Type 2 Diabetes Mellitus and Downhill Aerobic Exercise Training

Inclusion Criteria: * Have been diagnosed with Type 2 diabetes mellitus according to the American Diabetes Association (ADA) diagnostic criteria * Be able to walk independently and be physically capable of walking on a treadmill * Have no acute cardiovascular, neurological, or orthopedic conditions that would prevent participation in the exercise program * No major changes to antidiabetic or cardiometabolic treatments within the last 3 months * To be under regular follow-up and in a stable clinical condition * To have been informed about the study and to provide written informed consent Exclusion Criteria: * Patients with severe peripheral neuropathy or a lack of protective sensation * Lower extremity amputation * Diabetic foot ulcer or the presence of severe skin lesions that impair walking * Proliferative diabetic retinopathy or advanced retinopathy that could pose a risk of complications during exercise * Severe diabetic nephropathy (eGFR \<30 mL/min/1.73 m² or macroalbuminuria \>300 mg/g) * Uncontrolled hypertension (systolic blood pressure \>200 mmHg and/or diastolic blood pressure \>110 mmHg) * Fasting blood glucose level \>250 mg/dL with signs of ketosis * Unstable angina pectoris, a history of myocardial infarction within the past 6 months, or a history of clinically significant severe arrhythmia * Advanced heart failure (NYHA Class III-IV) * Having a chronic respiratory disease * Having participated in a regular exercise, sports, or physical therapy program within…