Aquatic Exercise in Adults with Type 2 Diabetes Mellitus: An Updated Systematic Review of Clinical Trials

Abstract

Objective: To analyze the acute responses and chronic effects of aquatic exercise programs in adults with type 2 diabetes mellitus (T2DM), considering glycated hemoglobin (HbA1c) and fasting blood glucose as the primary outcomes. Materials and Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. The search was performed in PubMed, Web of Science, Scopus, and the Cochrane Library in February 2026. Clinical trials involving adults with T2DM who participated in structured aquatic exercise programs were included. Risk of bias was assessed using the ROBINS tool. Results: Five studies met the inclusion criteria (n = 151). Three studies reported significant reductions in HbA1c, while three demonstrated decreases in blood glucose levels. The interventions ranged from 5 to 45 sessions, with moderate-to-vigorous intensity and a predominant frequency of three sessions per week. Conclusions: Aquatic exercise is associated with improvements in glycemic control in adults with T2DM; however, the available evidence remains limited and heterogeneous.