The Therapeutic Role of Exercise in Diabetic Cardiomyopathy: Underlying Mechanisms and Interactions with Antidiabetic Medications

Diabetes mellitus is an emerging global health concern, with its prevalence rising at an alarming rate. Cardiovascular complications are significantly more pronounced in diabetic individuals, underscoring the urgent need for effective therapeutic interventions. Significant efforts and investments have been dedicated to developing pharmacological treatments for diabetes. While each therapy offers its own advantages and disadvantages, their effectiveness in slowing disease progression remains limited. In contrast, exercise has gained recognition as a potent therapeutic strategy for diabetes and its complications, exerting metabolic and cardioprotective effects through various physiological and molecular mechanisms. Engaging in regular physical activity reduces cellular stress and inflammation, inhibits cardiomyocyte apoptosis and myocardial fibrosis, and improves endothelial and mitochondrial function, thereby maintaining cardiomyocyte homeostasis. Additionally, recent studies have investigated the potential synergistic effects of combining exercise with novel pharmacological agents, emphasizing its complementary role in managing diabetic heart failure. This review aims to discuss the mechanistic pathways through which structured physical exercise alleviates diabetic cardiomyopathy with additional consideration of its synergistic effects when combined with antidiabetic pharmacotherapies.