Most cases of type 2 diabetes (T2D) can be prevented by adopting a healthy lifestyle, highlighting that lifestyle modifications should be the primary defence against developing T2D. Although accumulating evidence suggests that exercise can be an efficacious therapy for T2D, especially in conjunction with pharmacological interventions, its long-term effectiveness remains controversial owing to significant adherence challenges. In this narrative review, we combine an evolutionary perspective with epidemiological and prospective interventional studies to examine the efficacy versus effectiveness of varying volumes of exercise prescriptions for treating T2D. Commonly prescribed and recommended volumes of moderate-intensity physical activity (150 min/week) have demonstrated low-to-moderate efficacy in improving glycaemic control, reflected by improvements in glycated haemoglobin levels. Higher exercise volumes have been shown to enhance efficacy. While exercise can be moderately efficacious under the optimal circumstances of short-term exercise interventions (≤1 year), there is little evidence of its long-term effectiveness, primarily due to poor adherence. To date, no study has demonstrated long-term adherence to exercise programmes in individuals with T2D (>1 year). From an evolutionary perspective, the finding that exercise interventions are often ineffective over time is unsurprising. Although often overlooked, humans never evolved to exercise. Exercise is a counter-instinctive behaviour that can be difficult to maintain, even in healthy populations and can be especially challenging for individuals who are unfit or have T2D morbidities. We conclude by presenting several considerations informed by evolutionary logic that may be useful for practitioners, policymakers and advocates of exercise as medicine to improve exercise adherence.

中文翻译：

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为什么运动可能永远不会是有效的药物：运动治疗 2 型糖尿病的疗效与有效性的进化观点


大多数 2 型糖尿病 （T2D） 病例可以通过采用健康的生活方式来预防，这凸显了生活方式的改变应该是防止患上 T2D 的主要防御措施。尽管越来越多的证据表明，运动可以成为 T2D 的有效疗法，尤其是与药物干预相结合，但由于依从性面临重大挑战，其长期有效性仍然存在争议。在本叙述性综述中，我们将进化论观点与流行病学和前瞻性干预研究相结合，以检查不同体积的运动处方治疗 T2D 的疗效与有效性。常用处方和推荐的中等强度体力活动量（每周 150 分钟）已被证明在改善血糖控制方面具有低到中度疗效，这反映在糖化血红蛋白水平的改善上。更高的运动量已被证明可以提高疗效。虽然在短期运动干预的最佳情况下（≤1 年）运动可能具有中等效果，但几乎没有证据表明其长期有效性，主要是由于依从性差。迄今为止，尚无研究证明 T2D 患者 （>1 年） 长期坚持锻炼计划。从进化的角度来看，运动干预随着时间的推移往往无效的发现并不令人惊讶。虽然经常被忽视，但人类从未进化到锻炼。运动是一种反本能的行为，即使在健康的人群中也很难维持，对于身体不适或患有 T2D 疾病的人来说尤其具有挑战性。 最后，我们提出了几个由进化逻辑提供的考虑因素，这些考虑因素可能对运动作为药物以提高运动依从性的从业者、政策制定者和倡导者有用。