Can Prediabetes be Reversed Through Exercise? Blog Banner
Prediabetes has become one of the biggest health challenges facing adults today. It affects millions worldwide and often goes unnoticed until it progresses into type 2 diabetes. For us as fitness professionals, this stage represents a crucial opportunity to make a measurable difference through exercise, education and long-term support. The evidence now shows that prediabetes can be reversed and the right training strategies can significantly improve blood sugar control, body composition and lipid health.
Trainers who deliver structured programmes, such as those developed in advanced pt courses, are ideally placed to help clients in this early phase of metabolic dysfunction. The goal isn’t to manage a disease, it’s to prevent it from ever developing.
Prediabetes occurs when blood glucose levels are higher than normal but not high enough for a diabetes diagnosis. According to the International Diabetes Federation, in 2019 about 374 million adults had prediabetes globally and that number could rise to over 540 million by 2045. Without intervention, the American Diabetes Association (ADA) estimates that up to 70% of people with prediabetes will eventually develop type 2 diabetes.
At this stage, the condition is still reversible. Exercise and nutrition are the two most powerful levers available. For us as personal trainers, understanding the physiology behind these changes helps shape smarter programmes and better client outcomes. This is where advanced education, like that on our personal trainer courses, becomes valuable as it equips professionals with the knowledge to interpret studies and apply evidence-based practice.
Prediabetes is not a mild condition. Elevated glucose levels, even below the diabetic threshold, increase the risk of cardiovascular disease, kidney damage and cognitive decline. It’s also associated with inflammation, poor endothelial function and insulin resistance. All of these conditions contribute to long-term metabolic damage.
Addressing it early means avoiding these complications altogether. Studies such as the Diabetes Prevention Program (Knowler et al., 2002) and the Finnish Diabetes Prevention Study (Tuomilehto et al., 2001) showed that lifestyle changes reduced diabetes risk by around 58%. Exercise plays a central role in that success, improving insulin sensitivity and reducing fat accumulation, particularly around the abdomen.
The short answer is yes. When clients adopt structured exercise routines, improve their nutrition and lose just 5–7% of their body weight, their glucose tolerance can normalise. The body becomes more efficient at using insulin, blood sugar stabilises and lipid profiles improve.
Physiologically, regular exercise increases the activity of AMP-activated protein kinase (AMPK) in skeletal muscle, which stimulates glucose transport into muscle cells via GLUT4 translocation. It also enhances mitochondrial function, meaning the body burns energy more efficiently. These processes together make exercise one of the most potent tools for reversing prediabetes.
For us as fitness professionals designing programmes for clients with prediabetes, exercise isn’t just a general health recommendation, it’s the frontline treatment. The latest research from Yan et al. (2025) provides clear evidence of which training methods are most effective. This large-scale network meta-analysis compared five types of exercise including aerobic training (AT), resistance training (RT), combined training (AT+RT), high-intensity interval training (HIIT) and Traditional Chinese Exercises (TCEs).
Seventy-four randomised controlled trials involving 5,683 people were analysed. The findings revealed distinct benefits for each modality across glucose, lipid and body composition outcomes.
The study’s results are summarised below. What you will notice is the each exercise type had measurable effects, but some produced stronger outcomes depending on the goal.
| Outcome | Most Effective Exercise | Effect (95% CI) | Application for Trainers |
|---|---|---|---|
| HbA1c ↓ | HIIT | –0.44 % (–0.55 to –0.32) | Strongest blood sugar reduction |
| 2-h Plasma Glucose | HIIT ≈ TCEs | –1.3 mmol/L | HIIT suits fit clients; TCEs suit older adults |
| Fasting Glucose ↓ | HIIT | –0.61 mmol/L | Ideal for time-efficient sessions |
| Total Cholesterol ↓ | AT + RT | –0.46 mmol/L | Blend endurance and strength blocks |
| Triglycerides ↓ | AT + RT | –0.55 mmol/L | Improves lipid metabolism |
| LDL ↓ | AT + RT | –0.35 mmol/L | Lowers cardiovascular risk |
| HDL ↑ | HIIT | +0.20 mmol/L | Boosts HDL through intensity |
| Body Weight ↓ | TCEs | –3.4 kg | Useful for weight and mobility work |
| Waist Circumference ↓ | TCEs | –4.3 cm | Targets visceral fat reduction |
| BMI ↓ | AT + RT | –0.89 kg/m² | Strong for overall metabolic improvement |
HIIT demonstrated the most powerful effects on blood glucose control and HDL cholesterol. Combined training (AT+RT) provided the best results for improving overall lipid health and reducing BMI, while TCEs such as Tai Chi and Baduanjin were most effective for lowering body weight and waist circumference.
For trainers developing structured fitness courses or client programmes, these findings can inform how to tailor interventions by age, mobility and fitness level.
The best exercise prescription for clients with prediabetes depends on their physical condition, preferences and access to equipment. Safety and progression are essential.
HIIT works well for clients who are moderately fit and can tolerate brief bursts of high effort. Intervals might involve one to four minutes of vigorous cycling, rowing or treadmill work at 85–95% of maximal heart rate, followed by recovery. Two to three HIIT sessions per week, each lasting 20–30 minutes, can produce meaningful changes in HbA1c within 12 weeks.
Combined aerobic and resistance training (AT+RT) is ideal for clients who prefer traditional gym sessions. A schedule of three to five weekly workouts, mixing 30 minutes of moderate cardio with two resistance sessions, has been shown to improve glucose control and lipid balance.
Resistance training (RT) alone enhances muscle mass and insulin sensitivity, improving the body’s ability to store and utilise glucose. Two or three sessions per week, using compound lifts or circuit formats, can significantly reduce fasting blood sugar.
Traditional Chinese Exercises (TCEs) such as Tai Chi, Baduanjin, or Qigong offer a lower-intensity alternative, especially for older adults or those with limited mobility. They improve balance, reduce stress and still achieve measurable metabolic benefits when practised three times per week.
Aerobic training (AT) remains valuable for endurance development and cardiovascular health. Activities such as brisk walking, swimming or cycling performed at 60–75% of HRmax for 150 minutes per week deliver strong glycaemic and lipid benefits.
Clients also benefit from practical education. Discuss the role of carbohydrate quality, portion control and protein intake (1.2–1.6 g/kg per day) in supporting exercise adaptations. Highlight the connection between sleep deprivation, cortisol elevation and reduced insulin sensitivity.
Can prediabetes be reversed?
Yes. Sustained exercise and small reductions in body weight can return blood sugar to normal levels.
How long does it take to see results?
Research shows improvements in insulin sensitivity and fasting glucose within 8–12 weeks of regular training.
Which type of exercise is best?
HIIT and combined aerobic plus resistance training show the strongest outcomes, but any consistent exercise helps.
Is walking useful for prediabetes?
Brisk walking contributes to blood glucose control but combining it with strength or interval work achieves greater metabolic benefit.
How much exercise is needed?
Aim for at least 150 minutes of moderate activity each week, plus two sessions of resistance training.
What if a client can’t do high-intensity work?
Low-impact options such as cycling, aquatic exercise or TCEs still improve blood glucose and lipid markers when performed regularly.
Prediabetes doesn’t have to progress to diabetes. Early intervention through exercise, supported by tailored programming and lifestyle guidance, can completely change a client’s long-term health trajectory. The data from Yan et al. (2025) reinforce that every form of exercise makes a difference. Keep in mind, HIIT and AT+RT stand out as the most effective, but TCEs are a safe and sustainable choice for many populations.
For us as fitness professionals, this represents an opportunity to influence health at its most critical stage. Coaching clients to reverse prediabetes is one of the most rewarding outcomes in our field. It showcases the direct impact of structured movement, informed programming and consistent support.
Prediabetes affects around 374 million adults worldwide and without intervention, up to 70% will progress to type 2 diabetes. Yet research shows this stage can be reversed through structured exercise and lifestyle change. In a 2025 meta-analysis of 74 trials, high-intensity interval training (HIIT) reduced HbA1c by 0.44%, while combined aerobic and resistance training improved cholesterol and triglyceride levels more than any other method. The Level 4 Obesity & Diabetes Management course gives you the specialist knowledge to apply this science in practice, enabling you to help clients lower risk, improve blood sugar control and restore long-term health through evidence-based exercise programming.
Level 4 Obesity & Diabetes Management Course – Distance Study
Start a career that changes lives and health outcomes. The Nutrition & Exercise Master Diploma™ combines advanced personal training with specialist nutrition coaching and obesity & diabetes management, giving you the expertise to guide clients from risk to resilience. In a 2025 meta-analysis of 74 trials on prediabetes, combined aerobic and resistance training reduced triglycerides by 0.55 mmol/L and total cholesterol by 0.46 mmol/L, while HIIT improved HDL by 0.20 mmol/L. All of this is clear proof that targeted training and smart nutrition can transform metabolic health. This all-in-one Diploma prepares you to apply that science every day, helping clients improve performance, lose weight and prevent chronic disease with precision-based programming.
Nutrition & Exercise Specialist/Master – Distance Study, In-Person & Live-Virtual
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