Sequence of aerobic and resistance exercise influences short- and long-term glycemic control in type 2 diabetes: A randomized trial

Combined aerobic and resistance exercise improves glycemic control in type 2 diabetes (T2D), yet whether the sequence of the two exercise modalities influences glycemic outcomes remains unclear. We examined acute and long-term glycemic responses to aerobic-then-resistance (AR, n = 28) versus resistance-then-aerobic (RA, n = 28) exercise in 56 community-dwelling adults with T2D over 8 weeks (3 sessions/week). Aerobic exercise was performed on bicycle ergometers for 30 min at 40%–70% heart-rate reserve; resistance exercise targeted major muscle groups at 60%–80% 1RM. Compared with pre-exercise levels, mean glucose ( p = 0.043) and HbA1c ( p = 0.007) decreased only in AR group. Among participants without insulin treatment, insulin levels fell in both groups (AR: p < 0.001; RA: p = 0.001). At week 8, AR showed lower glucose during exercise and recovery ( p = 0.036) and greater nocturnal glucose reduction ( p = 0.015) than RA. Similar conventional improvements seen in both sequences, yet aerobic-first lowered mean/nocturnal glucose at the cost of greater variability, while resistance-first minimized fluctuations.