Effects of concurrent training sequence on cardiometabolic risk factors in patients with type 2 diabetes: a systematic review and network meta-analysis.
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引用次数: 0
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.
期刊介绍：
Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology.
Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted.
Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
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