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4.3.4 Role of exercise in modulating gut microbiota in heart failure states Although the direct mechanistic link between exercise training-induced modifications in the microbiota and HF is unclear [155], it has been shown that aerobic combined resistance exercise may improve type 2 diabetic mice by increasing the number, abundance, and diversity of beneficial GM bacteria and by promoting GLP-1 secretion, decreasing TMAO levels, and oxidative stress responses endothelial cell function, thus preventing and controlling type 2 diabetic cardiovascular lesions [156]