Protocol
Concurrent training sequence: resistance before aerobic (same session)
When resistance and aerobic exercise are performed in the same session, randomized trials show a small advantage in lower-body dynamic strength when the resistance work comes first, and no difference in aerobic capacity in either sequence.
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How this letter has changedLatest: October 2026 · Corrected.
The record called three meta-analyses A study that pools the numbers from several trials into one combined estimate. independent replications; Murlasits, Kneffel and Thalib 2018 (PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 28783467), Eddens, van Someren and Howatson 2018 (PMID 28917030) and Gao and Yu 2023 (PMID 36776981) pool largely the same small trials, and the text now says so, with the third author of each of the first two named and Gao 2023's corrigendum (PMID 37215175) attached. Held 2026 (PMID 41762427), an umbrella review of 17 meta-analyses finding no significant sequence effect, and Wilhelm 2014 (PMID 25449853), a null comparison in older men, are added as the counterweight. Letter unchanged: B on consistent small pooled effects, not A.PMID 28783467 PMID 28917030 PMID 36776981 PMID 37215175 PMID 41762427 PMID 25449853
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This is about the order of exercise when strength work and aerobic work happen in the same session. Studies in healthy adults found a small gain in leg strength when strength work came first. The order made no difference to aerobic fitness. A 2026 review of many earlier reviews found no clear effect of order overall, only a trend toward strength first. No trial has tested whether the order changes deaths, heart events or other health outcomes.
When resistance and aerobic exercise are performed in the same session, randomized trials show a small advantage in lower-body dynamic strength when the resistance work comes first, and no difference in aerobic capacity in either sequence. Three syntheses agree on the direction, but they pool largely the same small randomized trials, so they are overlapping syntheses rather than independent replications; a 2026 umbrella review of 17 meta-analyses found no statistically significant Unlikely to be explained by chance alone at the threshold the study set. It says nothing about whether the difference is large enough to matter. effect of sequence, with a trend favoring resistance first for strength. Murlasits 2018 (PMID 28783467) pooled a 3.96 kg advantage in lower-body 1RM (95% CI 0.81 to 7.10) for strength-first, with no effect on VO2max The most oxygen the body can use during all-out exercise, a standard measure of aerobic fitness.. Eddens 2018 (PMID 28917030) pooled a 6.91 percent greater change in lower-body dynamic strength (95% CI 1.96 to 11.87, p=0.006) and found no effect of sequence on hypertrophy, static strength, VO2max or body-fat percentage. Gao 2023 (PMID 36776981; corrigendum PMID 37215175), across 19 randomized trials and 482 participants, found SMD 0.19 (95% CI 0.02 to 0.37, p=0.032) for lower-limb strength and SMD 0.02 (95% CI -0.21 to 0.25, p=0.859) for VO2max, with the strength difference concentrated in older participants, in women, in programs longer than 8 weeks, and at twice-weekly frequency. The graded endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score. is strength. No randomized trial has tested whether the sequence itself changes mortality, cardiovascular events, or any other clinical outcome, and the aerobic comparison is a null rather than a finding in favor of either order. A short aerobic warm-up is not the comparison these trials made; the endurance arms were full aerobic sessions.
Why this gradeThe reasoning, and what the grade does not cover.
Grade B on lower-body dynamic strength. Three meta-analyses of randomized trials, consistent in direction, with the studied protocol specified: both modes inside one session, programs of five weeks or longer, healthy adults. Not A on effect size How large a difference the treatment made, as distinct from whether the difference could be detected at all. and certainty rather than on endpoint type: one-repetition maximum is an instrument-recorded functional endpoint and is eligible for Grade A by the second route, but the pooled sequence effect is small, its lower confidence bound sits at SMD 0.02, which is indistinguishable from no effect, and a 2026 umbrella review of 17 meta-analyses found no significant sequence effect overall. Not C because the pooled finding rests on many small randomized trials rather than a single trial; the three syntheses are overlapping, not independent replications, and the B does not claim otherwise. The VO2max comparison carries no grade in either direction: the trials tested it and found no difference.
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No prominent contraindication A condition or medication that makes a treatment unsafe or unsuitable for a particular person. beyond those attaching to either component. This record concerns the ORDER of two sessions, not whether to do them.
The evidence, in fullSix papers, each linked to its PubMed record.
Murlasits, Kneffel and Thalib (J Sports Sci, 2018; PMID 28783467): systematic review A review that searches for every study on a question using a method set in advance, then assesses them together. and meta-analysis of chronic-effect trials comparing strength-endurance with endurance-strength sequence in the same session; lower-body 1RM higher by 3.96 kg (95% CI 0.81 to 7.10) with strength first, pooled VO2max difference 0.39 ml/kg/min (95% CI -1.03 to 1.81). Eddens, van Someren and Howatson (Sports Medicine, 2018; PMID 28917030): systematic review with meta-analysis, 10 studies, concurrent programs of five weeks or longer in healthy adults; resistance-endurance sequence favored for lower-body dynamic strength (6.91 percent change, 95% CI 1.96 to 11.87, p=0.006), no effect on lower-body hypertrophy (p=0.40), static strength, VO2max or body fat. Gao and Yu (Frontiers in Physiology, 2023; PMID 36776981; corrigendum PMID 37215175): systematic review and meta-analysis of 19 randomized controlled trials People are assigned to the treatment or a comparison by chance, so the groups differ only in what they received. It is the design that can show cause and effect., 482 participants (285 male, 197 female); lower-limb strength SMD 0.19 (95% CI 0.02 to 0.37, p=0.032), VO2max SMD 0.02 (95% CI -0.21 to 0.25, p=0.859); PubMed indexes it as a systematic review. The three syntheses draw on largely the same trials. Held et al. (Sports Medicine, 2026; PMID 41762427): umbrella review of 17 meta-analyses, 144 studies, 1,492 participants; no significant effect of training sequence, with trends favoring resistance first for strength and hypertrophy. Wilhelm et al. (Exp Gerontol, 2014; PMID 25449853): 36 older men, 12 weeks, no difference between sequences in knee-extension 1RM, power or sit-to-stand; PubMed indexes it as a controlled clinical trial. Grade B on strength.
Both strength (compound lift 1RM or 5RM) and aerobic capacity (VO2max or 12-minute Cooper test) at baseline and every 8 weeks. The key finding is that resistance before aerobic preserves strength gains: This is the order used in every session. Perceived recovery scores between sessions if training frequency is high.
Evidence notes: meta-analysis, randomized trial
Endpoint graded: Lower-body dynamic strength (1RM) and maximal aerobic capacity (VO2max) under concurrent training (functional)
Last reviewed: August 2026
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