Multimodal exercise interventions for enhancing cardiorespiratory fitness and hematopoietic stem cells in type 2 diabetes mellitus

Background Type 2 diabetes mellitus (T2DM) is associated with increased cardiovascular risk. Physical activity, including aerobic exercise (AE), resistance exercise (RE), and yoga (YG), has been shown to enhance cardiorespiratory fitness and mobilize CD34 + hematopoietic stem cells (HSCs), which play a vital role in tissue repair and immune function. This study aimed to evaluate the impact of these exercise modalities on HSCs mobilization and cardiorespiratory fitness in T2DM patients. Methods In this prospective interventional study, 120 participants (25–40 years) with T2DM were randomly assigned to one of four groups: AE, RE, YG, or a control (CN) group. Each group performed 50-minute supervised exercise sessions, three times per week, for 16 weeks. At 0, 8, 16 weeks, peripheral blood CD34 + cell count, Heart Rate, VO₂ max , and VCO₂ were measured. Results All exercises groups significantly increased peripheral blood CD34 + HSCs counts at both 8th (all p < 0.05; +30.77% (AE), + 33.33% (RE), and + 43.24% (YG) increase from baseline) and 16th weeks (all p < 0.05; +76.92% (AE), + 76.92% (RE), and + 108.11% YG). VO 2 max also significantly improved in all exercise groups at 8th week (all p < 0.05; +10.19% (AE), + 16.08% (RE), and + 18.54% (YG)) and 16th week (all p < 0.05; +24.27% (AE), + 32.16% (RE), and + 33.66% (YG)). Additionally, all exercise modalities, significantly reduced heart rate at 8th week (all p < 0.05; −6.82% (AE), − 4.44% (RE), and − 6.98% (YG) decrease from baseline) and 16th week (all p < 0.05; −14.77% (AE), − 8.89% (RE), and − 13.95% (YG)). No significant differences were observed in HSC mobilization or VO 2 max in the CN group. Conclusion All the interventions, AE, RE, and YG, were associated with improvements in cardiorespiratory fitness and CD34⁺ HSCs counts; highlighting the benefits of structured exercise regimens, in individuals with T2DM.