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Aim/hypothesis: This study aimed to investigate whether concurrent training, when added to a palaeolithic-type diet-induced weight loss intervention, is associated with altered physiological responses and circulating lipid dynamics during exercise and recovery in individuals with type 2 diabetes.

Methods: In a previously reported clinical trial, individuals with overweight or obesity who had type 2 diabetes (n=27) were randomised to either 12 weeks of palaeolithic-type diet (PD) or PD and supervised concurrent exercise training three times weekly (PD+E). Physiological and glycaemic responses to exercise and recovery were monitored during an exercise test at baseline and following the intervention. This secondary analysis focuses on a subgroup (n=21), in which plasma samples were collected before and after exercise, and after 30 min of recovery, and lipid profiles were analysed using mass spectrometry-based lipidomics.

Results: Glycaemic management during and after the exercise test improved similarly in both groups, whereas only the PD+E group showed improvements in cardiometabolic fitness. In plasma samples obtained at rest before exercise, the intervention reduced levels of triacylglycerols in both groups, with additional reductions of very-long-chain ceramides (>C22 acyl chains) in the PD+E group. During the exercise test, sphingomyelins and ceramides increased in both groups, but only PD+E resulted in improved clearance of these bioactive lipids from circulation during recovery. The specific lipid response during recovery from exercise was associated with improvements in fat oxidation during exercise.

Conclusions/interpretation: Concurrent training during PD-induced weight loss improves cardiometabolic fitness and is associated with an enhanced ability to clear bioactive sphingomyelins and ceramides from the circulation in the recovery phase after an exercise test. The improved lipid response during recovery and its association with the capacity for fat oxidation suggest that concurrent training during PD-induced weight loss may augment lipid handling beyond diet-induced changes, although causal mechanisms cannot be established.