Sustained and attenuated effects of transitioning from supervised to self-managed resistance training in older adults with type 2 diabetes and sarcopenia

Aims: This randomized controlled trial examined whether benefits achieved during supervised resistance training (SRT) were sustained after transitioning to self-managed home-based training in older adults with type 2 diabetes mellitus (T2DM) and sarcopenia. Methods: In this single-center, parallel-group trial, adults aged ≥ 65 years with T2DM and sarcopenia were randomized 1:1 to a 24-week resistance-training intervention or control. The intervention comprised 12 weeks of SRT followed by 12 weeks of self-managed home-based training. Co-primary outcomes were skeletal muscle index (SMI), handgrip strength (HGS), five-times-sit-to-stand (5TSTS), and SARC-CalF score. Secondary outcomes were HbA1c and SF-12 physical and mental component summary scores. Longitudinal changes were evaluated using generalized estimating equations. Results: Sixty-two participants were randomized (median age, 72 years; 67.7% female). At 12 weeks, SRT significantly improved HGS, 5TSTS performance, and SARC-CalF score, whereas SMI showed no significant between-group difference. At 24 weeks, SMI showed a modest favorable change, but earlier improvements in HGS, 5TSTS performance, and SARC-CalF score were attenuated after transition to self-managed training. SF-12 scores showed supportive, favorable patterns through 24 weeks, whereas HbA1c showed no clear intervention-related change. Conclusions: In older adults with T2DM and sarcopenia, transition from SRT to self-managed home-based training produced outcome-specific effects. Functional gains diminished after supervision ended, whereas SMI showed a modest, delayed, favorable change. These findings suggest that hybrid support models incorporating periodic supervision, remote monitoring, automated reminders, and feedback-guided exercise logs may be needed to sustain adherence, exercise quality, and functional capacity. Trial registration: Retrospectively registered at ClinicalTrials.gov (NCT07398495), February 23, 2026.