 201 ) were r and omized  to aerobic , resistance , or combined training for 9 months . HbA1c , waist circumference , total and trunk fat mass , appendicular fat mass , lean body mass , isokinetic leg muscle strength , peak O2 uptake , and estimated METs were assessed at baseline and follow-up . Change in HbA1c was evaluated across quartiles of change in body composition and fitness . RESULTS Change in HbA1c was associated with changes in body weight ( r = 0.13 , P = 0.052 ) , waist circumference ( r = 0.17 , P = 0.013 ) , trunk fat mass ( r = 0.19 , P = 0.005 ) , and estimated METs ( r = −0.16 , P = 0.023 ) . There was a trend in change in HbA1c across quartiles of waist circumference ( P = 0.011 ) , trunk fat mass ( P = 0.020 ) , and estimated METs ( P = 0.011 ) . Participants with increased estimated METs and reduced trunk fat mass had greater odds of having reduced HbA1c after training ( 3.48 , 1.46–8.31 ) . Finally , participants with increased estimated METs and reduced waist circumference were 2.81 ( 1.13–6.98 ) times more likely to have reduced HbA1c and type 2 diabetes medication use than those without improved fitness and central adiposity . CONCLUSIONS In patients with type 2 diabetes , a reduction in central adiposity and increase in fitness were the most prominent predictors of the change in HbA1c in response to exercise training CONTEXT Exercise guidelines for individuals with diabetes include both aerobic and resistance training although few studies have directly examined this exercise combination . OBJECTIVE To examine the benefits of aerobic training alone , resistance training alone , and a combination of both on hemoglobin A(1c ) ( HbA(1c ) ) in individuals with type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial in which 262 sedentary men and women in Louisiana with type 2 diabetes and HbA(1c ) levels of 6.5 % or higher were enrolled in the 9-month exercise program between April 2007 and August 2009 . INTERVENTION Forty-one participants were assigned to the nonexercise control group , 73 to resistance training 3 days a week , 72 to aerobic exercise in which they expended 12 kcal/kg per week ; and 76 to combined aerobic and resistance training in which they expended 10 kcal/kg per week and engaged in resistance training twice a week . Main Outcome Change in HbA(1c ) level . Secondary outcomes included measures of anthropometry and fitness . RESULTS The study included 63.0 % women and 47.3 % nonwhite participants who were a mean ( SD ) age of 55.8 years ( 8.7 years ) with a baseline HbA(1c ) level of 7.7 % ( 1.0 % ) . Compared with the control group , the absolute mean change in HbA(1c ) in the combination training exercise group was -0.34 % ( 95 % confidence interval [ CI ] , -0.64 % to -0.03 % ; P = .03 ) . The mean changes in HbA(1c ) were not statistically significant in either the resistance training ( -0.16 % ; 95 % CI , -0.46 % to 0.15 % ; P = .32 ) or the aerobic ( -0.24 % ; 95 % CI , -0.55 % to 0.07 % ; P = .14 ) groups compared with the control group . Only the combination exercise group improved maximum oxygen consumption ( mean , 1.0 mL/kg per min ; 95 % CI , 0.5 - 1.5 , P < .05 ) compared with the control group . All exercise groups reduced waist circumference from -1.9 to -2.8 cm compared with the control group . The resistance training group lost a mean of -1.4 kg fat mass ( 95 % CI , -2.0 to -0.7 kg ; P < .05 ) and combination training group lost a mean of -1.7 ( -2.3 to -1.1 kg ; P < .05 ) compared with the control group . CONCLUSIONS Among patients with type 2 diabetes mellitus , a combination of aerobic and resistance training compared with the nonexercise control group improved HbA(1c ) levels . This was not achieved by aerobic or resistance training alone . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00458133 Aim /hypothesisIn people with type 2 diabetes , exercise improves glucose control ( as reflected in HbA1c ) and physical fitness , but it is not clear to what extent these exercise-induced improvements are correlated with one another . We hypothesised that reductions in HbA1c would be related : ( 1 ) to increases in aerobic fitness and strength respectively in patients performing aerobic training or resistance training ; and ( 2 ) to changes in strength and aerobic fitness in patients performing aerobic and resistance training . Methods We r and omly allocated 251 type 2 diabetes patients to aerobic , resistance , or aerobic plus resistance training , or to a sedentary control group .  Peak oxygen consumption ( $ $ \mathop {V}\limits^\cdot { { \text{O}}_{\text{2 peak } } } $ $ ) , workload , treadmill time and ventilatory threshold measurements from maximal treadmill exercise testing were measured at baseline and 6 months . Muscular strength was measured as the maximum weight that could be lifted eight times on the leg press , bench press and seated row exercises . Results With aerobic training , significant associations were found between changes in both $ $ \mathop {V}\limits^\cdot { { \text{O}}_{\text{2 peak } } } $ $ ( p = 0.040 ) and workload ( p = 0.022 ) , and changes in HbA1c . With combined training , improvements in $ $ \mathop {V}\limits^\cdot { { \text{O}}_{\text{2 
    Output:
    
We conclude that exercise training is associated with reductions of HbA1c in patients with DM2 .
Thus , it can be a complementary tool in the management of these patients