Mind–body exercise for improving balance, aerobic capacity, walking ability, muscle strength, and mental health in patients with type 2 diabetes: a network meta-analysis

Objective: To compare and rank the effects of different mind-body exercise interventions on psychological and physical outcomes in individuals with type 2 diabetes mellitus using a network meta-analysis. Methods: This study systematically searched PubMed, Embase, Web of Science, and the Cochrane Library, and conducted a frequentist network meta-analysis using Stata with SUCRA-based ranking; risk of bias was assessed using RoB 2.0, certainty of evidence evaluated with CINeMA, and robustness examined through sensitivity analyses and publication bias assessment using funnel plots. Results: This study provides preliminary, outcome-specific evidence based on 13 randomized controlled trials involving over 500 individuals with type 2 diabetes mellitus. Network meta-analysis suggested that Pilates significantly improved balance ability (SMD = 1.52, 95% CI 0.77-2.28) and walking ability (SMD = 1.20, 95% CI 0.28-2.12) compared with control. Walking Meditation showed a favorable effect on aerobic capacity (SMD = 1.40, 95% CI 0.44-2.37), while yoga improved muscle strength (SMD = 0.79, 95% CI 0.26-1.33). Mindfulness-based interventions were associated with reduced anxiety (SMD = 1.05, 95% CI 0.46-1.63). Sensitivity analyses indicated that physical function outcomes were generally robust, whereas psychological outcomes were sensitive to influential studies. The certainty of evidence was predominantly very low according to CINeMA assessment. Conclusion: This network meta-analysis provides preliminary, outcome-specific evidence that mind-body exercise may improve physical function in type 2 diabetes, while effects on psychological outcomes remain uncertain and warrant further high-quality research. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251133289.