Ultrasound therapy for exercise-induced muscle soreness and fatigue relief in women with type 2 diabetes: a randomized controlled trial

Background: Exercise-induced muscle soreness and fatigue are significant barriers to physical activity in middle-aged women with type 2 diabetes (T2D), exacerbated by impaired tissue healing and chronic inflammation. Objectives: To evaluate whether post-exercise therapeutic ultrasound (TUS) effectively reduces exercise-induced muscle soreness and fatigue while improving metabolic and inflammatory biomarkers in women with T2D. Design: Randomized controlled trial. Methods: Thirty sedentary women with T2D (aged 41–49 years, glycated hemoglobin (HbA1c) 6.5%–9.0%) were randomized to a TUS group ( n = 15) or control ( n = 15). Both groups completed an 8-week aerobic cycling program (3 sessions/week, 45 min/session, 60%–70% VO 2 max). The TUS group received post-exercise ultrasound (3 MHz, 1 W/cm 2 , 7 min/leg) using the Intellect Mobile 2 device. Primary outcomes were pain (Von Korff scale) and fatigue (Borg scale), while secondary outcomes included fasting blood sugar (FBS), HbA1c, inflammatory markers (tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)), and creatine kinase (CK), assessed at baseline and post-intervention. Linear mixed-effects models adjusted for baseline pain differences. Results: The TUS group showed marked decreases in pain (−2.2, 95% CI: −2.8 to −1.6, p < 0.001) and fatigue (−1.8, 95% CI: −2.4 to −1.2, p = 0.004) compared to controls. Secondary outcomes substantially improved: HbA1c (−0.5%, p = 0.03), FBS (−19.8 mg/dL, p = 0.01), TNF-α (−24.9 pg/mL, p < 0.001), IL-6 (−11.9 pg/mL, p < 0.001), and CK (−30 U/L, p = 0.01). No adverse events were reported. Conclusion: TUS is a safe, effective adjunct for reducing exercise-induced muscle soreness and fatigue in women with T2D, with benefits in glycemic control and inflammation. Larger trials with sham controls are needed. Trial registration: This trial was registered at the Iranian Registry of Clinical Trials (IRCT20211201053244N1) on June 21, 2022.