ORIGINAL ARTICLE Effect of supervised exercise training on musculoskeletal symptoms and function in patients with type 2 diabetes: the Italian Diabetes Exercise Study (IDES) Stefano Balducci • Maria Chiara Vulpiani • Luca Pugliese • Valeria D’Errico • Stefano Menini • Gerardo Salerno • Luca Gargiulo • Andrea Ferretti • Giuseppe Pugliese Received: 5 November 2013 / Accepted: 5 February 2014 Ó Springer-Verlag Italia 2014 Abstract Musculoskeletal disorders are common in subjects with type 2 diabetes mellitus (T2DM) and may represent a barrier to physical activity (PA). In the Italian Diabetes and Exercise Study, we assessed whether a strategy aimed at minimizing the risk of injury and wors- ening of musculoskeletal symptoms favors participation in exercise training and results in improvements in joint- specific functional scores, along with amelioration of metabolic profile. Sedentary patients with T2DM (n = 606) from 22 outpatient diabetes clinics were randomized to twice-a-week supervised aerobic and resis- tance training plus exercise counseling (EXE) versus counseling alone (CON) for 12 months. Musculoskeletal symptoms were evaluated at baseline in the entire cohort by the use of a self-reported questionnaire in order to design tailored exercise programs with exclusion of painful segments, and validated joint-specific scores were calcu- lated at the end of study in a subgroup of CON (n = 65) and EXE subjects (n = 62). Musculoskeletal symptoms were present in more than  of EXE and CON subjects. Yet, volumes of non-supervised PA were high, whereas dropout rates and adverse events were low in both groups. Moreover, in the EXE group, no difference was observed between patients with and without symptoms in session attendance and PA/exercise volume. Scores for symptoms and functional status of limbs and spine were significantly better in EXE than in CON subjects and correlated with PA/exercise volume and improvements in fitness parame- ters. Preliminary evaluation of musculoskeletal symptoms is useful in favoring compliance with supervised training programs and obtaining significant benefits to the func- tional status of the involved joints. Communicated by Massimo Federici. For the Italian Diabetes Exercise Study (IDES) Investigators. A complete list of the IDES Investigators can be found as online appendix. Trial Registration: ISRCTN-04252749, www.ISRCTN.org. Electronic supplementary material The online version of this article (doi:10.1007/s00592-014-0571-5) contains supplementary material, which is available to authorized users. S. Balducci Á S. Menini Á G. Salerno Á G. Pugliese Department of Clinical and Molecular Medicine, ‘‘La Sapienza’’ University, Rome, Italy S. Balducci Á V. D’Errico Á G. Pugliese Diabetes Unit, Sant’Andrea Hospital, Rome, Italy S. Balducci (&) Á V. D’Errico Metabolic Fitness Association, Via Nomentana, 27, 00015 Monterotondo, Rome, Italy e-mail: s.balducci@hctdiabete.it; sbalducci@esinet.it M. C. Vulpiani Á L. Gargiulo Á A. Ferretti Department of Medical and Surgical Sciences and Translational Medicine, ‘‘La Sapienza’’ University, Rome, Italy M. C. Vulpiani Á L. Gargiulo Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Rome, Italy L. Pugliese Radiology Unit, Sant’Andrea Hospital, Rome, Italy A. Ferretti Orthopedic Unit and Kirk Kilgour Sports Injury Center, Sant’Andrea Hospital, Rome, Italy 123 Acta Diabetol DOI 10.1007/s00592-014-0571-5