Both exercise and metformin have been shown to independently improve glycemic control and insulin sensitivity in diabetics; the former has also been shown to drive cardiovascular improvements. Multiple studies have shown, however, that the combination of metformin and exercise leads to an inferior response compared to either intervention alone. For example:
One study showed metformin alone and exercise alone led to 55% and 90% improvements in skeletal muscle insulin sensitivity, respectively. Significantly, however, metformin + exercise led to a smaller improvement at 30% (3).
Metformin combined with exercise led to smaller improvements in both hsCRP and systolic blood pressure — and thus a smaller reduction in cardiovascular risk — than either intervention alone. (ibid)
Adding metformin to exercise blunted subjects’ increase in VO2max by 50% compared to 10 weeks of exercise alone. Subjects also reported greater perceived exertion than controls while exercising and taking metformin, which further indicates a reduction in cardiovascular improvement. These reduced improvements in aerobic fitness were associated with blunted improvements in muscular insulin sensitivity (4).
Similar effects have been seen with statins, where aerobic exercise training alone in overweight/obese adults improved VO2max by 10%, but when combined with statins therapy, VO2max improved by only 1.5% (5).
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