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Concurrent training sequences improve glycemic control and lipid profiles in patients with type 2 diabetesConcurrent Training Sequences May Improve Outcomes for Type 2 Diabetes

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Key Takeaway
Note that both CART and CRAT improve glycemic and lipid markers, but neither is proven superior over the other.

This systematic review and network meta-analysis evaluated the effects of concurrent training (CT) sequences, specifically aerobic training followed by resistance training (CART) and resistance training followed by aerobic training (CRAT), in patients with type 2 diabetes. The analysis included 965 patients and compared these sequences against a control group.

Both CART and CRAT were found to significantly improve body fat percentage, HbA1c, fasting blood glucose, total cholesterol, triglycerides, and low-density lipoprotein (p < 0.05). Based on unadjusted SUCRA probabilities, CRAT ranked highest for body composition, glycemic control, insulin resistance, and most lipid outcomes. Conversely, CART ranked highest for systolic and diastolic blood pressure.

Limitations include non-significant direct comparisons and low certainty of evidence according to CINeMA. The authors note that results are exploratory and do not establish the superiority of one sequence over the other. Unadjusted rankings may be influenced by factors such as intervention duration, participant sex, and participant age. Current evidence does not support a definitive recommendation for one training sequence over the other for clinical practice.

How this fits prior evidence

This finding addresses a gap in exercise prescription for type 2 diabetes by comparing specific training sequences. While other evidence highlights the role of SGLT2 inhibitors for kidney outcomes, HDAC3 as an epigenetic hub, and the importance of CGM-derived time in range for kidney disease, this study focuses on the physiological impact of exercise order. It provides evidence that both CART and CRAT are effective for glycemic and lipid improvements, though it does not establish a preferred sequence.

Researchers looked at how different exercise orders affect people with type 2 diabetes. They compared two methods: doing aerobic exercise followed by resistance training (CART) and doing resistance training followed by aerobic exercise (CRAT). Both methods were compared against a control group that did not follow these specific sequences.

Both the CART and CRAT methods showed significant improvements in several areas, including body fat percentage, blood sugar levels, and cholesterol. While the study ranked one method higher for blood pressure and the other higher for overall lipid outcomes, the evidence is currently limited. The researchers noted that these rankings might be influenced by factors like the age or sex of the participants.

Because the evidence is of low certainty, it is not yet clear if one specific order is better than the other. This means that while both types of exercise are beneficial, the study does not give a definitive recommendation on which sequence a patient should choose. You should talk with your doctor to decide which exercise routine is safest and best for your specific health needs.

What this means for you:
Both aerobic and resistance training sequences show promise for managing type 2 diabetes, but one is not proven better.

Common questions

Are both types of exercise effective for type 2 diabetes?

Yes, the study found that both aerobic training followed by resistance training and resistance training followed by aerobic training significantly improved outcomes. These improvements included better body fat percentage, blood sugar levels, and cholesterol levels compared to a control group.

Is one exercise sequence better than the other?

The study does not currently prove that one sequence is better than the other. While different rankings appeared for blood pressure and lipid outcomes, the evidence is of low certainty. The results may be influenced by factors like the age and sex of the participants.

What specific health markers improved with these exercises?

Both training sequences showed significant improvements in body fat percentage, HbA1c, fasting blood glucose, and cholesterol markers like triglycerides and low-density lipoprotein. They also showed improvements in systolic and diastolic blood pressure.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
PURPOSE: Concurrent training (CT), combining aerobic and resistance exercise, is recommended for managing type 2 diabetes mellitus (T2DM). However, whether the sequence of CT-aerobic training followed by resistance training (CART) or the reverse order (CRAT)-influences cardiometabolic outcomes remains unclear. This study compared the effects of CT sequences on cardiometabolic risk factors in T2DM using network meta-analysis (NMA). METHODS: An NMA of randomized controlled trials (RCTs) published up to January 2026 was conducted using five databases. Two reviewers independently screened and extracted data. Data were analysed using Stata 16.0. RESULTS: Twenty-seven RCTs (n = 965) were included. Both CART and CRAT significantly improved body fat percentage, HbA1c, fasting blood glucose, total cholesterol, triglycerides, and low-density lipoprotein compared with control (all p < 0.05). Based on unadjusted SUCRA probabilities, CRAT ranked highest for body composition, glycaemic control, insulin resistance, and most lipid outcomes, whereas CART ranked highest for systolic and diastolic blood pressure. Sensitivity analyses indicated that intervention duration influenced rankings for body composition, whereas participant sex influenced rankings for blood pressure. Meta‑regression further suggested that participant age might modify the relative efficacy of these sequences for BMI, HbA1c, and blood pressure, warranting cautious interpretation of unadjusted rankings. CONCLUSIONS: Both CT sequences improve cardiometabolic risk factors in T2DM. Although SUCRA rankings varied across outcomes, these findings are exploratory and do not establish superiority of either sequence. Meta-regression suggested that participant characteristics and training factors may partly account for ranking differences. Given the non-significant direct comparisons and low certainty of evidence according to CINeMA, current evidence does not support a definitive recommendation for one training sequence over the other. Future head-to-head trials are warranted. TRIAL REGISTRATION: PROSPERO CRD420261293127. Registered 25 January 2026.
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