Background <p>Chronic hyperglycemia monitored by HbA1c may be associated with bladder dysfunction and lower urinary tract symptoms in women with diabetes mellitus, but the role of aerobic exercise in this process is unclear.</p> Aims <p>The aim of our study is to investigate the impact of aerobic exercise (AE) on bladder function and urinary symptoms in women with Diabetes Mellitus (DM) who had Lower Urinary Tract Symptoms (LUTS).</p> Methods <p>The study included 44 women randomly assigned to AE (<i>n</i> = 22) and Control (<i>n</i> = 22) groups. Both received behavioral therapy; the AE group additionally performed moderate-intensity aerobic exercise. Bladder function was assessed by urodynamics, blood glucose by HbA1c, voiding frequency by a 48-hour bladder diary, and urinary symptoms and quality of life by King’s Health Questionnaire (KHQ) and Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire. Trial registration: ClinicalTrials.gov, NCT06249399.</p> Results <p>The groups had similar characteristic urodynamic features before treatment (<i>p</i> &gt; 0.05). However after exercise training, improvements in favour of AE group regarding the following urodynamic parameters as voiding time (<i>p</i> = 0.003), voided volume (<i>p</i> = 0.008), first urge to urinate (<i>p</i> = 0.003), compliance (<i>p</i> &lt; 0.001), maximum bladder capacity (<i>p</i> = 0.021), subheadings of KHQ (general health (<i>p</i> = 0.024), social limitation (<i>p</i> = 0.013), mood (<i>p</i> = 0.001), symptom severity) (<i>p</i> = 0.042), and of BFLUTS (storage functions (<i>p</i> = 0.004), quality of life (<i>p</i> = 0.017), and total scores (<i>p</i> = 0.012)), urinary frequency (<i>p</i> = 0.003), and blood glucose levels (<i>p</i> = 0.002).</p> Conclusion <p>AE training for women with DM and LUTS, was associated with improved bladder function, urinary symptoms and urinary system related quality of life.</p>