Daniel A. Cook still remembers the moment he realized exercise might do more than just lower blood sugar in people with type 1 diabetes—it could actually reshape the immune system’s behavior. At the Germans Trias i Pujol Research Institute (IGTP), where Cook leads research into the immunology of diabetes, a growing body of evidence is suggesting that physical activity may help protect the very cells destroyed by the disease. Type 1 diabetes, an autoimmune condition in which the body attacks insulin-producing beta cells in the pancreas, has long been managed with insulin therapy. But while immunotherapies are emerging, researchers are now asking whether something as accessible as exercise could complement these treatments by modulating the immune response itself.
The idea isn’t entirely new—exercise is already known to support cardiovascular health, improve well-being, and help regulate metabolism. But its potential role in immune regulation for type 1 diabetes has remained largely unexplored. In a new review published in Diabetes Care (2026), Cook and his team analyze preclinical and clinical data to uncover how physical activity might influence the disease beyond glucose control. In animal models, exercise has been linked to reduced infiltration of leukocytes into pancreatic islets—the clusters of cells housing beta cells—along with increased levels of anti-inflammatory mediators that may shield remaining beta cells from destruction.
In humans, the evidence is still emerging but promising. Some studies suggest that individuals who engage in regular physical activity experience a longer partial remission period after diagnosis, often referred to as the “honeymoon phase,” during which the body still produces some insulin. These patients also show immune profiles marked by anti-inflammatory markers, hinting at a systemic shift in immune behavior. While exercise won’t cure type 1 diabetes or replace insulin, the authors argue it could become a low-risk, patient-centered strategy to support emerging immunotherapies and possibly extend periods of remission.
Crucially, the review calls for more targeted clinical studies to determine which forms of exercise—whether aerobic, resistance, or interval training—offer the most benefit, and at what intensity and timing. Establishing clear immunological markers to track changes will be key to integrating exercise into clinical protocols. With early detection methods improving and new immunotherapies on the horizon, the timing is ripe to explore how lifestyle interventions might enhance these advances.
"Physical exercise could play an important role not only in metabolic control, but also in immune regulation in type 1 diabetes," says Cook. As research moves forward, the vision is clear: a future where exercise isn’t just recommended for general health, but prescribed as part of a broader strategy to preserve beta-cell function and restore immune balance.