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Prediabetes is often treated as one condition, but new research suggests the biology behind it matters. A recent pooled analysis found that exercise responses in people with prediabetes differed depending on how glucose regulation was impaired. In particular, people with isolated impaired fasting glucose showed the weakest increase in physical activity after structured lifestyle support. The findings raise an important question: Could identifying different prediabetes phenotypes help clinicians build more effective lifestyle plans?
Table of Contents
- Why prediabetes type may affect exercise response
- What researchers found about exercise response in prediabetes
- Why impaired fasting glucose may respond differently
- What the findings mean for diabetes prevention
- Conclusion
- Frequently asked questions
Why Prediabetes Type May Affect Exercise Response
Prediabetes describes blood glucose levels that are above normal but below the threshold for diabetes. However, people can reach that diagnosis through different metabolic pathways. According to the American Diabetes Association, prediabetes can be identified through elevated A1C, impaired fasting glucose (IFG), or impaired glucose tolerance (IGT).
Those categories overlap, but they are not biologically identical. IFG is more strongly associated with problems controlling glucose production by the liver. In contrast, IGT is more closely associated with peripheral insulin resistance, including reduced glucose uptake after a meal.
Those metabolic differences could influence how people with prediabetes respond to exercise interventions. Exercise affects skeletal muscle, insulin sensitivity, body composition, and glucose metabolism. Therefore, people with different underlying metabolic problems may not respond to the same lifestyle program in exactly the same way.
Still, this does not mean exercise is unhelpful for people with IFG. Instead, it suggests clinicians may eventually need to consider both the type of prediabetes and the type of intervention when developing personalized prevention strategies.
What Researchers Found About Exercise Response in Prediabetes
A 2026 pooled analysis published in Diabetologia examined data from three randomized controlled trials involving 2,150 participants at risk for type 2 diabetes. Follow-up lasted as long as 48 months.
Participants received either usual care or structured, group-based lifestyle interventions. The programs encouraged greater physical activity through education, goal setting, pedometers, and ongoing support. Researchers then examined outcomes according to glucose status.
The differences were notable. Compared with usual care, the intervention increased daily steps by an average of 523 among participants with IGT. People with both IFG and IGT increased their activity by an average of 808 steps per day. Participants with normoglycemia increased their activity by 247 steps.
However, participants with isolated IFG increased their activity by only 71 steps per day compared with usual care. The confidence interval crossed zero, meaning the researchers did not demonstrate a clear intervention effect in that group.
In addition, the intervention improved two-hour post-challenge glucose levels only among participants who had both IFG and IGT. Overall, the results suggest that the behavioral response to a structured physical activity program may differ across glucose-defined phenotypes.
Importantly, the findings should not be interpreted as evidence that exercise does not benefit people with isolated IFG. Rather, they suggest that different groups may respond differently to the type of structured lifestyle intervention studied.
Why Impaired Fasting Glucose May Respond Differently
Researchers do not yet have a complete explanation for the weaker physical activity response among people with isolated IFG. However, differences in underlying physiology offer one possible clue.
IFG is characterized largely by hepatic insulin resistance and problems with early insulin secretion. Meanwhile, IGT is more strongly associated with peripheral insulin resistance. Since exercise has powerful effects on skeletal muscle glucose uptake and peripheral insulin sensitivity, differences in physiology could contribute to different outcomes.
Behavior may also play a role. The new study measured how much participants changed their physical activity after receiving structured support. Therefore, the findings concern not only metabolic responses to exercise but also participants' response to an intervention designed to get them moving.
Previous evidence also suggests that lifestyle intervention outcomes can vary across prediabetes phenotypes. An individual-participant meta-analysis published in Diabetes Care examined whether conventional lifestyle programs affected type 2 diabetes incidence differently among people with isolated IFG, isolated IGT, or both conditions.
Consequently, phenotype may become increasingly relevant when researchers design diabetes prevention programs. However, more research is needed before clinicians can prescribe specific exercise programs solely according to prediabetes subtype.
What This Means for Personalized Diabetes Prevention
Current recommendations still strongly support physical activity for people at increased risk of type 2 diabetes. The ADA Standards of Care in Diabetes 2026 recommend at least 150 minutes per week of moderate-intensity physical activity for adults with overweight or obesity who are at high risk, as part of a comprehensive diabetes prevention program.
The new findings do not overturn that advice. Rather, they suggest that a standard exercise recommendation may not produce the same behavioral change in every person.
For example, someone with isolated IFG may need different support, monitoring, exercise strategies, or behavioral tools to achieve activity goals. Future studies could determine whether exercise intensity, resistance training, shorter activity sessions, digital coaching, or more individualized goal setting can improve physical activity outcomes in this group.
Meanwhile, clinicians can continue focusing on achievable activity goals while considering each patient's glucose profile, overall health, preferences, barriers, and progress. This approach may be especially useful because sustainable physical activity depends on more than metabolic status alone.
Patients and clinicians can also follow the latest research on Diabetes in Control for additional information about prediabetes, diabetes prevention, blood glucose management, and emerging treatment strategies.
Conclusion
Prediabetes may look like one diagnosis on a medical chart, yet it can reflect different metabolic problems. The latest pooled analysis adds evidence that those differences may also influence how people respond to structured physical activity interventions.
People with isolated IFG showed the weakest activity increase, while those with IGT or combined IFG and IGT showed larger gains. Importantly, these findings should not be interpreted as a reason for people with IFG to avoid exercise. Instead, they highlight an opportunity to study more personalized approaches.
As researchers learn more, individual responses to exercise in prediabetes could become one factor clinicians consider when tailoring diabetes prevention strategies. For now, regular physical activity remains a central part of evidence-based prevention, alongside healthy eating, weight management when appropriate, and ongoing medical follow-up.
Frequently Asked Questions
What is impaired fasting glucose?
Impaired fasting glucose means fasting blood glucose is elevated but does not meet the diagnostic threshold for diabetes. It is one recognized form of prediabetes.
What is impaired glucose tolerance?
Impaired glucose tolerance occurs when blood glucose remains higher than normal after a glucose challenge. It can occur alone or together with impaired fasting glucose.
Does exercise still help people with impaired fasting glucose?
Exercise remains recommended for people at risk for type 2 diabetes. The new research found a weaker physical activity intervention response in people with isolated IFG, but the findings do not show that exercise itself is ineffective or unnecessary for this group.
How much exercise is recommended for people with prediabetes?
The ADA recommends diabetes prevention programs that include at least 150 minutes of moderate-intensity physical activity each week for appropriate high-risk adults, together with nutrition and weight-management strategies.
Could prediabetes treatment become more personalized?
Potentially. Research showing different responses among prediabetes phenotypes may help scientists identify which lifestyle strategies work best for different groups. However, more evidence is needed before phenotype-specific exercise prescriptions become routine clinical practice.
This content is not medical advice. For any health issues, always consult a healthcare professional. In an emergency, call 911 or your local emergency services.