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Effects of concurrent training sequence on cardiometabolic risk factors in patients with type 2 diabetes: a
Zongxiang Li1,2, Cencen Liu3, Yanzhong Liu4
1Provincial University Key Laboratory of Sport and Health Science, School of Physical Education and Sport Sciences, Fujian Normal University, Fuzhou, China.
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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