Impact of exercise sequence in concurrent training on insulin resistance, glycemic control, and blood pressure in Type 2 diabetes

Abstract

This study compared the effects of aerobic followed by resistance (CART) and resistance followed by aerobic (CRAT) training on insulin sensitivity, glycemic control, and blood pressure against a non-exercising control group (COT). 39 patients with type 2 diabetes were randomly assigned to CART (n = 13), CRAT (n = 13), or COT (n = 13) for a 12-week supervised program. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) improved significantly (F = 24.460, p = 0.001, η² = 0.62), with CRAT showing a modestly greater reduction than CART (MD = 0.303, p = 0.022), while both training sequences produced greater improvements compared to COT (CART: MD = −0.493, p = 0.001; CRAT: MD = −0.796, p = 0.001). Fasting Blood Sugar (FBS) decreased significantly (F = 16.206, p = 0.001, η² = 0.519) in both CART (MD = −10.747, p = 0.001) and CRAT (MD = −11.459, p = 0.001) relative to COT, though no difference emerged between the two exercise sequences (MD = 0.712, NS). Systolic Blood Pressure (SBP) also declined in CART (MD = −4.896, p = 0.005) and CRAT (MD = −5.681, p = 0.001) compared with COT (F = 8.968, p = 0.001, η² = 0.374), again without a significant sequence effect (MD = 0.785, NS). No significant between-group changes were observed in Diastolic Blood Pressure (DBP). Overall, concurrent training effectively reduced insulin resistance, improved glycemic control, and lowered SBP in patients with type 2 diabetes. While CRAT offered a modest additional benefit for HOMA-IR, the findings suggest that concurrent training, regardless of sequence, provides meaningful clinical benefits for managing type 2 diabetes. Trial registrationPan African Clinical Trials Registry (PACTR202509591505325) pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=37070