Objective: Exercise is a cornerstone of diabetes management and the prevention of incident diabetes. However, the impact of the mode of exercise on cardiovascular (CV) risk factors in type 2 diabetes is unclear. Research design and methods: We conducted a systematic review of the literature between 1970 and October 2009 in representative databases for the effect of aerobic or resistance exercise training on clinical markers of CV risk, including glycemic control, dyslipidemia, blood pressure, and body composition in patients with type 2 diabetes. Results: Of 645 articles retrieved, 34 met our inclusion criteria; most investigated aerobic exercise alone, and 10 reported combined exercise training. Aerobic alone or combined with resistance training (RT) significantly improved HbA(1c) -0.6 and -0.67%, respectively (95% CI -0.98 to -0.27 and -0.93 to -0.40, respectively), systolic blood pressure (SBP) -6.08 and -3.59 mmHg, respectively (95% CI -10.79 to -1.36 and -6.93 to -0.24, respectively), and triglycerides -0.3 mmol/L (95% CI -0.48 to -0.11 and -0.57 to -0.02, respectively). Waist circumference was significantly improved -3.1 cm (95% CI -10.3 to -1.2) with combined aerobic and resistance exercise, although fewer studies and more heterogeneity of the responses were observed in the latter two markers. Resistance exercise alone or combined with any other form of exercise was not found to have any significant effect on CV markers. Conclusions: Aerobic exercise alone or combined with RT improves glycemic control, SBP, triglycerides, and waist circumference. The impact of resistance exercise alone on CV risk markers in type 2 diabetes remains unclear.