Physical exercise and glycemic control: Is HbA1c the best marker for assessing the effects of aerobic training?

Glycemic control, represented by HbA1c levels, is a central therapeutic goal in the treatment of T2D. Physical exercise, particularly aerobic training programs with high volume and/or progressive intensity, has been recognized an effective therapeutic tool in diabetes control, demonstrating significant potential in reducing HbA1c levels. However, evidence suggests that aerobic exercise may increase Hb levels compared to those who do not engage in physical activity, even while improving VO 2 . In light of this, we hypothesize that, contrary to the underestimation of glycemic levels in patients with hemoglobinopathies, there may be an overestimation of glycemic reduction. This is because aerobic training, while reducing glycemic levels, can simultaneously increase Hb levels, consequently underestimating HbA1c values. This hypothesis raises questions about the suitability of using HbA1c exclusively as a single marker for glycemic control in individuals involved in aerobic training programs. This consideration the need for a more comprehensive assessment of glycemic control markers in patients participating in regular exercise programs.