BACKGROUND: With the aging of population, sarcopenia in type 2 diabetes mellitus has gradually emerged in front of people. Increasing physical activity is an important approach to prevent and treat type 2 diabetes mellitus and its related sarcopenia. However, current intervention plan, effect evaluation and mechanism of different physical activities in type 2 diabetes-related sarcopenia are still not detailed. OBJECTIVE(S): To analyze the intervention program, effect evaluation and mechanism of physical activity in type 2 diabetes-related sarcopenia, thereby providing theoretical basis and practical suggestions for physical activity to improve the disease. METHOD(S): Search terms included "Diabetes Mellitus; T2DM; Sarcopenia; Muscular Atrophy; Exercise; Training; physical activity" in English and Chinese. PubMed and CNKI were searched for relevant literature published from January 1986 to February 2022, including review papers, research papers and meta-analysis. Finally, 53 literatures were included for the review. RESULTS AND CONCLUSION(S): Appropriate increase in non-leisure physical activity (daily steps above 5 401 per day) can reduce the probability of sarcopenia and maintain physical exercise function in elderly type 2 diabetes patients. Increasing leisure physical activity can prevent the incidence of sarcopenia in elderly type 2 diabetes patients, and any regular physical exercise can be effective. Resistance exercise is significantly superior to aerobic exercise in the prevention and treatment of type 2 diabetes-related sarcopenia. A resistance exercise of moderate intensity and above (3 times a week, 70% to 85% 1RM) can effectively increase muscle mass and strength performance in type 2 diabetes patients with sarcopenia, while aerobic exercise mainly delays skeletal muscle loss. Combining resistance exercise with aerobic exercise, nutritional intervention and health education can increase patient compliance and improve treatment efficacy. Resistance exercise mainly improves protein synthesis by activating IRS-PI3K-Akt, mTORC1, p70S6K and 4EBP1 signaling pathways, and improve muscle mass and functions by stimulating muscle satellite cell proliferation and differentiation. Aerobic exercise mainly delays muscle loss by inhibiting ubiquitin protein ligases Atrogin-1 and MuRF1 and skeletal muscle autophagy.

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