Type 1 diabetes is an autoimmune disease in which the immune system attacks the insulin-producing beta cells of the pancreas. Despite advances in glycaemic control and the development of new immunotherapies, there is still a need to identify complementary strategies that could help modulate the autoimmune process and preserve beta-cell function.
In this context, researchers from the Immunology of Diabetes research group at the Germans Trias i Pujol Research Institute (IGTP) have contributed to a review published in Diabetes Care that analyses current knowledge of the impact of physical exercise on immune regulation in type 1 diabetes. The paper, with Daniel A. Cook as first author, reviews preclinical studies and available clinical data to explore whether physical activity could play a role beyond glucose control and its well-established metabolic benefits.
Although exercise is already recommended for its benefits for cardiovascular health, wellbeing and metabolic control, and is known to contribute to immune system balance, its immunomodulatory potential in type 1 diabetes remains underexplored. The review brings together evidence suggesting that exercise could help reduce leukocyte infiltration into the pancreatic islets, protect beta cells and promote anti-inflammatory mediators in preclinical models.
In humans, the available evidence is still limited, but some studies suggest that physical activity could be associated with a longer period of partial remission and with immune profiles displaying anti-inflammatory characteristics. According to the authors, these findings support further investigation of physical exercise as a potential low-risk, patient-centred strategy within the management of type 1 diabetes.
The authors emphasise, however, that physical exercise does not cure type 1 diabetes or replace insulin treatment. Rather, it could help regulate the immune system and support future immunotherapeutic strategies.
The review also highlights the need for further clinical studies to determine which types of exercise, intensities, durations and timings of intervention may be most appropriate, as well as to establish immunological markers to assess their impact. This approach could be particularly relevant at a time when strategies for the early detection of type 1 diabetes and new immunotherapies for the prevention and treatment of the disease are advancing.
The authors suggest that gaining a better understanding of how physical exercise influences autoimmunity could open up new therapeutic opportunities complementary to pharmacological treatment. The aim would be to contribute to restoring immune tolerance, preserving beta cells and reducing secondary complications.
"Physical exercise could play an important role not only in metabolic control, but also in immune regulation in type 1 diabetes. Specific studies are needed to better understand its mechanism of action and to integrate exercise as a complement to insulin therapy, as well as a preconditioning strategy for immunotherapy," says Daniel A. Cook.
The paper positions this field as an emerging area with translational potential in type 1 diabetes.
Reference: Cook DA, Perna-Barrull D, Murillo M, Vives-Pi M. Exercise-Induced Immune Modulation in Type 1 Diabetes: From Mechanisms to Clinical Perspectives. Diabetes Care. 2026 Jun 12:dci260044. DOI: 10.2337/dci26-0044.
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