Effects of concurrent training sequence on cardiometabolic risk factors in patients with type 2 diabetes: a systematic review and network meta-analysis.
Li Z, Liu C, Liu Y. · Endocrine · 2026
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
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.