**9. Effects of exercise training on thermoregulation in diabetic patients**

The effects of aerobic fitness along with short- and long-term exercise training have been widely studied in the context of glucoregulation in type 2 and type 1 diabetics. The effects of exercise training on glycemic control in type 2 diabetics are well established. A recent metaanalysis by Umpierre et al. [96] reported that structured exercise training (over 12 weeks) consisting of aerobic exercise, resistance training, or a combination is associated with enhanced glycemic control (~0.7% HbA1c reduction) in type 2 diabetics. They also reported that structured exercise training of more than 150 min per week is associated with greater HbA1c reduction (~0.9%) compared to 150 min or less per week [96]. Structured exercise training also has beneficial effects on diabetes-related complications [97]. Greater benefits are apparent in type 2 diabetics with higher HbA1c before the exercise intervention [97].

In healthy individuals, it has been suggested that higher levels of aerobic fitness and/or physically activity improve the capacity to dissipate heat during exercise [98, 99]. A recent study indicated that the age-related decline in aerobic fitness was associated with the decreased whole-body evaporative heat loss during exercise in the heat [100]. Moreover, a group of trained middleaged males (~48 years) exhibited greater whole-body heat loss than an untrained group during exercise [100]. Other studies have also indicated that VO2max decreased ~7% per decade in sedentary, active, and even endurance-trained populations [101]. Despite reports of the relationship between aerobic fitness and thermoregulatory capacity in healthy people, there are no reports in with either type 1 [102–104] or type 2 [71] diabetics because aerobic fitness has not been considered as a potential factor influencing thermoregulatory capacities. Therefore, the increased aerobic fitness with exercise training in diabetics would improve thermoregulatory control, autonomic nervous system function, and cardiovascular responses, especially during exerciseinduced heat stress, as reported in healthy counterparts, however, the situation remains unclear.

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