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Background <p>Type 2 diabetes (T2DM) is linked to impaired metabolic and cardiovascular health, and concurrent exercise is a key intervention to enhance these outcomes. However, the effect of exercise sequence on these outcomes remains unclear. This study aimed to examine the effects of 12 weeks of concurrent training, performed in different sequences of aerobic and resistance exercise, on VO₂ Peak, glucose tolerance area under the curve (GT AUC), waist-to-hip ratio (WHR), and body mass index (BMI) in patients with T2DM.</p> Methods <p>In this randomized controlled trial, participants were allocated to Concurrent Aerobic-Resistance Training (CART = 13), Concurrent Resistance-Aerobic Training (CRAT = 13), or a control group (COG = 13). Training was conducted three times per week for 12 weeks. VO₂ Peak, GT AUC, WHR, and BMI were measured pre- and post-intervention. Data were analyzed using a mixed-model ANOVA to assess Group × Time interactions, followed, when significant, by Bonferroni-adjusted post hoc pairwise comparisons across groups to identify differences in intervention-related changes.</p> Results <p>Both CART and CRAT significantly improved VO₂ Peak, GT AUC, WHR, and BMI compared to the control group (<i>p</i> &lt; .05). VO₂ Peak increased by 2.999 mL/kg/min in CART and 2.147 mL/kg/min in CRAT, while GT AUC decreased by 23.01 and 24.22 units, respectively, reflecting enhanced cardiovascular fitness and glucose tolerance. WHR decreased by 0.106 in CART and 0.095 in CRAT, whereas BMI reduction was greater in CART (2.76&#xa0;kg/m²) than in CRAT (1.48&#xa0;kg/m²), suggesting a potential effect of exercise sequence on obesity indices.</p> Conclusion <p>Twelve weeks of concurrent training effectively enhanced cardiovascular fitness, glycemic control, and obesity indices in T2DM patients. While both exercise sequences provided benefits, performing aerobic exercise before resistance training may maximize BMI reduction, whereas improvements in VO₂ Peak, reduction in WHR, and glucose tolerance occur regardless of exercise order. These findings support adopting flexible, evidence-based concurrent training programs for metabolic and cardiovascular health.</p> Trial registration <p>02 September 2025, Registration no: PACTR202509591505325.</p>

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Impact of concurrent training order on cardiorespiratory fitness, glucose tolerance, and obesity indices in type 2 diabetic patients: randomized controlled trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月9日

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  • Friew Amare,
  • Alemmebrat Kiflu,
  • Aschenaki Taddese

摘要

Background

Type 2 diabetes (T2DM) is linked to impaired metabolic and cardiovascular health, and concurrent exercise is a key intervention to enhance these outcomes. However, the effect of exercise sequence on these outcomes remains unclear. This study aimed to examine the effects of 12 weeks of concurrent training, performed in different sequences of aerobic and resistance exercise, on VO₂ Peak, glucose tolerance area under the curve (GT AUC), waist-to-hip ratio (WHR), and body mass index (BMI) in patients with T2DM.

Methods

In this randomized controlled trial, participants were allocated to Concurrent Aerobic-Resistance Training (CART = 13), Concurrent Resistance-Aerobic Training (CRAT = 13), or a control group (COG = 13). Training was conducted three times per week for 12 weeks. VO₂ Peak, GT AUC, WHR, and BMI were measured pre- and post-intervention. Data were analyzed using a mixed-model ANOVA to assess Group × Time interactions, followed, when significant, by Bonferroni-adjusted post hoc pairwise comparisons across groups to identify differences in intervention-related changes.

Results

Both CART and CRAT significantly improved VO₂ Peak, GT AUC, WHR, and BMI compared to the control group (p < .05). VO₂ Peak increased by 2.999 mL/kg/min in CART and 2.147 mL/kg/min in CRAT, while GT AUC decreased by 23.01 and 24.22 units, respectively, reflecting enhanced cardiovascular fitness and glucose tolerance. WHR decreased by 0.106 in CART and 0.095 in CRAT, whereas BMI reduction was greater in CART (2.76 kg/m²) than in CRAT (1.48 kg/m²), suggesting a potential effect of exercise sequence on obesity indices.

Conclusion

Twelve weeks of concurrent training effectively enhanced cardiovascular fitness, glycemic control, and obesity indices in T2DM patients. While both exercise sequences provided benefits, performing aerobic exercise before resistance training may maximize BMI reduction, whereas improvements in VO₂ Peak, reduction in WHR, and glucose tolerance occur regardless of exercise order. These findings support adopting flexible, evidence-based concurrent training programs for metabolic and cardiovascular health.

Trial registration

02 September 2025, Registration no: PACTR202509591505325.